Coming back from a well-needed vacation

So first off a quick update, I did indeed manage to pass the my internship and then had a week off to go on a carribean vacation. Now we all needed it and I was definitely burned out and frustrated from my internship. It was nice to forget about everything, to be able to go to a buffet for 3 meals a day, to be able to go swimming whenever we wanted to, and to be able to just relax and watch tv (Harry potter) during the day when it was too hot to go out and not worry about the responsibilities that we have to deal with at home. Of course no vacation is perfect and yes we did get a bit of sunburn and one day of overheating from being in the sun but otherwise no major issues that occured on our other vacations and the family left back home survived so all in all it was a nice enjoyable vacation.

Of course all good things must come to an end and I realized that all the responsibilities are waiting for you when you come back and they usually double. So it was fitting to come home to an empty fridge, a strange smell in the kitchen, a leaky door, an overgrown yard, unhappy family and cat, smoking neighbour, 15 phone messages, mail and email, having to do 2 loads of laundry, and of course lots of new course materials waiting to be printed....yes back to the rat race with barely any time to sit down and relax, not to mention actually think about things and enjoy life.....

It is definitely hard to go back to the stressful life that we quickly become accustomed to but I did realize that it is important to take a break once in a while because otherwise the stress and lack of sleep just piles on and health and safety become an issue and what's the point of living if we can't enjoy the little things in life because we're all running around in the hamster wheel not being able to stop.

Back to Square One

So here I was thinking that I was making progress and feeling confident in my new internship when boom come the evals....yeah confidence dropped about 10 below zero and anger escalated 10 above zero.....came home partially drowned the pain and anger with some nice wine and tv shows....never believed in alcohol but sometimes in moderate and controlled doses it can blunt things a bit and stop your brain from spinning and after a while makes things a bit clearer..that is if it doesn't give you a headache..

Yeah not doing too well would be an understatement, the biggest shock for me was that it was totally unexpected and I actually thought I was doing a lot better, I mean I'm not nervous when talking with patients, I can comfortably talk and even joke sometimes, and my clinical skills are getting there, I mean I've only been there for a few weeks am I really going to have all their clinical skills and reasoning that they have when they've worked for years?

Well I've realized that my biggest problem is confidence and the instructors sense that, the best advice I've got in my other placement was fake it until you make it, and I therefore have to pretend to be confident in my assessment and analysis skills even though I'm not and that's probably my biggest issue......the other thing is I ask too many questions and that's frustrating since I want to clarify everything but the reality is to learn eventually I have to go on my own and I'll have no one to clarify with so I have to start formulating my own judgements and trusting them because otherwise I will not be able to move forward.

So I quess I have to keep fighting and try harder since the fight never stops and if you let your guard down for even a second you lose the fight....and I've definitely been too relaxed.

I was really mad at first since I think I am progressing quite fast, and it has taken a lot for me to learn how to talk to patients, nurses, docs without getting nervous, learning to function in a fast-paced environment which has always been difficult for me since there are a lot of distractions and its hard to concentrate but I have realized that its not enough and I have to go beyond that and keep pushing my boundaries since its never enough...

The thing I learned is to learn to let go of the anger, and to stop the endless complaining at some point and figure out how I can improve, since being angry and blaming others and myself doesn't really make me feel much better and doesn't really fix the problem, but doing something or distracting myself does in a way help me deal with the problem. So I am not as angry anymore and I will critically think about how I can improve and survive yet another placement....since it's about surviving.

Not enough time to do it all

So it's been a fairly exhausting couple of days and hopefully will settle down soon, for some reason weekends in my family are always crazy busy, since we try to complete all our errands in 2 days....

Let's see yesterday (sat) we managed to visit 3 different hardware stores trying to find suitable materials for our renovation (partly successful), sewed up clothes for my grandfather, organized flyers for the neighbourhood group,and went to my parent's friends place for a small party, all the while managing my grandmother's angina symptoms (no problem now). Today we delivered those neighbourhood flyers, played tennis, and I helped a friend prepare for her exam all the while trying desperately to remember something I learned 2 weeks ago (my short memory is very very short).

