I am standing in front of the counter in the school office. The school secretary is chatting amiably with another staff member; while I wait to get her attention, I nod my head and smile as though I am part of the conversation. Meanwhile, I am juggling three large notebooks that are slipping out of my arms. One of them falls to the ground, and papers scatter across the floor; in dismay and embarrassment, I begin scooping them up.

Then I wake up.

This dream that I had during my second week on the job isn't far from the reality of what I have been experiencing as a new, school-based OT: Trying to get my foot in the door, establishing relationships, figuring out how to carry lots of stuff, and fighting to stay organized and on top of my paperwork. (The OT work itself--treating a diverse caseload of students--is another whole learning curve.)

Any change in jobs (not to mention careers) involves an adjustment period; but I was totally unprepared for the dizzying disorientation I felt during my first couple of weeks. Where was the school, the entrance, the front office, and the best place to park? Where was the room where I would be seeing students, the bathroom, the teachers lounge where I could eat my lunch, and a computer I could use? Who was the school secretary, the principal, the resource teacher, and the classroom teachers who had the students on my caseload? Who were my students, and how soon would their faces be familiar enough that I could pick them out from the other students in their classrooms?

Assimilating all this information in one school would have been challenging enough, but I've been assigned to nine buildings. On most days I work in two or three different schools, and there are two schools I typically visit just once a month. No wonder it's taken me awhile to remember that this is the building where I can park in the back, and this is the one where I'm better off parking across the street... this is the building where I use the music room, and this is the one where I use the art room... this is the building where I move my magnet to indicate whether I am IN or OUT, and this is the one where I don't have to sign in... You get the picture.

Difficult as it's been, the stress of this transition has given me a feeling for what children experience at the beginning of the school year, when they are faced with a different classroom--sometimes a new school--a different teacher, a different group of classmates, and a new routine. Of course, for many preschoolers and kindergarteners, the whole school experience is new and unfamiliar; no wonder they may feel overwhelmed! And then we raise the bar each year, reminding the students that they are not as young as they were the year before, and that more is expected of them.

I don't think we pay enough attention to the stress of transitions and how to ease the way, whether it's bringing a new employee on board, helping students begin a new school year, or preparing the students on our caseload--and their parents--for the "leap" from grade school to middle school, middle school to high school, high school to whatever comes next.

As I continue to grow in confidence and knowledge in my new career, I'll try not to forget how it felt to be a "stranger in a strange land." I'll be a better therapist, for it.

I guess most jobs involve much more than what first meets the eye, and what most people assume. School-based occupational therapy is definitely one of them.

My first day began with a District-wide convocation for all the employees at all our schools. (My special ed. agency was included, even though we, as therapists, are not employed by the school district.) This gathering was everyone's chance to meet the new superintendent of schools--someone who, it appeared, is taking more of an interest in school-based therapy services than have previous administrators.

After lunch I met (and met with) my OT and PT colleagues at our area office. The primary purpose of the meeting was to distribute caseloads for the year.

So now I know what it means to "get your caseload"! In my case, I was handed ten pieces of paper representing the ten different schools to which I have been assigned (!), with lists of the students in each building who receive OT services.

I spent the rest of my week getting Organized--yes, with a capital "O"!--a multi-faceted process that is still "in process."

First there's the organization of paperwork: Making sure that each student has a current release form signed by the parent/guardian, and a current prescription from their pediatrician. Looking in the student's files for last year's annual progress report and this year's OT goals. Putting together notebooks which include this information as well as various record-keeping forms. Double checking that the "service agreement" noted on the caseload summary form (how often each student will be seen, and for how many minutes) matches the information recorded on the IEP.

Next there's the organization of the schedule: Visiting each of the schools. Figuring out where to park and which door to go in. Meeting the school secretary and school principal. Ascertaining whether the students on one's list are indeed enrolled at that school (and if not, filling out a form for the area office). (One of my schools had a list of only two students. Neither was enrolled there. That put me down to just nine schools!) Finding out where and when (which day[s]) there is a room available for pull-out OT sessions. Getting the students' teacher and classroom assignments. Checking in with each teacher and negotiating the student's weekly, or monthly, OT appointment time. Making out a tentative schedule in which each school is allocated a day (or part of the day), and each student has an appointment time.

