Day in the Life of an Occupational Therapist
Three occupational therapists wrote down everything they did on one ordinary workday.
These characters are composites, built from dozens of real accounts, interviews, and community threads. The people aren't real. The experiences are.
What you'll learn
- How three OTs in different settings spend a full workday, hour by hour
- The invisible work that fills the gaps between patient sessions
- What the job actually feels like when you describe it to someone who wasn't there
Wren's Monday
Alarm. I packed my therapy bag last night, which is the only reason mornings work. The bag has a weighted pencil, two types of pencil grips, a slant board, a putty egg, a fidget kit, scissors with loop handles, and a folder of visual schedules I laminated at FedEx on Saturday. Overnight oats from the fridge. I eat them standing at the counter because sitting down feels like a commitment to being comfortable and I can't afford that at 6:15.
Pull into the parking lot at Ridgemont Elementary, my first school. I have a room here. Technically it's a storage room with a table, two child-sized chairs, a yoga ball, and a shelf of therapy materials I brought from home. The fluorescent light on the left side flickers. I've put in three work orders. The custodian, Mr. Reeves, told me the bulb is on backorder. That was in October. I set up for my first session: lay out the slant board, get the adaptive scissors ready, pull Frankie's IEP goals on my laptop.
Frankie arrives. He's a 5th grader with cerebral palsy, mostly affecting his right side. He uses the slant board for writing because the angle reduces the wrist extension he'd need on a flat surface. Today we're working on paragraph writing, which is an IEP goal: "Frankie will write a 4-sentence paragraph with appropriate spacing and letter sizing in 3 out of 5 trials." He wrote 3 sentences last session with spacing that was, honestly, impressive. The fourth sentence fell apart because his hand fatigued. Today I have him do hand warm-ups first: squeeze the putty egg 10 times, finger spreads, wrist circles. Then writing. He gets through all four sentences. The spacing drifts on the last one but the letters are sized correctly. I count it. Three out of five now. Two more to go before the annual review in May.
Next session: a 2nd grader working on scissor skills. She's using loop-handle scissors because she can't sustain a traditional open-close pattern yet. We cut along thick black lines on a worksheet I made. She's improving. Six weeks ago she couldn't stay within a quarter inch of the line. Now she's within an eighth on straight cuts, still drifting on curves. I note the progress. Her teacher, Ms. Nguyen, stops me in the hall after and asks if she can use the loop scissors in the classroom too. Yes. Absolutely yes. That's the whole point.
Third session. Then a 15-minute break that I spend writing a quick progress note on Frankie and checking my email. An email from Ms. Dwyer, the 3rd grade teacher. She wants to refer a student for "handwriting help." This is the fourth referral from Ms. Dwyer this year. I've evaluated two of the previous three and both times the handwriting issues were secondary to attention. The kids could form letters fine. They just couldn't sustain the focus to complete a writing assignment. That's not an OT issue. That's a conversation with the school psychologist. I reply asking Ms. Dwyer to fill out the referral form and include classroom observation notes, which will help me figure out whether this is motor or attention before I pull the kid out of class for an evaluation.
Fourth session: Owen. First grader. Developmental coordination disorder. Owen cried during handwriting last week, which is the thing that's been sitting in my chest all weekend. Not dramatic crying. Just quiet tears rolling down his face while he tried to write the letter K. He said "my hand won't do it." Six years old and already narrating his own body's failure. Today I skip the handwriting. I pull out a dry-erase board and we practice the K in large motor first, standing up, whole arm moving. Then smaller on the board. Then I put a piece of sandpaper under his paper so he gets tactile feedback as he writes. The resistance helps. He writes three Ks. They're shaky but they're Ks. He doesn't cry. He says "that paper feels weird." I say "yeah, it does." Small win. I'll take it.
Fifth session cancelled. The student is absent. I use the time to write progress notes. Each note takes about 8 minutes. I need to document the goal addressed, the activity, the level of assistance, and the student's performance relative to the benchmark. I write notes on Frankie, the scissor student, and Owen. The language has to be specific enough that another OT could read it and replicate the session. "Student demonstrated improved letter formation" means nothing. "Student produced 3 of 4 target letters (K, B, R) within appropriate size parameters on lined paper using tactile feedback (sandpaper underlay), with verbal cuing for starting position" means something.
