Melissa Zepeda

Reflective Paper 1
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I first met patient L on May 15 2017, on the ortho-trauma acute care floor of a major

medical facility. During this time my supervisor would have me perform evaluations and

treatments on my own but would remain in the room as an observer while I was with patients.

Factual Strand

Patient L was admitted to the ortho-trauma specialty service floor (OTSS) after being

transported by ground ambulance as a Trauma 1 in Salt Lake. On the morning of the 15th patient

L was assigned to me as a new evaluation for OT services and I performed my usual chart

review. I learned that patient L had attempted suicide by jumping on train rails as a train

approached. Through more chart review I learned that she had been admitted to the hospital prior

for another suicide attempt. From this latest attempt she had sustained an above the knee

amputation and an above the elbow amputation both on the same side. She was considered to be

homeless and she was just about my age. The PT assigned to her approached me to co-evaluate

her based on her psychosocial issues and her current functional ability. Altogether we had four

people present in the room for her session: her 1:1 aide, the physical therapist, my supervising

occupational therapist, and myself. As we entered the room it was dark, she was laying in bed

with the head of the bed slightly elevated, her eyes were closed and she had the sheets up over

her body, her lunch was on her side tray, and her 1:1 aide was sitting on the couch in her room.

After we introduced ourselves the PT took the typical approach she uses for the floors routine

joint replacements which was cheerful yet aggressive. Patient L remained adamant that she did

not want to get up and work with us because she would just be in a wheelchair anyway, after

some time and conversation we were able to convince her to try and sit on the edge of the bed to

eat her lunch. During this process she experienced immense pain from her ribs and back, which

were severely bruised and requested to stop and lay back down. Once we had assisted her to a
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comfortable resting position the physical therapist left. We stayed in her room for an additional

30 minutes arranging her tray so she could eat, during this time we were able to engage in critical

conversation initiated by my supervisor seeing a small picture of a young boy on her tray. We

learned that patient L had a son who was living with her mother at the time. She opened up to us

about her history of addiction and homelessness, and expressed her concerns for her future with

two amputated limbs. Together we were able to work through scenarios for one-handed

techniques and educate her concerning the potential for adaptive equipment and DME.

Out of all the traumas I saw this Summer, patient L is one I will never forget. Not

because her story is intensely emotional and tragic, but because for me it solidified the unique

role of an OT in this setting and the absolute need to treat everyone holistically.

Retrospective Strand

This incident was quite emotional for me; from the time when I reviewed her chart to

when I wrote up her session note I experienced a whirlwind of emotions. In many instances

when I would see trauma patients that were similar in age to myself I would apply the situation

to my life and ponder my emotions in that state. This incident was no different; I felt extreme

empathy and compassion for patient Ls situation before I had even met her. As I grew to know

her I discovered that her initial doubt and lack of motivation was due to the acute nature of the

trauma and that she was truly a resilient lady.

This was definitely not how I had pictured our first session going; functionally we were

not even able to get her sitting edge of bed for a meal. But this incident taught me much more

than I could have anticipated about the power of treating patients as if they are your own family

members. We were able to gain much more insight into patient Ls psychosocial needs though

conversation than we could have if we did a full ADL assessment. In this session, for this patient,
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we were able to provide her with the psychosocial support and education she needed and only we

could have done that.

This incident also remains firm in my mind due to the abrupt departure of the PT once the

patient made it clear that she would not be sitting edge of bed or getting up at all. For me, as an

OT, this was the critical point in establishing rapport with this client. When I analyze the event in

my mind, patient L had just failed to complete an activity that was requested of her and she was

possibly wondering what these health professionals thought of her and how they would react.

The PT continued to have difficulty engaging with the client in future sessions and I believe this

was a direct reflection of their first meeting.

Substratum Strand:

Prior to this incident, as I reviewed patient Ls chart, I knew the session might be a

challenge. Even though I have a background in Psychology and I have been well prepared by this

program to address psychosocial issues, I still felt like I was lacking in experience. While the

incident was occurring, I was surprised by my level of knowledge concerning how to address an

individual dealing with suicidal ideation and depression. I was able to use motivational

interviewing methods to keep her talking and expressing her concerns both for positively

changing her behavior and remaining the same. I was able to encourage her to look past her

current state in order to seek out the future with her family that she desired. Although I knew she

would ultimately leave the acute floor for a psychiatric unit, I felt it was necessary to address

these concerns as they emerged through our conversation.

Connective Strand:

This incident has changed my perspective in many ways; especially concerning the need

to address each client holistically. In this incident, if we were to solely address patient Ls
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functional concerns we would have been more than able to fill out our documentation and

continue through our day. But at this point in my education I could not even fathom hearing a

patients psychosocial concerns and not addressing them. The phrase that comes to mind when I

think about this incident and all the patients I will have in the future is leave no stone un-

turned. Anything a patient discloses during a session could be used to impart a session with

personal meaning. This session also taught me that I needed to have more confidence in my

abilities and be more assertive. For example, after patient L could not make it to the edge of bed

there was a pronounced silence in the room. I had thought in the moment that I should say

something encouraging and indicate that the pain she was feeling was normal for her type of

injuries but I was a timid around the situation at that point. Throughout the remainder of my

fieldwork experience I worked on building my confidence and at the end of 12 weeks I felt very

confident in my abilities and clinical judgment.