Of course, there's also the organization of the therapy sessions themselves: What are the goals for each student? What activities will I use in each session? What materials will I need? But I haven't had much time to think about all that, yet. I won't be starting any treatment sessions until this next week, but even so, I will still be trying to work out the schedule and won't be able to get to everyone, at least at first.

No doubt about it--for a new therapist like myself, there's a huge learning curve here, and I have to trust that I will be able to learn what I need to know in order to be successful here, bit by bit.

In the meantime, I am in awe of my colleagues who have mastered this demanding juggling act.

For some therapists it's their niche. For others, it's a place they'd never consider working.

I'm talking about SNF's, aka long term care facilities, aka nursing homes.

By happenstance I've just been working in one for six weeks; it was the place I was assigned for my temporary, summer job.

I'm still getting my feet wet, but it doesn't feel as though SNF's are my niche. I found this area of practice to be extremely challenging, particularly psychologically. On the other hand, there was also something about my experience at "Greenwood" (not its real name) that hooked me.

Even if it's well run, there's an inherent sadness about the typical/traditional nursing home--one that's large and institutional. Namely, the artificial separating out of the frail, infirm elderly, with little or no contact with the span of generations, the ongoing stream of life, as well as the outside world. It's hard to shake the image of nursing homes as warehouses where old people await death. (Maybe that's why we've come up with an alternate language, where we speak of "long term care" and "skilled nursing.")

Essentially, I don't believe in nursing homes. That doesn't mean that I think family care is the answer; that's not always practical, possible, or even safe. But there are other alternatives.

Several years ago I became aware of "Eden Alternative," a small, not for profit organization dedicated to "improving quality of life and quality of care for those living in nursing homes," and "eliminating the plagues of loneliness, helplessness, and boredom that make life intolerable in most of today's long-term care facilities" by providing nursing home residents with personal "companionship, the opportunity to give meaningful care to other living things, and the variety and spontaneity that mark an enlivened environment." (edenalt.org) Some day I may use this blog to explore this concept--this vision--in more detail, but suffice to say that I'd be thrilled to have the opportunity to work in an Eden-oriented facility. I sincerely hope "Eden" is the wave of the future.

In the meantime, less enlightened nursing home facilities are the norm in the USA, and a large percent of our institutionalized elderly live in them. [Does anyone reading this know of any specific statistics?] How much longer can they wait for better quality of life, better quality of care?

There's a shortage of occupational therapists in my community (as there is nation-wide). My supervisor at Greenwood, a COTA, has never had a full time OT on staff. She hoped I would stay on permanently--there's no one standing in life for the job-- but I was already committed elsewhere.

And so I've left Greenwood. As I walked out the door, I was looking ahead to my new opportunity in the public schools. But I did look back. I'm not sure I'm done with "SNF's"... or that they are done with me!

(to be continued???)

[If you work in a nursing home, aka SNF, aka long term care facility, please COMMENT on your experience and your motivation for this work.]

On the surface you see a fairly "ordinary" person: A wife and the mother of three. A scholar with a doctorate in education. A teacher. A published author. A motivational speaker and consultant.

But Liane Holliday will tell you she has spent most of her life "pretending to be normal."

As a child Liane refused to read certain words aloud because they hurt her ears, or looked ugly. She loved to eat crunchy things... even if they were poisonous. And she would hit other children who accidentally brushed against her in ballet class.

Liane's parents took her to a psychiatrist when she was three. His IQ test placed her in the gifted range; he attributed Liane's "quirkiness" to permissive parenting.

During her teen years Liane wore bedroom slippers to school because they were the only footwear that felt comfortable. Motivated by a love of water, she joined her high school swim team but quit when she couldn't learn the strokes. She interacted with a diverse group of friends that included top students, athletes, student government leaders, and speech club members; but her peers chided her for coming to school in the same outfit several days in a row, and habitually blurting out whatever she was thinking.

Still, it wasn't until she went away to college that Liane realized how different she was from other people. The other freshmen seemed to be coping with the transition so naturally and so easily. Why was it a struggle for her to locate her class buildings and classrooms (well beyond the first day), think through consequences instead of acting impulsively, recognize when others were taking advantage of her, and navigate a successful social life?

As she looks back on this time in her life, Liane writes,

"I wonder, now... if my sudden exposure to a world of change was somehow responsible for making me come face to face with the variances that altered the way I saw things, the way I thought. Without the protective attention of my childhood friends and family, I was bound to fall flat on my face."

