Just plugging along...

So, here I am still plugging along. Another weekend passed, and gearing up for a shortened work week this week! (I looooove holidays!) I'm looking forward to making a move in my current company, as I had an opportunity present itself to me not long after I posted on this blog last. It was sort of a serendipitous type of thing... I was feeling a overwhelmed, over worked and a little hopeless. And then opportunity came, saving me. Ha.

Eh, the funny thing about life is sometimes when you think you can't push any further and that no one has noticed you've been busting your tail, every once in awhile someone has been paying attention and then good things happen.

I'm looking forward to the move within my current company to give me a bit of freedom (although I've only been there since February, since I was a student there, I had a slight head start on the happenings) and more motivation to continue pursuing my interests with the cardiopulmonary aspect of physical therapy.

And, when a good opportunity comes to further your career, you've got to take it... So, I am. I'm going to be moving to a different office location to help form an agreement with my current company and  a company that is going to be opening some breathing disorder centers. It's a great time to jump head first into being the PT that's interested in cardiopulmonary in our company because no one fills that area, and who knows where it will lead. Maybe nowhere, but maybe somewhere. All I know is that I needed something to come along before I got so burnt out that I made a rash decision, and it came all on its own.

Two. Thumbs. Up.

I hate being vague on here, but I don't like giving too much information that is personal. But, I am very excited for this opportunity and I love my cardiopulmonary patients! :)

The New Grad Blues

Ok, so... Here it goes... I have the new grad blues. I think this is normal... Or at least, I keep meeting with my former advisor from PT school (what a great opportunity that she can continue to be my mentor!) and she makes me feel this way. I had all these aspirations and "life will be so much better when..." moments, so to be honest I feel a little let down. Things aren't really panning out the way I had foreseen in my dreams.

Without sounding like a big baby, just take this with a grain of salt. The reason (well not the only one...) that I chose the job I did was because I had a clinical rotation there and it wasn't overly busy. The environment was slower than most OP clinics and of course, the pulmonary and cardiac rehab was a huge pull for me... However, since I started we have been blowing the doors off the clinic with so many new referrals. In fact, in April I saw the most patients a PT has seen *ever* in one month at the clinic. This is great for experience, great for keeping the day moving fast, but awful for my personal health. I am literally being run into the ground, sometimes needing to stay until 9pm at night to finish everything that I need to do... It's like I'm starting to get burnt out and I have literally just begun.

I know that OP clinics are busy, I get it. (Like I said, not trying to be a baby... although, this is my blog so I can say what I want!) But, I wouldn't be in OP if it wasn't for this particular company and their cardiopulmonary aspect. I'm starting to worry that perhaps this isn't the setting for me. I know that if I were to leave my current position (as in some day, like when I'm ready to move forward with my career) I wouldn't really want to take my base knowledge of orthopedics and head to another OP clinic. It's just not me. There are plenty of people who love ortho and that is fantastic. And I am loving the well-rounded experience I am getting right now, but it's not something I'm going to specialize in later on in my career. Additionally, I am a bit worried about my base knowledge I'm gaining in cardiopulmonary. This is something I have great interest in but I am trying to be realistic about my options for moving forward in this specialized area. I'm not so sure that there are that many opportunities for someone who wants to focus purely on cardiopulmonary.

So, this newfound doubt plus the overwhelming stress of literally doing nothing but work/sleep has me feeling blue. In fact, it has me feeling like maybe I shouldn't have gone to PT school at all. I love my patients and I love patient care and I love most things about my job, but the stress is too much. I just feel like I am being pushed so much for being a new grad. I mean, I'm seeing as many (and sometimes more!) patients a day as my mentor/boss who has almost 20 years of experience. It's just daunting. I'm not asking someone to pat me on the back and baby me, but for crying out loud - I. Am. Exhausted.

Yes, you do need to do research after graduating ;)

(But, it's so much more fun!)

So, I got some exciting news that I am going to be taking the lead in revamping our cardiac rehabilitation program at my job. This is great for a few reasons:

1. I *LOVE* cardiac patients, cardiac pathologies, cardiac responses to exercise; I love the heart!

2. Up until this point the cardiac patients have been performing a modified version of the pulmonary program, which isn't "wrong" per say, but it is also not the best we can be doing for these patients

3. I am excited to use my creativity and new knowledge to change the face of this program and then hopefully help market my company and make us a larger player in this field in the area

So, this weekend I found a couple of articles from the American Heart Association on their core components and guidelines, as well as some performance measures for cardiac rehab. I'm hoping to read through those articles later today and then also look back on my school notes and in my textbooks to remind myself of all the important things that should be considered when dealing with a cardiac patient.

I'm so excited to be able to have this opportunity, with a patient population I'm very passionate about... I know I just posted last time about the stress test that I completed, and the reason for that is that I have a congenital heart issue. Thankfully, it doesn't limit my ability to do anything, but it has made me very interested and passionate for the cardiac world. And, I feel I'm in a unique situation where I can maybe relate (a little!) to my patients.

I'm also drooling over the AACPR's textbook on Cardiac Rehab, but it's also $60. I'm going to email my cardiopulmonary professor and my boss to see if we have a copy of this anywhere that I could borrow, before I consider buying it... I don't want to overwhelm myself with information, but I think it could be helpful.

I am also planning on becoming a member of the AACPR because I feel like there is a ton of information on there that would be beneficial. My cardiopulmonary professor and the respiratory therapist are both members (in our area) and it seems like it has been useful for them, so I'm debating on when to join.

So, things are feeling very exciting and also a nerve-wracking, but as I investigate, I'll be sure to post some good cardiac rehab information! :)

How did 8 weeks pass by so quickly?!

