So I thought I'd continue my updates with the school/placements.
My Placements
So at the beginning of november I finished my hospital placement, and surprisingly I was actually well-liked for the first time, and appreciated. In fact the strange thing is that everyone on the team accepted me and I actually worked really well with all of them. I was really sad leaving them and my perceptor even gave me a mark of being at entry level practice and with distinction. What was even more remarkable is that I was actually sick for 3/5 weeks and everyday struggled to control my asthma. It wouldn't be surprising for me to constantly wheeze, and be SOB. I learned to hide it well, but sometimes I just couldn't like when I was forced to take the stairs, then I would get noticeable SOB and would have to pretend to do notes to recover. I wasn't sure what it was that I actually had, because mostly all I had was a scratchy throat, no cough or fever, I was sure it was strep and so started antibiotics, but they didn't really help. Eventually with rest whatever it is I had finally was gone and I finally recovered.
I was really lucky because there were only 5-6 patients on this unit, and sometimes we would only have 3 patients for the whole day. So we would see the 5 patients together and thankfully most were ambulatory so it wasn't that physically difficult. Most days, we would start at 10 and finish at 3 with a full hour lunch, and she was actually surprised when I would try to work through my lunch! The patients were interesting since this was an inner city hospital, a few had dementia, a few others had personality/anxiety disorders. The only difficult part of the placement was that it would take me 1.5 hours to get there and another 1.5 hours to get back. I felt at home there, and I even though I can never really imagine working in an acute setting mostly because most of my day involved transfers and ambulation and then writing lots of notes, I really liked the team environment.
My 2nd placement was another story. I knew it was going to be a lot more difficult that my previous one as soon as I saw an email stating that I'll be having 2 instructors in both inpatient and outpatient setting in this case neurological rehabilitation. Considering my previous experience with 2 instructors, I was very very nervous. I can't even begin to describe how vastly different my experience was. Let me first say that this rehab center is a very busy place and they are very understaffed. Every physio is expected to have 10pt on their workload which is crazy considering 8 are neuro patients. A patient only gets 30-45min of therapy/day which is definitely not enough to recover properly and the therapists are very overworked often having no time for lunch and working overtime to finish paperwork. In my opinion, it wasn't fair to add a student into that mess because in that kind of environment it is very difficult to just see all patients let alone try to teach anything to a student.
To add to the craziness, my instructors expectations in general were definitely not the most reasonable, and add in all the stress from my grandmother's fracture and MI and hospital stay and it is a recipe for disaster. Their expectations were that by the end of the placement, I see 7pt/day by myself, which to me is ridiculous, considering that at another neuro facility the PT only sees 6pt and the student would only be expected to see 4, so for me to see double that was completely unfair.
It was definitely a struggle, and I dreaded coming there every day. I did learn how to attempt to improvise, and how to be more assertive ie: attempt to seem like I know what I'm doing. I learned that its important to lower the tone of your voice to seem more in control, and to try to reassure clients daily about their progress.
I realized early on, that I wouldn't be able to do neuro as a job because it is just too physically challenging, and the treatments are very vague. Even by the end, I still was not able to transfer clients properly myself, I managed somehow but I did start to have some back pain, and apparently I was told my legs are too long and in general my knees are too weak (injury) to properly 'lift with the legs'. I wanted to learn how to facilitate gait training, but what I realized is that its a lot tougher than it looks and the treatment varies quite a bit. What works on one person doesn't work on another, and because of different areas of the brain affected by the lesion (stroke), different muscles are weak for different people, and trying to figure out which muscles to activate is very tricky. I was always pressing too lightly or too hard, and often in the wrong place.
I also found it very tough psychologically. How do you tell a person they won't be able to walk on their own? How do you live with the fact that this person is not getting the amount of therapy that they need to get better? How do you explain to the person that they won't be able to go back to living on their own, or going back to their job? We're taught that our job is to get the person to their maximum level of functioning, but is that really good enough? Will this person be satisfied with having to walk with a walker and not being able to work? But in all of those cases, we're expected to swallow our own feelings, and convince the person that they are improving and they have the potential to continue to improve and given their condition they are doing very well....the problem is I know what its like to be on the other side of the coin. I know how hard it is for that person and their family to have their lives completely disrupted and have to adjust to a new condition that affects every aspect of their lives. I often felt like I was lying to them about how well they were doing.