For some reason I thought when I wouldn't study I would have loads of time to do loads of things for myself.....hmmm....not working out very well......

I don't mind being busy and some of the above projects like the renovation and flyers will be finished soon, but of course other things always come up and being pulled in 10 different directions is often quite difficult. My friends want to hang out, my parents want to clean/organize/renovate/play tennis, my cat wants to play, while my grandparents want quality time with me, and of course I can add dealing with an ant infestation in my room due to the lack of cleanliness....in addition I need to start reviewing the next unit before it starts so I am have some sort of knowledge base for the next unit....How can I choose?

What is more important? Family? Friends? School? Pets? It's the never ending question of life balance that never get's solved, since at the end of the day, I often don't remember what I did and I am extremely drained and feel like I'm surviving one day and moving to the next yet not really living.....

I have learned to let a lot of things go already due to time constraints but am not sure what else to do...Our house is rarely cleaned and right now looks like a complete mess....I don't go clothes shopping even though I badly need to due to sheer exhaustion, lack of time and danger of driving to malls with insane drivers on the weekends. I rarely go out with my friends due to a) the fear of getting sick which will derail above schedule and b) the logistical nightmare it often entails and the danger of driving.

I want to be able to enjoy life but what often happens is we go from one emergency to the next....and my downtime is spent browsing the news and facebook without being productive. I think I need to start setting a schedule for priorities that need to be completed everyday and then I won't feel so overwhelmed and feel like I completed nothing....and at least try to do some tasks on the weekdays so that there is at least some free time on weekends to do the things I want to do...should start on the now right?

Hope everybody had a good weekend!

Gaining Confidence and professionalism

The hardest thing that I've faced in the PT program has not been the huge amount of info or schoolwork, but it has been to gain enough confidence to be able to comfortably talk to patients and how to be professional.

It's interesting how much of a difference the instructor makes. In my last placement, I felt totally overwhelmed, and was continuously criticized for things like how I dressed and how my hair looked (note it was -10 and february, so I definitely had bad hair days...)and how bad my charting was. This constant criticism did nothing for my confidence, I felt I knew nothing, was incompetent and this definitely affected the way I interacted with clients. I often stuttered, was incomprehendable, and the clients sensed that I was not confident, and therefore did not believe or trust me. Part of the problem was that the setting was above my knowledge base since we did not cover the unit yet, but the instructor did not make it easy.

This placement has been much better, even though it has been intense, the instructors do not criticize me, but actually support my learning and allow me to make small mistakes without it being a big deal. The biggest thing I've gained is confidence. I no longer have a high-pitched voice, no longer stutter, and patients are actually confident about the information I give them and even though I don't know a lot, I feel I'm actually starting to see patterns, and am doing things without getting prompted from the instructors. That's not to say, there are not things I'm frustrated with, the fact that I have 2 instructors, means I have to remember 2 different charting methods which is difficult. In addition, being on 4 different units is challenging since each unit is different in structure and pt population and having to flip that switch in my brain is sometimes difficult and exhausting but I'm fortunate to see so many different units.

What is professionalism? Well I've learned it refers to different patterns of behaviour in different settings. In my role as PT in an acute care hospital, I have to remember my own scope, time limitations, pt load, pt needs, as well as the role of others and balance all those expectations as best I can. even if I don't agree with something the care the pt is receiving or if the operation was even indicated, it is not my role to address those things, if I do it can create a very hostile working atmosphere and I still would not be able to change anything. How do I determine if a surgery complication was due to negligent error by the surgeon or a normal complication that can occur? I can't and even if I could would this help the person having to deal with this complication? probably not. Unfortunately, complications are part of the risk of surgery and they increase as a person's age increases.

