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. ;)

Observing my first surgeries!

     Last Friday and today I had the opportunity to go and see my first surgeries! Both were total knee replacements, but I got the opportunity to see two different surgeons to see if any of their techniques were different. They worked about the same way, although the surgeon I saw today moved much faster than the surgeon I observed on Friday. I was really glad I got the chance to see both because the surgeon I observed on Friday was a little slower and took the time to explain everything he was doing, which was really helpful. It was even more helpful when I went today since the surgeon today moved much faster, I felt like I had an idea of what was going on. The OR is a really interesting place... I was surprised how many people were present and how they are professional, but it is not stressful. I was explaining everything to my dad and he said, "So it'd be like you coming and talking to me while I'm working on a car!" and that describes it perfectly! They are able to do their job but also are having casual conversation at times during the procedure! It blew my mind! Really awesome! I'm excited because I am also going to get the opportunity to observe a total hip replacement as well as a cardiac surgery. My CI has been really nice about trying to find some times for me to go to observe surgery and so I'm really thankful for that because it's really interesting and it's a nice break from the day.

     

     Today my CI let me take the lead for the whole time for two evals instead of us tag teaming like we had been. Overall, they went ok. I'm sure I'm my own worst critic! It's funny how I had all of these plans for certain things when I was in class but it doesn't really apply and everything can change so quickly in real life. It just makes me nervous because I feel like I know the right things to do, it's just the way the hospital works is so different than I expected.  I feel like if I did the evaluations that I practiced in school I would feel a lot more confident, but trying to adapt to how things are run at this hospital has been stressful for me. I almost wish we would've spent the extra time in neuro to do the write ups after patient sims like we did in musculoskeletal and cardiopulm, especially the deciding where the patient should go next... That's the hardest part, is evaluating someone and having one snapshot and basically having to make a call on where they should be discharged to and if they are a good candidate for therapy. But, I feel like I'm already starting to get a little better and hopefully with more and more practice I will get even better.  I just wish I could feel more confident, but I'm taking it one day at a time and my CI seems to be fine with where I am and where we need to go next. 

Week Two of Acute Care

Well, this week has been a little rough at times for me. Monday was a frustrating day because I got my log-in information, but the documentation program is very tricky and it took me over an hour to document an evaluation. I was so frustrated afterwards at the things that I missed from my subjective information and how long it took me. My CI wasn't upset and told me that I will get the hang of things and not to be too hard on myself. It was still really frustrating! I came home on Monday night and made a note card of all the questions I need to be sure to ask to be able to fill out the correct information on the evaluation form, so hopefully that will help me not to forget. Luckily on Tuesday and today I have done much better with documentation and remembering all the information we need. My CI is currently on the floating rotation so we have been doing a little bit of everything and yesterday we got two total knee replacements. I was excited because I didn't get to deal with any replacements in my first clinical rotation. It's been nice to be able to see the same patients two times a day for the past two days. Most of the patients we have seen are either already discharged or have gone to another facility except for one. We currently have a patient who had a BKA and just had a BKA done on her other side. She has been having good and bad days (she had the surgery last Friday) and they seem to not have her pain medications quite figured out. She was very lethargic on Monday and today, but did really well yesterday. She will be going to a long term care facility when she gets discharged from the hospital but no one is saying when that will be, so I have a feeling we will be working with her for awhile longer. She is a very funny lady and has a pretty good attitude about her situation, which is always helpful. 

I made it through week one!

               Well, I made it through my first week of acute care! And, by day three I really have started to like it. Today we had orders to go treat a cardiac patient in the ICU. I was so excited! It was a co-treat with occupational therapy as well, so there was quite a crowd of us that went. Throughout the week my CI has been easing me into more interaction with patients, but in this instance I didn't really get to help much. I was so excited because the patient was a cardiac patient and also had a lot of different lines, tubes and drains. I wasn't taken aback by any of it because I remembered everything from cardiopulm and was ready to rock and roll. Unfortunately, all I really got to do was sort of help with keeping the lines under control, which I know is important! But, I was really dying to get in there and help the patient with standing and everything. (Later this afternoon I told my CI I am ready to jump in and do more, but that I appreciated that she allowed me to get accustomed to the hospital this week; I like to learn by first watching and then doing, so it has worked nicely for me, but I am ready to DO!! She was really receptive to this and I feel like we are both on the same page, so I’m looking forward to the coming week!)