Some days I felt so frustrated and overwhelmed I just thought I would start screaming if one more thing went wrong. Let me paint a picture, there is a small gym about the size of a living room, where there are often 7 clients and 7 therapists, so a total of 14 people, in a tiny space all trying to do assessments and exercises. Now there's me with a general social anxiety and add in some mild ADD, and you have a problem. Not only was I overwhelmed by the number of people in the small space, I felt I couldn't really concentrate because of all the noise and felt the need to often shout to be heard. Often times in the morning when I was in the small gym, I would get a bad headache from all the noise which made it even harder to keep pretending that I know what I'm doing.
In the outpatient part, I felt a lot more comfortable because it was a lot bigger, there was a lot more space and thankfully no need to shout. All the clients that came were comfortable and in control and wanted to improve, I didn't have to keep convincing them to do their exercises to get better. I even had an opportunity to take over my instructor's caseload for 2 days when she was sick, and surprisingly with a few hiccups, I managed to do it. Now, of course, in general I was following the exercise sheet and was unsuccessful when trying to do gait training for a particularly low level patient, but I think everyone more or less felt comfortable with me, and I was trying my best to appear confident and I think I succeded.
Looking back, I felt like a lot of the clients deserved a lot more time than what we had. It is hard, especially if the clients are younger. There were a lot of people in their 50's and some even in their 20's and their lives have just been turned upside down with their stroke or other neurological disorder. The most frustrating for me was when I knew they reached a plateau, and no matter what I tried to do, they couldn't keep improving beyond their limit, and I think that it was even harder for me to accept than for them.
I wish I could say I did well, or improved my performance by the end, and personally I think I did, but alas, for my instructors it wasn't good enough. I kept messing up the paperwork (note in my defense, there was a ton of sheets to fill out and definitely not enough time) even though I kept staying well into my lunch time to finish it (20min lunch). I was messing up some parts of the assessment (parts which we didn't learn about...), and was apparently not showing enough initiative (I hate that word) and interest...ie: I was supposed to figure out how to fill out all the paperwork myself, and had to try to ask more questions (no time..). The more interesting comments were that I did not socialize enough with the staff....which was very interesting given that first off I'm not that social by nature, and secondly I couldn't even remember all the 20 staff members names to actually properly socialize, and often was so overwhelmed by figuring out the paperwork and exercise that needed to be given that socializing was the last thing on my mind.
By the end I was just tired of pretending of appearing fine and happy, and tired of not being able to speak my mind. They said that I needed to ask more questions and communicate with them more, but whenever I tried to be honest they would just criticize me and tell me that I just had to work on the skill more without telling me what I was doing wrong or how to fix it. They said that my personal life shouldn't interfere with my job which I agree with, but everyone's human, and in a real job people can take time off to care for their family. They had no idea how much energy it actually took for me to come to work every day and completely shut out my personal life and appear normal and happy. None of the clients noticed it, and they all appeared satisfied with their care, isn't that what's most important?
I've learned by now to take the good with the bad and go with the flow. I learned a lot, and I myself think I've matured and grown a lot as a therapist. I do wish that it would get easier not harder, and that they would prepare us more in class, but I think that's wishful thinking. I've realized that I won't get along with everyone, and I have to keep going out of my comfort zone to make interactions with others easier because that's the only way to learn. My final lesson, I've learned is that learning never stops, there is no way to learn everything in 2 years of school, we have to continue to research and take more and more courses to be able to offer the best possible treatment for our clients, because in the end that is what its all about.
Tuesday, December 27, 2011
Monday, December 26, 2011
Crazy 2 months
So its been a whirlwind of 2 months with so many problems that after every day I was just so exhausted I couldn't even begin to start to post. So without further ado...
Family
So my grandfather's pneumonia finally resolved after the terrible cough he had continued for another 3 weeks, and we got a long 10day course of antibiotics, of course when one problem is resolved another emerges. So on Nov 24 my grandmother broke her hip (greater trochanteric fracture) after we're guessing semi-passing out and falling to the floor from low B.P (90/40) at 10pm while she was going for a late night snack (something which we kept telling her not to do...). So began a 3 week nightmare hospital stay....
