Friday, January 18, 2013
Destruction and deconstruction of occupational therapy documentation
In the novel 1984, Winston Smith had the responsibility to take old documentation that no longer was determined to reflect current reality and then dispose of that documentation down a 'memory hole.'
I don't know how often most occupational therapists think about the things they write. I think about it a lot. In part I spend a lot of time thinking about it because I have this pragmatic issue with where I have to store all of my patient files. When I worked for other institutions I never worried about the long term storage of my documentation. I would write things, and eventually they would end up in files somewhere, and maybe those files were microfilmed and stored - I really have no idea.
Now I have the responsibility for keeping my own files and since there is a pragmatic space concern to it all I also have the understanding that I can't keep those files forever. That gives me the power of purging, which I actually explored a little bit here. The issue flared up again today because I took an unusually occurring spare hour and found a whole pile of charts that were eligible for destruction.
The process is painful to me, and that is interesting, so I have been thinking about it. I am so fond of some of those kids - now represented by nothing more than initial evaluations and a series of notes culminating in a discharge summary. But it is not just the notes. It is the memory of the joy of play, the hard work and accomplishment that pushed the children's development forward, the thanks from the parents - from spoken words of kindness in a card to little treats at Christmas. I still have some of their pictures, all organized in a collage. What does the memory of this work mean? Does the memory disappear once the charts go down the memory hole? If the memories are still somewhere, are those efforts and those lives all still a part of me? Are they even correct - and if they are not - what does that mean? Would Langston Hughes be upset if I said, "These are my pages, for OT?"
I have to purge Jackie's chart. I have to destruct it but I am getting hung up on deconstructing it. Deconstruction of meaning is so complicated and so full of possibility for being incorrect. Don't we mean for our evaluations and notes to all be correct? What I think, though, is that in the "chart" the constructed representation of what 'happened' it is usually entirely incorrect. In the deconstruction that follows years later when you think about it and prepare to throw it all down the memory hole this becomes evident - because this unknown and new representation of Jackie is not just the Jackie-of-the-notes. I know this now because I was at a restaurant the other day and I saw her whole family at another table - at first it was only the mother that I recognized but then I squinted and tilted my head and noticed that the mother was with Jackie-not-of-the-notes! This new representation of Jackie wears a college hoodie and is a beautiful young woman - and I would have found out more but I had no intention of intruding on their privacy. I hope she goes to that college. I really hope that she goes to that college.
Each day ticks away a new possibility to purge, and each purge is a brute application of the reality that Derrida says there is nothing outside the text. It is a concept that in all honesty makes me question the validity of note writing so deeply that I am simply thankful that the memory hole exists. Text (or rather con-text) changes so radically that it makes those charts so presently incorrect.
I guess that makes every day a good day, mostly because this allows Jackie-not-of-the-notes and all of my other kids to be unfettered from that text. More unfettered. I hope.