Still, Liane picked herself up, earned her undergraduate degree in six years, and went on to continued success despite the challenges she faced on a far from level "playing field."

When one of her children was diagnosed with Asperger's Syndrome Liane suddenly had a name and a framework for understanding her own "peculiarities" and was able to recognize that she was not alone. In Pretending to be Normal; Living with Asperger's Syndrome (Philadelphia: Jessica Kingsley Publishers, 1999)-- written for both the non-Asperger's public as well as people who share her diagnosis-- she describes her experience of how it feels to live with Asperger's, and she discusses the strategies she has developed for coping with the environmental stresses and interpersonal challenges of everyday life.

Not a scholarly or academic text, this book is mostly a personal memoir by an unusually self-aware, self-educated individual writing from a "client's" perspective.

One of the strengths of this book is its Appendices, which contain Liane's direct advice regarding a variety of practical situations, including self-disclosure, college life, employment, and home organization. Here is a sample:

"Prepare a business card that contains essential information about the syndrome that you can hand out to strangers whose help you might suddenly need." (p. 129)

"Try to establish a 'safe" place on campus where you can go to relax and re-group." (p. 132)

"Assign each member of the family a color, and then try to purchase as many personal items as you can in those colors, letting everyone know that they things are the bule or yellow or pink or whatever color they have selected." (p. 150)

There is also an appendix for "Non-AS Support People" as well as a list of printed and organizational resources-- AOTA is the first one mentioned-- and a glossary.

As an OTR/L about to begin school-based practice, I appreciated this book for giving me a window on what life can be like for a child with Asperger's Syndrome (though most of this volume deals with adulthood), as well as reminding me that I will be relating to special needs parents as well as special ed. students! This book also underlined the importance of helping college bound special ed. students prepare for the transition to campus life and access services that will provide them with ongoing support and advocacy.

In her last chapter Liane writes,

"No matter the hardships, I do not wish for a cure for Asperger's Syndrome. What I wish for, is a cure for the common ill...that makes people compare themselves to a normal that is measure in terms of perfect and absolute standards, most of which are impossible for anyone to reach... it would be far more productive and so much more satisfying to live according to... the fluid and affective domains of life, the stuff of wonder... curiosity... creativity... invention... originality. Perhaps then, we will all find peace and joy in one another." (p. 122)

(Liane has written two other books-- Asperger Syndrome in the Family: Redefining Normal and Adolescents and Asperger Syndrome in the Adolescent Years: Living With the Ups and Downs and Things in Between. She is available for speaking engagements and can be reached through her website, www.aspie.com.)

In hindsight, my last posting-- "Adventure in Cyberspace"-- strikes me as naïve in its tunnel vision.

In her COMMENT, Kelly Alward spoke of her "mixed emotions" in regard to her own webinar experience, adding, "I wonder where all this is leading." And Bob Stott's article on current trends in continuing ed. (http://www.therapytimes.com/030209Conferences) raises the specter of "distance learning" replacing live workshops altogether.

My glowing review of the first webinar in which I participated had to do with my excitement around finding another option for CE-- an additional choice available to me. I certainly do not think webinars are the answer to continuing ed.

As economic and time pressures-- as well as increasing demands for productivity in the workplace--create a need for low cost, efficient, localized, and job-specific "trainings," we run the risk of reducing CE experiences to the delivery of information. However, to grow and thrive as professionals we need more than stimulating content; we need to be in community with our colleagues over time, and we need to examine the particular work we do within the broader perspective of our field as a whole.

Learning within this larger context cannot happen in a webinar, where our relationship with our co-learners (who may or may not share our profession) is largely invisible and exists only in the moment. It is possible to develop a sense of camaraderie and collaboration with the other OT's we know in our jobs, communities, or practice areas, [If you are not an OT, substitute your own profession for my specific professional references.] and to give and receive mentoring within this limited circle. But there is nothing like a national, or even state-wide, OT conference for helping us define and re-define ourselves as occupational therapists and expand our consciousness beyond what we need to know in order to fulfill (narrow) job responsibilities.