To give some perspective, before the fall, my grandmother had 3 different B.P meds + was using a nitro puffer 5X/week...so she had major heart problems before everything. So, after a lot of deliberation, we decided to call the Amb. Everybody right away started looking at me and asking if its fractured or not, as if I'm the biggest expert, so from my complete lack of any experience, I did observe it was Externally rotated which is never good, and she couldn't weight bear and was in a lot of pain. I was hoping it was just dislocated, but alas x-ray determined large fracture.... Now the next adventure was actually getting to the hospital, since we wanted a better hospital, and I knew that if I didn't request it they would send us to the crappiest one in the city (already had a few nice visits there), so with the paramedics hint, we said that of course we were there already in the past month....yes the wonders of canadian medicine, you have to lie to get to a better hospital.
Of course the first thing they do in the ER? They give morphine for the pain of course because its not moral for the person to have any pain, what happens in an elderly person with many comorbidies? They go into withdrawl, complete with hallucinations, paranoia...yep, let's just say it didn't start well. We were lucky though since thankfully a bed opened and she was able to get her surgery only a day later. This is where the real problems started....First she had a loss of consciounsness--> ICU visit--> chest pain which I had to battle with nurse to get a little relief with nitro--> back to awful ward where they ignored us and any complaints including continuing chest pain, note my mom was there 24hr/day since my grandma was delirious and doesn't speak english, so needless to say she was exhausted. I was there on weekends and did lose it a couple of times with the nurses and their 'care'. --> MI...after basically 3 days of chest pain where we were giving nitro ourselves, they finally noticed elevated troponin, ST seg depression....and this is only after my mom made up that she was having chest pain for 3 hours and a smart nurse finally took her seriously. Of course being very lucky, they did not have a cath lab at this hospital so they had to send to another hospital and considering this was an 'emergency' she got into the cath lab 1.5 days after the initial dx of the MI and was stented at 11pm at which time she was extremely exhausted and barely keeping it together...very very frustrating.
I wish I could say our nightmare ended, but lucky for us 'protocol' always needed to be followed. So we spent a few days in the telemetry ward, then the ortho ward, and thankfully we were able to actually start going home at night and my mom was actually able to get some sleep. Now at this point, 2 weeks after coming in, she was able to walk short distances with a walker and we really really wanted to take her home...but alas there is the 'protocol' of going to rehab first. So we refused 2 places, even though we were being forced to choose 3 and were warned that we would go home if a spot didn't open in a few days, unfortunately for us a spot did open....
Now to give some perspective this was the same rehab place where I was doing my placement, so I assumed that it would be a good place to recover in...boy was I wrong. So she got place on an ortho unit, which was problematic since her major problem was the heart not the hip, and right away this unit almost completely ignored the MI and heart problems and only focused on the hip fracture. Now because we don't have private insurance and couldn't pay $300/day for a semi-private room, she was placed in a ward suite with 4 beds and 1 shared bathroom, did I mention that one lady was continuously vomiting? My grandma was not feeling well at this point, and we still weren't sure what meds should be used to stabilize her B.P which was still flcutuating madly, so we requested that like at the hospital they help her use a bedpan at night, since she is less stable and more disoriented, and she was using a commode at night. We verbalized this several times, and every time, we were told this is a rehab facility, and that to improve they had a protocol to help their pt walk to the bathroom and they would use their 'judgement' to determine if she needed assistance. Of course they refused to let us stay the night... So on the 2nd day, my mom arrives, to learn that she had a syncope episode after walking to the bathroom and they are sending her to emerg for more tests...oh oh. So my mom goes over to emerg, where they find nothing, except fluctuating B.P. which they can't do anything about until the heart calms down a bit, and send her home...after a 7hr wait for the ambulance to take her back.
At this point we were so frustrated at their lack of any kind of understanding and treatment (she wasn't getting any therapy because she wasn't feeling well) that we thought we wanted to take her home. At this, everyone basically thought we were nuts, and the doc refused, said that she is too unstable (not sure what they were doing to make her more stable), the nurse manager trying to defuse the situation (we were not happy) threatened us that if we leave AMA we will get no homecare, and can't get an ambulance to take her home because our house can burn down and she wouldn't be able to leave! but if we stay until monday she will convince the nice (spineless) doc to release us. Now after the last emerg you would think they would learn that she isn't stable and her fluctuating B.P means that it's prob not a good idea to force her to walk to the bathroom at night for 'therapy'..nope. So we tried to be proactive and explain our concerns to the her nurse about getting her up at night, and the nurse went nuts, started shouting that she has no right to a personal commode since it is a 'public room' and that if she can walk for 100m, she can easily walk to the bathroom.