Pack the bag. Drive to Creekview Elementary, my second school. The drive is 20 minutes if the light on Peachtree Industrial catches me, which it does, always. I eat a Kind bar in the car. This is lunch. Creekview is a newer school with better facilities, but I don't have a dedicated room here. I share a space with the speech-language pathologist, Lenore, who is there on Tuesdays and Thursdays. Mondays the room is mine. It has a real table, actual child-sized chairs that match, and a window. Luxury.
Set up. First afternoon session at noon. While setting up, a teacher I don't know well stops by the door and asks if I can "fix" a student's pencil grip by Friday because they have standardized testing next week. I take a breath. I explain that grip patterns are motor habits built over years, that changing a grip is a process that involves strengthening, motor planning, and practice, and that forcing a new grip right before a high-pressure test would likely make the student's writing worse, not better. She looks disappointed. I offer to give the student a pencil grip to try, which might help with comfort and endurance even if it doesn't change the underlying pattern. She takes the grip. I know she wanted a different answer.
Afternoon sessions. Three back to back. A kindergartner working on self-care skills, specifically buttoning and zipping, because independence with dressing is part of her IEP. She gets the top button of a button board in 14 seconds today. Last month it was 30. A 3rd grader with sensory processing differences who needs movement breaks built into his day. We practice his "engine check," which is a self-regulation tool where he rates whether his body feels too fast, too slow, or just right. He tells me he's "too fast" today because he had a donut at breakfast. He's probably right. We do wall push-ups and heavy work (carrying a stack of textbooks to the library and back) and he re-checks: "just right." He grins. Third session is a consultation with a teacher about setting up a sensory corner in her classroom. I walk through what to include (weighted lap pad, noise-canceling headphones, a visual timer) and what to skip (anything that becomes a toy or a distraction for the whole class).
Last session of the day. A 4th grader working on keyboarding as an alternative to handwriting. His fine motor skills are significantly delayed, and the IEP team decided that keyboarding is a more functional goal than continuing to push handwriting. He can type 8 words per minute using a hunt-and-peck method. We're working toward home row positioning. Today he keeps his fingers on home row for two full sentences before reverting. Progress is slow, but his written output on the computer is already double what he produces by hand. The right tool matters more than the right technique sometimes.
Sessions done. I stay at Creekview until 4 to finish IEP progress notes. I have quarterly progress reports due next week for 12 students across all three schools. Each report requires me to pull data from my session notes, calculate performance percentages against goal benchmarks, and write a narrative summary for the parents. The narrative is the part that takes the longest because parents read it closely and I want them to understand what their kid is actually doing in OT, not just whether a box is checked.
Drive home. My apartment is 25 minutes from Creekview. I call my mom on the way. She asks how my day was. I say "good, busy." That's the version. The real version involves a six-year-old who can't write the letter K and a teacher who thinks I can rewire a grip pattern in four days. The real version doesn't fit in a phone call.
Home. Change out of my work clothes, which have putty residue on the right knee from kneeling at the table with the kindergartner. Documentation until 6. I finish two progress reports and start a third. The EMR system the school district uses is called TherapyLog. It's slow. Every page takes 4 to 6 seconds to load. I've timed it. Over the course of a documentation session, those seconds add up to about 12 minutes of staring at a loading screen.
Robbie gets home. He teaches PE at a middle school about ten minutes from our apartment. He asks about my day and I tell him about Owen. I tell him that Owen tried to write the letter K on sandpaper and it worked, sort of, and that last week Owen cried. I don't tell him about the sandpaper science, the proprioceptive feedback loop, the way tactile input helps a brain coordinate a motor sequence. I just say "it worked, sort of." He says "that sounds hard." And it was. The gap between what happened in that session and what I just described to Robbie is enormous. Everything important got lost in translation. I don't know how to explain what it feels like to watch a six-year-old discover that his hand can, in fact, do it, if you change the surface. The feeling doesn't have a shorthand. So I say "yeah, it was." We order Thai food. I don't think about the quarterly progress reports until tomorrow.
