The elegance of silence is best found in a room full of voices yet to be read.

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For me this year started off with my body physically attending lectures and even fieldwork preparation but my brain still on vacation. Which isn’t unusual per say, in fact in my 3 years of studying this was the first fieldwork preparation I attended, and it left me gob smacked for sure. The reality of the amount of, not only theory we were covering and the relevance of the past 2 years but as well as the idea of implementing that and treating patients to my full capacity was a sad trombone sound effect moment for me.

Sitting in that lecture hall and presenting my groups analysis of that case study and what our clinical reasoning was for what we planned made me realise that this year was about putting theory into practice after all. I didn't what I knew or didn't know but I was confident I would make it regardless.

In the words of famous baseball catcher Yogi Berra:” In theory, there is no difference in theory and practice-in practice there is.” Now my interpretation might not be what he meant but I know this struck me because I’ve always been an academic and OT has forced me to not only adapt to putting that knowledge into practice but within practice to be able to think on my toes because we work with people and no matter how many books, articles, and research I do. The people I see will never be predictable and the sessions will not always be a free-flowing downward stream, the weather quickly changes in sessions and that’s the beauty of this quote. Without discounting theory’s role in practice, I understand now that practice on its own has knowledge.

On my first day, I was so prepared that I felt little to no anxiety waking up. Of course, that was short-lived because as soon as I got my SCI patient and went to the ward, HE WASN’T THERE !! I hoped the OT was going to say “oh okay then I guess you can chill today, and we’ll get you another patient on Wednesday “ but no I wasn’t that lucky, I got a CVA patient. Now I am familiar with this diagnosis, so I wasn’t stressed, that’s until I went to see her. She presented in a way I’d never worked with before because it wasn’t the right CVA, left hemiplegic I was used to, but this Left CVA patient was going to present in ways I had never assessed or treated before. That scared me so much my anxiety sky-rocketed almost immediately. So I dealt with it the best way I know, I opened up the cabinet in my brain filled with all that theory and assessed her the best way I knew how. It wasn’t smooth sailing because my first obstacle was finding a way to communicate with my patient and ways to understand when she was trying to communicate with me because she not only has oral apraxia but also responsive aphasia. I had a mini meltdown for 2 seconds in my head because I intended on doing my interview so theory had to take a back seat right here. I had to then use practice and what I had seen from colleagues at other placements to get through the session and still achieve my assessment aims and some background information. It was a productive session but the cog wheels in my brain were spiraling already planning our next session and how I was going to effectively communicate and treat my patient.

I spoke to my supervisor who had observed a good portion of the session and her feedback most definitely eased my stress after the session. She gave constructive criticism which I absolutely prefer, as well as went as far as throwing me little golden nuggets as to how I could overcome this communication barrier I was struggling with. Speaking with her helped consolidate and validate my observations of that session and I went home back in my little to no anxiety state. I already had ideas on how to use the facilities resources to help me treat my patient and I was on a roll. I planned my first treatment session to be a colour sequence matching game that I had created for another CVA patient I saw 2nd year. The beauty of creativity I didn’t know I had was comforting in this moment, this activity had been trialed and errored so this time I made a few adaptations to meet this client’s specific treatment aims and I was ready and confident. The session was a great success in my eyes, the client was actively engaged, I heard her laugh for the first time and I could see the gratitude and excitement in her smile when we finished the session. So, the next session had to be her choice from a few pictures activities that I had chosen, and she chose painting and that was what we were going to do for our last session of the week. 

I went home motived and happy to plan the next session. Now I went into the third session expecting yesterday’s outcome, and Thursday was not like Wednesday. The session was successful, I was able to get more observations, more insight into my client’s condition don't get me wrong. All in all, I got a lot of information I needed in the session, but she was not as engaged and cheerful as she was the previous day. In that moment I told myself “Back to the drawing board”.

I still haven’t figured out why she chose the activity if she did not like it. My client was familiar with the activity, maybe she felt inclined to choose it among the choices presented to her. In theory when you give someone options and they choose to do something, they should be interested in it. Practice and reality say “Be willing to step outside of your comfort zone once in a while; take risks in life that seem worth taking. The ride might not be as predictable as if you’d just planted your feet and stayed put but will be a heck of a lot more interesting.” -Edwin Whitacre Jr.  (Quotefancy: Edwin Whitacre, Jr. Quotes, 2023).

So, theory maps out the path we need to take in intervention, but practice shows us the how to get there and it’s my goal to help her not only step out of her comfort zone but expose her to things she may not know she could enjoy doing or even do for leisure. Another lesson learned this week alone about going from theory to practice.

After today’s classes, Ma’am Gayas instructed me to do something. I felt her excitement as she told me to make my own test items based on the previous topics. I picked up my pen and the book, then began writing some ideas down. This was what I came up with: 

She gave me a few comments about how I could make the items better, such as keeping the sentences short and avoiding too much clues within the statements. I took note of her suggestions on my heart, so that I would be able to apply it the next time.