Well guess what, at 4am the next morning, we get a call that the doc sent her back to the emerg after ANOTHER syncope episode following a walk to the bathroom. We were not happy. At this point we decided enough is enough and we will take her home whatever way we can because she was getting worse and we couldn't take this constant emerg visits every 2 days. So after again everything came back normal, we convinced the ER doc that since she is being 'released on mon' anyway, we want to take her home directly, which the previous ER doc refused. So after another hr wait for the ambulance, we couldn't believe our luck that we finally managed to escape from our medical rehab prison.
You're probably wondering, were we crazy going against the doc and the facility? was the doc right in wanting her to stay (in that awful place) and sending her to ER all the time? Well i think we were right. I won't lie, because she was very far from stable in the beginning, and she did have a couple more scary syncope episodes, and her B.P. did continue to fluctuate, which meant we had to constantly adjust her meds. It also meant that we had to stay with her 24hr/day, and we would take shifts sleeping on a mattress on the floor to make sure we helped her use a bedpan at night. But in the end, we did not once come back to the emerg, and we have been able to after 2 weeks at home get her fairly stable all the while reducing her meds. She is now able to walk on her own, watch tv, and I've started doing the regular hip exercises at home, we have even stopped constantly measuring her B.P, and she hasn't had a syncope episode in 1.5 weeks.
The most likely reason for the syncope? we're guessing it was orthostatic hypotension, which we told them she had before, and in addition a lot of weight loss. She was basically not eating for 3 weeks, because the food was so bad and was actually causing her indigestion.
After all that, we are basically labelled as difficult family members who left AMA and are putting her at 'risk' and are therefore denied home physio and probably more homecare. This experience has def taught us a lot, the most important lesson being to never be afraid to speak up, and that the 'professionals' don't always know best, and sometimes you have to go against the system which can be very frustrating.
Family
So my grandfather's pneumonia finally resolved after the terrible cough he had continued for another 3 weeks, and we got a long 10day course of antibiotics, of course when one problem is resolved another emerges. So on Nov 24 my grandmother broke her hip (greater trochanteric fracture) after we're guessing semi-passing out and falling to the floor from low B.P (90/40) at 10pm while she was going for a late night snack (something which we kept telling her not to do...). So began a 3 week nightmare hospital stay....
To give some perspective, before the fall, my grandmother had 3 different B.P meds + was using a nitro puffer 5X/week...so she had major heart problems before everything. So, after a lot of deliberation, we decided to call the Amb. Everybody right away started looking at me and asking if its fractured or not, as if I'm the biggest expert, so from my complete lack of any experience, I did observe it was Externally rotated which is never good, and she couldn't weight bear and was in a lot of pain. I was hoping it was just dislocated, but alas x-ray determined large fracture.... Now the next adventure was actually getting to the hospital, since we wanted a better hospital, and I knew that if I didn't request it they would send us to the crappiest one in the city (already had a few nice visits there), so with the paramedics hint, we said that of course we were there already in the past month....yes the wonders of canadian medicine, you have to lie to get to a better hospital.
Of course the first thing they do in the ER? They give morphine for the pain of course because its not moral for the person to have any pain, what happens in an elderly person with many comorbidies? They go into withdrawl, complete with hallucinations, paranoia...yep, let's just say it didn't start well. We were lucky though since thankfully a bed opened and she was able to get her surgery only a day later. This is where the real problems started....First she had a loss of consciounsness--> ICU visit--> chest pain which I had to battle with nurse to get a little relief with nitro--> back to awful ward where they ignored us and any complaints including continuing chest pain, note my mom was there 24hr/day since my grandma was delirious and doesn't speak english, so needless to say she was exhausted. I was there on weekends and did lose it a couple of times with the nurses and their 'care'. --> MI...after basically 3 days of chest pain where we were giving nitro ourselves, they finally noticed elevated troponin, ST seg depression....and this is only after my mom made up that she was having chest pain for 3 hours and a smart nurse finally took her seriously. Of course being very lucky, they did not have a cath lab at this hospital so they had to send to another hospital and considering this was an 'emergency' she got into the cath lab 1.5 days after the initial dx of the MI and was stented at 11pm at which time she was extremely exhausted and barely keeping it together...very very frustrating.
