I don’t remember his name but I remember exactly where his house is, every time I go past it. I remember hearing he was a healthy guy in these golden years of his life and that he was still active on the tennis court, even while he was in his mid-80’s. In fact, it was a tennis match that was his downfall – he lost his balance and fell during a game, breaking a hip and banging his head, thereby getting a bleed on his brain.

When I got him as a patient he had already been through a few weeks of hospitalization and a few months of rehab – physically, he was almost OK so I didn’t need to see him for a very long time – give him an exercise program to keep his arms strong because he wasn’t as mobile as he used to be, teach him how to get himself a snack or a drink while using a walker and teach him safety around the house because he paid NO attention to it whatsoever…even after multiple teachings and reminders. Whether his non-compliance was a result of his brain injury, a poor memory or just behavior, since he didn’t follow through with the safety stuff, I recommended to his son that Dad have ongoing supervision – a family member, a sitter or whatever. The son agreed to my face but since the guy was alone in the home just about every time I arrived, I suspected it was going in one ear and out the other. Apples don’t fall far from the tree, y’know? Ah well, you can lead a horse to water but you can’t make him drink. Document, document, document. Save your ass.

Fast forward two weeks, he became the best he was going to be and I discharged the guy, rather happily I might add, because it was frustrating to go over the same stuff and neither the patient nor the family would follow through on most of what I recommended – even just what to do when someone was indeed in the house with him, to make sure that he didn’t fall – no “Dad, use your walker,” no “Dad, don’t just plop into chairs – hold onto the arms and sit into them slowly,” no nothing. Although he oozed non-compliance, the patient seemed a little upset about my leaving – he thought I could help him to be even better but, especially with his not follow through on things, I knew he really had plateaued so I felt justified in discharging him from OT.

Two weeks later, I got the same guy back – he said he can’t feed himself. What the…? I made an appointment to see the guy, all the while wondering what the hell had happened in the 14 days since my last visit. He certainly could feed himself before???

So I do the whole Initial Evaluation again – that’s the law. Even if he just had one less than a month before, I had to ask all of the same questions all over again. But I was super thorough when I got up to the questions about self-feeding. Could he bring a fork or spoon to his mouth? Yes. Could he take a drink by himself? Certainly. Could be cut his own food? Yes. Then what was the problem?

“Well, when I go to a restaurant and get a salad, if they give me cherry tomatoes I have problems cutting them in half. They tend to roll away.”

Wait…that’s it? He requested another OT Evaluation and, in essence, totally wasted Medicare’s money to pay for same, because he couldn’t cut cherry tomatoes? Was he kidding? Holy crap. I wasn’t sure who I was more annoyed at…the patient who really could feed himself, or the nurse who had requested that O.T. do a re-eval because she hadn’t delved any deeper when he said he couldn’t feed himself.

But back to his issue – he couldn’t cut his cherry tomatoes. Did I have any suggestions? Of course I did.

“Stab them with your fork instead.”

Word for word how this visit was documented: “Occupational Therapy initial evaluation completed today. Patient well-known to this therapist, as he was discharged from OT two weeks ago. Chief complaint from patient, and sole reason for re-evaluation, is his inability to cut cherry tomatoes. This therapist taught patient how to maneuver cherry tomatoes to his mouth safely and independently, at which time patient demonstrated understanding of same. Also reviewed safety recommendations as discussed during OT visits during previous admission 2 weeks ago – patient reports understanding and following through with same (although this therapist saw evidence of non-compliance with same during course of today’s session, which is consistent with patient’s behavior during previous admission). No other OT needs at this time. Discharge OT.”

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