Reflective Diary Paper

Factual Strand
I had a patient with terminal brain cancer who I will refer to as Todd. He had only been
diagnosed a few months prior and his wife was still in a state of denial. He was referred
to the inpatient rehabilitation hospital in hopes of regaining some of his strength after a
hospitalization. After a week of rapid progress, he began to physically decline. I chose to
focus on energy conservation techniques to help him still complete the tasks he needed to
and he agreed that he would like to learn these techniques. He reached the point where
physically demanding therapy was no longer helping him but harming him. I asked Todd
if he felt that he could complete the hour long occupational and physical therapy sessions
and he said he could not. He said he felt that the energy conservation techniques were
helpful for him. The therapy team informed him and his wife that therapy was no longer
beneficial and recommended that he discharge and enjoy time at home. His wife insisted
that he simply needed more physical therapy. She wanted to extend his stay in hopes of
maximizing his physical potential. The physical therapist recommended that she attend a
therapy session with each of the disciplines to see how he was faring. In the occupational
therapy session that she attended, Todd needed a few minutes to rest in between every
ADL and occasionally needed a break during an ADL. I discussed with his wife the
benefits of energy conservation techniques for a progressive condition like cancer. She
agreed that there were benefits but questioned whether it was a lazy way out of
completing ADL. I explained that energy conservation is a balancing act, in which energy
needs to be conserved while still utilizing the strength that he does have. She verbally
agreed that it seemed useful, but still insisted that Todd needed more time in therapy. I

explained that he rarely had enough energy to endure just a one-hour session with me. I
asked Todd if he agreed that energy conservation was useful for him and he stated that he
felt the energy conservation techniques were helpful. I then asked if he felt that he did not
have enough energy for the therapy sessions and he said he did not have enough energy.
Despite Todds statements and the therapy teams recommendations Todds wife insisted
that he needed to extend his stay. He stayed at the hospital for another week before being
transported in an ambulance to the ER with heart problems and passed away a few days
later. This was significant to me because I was heartbroken that my patient passed away
and wondered if I used the correct approach in my family intervention. I also felt it was
significant because I had to advocate for what I felt was the most beneficial type of
therapy for Todd with his wife.
Retrospective Strand
I was very frustrated during this experience. It was depressing to watch Todd decline and
know that I had no control over whether he would go home and enjoy his time with his
family. I cried about the end result and found myself brooding on it for well over a month
after it occurred. During the discussion with his wife I wanted to chastise her for not
listening to medical advice and her husbands wishes. However, I knew that this was not
an appropriate approach to the situation. I realized after some reflection that leading Todd
to tell his wife his opinion about the situation may not have been the best approach. I was
likely putting myself in the middle of a family disagreement. My place was to educate
and let the family make the decision. I learned that I need to avoid being overinvolved in
a situation like this and avoid letting my personal feelings about the situation guide my

response. My tone of voice was appropriate and I avoided coming across as

condescending, but I still could have handled the situation in a better way.
The other members of the therapy team were also very persistent in their efforts to
convince Todds wife to take him home. This encouraged my desire to get him home as
well. I also knew that Todd wanted to be home with his family but also wanted to respect
his wifes wishes. This knowledge also encouraged me to persistently try to convince his
wife of his needs.
Substratum Strand
The experiences that truly impacted my actions the most were my personal experiences
of losing loved ones. I have learned that there is never enough time to spend with the
people you love when they are about to pass on. This is especially true when those
individuals are losing their cognitive abilities, as Todd was. I was also influenced by my
value of family time. I also value self-advocacy, which I felt that Todd had difficulty
with, as he expressed a desire to return home but would not advocate for that desire.
These experiences and values combined motivated me to try to convince Todds wife that
he needed to go home and be with his family. I also have learned to value the idea of
death at home, since studying how much less traumatic it is for those left behind. I firmly
believed that Todds family would be happier if he passed away with them at home. I
value the opinions of doctors and other professionals, so it was difficult for me to see
Todds wife so blatantly disregard that advice when she could see the negative effects of
his continued rehabilitation.
Connective Strand

I learned from this experience several valuable lessons. The first is that I cannot always
convince a person of the value of a certain type of therapy. Even if I have research to
back up my knowledge of the benefits of certain types of therapy, it may not be enough to
make it acceptable in the eyes of another. Secondly, I learned that I cannot let an
experience that ended this tragically weigh me down. I need to find a better way to let go
of tragedy and avoid blaming myself when a family makes a decision that ends poorly
when I did my best as a therapist to prevent it. Thirdly, I learned that it is important to
allow families to make their own decisions. It will not always be appropriate for me to
mediate family discussions, even if I want to do so.
I learned that my primary area for growth is coping with the death of a patient and coping
with patients rejecting sound medical advice. My instinct is to continue offering this
advice, but this will usually not change the individuals mind. My action plan is to have a
written record of how many times I have given the advice so I do not give it too
excessively. I will also try to give my patients more time between repeating a
recommendation in my future practice. I will also try to find other methods of treatment
when a patient is reluctant to use the plan I have suggested.
I do have family members that I can turn to with my heartbreak about patients, but
I need to find other coping mechanisms as well. One that I plan to try is journal writing. I
will ensure that I change names and that I do not include any patient identifiers, but
sometimes just writing out an experience can help me process it more positively. In my
future practice, I plan to utilize my action plan and be on the constant lookout for new
ways to cope.