I wish I could say our nightmare ended, but lucky for us 'protocol' always needed to be followed. So we spent a few days in the telemetry ward, then the ortho ward, and thankfully we were able to actually start going home at night and my mom was actually able to get some sleep. Now at this point, 2 weeks after coming in, she was able to walk short distances with a walker and we really really wanted to take her home...but alas there is the 'protocol' of going to rehab first. So we refused 2 places, even though we were being forced to choose 3 and were warned that we would go home if a spot didn't open in a few days, unfortunately for us a spot did open....
Now to give some perspective this was the same rehab place where I was doing my placement, so I assumed that it would be a good place to recover in...boy was I wrong. So she got place on an ortho unit, which was problematic since her major problem was the heart not the hip, and right away this unit almost completely ignored the MI and heart problems and only focused on the hip fracture. Now because we don't have private insurance and couldn't pay $300/day for a semi-private room, she was placed in a ward suite with 4 beds and 1 shared bathroom, did I mention that one lady was continuously vomiting? My grandma was not feeling well at this point, and we still weren't sure what meds should be used to stabilize her B.P which was still flcutuating madly, so we requested that like at the hospital they help her use a bedpan at night, since she is less stable and more disoriented, and she was using a commode at night. We verbalized this several times, and every time, we were told this is a rehab facility, and that to improve they had a protocol to help their pt walk to the bathroom and they would use their 'judgement' to determine if she needed assistance. Of course they refused to let us stay the night... So on the 2nd day, my mom arrives, to learn that she had a syncope episode after walking to the bathroom and they are sending her to emerg for more tests...oh oh. So my mom goes over to emerg, where they find nothing, except fluctuating B.P. which they can't do anything about until the heart calms down a bit, and send her home...after a 7hr wait for the ambulance to take her back.
At this point we were so frustrated at their lack of any kind of understanding and treatment (she wasn't getting any therapy because she wasn't feeling well) that we thought we wanted to take her home. At this, everyone basically thought we were nuts, and the doc refused, said that she is too unstable (not sure what they were doing to make her more stable), the nurse manager trying to defuse the situation (we were not happy) threatened us that if we leave AMA we will get no homecare, and can't get an ambulance to take her home because our house can burn down and she wouldn't be able to leave! but if we stay until monday she will convince the nice (spineless) doc to release us. Now after the last emerg you would think they would learn that she isn't stable and her fluctuating B.P means that it's prob not a good idea to force her to walk to the bathroom at night for 'therapy'..nope. So we tried to be proactive and explain our concerns to the her nurse about getting her up at night, and the nurse went nuts, started shouting that she has no right to a personal commode since it is a 'public room' and that if she can walk for 100m, she can easily walk to the bathroom.
Well guess what, at 4am the next morning, we get a call that the doc sent her back to the emerg after ANOTHER syncope episode following a walk to the bathroom. We were not happy. At this point we decided enough is enough and we will take her home whatever way we can because she was getting worse and we couldn't take this constant emerg visits every 2 days. So after again everything came back normal, we convinced the ER doc that since she is being 'released on mon' anyway, we want to take her home directly, which the previous ER doc refused. So after another hr wait for the ambulance, we couldn't believe our luck that we finally managed to escape from our medical rehab prison.
You're probably wondering, were we crazy going against the doc and the facility? was the doc right in wanting her to stay (in that awful place) and sending her to ER all the time? Well i think we were right. I won't lie, because she was very far from stable in the beginning, and she did have a couple more scary syncope episodes, and her B.P. did continue to fluctuate, which meant we had to constantly adjust her meds. It also meant that we had to stay with her 24hr/day, and we would take shifts sleeping on a mattress on the floor to make sure we helped her use a bedpan at night. But in the end, we did not once come back to the emerg, and we have been able to after 2 weeks at home get her fairly stable all the while reducing her meds. She is now able to walk on her own, watch tv, and I've started doing the regular hip exercises at home, we have even stopped constantly measuring her B.P, and she hasn't had a syncope episode in 1.5 weeks.
The most likely reason for the syncope? we're guessing it was orthostatic hypotension, which we told them she had before, and in addition a lot of weight loss. She was basically not eating for 3 weeks, because the food was so bad and was actually causing her indigestion.
After all that, we are basically labelled as difficult family members who left AMA and are putting her at 'risk' and are therefore denied home physio and probably more homecare. This experience has def taught us a lot, the most important lesson being to never be afraid to speak up, and that the 'professionals' don't always know best, and sometimes you have to go against the system which can be very frustrating.
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