Canadian Association of Occupational Therapists

mOmenTs
COLUMN EDITOR: HADASSAH RAIS

Rediscovering leisure: Timing and client choice
By Mary Edwards

I hung it in a prominent place in my living room as a constant reminder of the importance of occupation and particularly leisure…

He was a large man that you took notice of as his diminutive wife, Anne, wheeled him into the occupational therapy department. It was his initial treatment session and it was obvious that his current level of function embarrassed him. Len was an individual who had always been in “total control.” He had suffered a major stroke that resulted in almost total right-sided paralysis. Len participated as well as he could in the initial occupational therapy assessment as I asked questions about his former interests, current situation and future goals to help me plan my intervention. Initially, treatment focused on functional mobility so that he could develop skills in transfers and wheelchair mobility to facilitate his return home from hospital. We also focused on self-care skills, helping Len and Anne work as a team like they never had done before. As time progressed, Len gradually improved functionally. However, he still had a dense right hemiplegia and there was little expectation from the health care team that this would change dramatically. A home visit was planned to determine the outstanding issues to be addressed to facilitate his discharge.

Anne showed me through the house. I was struck by the artwork hanging on the wall. “Len loved to paint,” Anne remarked, and it reminded me that they had mentioned that early in our therapeutic interactions. In a cosy corner of the living room sat an organ, music still on the stand, not disturbed since Len had last played before his stroke. “He loved the organ too. He gave music and art lessons before the stroke,” Anne remarked with a slight tear in her eye and proud but sad tone in her voice. Len’s paintings were explosive with energy and passion. It was obvious that he was an accomplished artist. I felt that I must respond to that in some way.

The next day Len and I spoke of how the home visit went. We discussed the physical layout, supports and barriers. All was going well and despite his concern over how much he still relied on Anne for assistance, he was looking forward to returning home. I commented on the paintings that I had seen, remarking that they were extremely vibrant and expressive. Len appreciated the compliment, looking somewhat absorbed in his thoughts. Then I asked Len about whether he had thought about starting to paint or play the organ again. He glared at me in amazement as he picked up and “dropped” his flaccid right hand to his lap. He didn’t have to say much — his message was clear. Len proceeded to tell me that he would never paint or play the organ again because he only could use his left hand and would never be able to achieve his previous ability. He abruptly turned away from me and wheeled himself out of the occupational therapy department, leaving me to reflect on our interaction and whether or not I had just ruined our therapeutic relationship. I was devastated!

We continued planning his discharge, focusing on everything but painting and playing the piano. I did a follow-up home visit, still not mentioning the leisure pursuits Len used to enjoy. Anne indicated that Len was bored with “nothing to do” since he had come home. She thought he might like to get back to painting, but based on his reaction to me, she had not suggested it to him. There was a creative void in Len’s life that neither Anne nor I felt we could approach with success.

Four years passed, I had changed jobs and moved away from the community where Len and Anne lived. One day I received a personal letter at work. Not knowing the source I opened it to find a letter from Anne, requesting that I come to visit them because Len had something to say to me. Thinking that he was still angry at my previous suggestion, I was slightly cautious about responding to the request. Yet, curious about what Len wanted to tell me, I called Anne and arranged for a visit.

When I arrived at Len and Anne’s home I took a deep breath and rang the doorbell. Len, expecting my visit, greeted me at the door in his wheelchair and welcomed me in. He once again “lifted and dropped” is flaccid right hand to his lap, indicating that there had been little physical change since I had last seen him. As we entered the living room I noticed the organ was still there, with lots of music near by. “He is giving lessons again,” Anne said with tears in her eyes and a voice full of admiration and pride. Len was beaming as well. “I want to thank you for planting a seed,” he said to me. “I was very angry when you suggested I resume painting. I was mad at you for suggesting it and mad at myself for not being able to do it. But over the years, I’ve heard your voice over and over in my head and I have been painting for about a year now. It’s not as good as before, since I do it with my left hand, but I get pleasure from it and I am teaching others as well!” I almost broke into tears. I felt that I could take little credit for Len’s accomplishments, but I was very proud of his progress. Just then he reached for a large brown package. “It’s for you, open it!” he said. I unwrapped a beautiful oil painting of a woodland scene with a peaceful stream running through it. It was far better that I could ever hope to paint. “Turn it over,” Len instructed. On the back was printed in a somewhat primitive and shaky script: TO MARY: PAINTED WITH LEFT HAND. THANK YOU. LEN

It has hung in a prominent place in my living room for almost 20 years now, as a constant reminder to me of the importance of occupation and particularly leisure and the importance of timing in the recovery process. Thank you Len, for what you taught me about being an occupational therapist.

About the author
Mary Edwards is a Clinical Manager in the Rehabilitation and Orthopedics Program at Hamilton Health Sciences and Assistant Professor in the School of Rehabilitation Science, McMaster University. For the past 15 years her role has been primarily administrative in nature, but she has fond and vivid memories of special clinical experiences that she has had the pleasure of sharing with her clients during her career as an occupational therapist.

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