So a week has gone by and I thought I'd reflect on it. I am in a very good hospital and am in a semi-acute floor which means the patients are mostly post-surgery and are not critical since they're not in the ICU so they're fairly stable and the goal is usually D/C in a few days. The first few days I felt very lost, since we didn't study surgeries and I didn't know what the procedures were or what I was supposed to look in addition to not knowing where all the supplies are...it was stressful. This placement is different than my last since we are supposed to see our own patients independently and write their notes ourselves which is sort of scary. After a few days though I did manage to see a routine and it definitely helps having very patient instructors.
At first I thought I would get too emotional and attached but I have developed a barrier and know that I have to act professional and put all my thoughts and feelings aside and act within my role but it does have challenges. I now no longer question or think about any of the problems or issues in the hospital because I've realized that there are no simple solutions and definitely nothing I can do to fix anything since it is way beyond my scope and responsibility.
An example of this is my thoughts on whether the surgery was actually needed and could the complications been avoided? I have learned a lot about the complications that can occur during surgery and while most do go according to plan, 20% or more don't and the problems could range from mild to very problematic. I did feel that a lot of people are not given a good understanding about these risks and what might or might not happen if they don't get the surgery...will they be able to live for another 5 years without it? Even with the surgery will their lifespan greatly increase past the 5 year mark? I've realized that surgery makes sense for younger and middle aged people but for older people that have 5 other conditions and take 10 different meds, will the surgery actually improve their quality of life?
Most doctors assume that if they find a problem they are obligated to fix it unless it is impossible or if the person declines but is this the right protocol? The person might have lived with the partially blocked vessel for 10 years and led an active life but of course they have to fix it since it is partially blocked and could theoretically become fully blocked, but does this risk outweigh the many risks associated with surgery? Sometimes it does, but if the person has a lot of other issues the risk with surgery might not outweigh the risk of the disease.
I know quite a few people including close relatives that declined elective surgery with sometimes dangerous conditions since they are living well and don't want to face the risks, and I in general agree with them. Now if the problem is actually life threatening that is a different story but the problem is it is hard to determine what is and what isn't life threatening, since one person can live with something for 20 years while another might only live for 1 year and predicting this type of timeline is difficult. So how do the docs decide who needs the surgery? Well I've realized here in NA, they mostly take the cautious route and say everybody is recommended for surgery even though that may not be the best decision for a lot of people.
The PT role in a hospital is a lot more limited than I thought. A big part of the job is discharge planning and evaluating whether a person can walk safely and without their, B.P, H.R and O2 rising/dropping, and evaluating whether they can function in their own homes and whether they need rehab, home care or can be independent with family support. There is also an education component about D/C teaching and safe transfering. This sounds mainly straightforward but get's more complicated when you see a person's O2 dropping and don't really know what to do.....or if its a more complicated situation and it takes an hour just to help to transfer....
In general I do not enjoy the hospital setting since it does turn into a routine after a while and constantly worrying that I will get some sort of infection is not fun...and I just personally feel I can do a lot more than just walk with a person but since it is an acute setting and there is no time, it is not possible to do more...Also I feel somehow its wrong to know more and understand more of their medical history than the person who is often times not given the whole story for various reasons.
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