  This week has been so busy and has been going very slowly. I am thankful, though because it's my last week and I'm not ready to go! I discharged another patient this week, but all the other ones I started saying goodbye to today. Some of them I am really close to because I started treating them as soon as I started and I will miss not getting to know how they finish up. I had a couple of my male patients tell me how much they appreciated my kindness and how much they will miss me.  The same patient that brought me flowers last week told me I took "care of him best". It was so cute! I am really going to miss everyone. I'm not looking forward to saying goodbye to all my pulmonary patients tomorrow, they have been the ones I have had the most fun with! 

     Today I gave my in-service on CHF. It went pretty well and then we all had lunch together for my "farewell" which was really nice. My CI even bought me a cookie cake! Everyone just keeps hugging me and telling me about how much they don't want me to leave. I really feel like I'm a part of their family now! 

     And, we talked a bit about the possibility of maybe me having a job there when I graduate... It's very unofficial now because they weren't planning on hiring anyone, but it was really exciting to think that I may have a small lead on something already! 

     This has been a really rewarding clinical experience and I have really loved the chance to work with cardiac and pulmonary patients. I will definitely miss it!

Back in the clinic! ClinEd 3 begins!

Today was my first day of my clinical experience at my new placement, which is an out patient clinic that specializes in pulmonary rehab. It was a long one (10 hours!) Big shift from doing acute back to out patient. The clinic is small, but it seems nice. My CI is young (she graduated from the same school as me 3 years ago!) and is actually a year younger than me in age. That doesn't bother me as long as I can learn from her.  The clinic serves about 50% out patient and 50% pulmonary rehab. I'm really excited about the pulmonary rehab aspect.The respiratory therapists work on aerobic conditioning (they work the patients up to 20 minutes on 3 different machines TWICE a visit [2 hours of aerobic work!!!]) then PT works on strengthening, balance and reiterating what the RT's teach (like breathing techniques, energy conservation, etc.) I had forgotten that Medicare Part B does not allow students to provide treatment to patients, so I was a little bummed because a lot of the patients today (especially the pulmonary patients) were Medicare and so I wasn't allowed to treat them. Although, it was nice because I did get to sort of observe and see how things happen. I am just hoping that there will be a good number of non-Medicare patients in the pulmonary rehab program for me to treat, since it was the reason I wanted to come to this clinic. Besides that, the day was ok. I got a little prepping on the computer documentation (which is, of course, a new program than I've dealt with previously) and some more information on billing. My CI had me write down three goals for this experience... I said that I wanted to become comfortable and competent with cardiopulmonary patients in this setting (since I am competent in the acute setting), to become independent with orthopedic patients (again), to become better at time management and multi-tasking, and to continue to excel with documentation. My CI seems very open and told me that I can ask her any questions or if I get overwhelmed or not challenged enough to let her know.  I think I am her first student, so it should be interesting for both of us as this goes. 

Could this rotation go any slower?

 Whew. This was a long week! It was a weird one too, lots of running up and down stairs with people wanting us to come back later, being at testing, etc. Nothing really special happened. 

      We have a patient in the ICU that is really having a hard time bouncing back from her CABG and it's been a huge mystery. She is just extremely lethargic and not really responsive other than moaning or occasionally saying one-two words. You have to constantly give her verbal and tactile cuing to stay awake and most of the time when her eyes are open she will focus on you and then all of a sudden lose her focus and have that look of "nobody's home". It's very odd and it has taken all week for the surgeon to finally consult neurology. They had thought it was medication related and so they have taken her off of all her pain meds, she has a UTI (which could be playing into it) and some other issues. But it's just very puzzling. Every day I keep hoping it's medication related and we'll go in and she will be completely awake and alert, but it hasn't happened yet. Her family is questioning the nurses constantly about what has happened and I feel bad because no one really has an answer for her. They finally did a CT scan to check for stroke signs, but it was all negative. I hope when I go on Monday she's made a miraculous recovery!

     I can't believe that this coming week is week five! It is going by fast! I like that it's going by fast because I go up and down about my experience, some of it is good but some of it is just ok so I keep making the best of the situation I'm in! And I'm getting excited for December to get closer and closer, of course! But, I am trying not to wish this experience away because the freedom of what "real life" will be like is great! I am still undecided about acute care. I definitely think that I could like it, but I think I would like it better if I were calling the shots and could do things in the order I'd like too! But, it's nice to see how other therapists work and to get the experience of trying new ways of doing things because I feel like even though I want to resist it (because it's not how I "practiced") I can still learn something from it.

Cardiac Surgery

     This week has been a little bit of a roller coaster ride... At the beginning of the week I was feeling really frustrated, but yesterday and today were better. On Wednesday I got to observe a CABG and aortic valve replacement. Seeing an open heart surgery was probably one of the greatest moments of my life. Being a heart patient myself, I was really looking forward to the experience and it definitely lived up to my expectations (and then some)! Best of all the perfusionist (the person in charge of the heart lung machine) used to work at Children's Hospital in Pittsburgh. We got talking and he asked when I had my surgery (June of 1989) and my surgeon's name... it just so happened I had my surgery during the time that he worked there and I also had my surgery with one of the surgeons he worked with! So, there's a very good chance that he was MY perfusionist long ago! So cool! I told him thank you, just it in case it was him. So neat! 

     Yesterday and today I have been doing more evaluations and treatments and it went a little smoother. She even told me that my notes a really good this afternoon before I left, so that made me feel good! So, overall- up and down and hopefully things will continue to be up and stay up. ;)