Curtis's Thursday
Alarm. Gym bag is already in the car. I go before shift because after shift I have nothing left, physically or mentally. Twenty minutes on the rowing machine, then upper body. The gym is a 24 Hour Fitness about 6 minutes from the hospital. It's me and the same four people every morning. The guy on the bike in the corner, the woman who does deadlifts in running shoes, the two older men who walk laps around the perimeter talking about the Broncos. We don't talk to each other. We just coexist at 5:45 AM. That's its own kind of community.
Hospital. Badge in through the staff entrance by the loading dock. I changed at the gym so I'm in scrubs already. The OT department is on the second floor, a bullpen with six desks, a small treatment kitchen, and a supply closet. I log into Epic, our EMR, and check for new admits overnight. Three new patients on my caseload: a 78-year-old post-hip replacement, a 42-year-old who fell off a ladder and fractured his pelvis, and a 29-year-old who had emergency gallbladder surgery. The hip and the pelvis are mine. The gallbladder will be quick: assess, make sure they can dress and toilet independently with the abdominal precautions, and likely discharge from OT the same day. I review Lamar's chart too. He's been on my caseload since Monday. Stroke, left-side neglect. Today is day 4.
First patient. Mrs. Chen, the hip replacement. Room 4112. She's 78, had a right total hip arthroplasty yesterday, and is alert, oriented, and slightly annoyed because the night nurse woke her up every two hours. Standard ADL training. I introduce myself, explain what OT does (a version of this conversation I've had roughly 3,000 times: "I'm the therapist who helps you do the things you need to do every day, like getting dressed, getting to the bathroom, getting in and out of bed"). We start with bed mobility. She needs to roll toward her non-surgical side, use the trapeze to sit up, and keep her operative leg from crossing midline. She does it well. Then we work on dressing. Lower body dressing with a hip replacement means using a reacher and a sock aid because she can't bend past 90 degrees at the hip. I hand her the sock aid. She looks at it like it's an alien artifact. "I'm supposed to put my socks on with this?" Yes, ma'am. For the next 6 to 12 weeks. She tries. It takes four attempts. She gets the right sock on. The left sock defeats her. We'll try again tomorrow. I note her performance: moderate assist for lower body dressing, verbal cues for hip precautions x4.
Lamar. Room 4208. He's 62, had an ischemic stroke on Monday, and the primary deficit is left-side neglect, which means his brain isn't processing input from the left side of his body or the left side of space. When he looks at a clock, he only draws the numbers on the right half. When he eats, he finishes the food on the right side of his plate and says he's done. His left arm is there. It works. He just forgets it exists. I brought the orange sock. This is something I started doing a few years ago after reading a study on visual anchoring. A bright-colored marker on the neglected hand gives the brain a reason to scan left. I slip the orange sock over his left hand. "What's that for?" he asks. I tell him: "It's a reminder. Every time you see orange, you look left." He nods. We work on grooming at the sink. I set up his toothbrush, toothpaste, and comb on the left side of the sink surface. Without the sock, he would have turned only right and missed them entirely. With the sock, he catches himself twice, looks down at his left hand, and scans left. He finds the toothbrush. He brushes his teeth with minimal assist. It's not perfect. He still misses the left side of his face when he tries to comb his hair. But the sock is working as a cue.
The pelvis fracture, Mr. Novak. He fell 8 feet off a ladder while cleaning gutters. 42 years old, a high school shop teacher, strong, frustrated. He can't bear weight on his left side for 6 weeks. I assess his ability to transfer from bed to wheelchair using a sliding board. He's too proud for the sliding board at first. Wants to just push up and swing over. I let him try. He makes it halfway, pain stops him, and he grabs my arm. I'm braced for this. We do it again with the sliding board. He hates it but it works. Toilet transfer is next: wheelchair to toilet using a grab bar and the sliding board. Same resistance, same result. He asks me how long until he can stand on his own. I tell him that depends on what the orthopedic surgeon says at his 6-week follow-up. He asks "what do you think?" I tell him 8 to 10 weeks for full weight-bearing with daily activities, probably 12 before he's back teaching shop class. He goes quiet. I chart: "Patient demonstrates understanding of weight-bearing precautions but requires verbal redirection to maintain compliance. Recommend continued OT daily."
