Tuesday, July 5, 2022

 Tuesday, July 5, 2022 

   

   At 9:00, I had the M & W sisters. I did the Gating Game with both. M finished the game on the story she had written, Salt and Pepper. She didn’t want to start the game with a new story. She has trouble picking words that could make sense in a story. It was a challenging process for her, but she claimed to enjoy it anyway.

   I set my alarm for 10 am because I had a PT appointment at 10:30. I showed Katie the bruise on my knee. She was concerned about the continued swelling in both my legs. She wrote the following comments for me to share with my surgeon:

  -Insidious bruising medial patella (That’s the bruise to my knee.)

  - ongoing diffuse bruising in the surgical lower extremity (left)

  -ongoing edema (1+ in thigh, 2+ in lower leg and surrounding incision) throughout the surgical extremity.

  -mild tenderness with deep palpation on the lower leg.

She told me that she was concerned about the blood flow in my left leg because of my spider veins. She didn’t see any immediate concern for a blood clot.

  I planned to stop at the bank again even though I was exhausted. The parking lot was jammed again. This problem started recently. I suspected those cars weren’t from people going to the bank. Something else is going on. The moment I had the energy, I would go inside and check.

  My first chore when I got home was hanging up my laundry. I had my linens in the load and wanted to return them to my bed. Then I went down for a nap. I had a two pm appointment with adolescent D. I set my alarm. I had a little under two hours. I was sound asleep when my alarm went off. I could have put in another hour.

  D got on the Zoom session promptly. I asked him about his week at Boy Scout Camp. Yes, he had a good time, mostly being outdoors with his friends. Yes, he did some reading while there. Yes, he understood what he read. Yes, he was surprised by how well he did. He wanted to continue working on the sight word list his other tutor put together. He did fairly well on the list of words he demonstrated he could recognize. Fairly well means he could read the list with relative ease and at a good speed. However, he missed several words: want, won’t, they, and black. In the case of black, he overlooked the l, confusing the word with back. The other three were his demons. We have been working on remembering them forever. We reviewed went and want. I asked him to tell me the trick I taught him to help him remember how to tell them apart. He had no idea what I was talking about. He has trouble remembering most of what he hears.

  He did a lot of spacing out today. I believed it was psychological; I’ve seen a pattern. He did it when he felt challenged or confused. I asked him if he tried to control it. He said yes. I said how. “He just snapped back.” That sounded like something that happened to him, not something he controlled. He said he made himself do it. I asked him what he did. I was trying to cultivate cognitive self-awareness so he could take charge of the process. 

   What challenged him today was identifying want, went, and won’t, and stating the VCe rule. He couldn’t even remember the difference between the a in hat and the a in hate. His mind was a total blank today. I tried to get him to remember anything he recalled about this pattern, not even something directly relevant. Could he remember how it felt when we did this work? The weather? A smell? A feeling he had? Anything. Nothing came to mind. 

   He disagreed with my theory as to the cause of his blanking out. As I wrote, some other questions came to mind. Did he ever space out when he was having fun? If it happened, then it could also be a form of seizure. I had to consider it as a possibility. 

  There’s a second possibility. When I proposed he disappears because the situation feels threatening, does he think I mean he does it deliberately? At the end of the session, he apologized for blanking out. I assured him he didn’t have to apologize. This was my job. My concern was finding a way to help him get control of his mind. I never thought for a minute he disappeared deliberately.