                I haven’t gotten my log in information for the electronic documentation, but my CI had me hand-write my notes while she typed them and then we compared. I have been doing pretty well with it. Basically, I am definitely including all of the important details and just need to work on being concise and writing everything clearly. My CI told me she would much rather that I write more than necessary and then edit then not have enough, so it has been working out well. One thing that I am struggling with is keeping track of time. We have to document the time that we spend reviewing the electronic medical record, the handwritten chart, the actual treatment time, and the amount of time we spend documenting. I am doing well at remembering to write start times and not so good at remembering the end times! I think that I will get better at this though, it’s just a new thought process that I’m not used to yet. 

               I am glad that I am really starting to appreciate and like acute care! I’m excited for what the next 9 weeks will bring and how much I will learn from my CI and all the other staff. 

First Day of ClinEd II: Acute Care

Today was my first day of acute care for ClinEd II. I can’t believe I’m out on clinical again! It seems like it has been such a long time since I was able to be with real patients. I was nervous, but not as nervous as before I started my first clinical. This time I felt confident that I could interact with patients and was more nervous about getting there early, having a good CI and liking my placement. 

Lucky for me, I did all those things. I got a quick orientation as far as being introduced to everyone and my CI oriented me to the electronic documentation system as well as our orders for the day. We ended up seeing six patients. This is a huge difference from out-patient when I was used to seeing 10-13 patients. It seemed slow, but we weren't really sitting around doing nothing either.

 I came home a little worried because I am really hoping that I like this experience and I had an “ok” day. Nothing horrible happened, but nothing really exciting happened. But, I am keeping my hopes up that I will begin to like it more as I get used to how everything works. My CI was really good about explaining everything to me and told me she obviously doesn’t expect me to remember everything all at once. I observed for most of the day, but did get to assist with a couple people with walking. I felt fairly comfortable and I’m definitely ready to jump in, but I was also glad that my CI did not throw me to the wolves and instead allowed me to observe and get used to how everything works. 

So, here's to hoping things can only go up from here!

Clin Ed V... wait, what?

So, today when I got home, I had some pretty exciting mail. I had a letter from my fifth clinical instructor! I don't start my last clinical until October, so it is a little far out, but I was excited to open the letter. My future CI sent me a little note just saying hello and just some very basic paperwork on what is appropriate dress, expectations, how things will work, etc. Really awesome!

The reason why I'm so excited about this particular placement is because it is in a setting that I didn't think I'd be able to get a chance to experience... early intervention. For those who may be reading that don't know early intervention services are started prior to preschool for those children who are having developmental delays or other types of delays. In the state that I reside, children are eligible for physical therapy early intervention if they have at least a 25% delay in gross motor development or they have a medical diagnosis that can lead to gross motor developmental delays (such as Down Syndrome or Cerebral Palsy). Now, most of you may know, especially if you will take a look at the banner on the top of this blog, that I used to be a teacher.

Obviously, pediatric physical therapy is something that I have toyed with and thought about, since I do have a little bit of a background in children. However, this semester I have learned that pediatric physical therapy is definitely something more than what my skills as an educator were, and I expected that; what I didn't expect was how much I'd love thinking about pediatric PT, almost as much as I loved thinking about my teaching days. (I do have fond memories, it's just some things aren't meant to be...)

So, given that I've had some years dealing with children and teaching, I really wanted to get into pediatrics with an age group and a setting that I didn't have any exposure to and EI was that opportunity. So, of course when I found out that I did get the placement, I was so excited. And, today, getting that letter made me realize how much I am looking forward to rounding out my PT school days with that clinical.

It seems like so far away, and in just a couple of weeks I'll be heading off to Clin Ed II at the hospital, so I have a ways to go before I can really start dreaming about my days with the kids... But, it was a great surprise in the midst of finals week to see that there is hope that I will make it to the end of this year and will FINALLY graduate. :)