Family meeting for a patient on the TBI unit. Kris, my colleague, has been covering this patient on weekends. The patient is a 55-year-old man who fell on ice three weeks ago and sustained a traumatic brain injury. He's making progress. He can dress himself. He can feed himself. He can walk to the bathroom with supervision. The family is here to discuss discharge planning. They sit in a semicircle in the conference room: his wife, his adult daughter, and his brother. Dr. Yeh, the attending on the neuro floor, explains the medical status. The speech therapist talks about cognitive recovery. Then it's my turn. I explain what "independent with ADLs" means. It means he can perform basic self-care activities without physical help. It does not mean he's back to normal. It does not mean he can drive. It does not mean he can manage his finances, cook a meal unsupervised, or return to his job as an accountant. The daughter asks "but he can get dressed on his own, so he's basically okay, right?" And I watch the realization cross the wife's face before I answer. She knows. The daughter doesn't, not yet. I explain that ADL independence is one part of a much bigger picture. That he'll need outpatient cognitive rehab, possibly for months. That he may never process information at the speed he used to. The room gets quiet. The wife nods. The daughter starts crying. The brother puts his hand on her shoulder. This is the hardest part of my job. Not the physical work. The moment when a family understands the distance between "alive and getting better" and "the person you remember."
Gallbladder patient. Quick eval. She's 29, had a laparoscopic cholecystectomy, and is medically ready for discharge. I assess her ability to dress, toilet, and perform a kitchen task (making a cup of tea in the therapy kitchen). She does everything independently with appropriate body mechanics. I teach her log-rolling for getting in and out of bed to protect the incision, and give her a handout on activity precautions for the next two weeks. No lifting over 10 pounds, no twisting. She asks if she can go to her spin class next week. Not yet. Two weeks minimum. She's disappointed but she's going home today. I discharge her from OT services. Total time with this patient: 35 minutes. Some patients are in and out. That's fine. The ones who stay are the ones who keep me up at night.
Documentation block. 45 minutes to chart on the five patients I've seen this morning. I open Epic and start typing. Mrs. Chen: functional mobility assessment, ADL training, hip precaution education. Lamar: left neglect retraining, grooming, visual anchoring with orange visual cue. Mr. Novak: transfer training, sliding board, toilet transfer, weight-bearing precaution education. The TBI family meeting gets a separate note in the interdisciplinary section. The gallbladder is a discharge summary. I type fast. I've been using Epic for 6 years and I still think the documentation templates are designed by someone who has never treated a patient. The drop-down menus don't match the language I actually use. "Moderate assistance" doesn't capture "he grabbed my arm mid-transfer because his pride told him he didn't need a sliding board." But the system doesn't have a box for that.
Lunch. I walk to the cafeteria. Marina is there, which doesn't happen often because labor and delivery runs on its own planet. She's a nurse on L&D, works 12-hour shifts, and today she happened to get a break at the same time as me. We sit by the window. She had a delivery this morning that went smoothly: first-time mom, spontaneous vaginal birth, 7 pounds 8 ounces. She tells me about it in one sentence. I tell her about Lamar and the orange sock. She says "that's actually kind of beautiful." I hadn't thought of it that way. I was thinking of it as a clinical intervention for left-side neglect. She saw something else in it. That's what happens when two people in healthcare sit together and trade stories. The same work looks different depending on which side of it you're standing on.
Epic crashes. The whole system goes down. I had the TBI family meeting note open, about 400 words into it. I hadn't saved because Epic auto-saves every 2 minutes and I trust that feature more than I should. The system comes back up at 1:35 PM. My note is gone. Twenty minutes of documentation, lost. I stare at the screen. Then I start over. I rewrite it faster the second time because the frustration sharpens my efficiency. Still. Twenty minutes I'll never get back. Kris walks by, sees my face, and says "Epic?" I nod. She says "I lost a whole eval yesterday." We don't talk about it further. There's nothing to say.
Afternoon patients. A 68-year-old woman post-cardiac surgery who needs to learn energy conservation techniques. She gets winded brushing her teeth. We practice pacing: brush for 15 seconds, rest, brush for 15, rest. She tells me she used to run 5Ks. I believe her. The body she has now is not the body she remembers. We work on seated dressing to reduce energy expenditure. She can dress herself in 12 minutes seated versus 20 standing, and her oxygen saturation stays above 94 percent the whole time.