Another thing I have to do is balance different needs of different patients and which ones are worth standing up for, this is probably a surprise to some but unfortunately with limited resources you can't fight for every patient since then you'll never win. Trying to fight with the doc that a pt is not ready to be discharge is difficult, so you have to choose your fights carefully. Also with limited time, you have to prioritize who get's to be seen and who doesn't need to be. In a perfect world, all pt would be able to have a long PT session but unfortunately then we'd have to work 24 hours a day. Finally being professional means leaving your problems, thoughts and feelings at the door and putting on a different hat and this is true for many different working environments since the pt and you should only focus on their own recovery, they don't need to hear problems in your life or what you think of their decisions, they want to get better and the best that you can do is educate them about how to make better future decisions but ultimately it's their life and it's up to them what they decide to do.

Reading the news and feeling helpless

So I like to be informed of the news around the world but at a certain point it becomes too much. Most of the news in the newspapers is negative there is very little positive news pieces, and by reading more and more about what is wrong with the world, everyone becomes pessimistic and decides they can't change anything anyway since there are too many problems and they are too big, and so people don't try.

Now unfortunately this is my thought process also, I listen to all the negative news and think only about the negative side of living and of course that contributes to the helplessness and the depression. Take today for example, it's cold, now its raining, the crazy politicians are fighting again, and we have the 4th? election here in the past 3 years? My acne is now worse, and tomorrow I have to be at work an hour early, which means waking up at 6am....what else, let's see, that Japan's nucleur site will turn into Chernobyl, that 3 kids were injured when one brought a gun and it accidentally fired, the libya mess is continuing, the gas is now 1.35, and a university student was killed in her apartment by an unknown attacker at a university.....not to mention that I feel completely incompetent seeing my own patients at my placement.......

See the problem? No wonder I feel helpless and depressed, I only think about the negative, day in, day out....I actually studied this pattern believe it or now, and yet am following the same one....

So..to break this habit I'm going to try to think of 5 positive things that have happened today, its actually a lot harder than thinking about the negative which I must have listed about 20 things. Let's see:

1) I had a nice chat with a few med students today, and was not intimidated and was not nervous, and did not feel as I was inferior to them.
2) I'm slowly becoming more confident in my placement, and was actually able to answer pt questions more confidently (without stuttering, or long silences where my brain desperately tries to find some sort of sentence) and making it seem that I know more than I actually do...progress
3) I had a nice family pesach meal yesterday and today and enjoyed the wine the most, hmm maybe I should sit down with my family for a meal more often...
4) My friend is raising money by running for a worthy cause
5) There is a 4-day weekend coming up with no school work! well at least official school-work....

My negative thinking has gotten so bad, that I think, no matter what positive thing I do it will somehow turn around and bite me, or will end up being negative anyway so I view any good deed as completely useless when that's the wrong way to think, since I can't change wars, or politics on a national scale, and I can't change what they do even though we like to think we can by voting for different parties but in the end it doesn't really make that much difference. But what I can change is the relationships I have with others or looking at things on a much smaller local scale, making a pt feel comfortable, easing their concerns, talking to a friend about their problems, playing with my cat, visiting with my grandfather and grandmother, supporting a local business by buying products from them instead of something cheaper but where a person is making min wage, reducing the amount we drive....even though those seem to be very small things, they do make a big difference to those people, I can't stop wars, stop climate change or stop someone dying from cancer, but I can make small lifestyle changes that do help others just not on a large scale....

That wasn't as hard as I thought, now I challenge everyone (even though there are few) that read this blog to write 5 positive things that have occured in the past day and how you can/are helping others, or producing small changes in the community.

Hospital Paperwork

I have realized the thing I hate most about the hospital environment is the amount of paperwork that needs to be done. After spending 30 min walking the person and monitoring their hr, I have to spend another 30 min writing a 1.5 page essay about the 20 gazillion aspects of the walk, why? Well its because of lawsuits! In some rare case that someone decides to sue us, the proper documentation saves our hide, since we documented everything.

So in this twisted world, it is more important to spend 30 min documenting instead of helping another person....I didn't mention the 15 min I have to spend before seeing the person, trying to read other people's completely not legible writing and reading through 20 pages of the chart trying to find out where the information I need is located....very frustrating.

Thoughts on my placement in the hospital- 1st week

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.