While other, more focused CE offerings spotlight the "experts" among us (the presenters who have the knowledge that we do not), at an AOTA conference the emphasis is on our profession and our professional community. Seeing other therapists in relatively large numbers, glimpsing our professional membership as a whole, and interacting with colleagues from a diversity of practice areas and a widespread geographical distance--these experiences are educational in and of themselves. Beyond any "CEU-worthy" programming we attend, in joining this gathered body we come to understand that we are not just individual OT's--we, together, are the AOTA, and AOTA membership brings both privileges and responsibilities. As we take our place within the continuum of practice that includes the retired, master clinician and the neophyte student, we are inspired to recognize and honor our profession's past, define and evaluate its present, and envision and invent its future.

Vital statewide and national conferences promote a healthy professional Association, which in turn impacts the welfare and viability of occupational therapy practice as a whole. The AOTA is the linchpin, "anchoring" both practitioners and jobs to the profession.

Faced with intense competition for our CE dollars, today's conference planners must work harder than ever to get our attention and motivate us to register, justify costs and balance the budget, and develop a substantive menu of programming to serve a broad audience. Meanwhile, it's not surprising that a current discussion on "OT Connections" (a forum through aota.org) raises concerns about the strength and influence of AOTA. There's a perception that the grass is greener in "PT land"--that the APTA is a more powerful organization than AOTA--but I don't know whether that's true.

(I welcome COMMENTs from physical therapists, as well as other health care and allied medical professionals, about how we can support and strengthen our own professional organizations while also building alliances with one another to advance our common welfare [as well as the well-being of our clients]).

Insofar as we allow ourselves to operate as Lone Rangers, isolated from our particular professional association, we do a disservice to our own careers as well as our career field.

A webinar? I had never participated in one before and didn't know what to expect. But as a school-based therapist--as well as a grandmother of a two year-old--I was interested in what I could learn about "A Sensory Approach to Potty Training." The price was right--Britt Collins, M.S. OTR/L was offering her services free of charge. So I signed up.

Beyond the useful information I gleaned from this experience, I came away from this adventure in cyberspace with great excitement about this new (at least to me!) form of technology.

I am not computer savvy, and so I was a little nervous about whether I would be able to find the right "room" via my computer. Well ahead of the event, I received instructions via e-mail telling me what I needed to do to join in. Check in time started at least half an hour before the presentation was scheduled to begin; I allowed myself that breathing room, sat down at my computer, and crossed my fingers.

I clicked onto the link that had come through in my e-mail then followed the simple directions: I entered my name and e-mail. No password to enter. I clicked "Join in." From there, I had no trouble downloading the free software that allowed me to watch and hear the proceedings.

Sponsored by ot-advantage.com--- I had happened upon their website while surfing for occupational therapy resources--- the webinar was moderated by Alison Bodor. Both Alison and the presenter, Britt Collins-- who were webcasting from two different locations-- seemed comfortable and experienced in the use of this technology; and when I checked in, I could see the two of them on different screens, and hear them completing their set-up. There was also a message that indicated to the rest of the group that I had checked in.

Once the presentation began, much of what occurred was similar to what you might experience at a live workshop. There was a Power Point presentation which was shown slide by slide, with added narration by Britt. There were also a couple of short video segments. The sound wasn't totally in synch with everything you saw on camera, but the lag was minimal.

So what about "audience participation"? There was a "chat" feature through which Alison could solicit feedback from us--- we would type in our answers--- and then we could view everyone's responses. (Alison did that at the beginning of our time together, to give us a sense of the group's make-up.) We could also type in questions at any time---or respond to Britt's invitation to share our own ideas--- and this "conversation" was also visible on screen.

Honestly, this particular webinar was the next best thing to a live workshop. Britt Collins--- a school-based OT in Washington State-- is a knowledgeable and creative professional and an enthusiastic and seasoned workshop leader. The quality of her presentation was excellent, and the exchange of information within the group was valuable.

The only drawbacks to the webinar were the limited amount of time--- the hour flew by--- and (because of the medium) the lack of opportunity for face to face interaction and networking.

Since "A Sensory Approach to Potty Training" was offered on June 3, OT-Advantage has hosted another webinar entitled "Functional Goal Setting for Hand Rehabilitation." If this form of learning appeals to you, or if you'd like to learn more about sensory techniques and potty training, visit ot-advantage.com.

I encourage you to take some time, now and then, to google your professional interests and questions on the web--- the more specific the better; you may be surprised by the resources you find.

And I'll continue to pass on to you my own best discoveries.

Don't Ask, Don't Tell?

How do you handle pain?.. Your own?... Someone else's?...