Lamar again. Second session today. Afternoon sessions are usually harder for stroke patients because they fatigue over the course of the day. I keep it short: 25 minutes. We work on feeding. I set his lunch tray with all items visible and ask him to eat. He finishes the chicken on the right, the roll on the right, and the fruit cup in the center. The green beans on the left remain untouched. I point to his orange hand. He looks at it, scans left, finds the green beans. "Those have been there the whole time?" he says. Yeah. They have. That's neglect. Your brain simply deleted the left side. He eats the green beans. We practice scanning the full tray three times. By the third time, he catches the left side without me pointing to the sock. One practice session. Small data point. But it's the kind of moment that tells me the cue is being internalized, not just followed.
Final documentation push. I re-chart the TBI family meeting note (again, with slightly less patience than the first version). I finish the afternoon session notes. I update Lamar's discharge plan: he'll need inpatient rehab after acute care, probably 2 to 3 weeks, then outpatient OT. I write the recommendation and send it to Dr. Yeh for the team meeting tomorrow. Total patients today: 7, not the 9 I was scheduled for. Two cancelled: one was discharged overnight, one refused therapy. Refusals happen. You offer, you explain, you document the refusal, and you move on.
Clock out. Walk to the parking garage. Fourth floor, same spot I've parked in for 3 years, by the stairwell because the elevator is slow and I don't have the patience. Marina's shift doesn't end until 7. She texted me a photo of the newborn in a crocheted hat the grandmother brought. I send back a thumbs-up. Different kinds of emergencies, different kinds of days. Same cafeteria. Same parking garage. Same exhaustion, wearing different faces. I drive home. The radio is off. After 8 hours of talking to patients and families and other clinicians, silence is the reward.
Sage's Wednesday
At the clinic. Renata, the clinic owner, is already in her office reviewing authorizations. Renata is a PT who started this practice 9 years ago. It's a 4-person shop: Renata, two PTs, and me, the only OT. I make coffee in the clinic kitchen, which is really a counter with a Keurig and a mini fridge. Check the schedule. Eleven patients today, first one at 8, last one at 4:45. Forty-five minutes each, back to back, with a 30-minute lunch wedged between patients 6 and 7. I review the morning charts. Post-surgical trigger finger, wrist tendinitis, a Colles fracture at 6 weeks, a mallet finger in a splint, and a new eval for a thumb CMC joint replacement. Five patients before lunch. Standard Wednesday.
First patient. Post-surgical for a Colles fracture, which is a break at the distal end of the radius. She's a 52-year-old yoga instructor who slipped on her front steps in January. Six weeks out, cast is off, and she's been in therapy with me for 2 weeks. Today: active range of motion, edema management, and scar mobilization. Her wrist flexion is at 38 degrees. Normal is about 80. Extension is 30 degrees, normal is 70. She's frustrated because she can't do downward dog. I tell her we're tracking well for 6 weeks post-fracture. She doesn't believe me because the gap between 38 and 80 feels enormous when you're the person living inside that wrist. I show her the progress chart: she was at 22 degrees of flexion two weeks ago. She went from 22 to 38 in fourteen days. The math helps. Not completely, but it helps.
Burt. He's 58, a carpenter, 2 weeks post trigger finger release on his right ring finger. The incision is healed, the tendon is gliding, but his grip is weak. He's nervous about going back to work. "I need to hold a circular saw," he tells me. "If I can't grip it, I can't work." This is the session I've been planning for. I pull out the Jamar dynamometer, which is a metal handle connected to a hydraulic gauge. It measures grip strength in pounds. Standard protocol is three squeezes on each hand, alternating. Right hand: 40, 44, 42. Average 42 pounds. Left hand: 76, 80, 78. Average 78. He needs at least 55 pounds on the right to safely grip a circular saw with the kind of sustained force carpentry requires. He's at 42. The gap is 13 pounds. I tell him we can close that gap, but it's going to take about 4 weeks of progressive strengthening. Putty exercises, grip rings, then resisted gripping with increasing load. He nods, but I can see the math in his eyes. Four weeks of no income. His wife works part-time at a veterinary clinic. He asks if he can do light duty. I tell him that's between him and his employer, but from a hand function perspective, anything that doesn't require sustained power grip or vibration is probably fine at 42 pounds. He can push paper, he can type, he can use a screwdriver. He can't run a saw.
New eval: thumb CMC joint replacement. The patient is a 64-year-old retired dental hygienist. Thirty years of scaling teeth wore out the basal joint in her dominant thumb. Surgery was 10 days ago. She's in a thumb spica splint that immobilizes the thumb and wrist. Today is the first post-op visit. I remove the surgical dressing, check the incision, measure the edema with a volumeter (her right hand displaces 412 mL, left hand 365 mL, so 47 mL of swelling). I fabricate a custom thermoplastic splint to replace the bulky surgical one. I heat a piece of Orfit thermoplastic in the hot water pan at 160 degrees, wait until it's pliable, mold it over her thumb and wrist in about 2 minutes, hold it while it sets, then trim the edges with bandage scissors and line it with self-adhesive foam padding. The whole fabrication takes 12 minutes. She says "that's so much better than the other one." It is. Custom splints always are. That's why they send people to hand therapists instead of just leaving them in a stock splint.
Mallet finger. A 28-year-old guy who jammed his finger playing basketball 5 weeks ago. Ruptured the extensor tendon at the DIP joint, which means the fingertip droops. He's been wearing a stacking splint 24/7 for 5 weeks. Today I check the tendon. I remove the splint with his finger resting on the table to keep the DIP joint straight. I test the extension. He can hold his fingertip up against gravity. No lag. That's good. We're at 5 of the recommended 6 to 8 weeks of full-time splinting. I tell him: one more week in the splint, then we start a weaning protocol. He asks if he can play basketball this weekend. No. Not for at least 3 more weeks after the splint comes off, and even then he'll need to buddy-tape the finger. He's heard this before. He asks every session. I give the same answer every session. The tendon doesn't care about his basketball schedule.
Jeanine. She's 34, an office worker, referred for wrist tendinitis. She's been coming for 3 weeks. The tendinitis started after she switched to a standing desk. Her physical therapist suggested the standing desk for her back. Now her back is better and her wrists are worse. This is the kind of irony that keeps ergonomics interesting. Today she brought photos of her workstation on her phone, which I asked for last session. I study them. Her keyboard is 4 inches too high on the standing desk surface, which means her wrists are extended about 25 degrees while typing. They should be neutral or slightly flexed. Her monitor is tilted back, forcing her to reach forward for the mouse, which loads the wrist extensors. I sketch out the adjustments on a notepad: get a keyboard tray that drops the keyboard below the desk surface, move the monitor 6 inches closer, switch the mouse to a vertical ergonomic model. The tendinitis is mechanical. Fix the setup, fix the problem. I also give her nerve gliding exercises and an eccentric wrist extension protocol: 3 sets of 15, twice a day, with a 2-pound weight. She writes it all down.
Lunch. Twenty minutes. I eat a salad at my desk while writing notes on the morning patients. The documentation for the splint fabrication alone takes 6 minutes because I have to include the material used, the position of immobilization, the wearing schedule, the patient's skin integrity, and the education provided. Insurance requires this level of detail to reimburse the splint at the correct code. An Orfit thumb spica splint billed under CPT 29125 reimburses around $85 from Medicare. The thermoplastic material alone costs about $22. The labor is where the margin lives, which is why Renata needs me to fabricate at least 3 splints per week to justify the supply cost. I made one today. That's the business side of hand therapy nobody talks about during OT school.
Afternoon. Patients 7 through 11. A carpal tunnel post-surgery who is 4 weeks out and regaining sensation. I test her two-point discrimination with a disk-criminator: 6 mm at the index fingertip, which is normal. She couldn't feel the prongs at all two weeks ago. A 45-year-old plumber with De Quervain's tenosynovitis, which is inflammation of the tendons at the base of the thumb. Common in jobs with repetitive gripping and twisting. I use Finkelstein's test to assess: he winces. Positive. We do iontophoresis to deliver dexamethasone through the skin, then ultrasound, then he does isometric exercises with a resistance band. His pain is a 4 out of 10 today. It was a 7 when he started three weeks ago.