How do you respond when you are lying on an examining table, and your doctor says, "This is going to hurt"? When you are a treating a patient who tells you, "I was in a lot of pain after our last session"?

When I entered occupational therapy school I was oblivious to the fact that I was preparing for a career that might call upon me to cause people physical pain for the sake of their eventual healing. This pain factor within our profession was never part of a lecture or class discussion but was occasionally present "between the lines."

I remember my pediatrics professor telling us about a child with serious burns who wanted a hug at the end of her OT sessions; my professor was pleased when she came up with a way she could do this without causing the child more pain. And I'll never forget the patient with rheumatoid arthritis whom I treated as a fieldwork student; while using some kind of metal instrument to get a joint measurement, I managed to squeeze his inflamed joint instead. Apologizing to him did not alleviate my guilt!

Working in mental health--and beginning next month, school-based practice--I have avoided "pain-filled" settings such as acute rehab and hand therapy, but I have frequently wondered how my colleagues in those positions cope. How do they strike that balance between compassion and detachment? How do they differentiate, and help their clients differentiate, between "normal," to be expected pain, and pain that indicates some aspect of treatment has gone wrong? And how do they approach the subject of pain with their clients?

In my own experience, many health care professionals avoid the topic, with the attitude, "Don't ask, don't tell."

Several years ago I experienced a non-routine gynecological procedure. As the doctor began, I was lying on the examining table, listening to music on my CD player, and feeling very relaxed. Suddenly I experienced painful contractions. They caught me by surprise--the doctor hadn't prepared me--and I started yelling. The unexpected pain frightened me; I began to panic, thinking it was a sign something was wrong. I started to sit up, and the nurse sternly told me to lie back down. I tried focusing on my breathing but started to hyperventilate, and the nurse chastised me for getting so worked up. As the contractions continued, I yelled some more. Fortunately, the test didn't last long.

I felt shaky as I got dressed. I told the nurse I had cramps; she didn't respond. I asked her for some water, and she directed me to the water fountain down the hall; I had to ask for a cup and get the water myself. When the doctor came in I asked her if the procedure was typically painful; she said no, and that no other patient had reacted the way I had. I would have felt better if someone had at least acknowledged, "That was rough for you." Instead I felt like I had lost my dignity.

I was puzzled by my doctor's apparent lack of understanding that a procedure that caused contractions and cramping might be "uncomfortable" at the least. It was clear to me that just because other patients hadn't yelled or complained didn't mean no one else had found the same procedure painful. It was even more obvious that neither the doctors nor the nurses wanted to deal with my pain.

"Don't ask, don't tell," says the health care practitioner to the patient. "Don't ask me if this is going to hurt, and don't tell me if it does."

And when the patient doesn't ask, and doesn't tell, s/he lets the professional off the hook.

I began imagining how things could be different.

What if, at the beginning of their relationship with new patients, health care practitioners could comfortably and confidently raise the topic of pain? Get the patient's self- assessment of their pain tolerance and their level of anxiety about being there? Find out from the patient how much s/he would like to be told in the event an exam or procedure would (or might) be painful? Assure the patient that s/he need not be stoical? Encourage the use of specific strategies to help the patient cope with the pain?

Patients would always have the option of saying, "Don't tell me if it's going to hurt; just do what you need to do."

But what if those of us who wanted to be pro-active could be given sufficient information so that we would understand what the practitioner was going to do and why, feel reassured that s/he was sensitive to our pain, and be prepared to do what we could to make things easier on ourselves?

Don't ask, don't tell?

As allied medical professionals, how do we handle pain?

Please Comment!

In second grade Samantha Abeel brought in an invisible dragon for Show and Tell. In fourth grade she was chosen to participate in a creative problem solving competition called "Odyssey of the Mind." When she was fifteen she published a book of poetry.

Meanwhile, Samantha made so little progress on the piano--despite conscientious practicing--that her teacher recommended she quit. She couldn't read a clock, make change, or judge approximately how much time it would take to complete routine tasks. She was baffled about where to position the knife, fork, and spoon in a table setting.

Recognized by the school system as neither gifted nor special ed., Samantha was placed in regular ed. classes, where she excelled in most courses (and related standardized tests) but fell far short in math and science. School staff explained this discrepancy by insisting Samantha simply needed to put forth more effort.