Patient cancels. My 2:15 was a follow-up on a flexor tendon repair, but she called this morning and rescheduled to Friday. I have 45 minutes of unexpected open time. I use it to catch up on documentation. I'm three notes behind, which is normal for a Wednesday. I also update Burt's home exercise program in our system, print it, and attach a grip strengthening progression chart. Putty exercises weeks 1 and 2 (soft resistance), grip ring weeks 3 and 4 (medium resistance), then weighted grip exercises weeks 5 and 6. If he follows the program, he should clear 55 pounds by mid-May. I write "55 lbs by May 15" on a sticky note and put it on his chart. Goals need a date. Otherwise they're just wishes.
Two more patients. The first is a 70-year-old woman with Dupuytren's contracture. Her ring finger is flexed about 40 degrees at the MCP joint and she can't straighten it. She had a needle aponeurotomy two weeks ago and I'm working on maintaining the extension she gained from the procedure. We do scar massage, passive stretching, and I adjust her night extension splint. She says her hand "feels more open" than it has in two years. The second is a teenager, 16, who broke his scaphoid bone skateboarding. Eight weeks in a cast, just got it off. His wrist range of motion is poor: 30 degrees of flexion, 20 of extension. He's stiff and impatient. I tell him it'll take 6 to 8 weeks of therapy to get full motion back. He says "that long?" I tell him the scaphoid has poor blood supply and heals slowly, and that if he pushes too hard he risks re-fracturing it. He doesn't love this answer. Sixteen-year-olds never love the answer about patience.
Last patient of the day. A woman with rheumatoid arthritis who comes every two weeks for joint protection education and custom ring splints to prevent ulnar drift in her fingers. Today I adjust two of her silver ring splints that she wears daily. They're functional and, honestly, elegant. She bought them from a medical jewelry company I recommended. They stabilize her MCP joints while looking like regular rings. She told me once that nobody knows they're medical devices. That's good design. We review her joint protection strategies: avoid sustained grip, use built-up handles on kitchen utensils, open jars with a rubber pad instead of twisting. She's been doing this for three years. She knows the drill. But she comes every two weeks anyway because, she told me, "you're the only person who understands what my hands actually feel like." That sentence carried me through the rest of the afternoon.
Final documentation. I finish the last three notes, review tomorrow's schedule (10 patients, a manageable Thursday), and clean my treatment area. Wipe down the tables, restock the hot water pan with thermoplastic sheets, return the dynamometer to its case. Renata is still in her office on the phone with an insurance company. I can hear her voice through the wall, steady and patient, explaining why a custom splint is medically necessary for a patient whose insurance denied the claim. This happens about once a week. She fights these fights so I can treat patients. I don't think I tell her that enough.
Drive home. Stop at Albertsons for chicken and broccoli. My husband, Dan, is home when I get there. He asks about my day. I say "Burt is at 42 pounds." He knows who Burt is because I've been talking about Burt for two weeks. He knows that 42 pounds is not enough for a circular saw because I explained it on the first day. He says "getting closer?" I say "four weeks." And that's the whole conversation. It tells us everything. I don't need to explain the dynamometer, the grip protocol, the worry about income, the look on Burt's face when he realized he can't hold a saw. Dan knows the shorthand. That's what 14 years in the same job does. Your work stops being a story you tell and becomes a language someone else learns. I start dinner. Harold, Dan's father, calls to ask about the exercises I showed him for his left hand. He had a stroke last year. I walk him through the finger extension sequence over the phone while seasoning chicken. That's the line between work and life in this field. There isn't one.
Frequently Asked Questions
What does an occupational therapist do all day?
It varies wildly by setting. School-based OTs work on sensory processing, handwriting, adaptive equipment, and IEP goals, often traveling between multiple schools in a single day. Acute care OTs in hospitals focus on ADL training (dressing, bathing, transferring from bed to chair), cognitive assessment, and discharge planning. Hand therapists in outpatient clinics fabricate custom splints, perform manual therapy, progress exercise programs, and test grip strength. Across all settings, documentation takes 25 to 40 percent of the workday.
How many patients do occupational therapists see per day?
Acute care hospital OTs typically see 8 to 12 patients. Outpatient OTs see 8 to 12 patients in 45-minute sessions. School-based OTs see 6 to 10 students, with the rest of their time going to documentation, travel between schools, and IEP meetings. Skilled nursing facility OTs see 10 to 14 patients daily, driven by productivity requirements of 85 to 90 percent. Home health OTs see 5 to 7 patients, including drive time between homes.