In middle school Samantha began experiencing panic attacks that kept her awake most of the night and caused significant weight loss. Finally, in the 8th grade, Samantha's mother was able to persuade the school to re-test Samantha and register her for a special ed. math class. It was only then that Samantha and her parents learned that she had a learning disability--a problem outside her control, that had to do with the way her brain processes information; its name was dyscalculia.

My Thirteenth Winter; A Memoir by Samantha Abeel (New York: Orchard Books, 2003) takes Samantha into her young adult years, through her college experience, graduation, and subsequent "first" job.

You will not find a more eloquent description of the devastating effects of living with an undiagnosed (learning ) disability. (During college, Samantha was also diagnosed with depression.)

This book has many powerful lesson, including: The diverse population of individuals we classify as "special ed." or "gifted"; diagnosis as a source of both grief and hope; and the importance of recognizing and nurturing each person's gifts and talents, particularly when they are challenged with a significant disability.

As a cautionary tale, it underscores the damage we do when we tell our children who are struggling (or any of our clients in therapy), "You just have to try harder!"

Since the publication of her memoir, Ms. Abeel has earned a Master's Degree in Social Work. Currently, she lives in Michigan and is available to speak to groups of teachers, other professionals, parents, and students; she also leads writing workshops for young people. You can contact her through her website, http://www.samanthaabeel.com.

It's not easy, but Samantha is taming her invisible dragon.

(For more information about dyscalculia, visit www.dyscalculia.org [currently under construction] and www.dyscalculiaforum.com [which includes short, U-tube videos and an international discussion forum].)

[If you have personal experience with dyscalculia--you have been diagnosed with it, or are a helping professional or family member--please share with us through "Comment."]

"Trombly and Scott was five years old. Gary Kielhofner was a prominent name in the study of human occupation. An "arts and crafts" class was mandatory. And we received our full credentials--registration with AOTA--as soon as we graduated and passed two three-month "affiliations" (one in "psychiatry," one in "phys dys")... It was easier for a new grad to find a job in mental health than pediatrics."

As I explained in last week's (initial) posting, that was my experience in the '80's, when I entered the field of OT. Then I left the profession to enter seminary. Here's where my story picks up:

Fast forward about twenty years to 2008. My career as a minister of religious education had been rewarding in many ways, but I was burned out and needing a change. A friend of mine who is a school psychologist suggested I return to occupational therapy. I checked out the market. Good news! After making some inquiries about what it would take for me to update my credentials, I was suddenly awake, again, to the field I left behind and curious about what had been happening in the OT world since I'd been slumbering.

Evidence-based practice. IADL. IDEA. Licensure. NBCOT. Branding. The Centennial Vision. So much has changed since my days in OT school (though Gary Kielhofner is still at it)!

But I managed to pass my NBCOT exam for state licensure. I acquired the necessary PDU's for re-certification. I interviewed for five different positions. I accepted an offer. I'm back in business!

Our profession has matured in the years I've been away, just as I have.

During that "break in service" I have had surgery; dealt with chronic medical conditions; sat at my mother's bedside after she was diagnosed with cancer; investigated community resources that would allow her to return home after major surgery; ministered to seniors as they experienced a decline in health or memory; supported families throughout health scares and medical crises; struggled with mental health professionals and the public school system to meet my daughter's special needs; and spent a year without a job.

These personal and professional experiences have given me insights into how it feels to be a patient; what it means to be a caregiver; how injury and illness in one family member can affect the others as well as the family system; how aging can be "graceful" or devastating; how difficult and frustrating it can be to be a child's advocate; and what it feels like to lose an occupation that has been a significant source of identity, purpose, and pride. This kind of knowledge and awareness is something I did not possess at the time I graduated from OT school and began my practice.

And so I begin this blog, not as an expert or master clinician but as someone with "beginner's eyes" as well as a way of seeing that comes from having lived in the "real world."

Occupational therapy is as broad as the human experience and as creative as our own imaginations; I am interested in all its facets. To broaden the scope of what this space can address, I invite members of my reading audience to step up and take a turn as "guest blogger." (I'm serious about that!)

And when I stimulate your thinking, stir your curiosity or your imagination, raise your consciousness, or push your buttons, please click on "Comment" and let me know someone out there is reading this!

I see this blog not as a monologue but as a conversation-starter.

Please collaborate with me (something I know we OT's are good at!). Let's make this blog our blog.