Week 3: Friday.

This morning started with me receiving a new patient on my caseload. Patient S has Alzheimer's Disease and is a long term resident. Patient Y walked in to the gym on her own. We played catch with a rubber ball and then a tennis ball. After her session was done, I went to get patient H. She was dressed and in her wheel chair, ready to go. We started off with sitting exercises. Hip abduction 3x40 with red theraband, then long arc quads 3x10 with 2lb weight on RLE and 1lb on LLE. After that I let her rest for 5min while I helped another student with a chair follow. After I came back, I asked M to help with chair follow. She stood up with min assist. We then proceeded to walk out the door and down the hall to the right. At about 20 feet, H suddenly came to a stop and said "I need to sit." She then sat down into the chair while still holding on to the rolling walker with both hands. As she let go of the walker, her had rolled to the right and her body started convulsing. M immedicately called for my CI while she and I put her leg rests under her legs. I shouted for my CI again and he came and took H into the gym. My CI had the other male PTA put her down on the mat. "Does she have a pulse?" The answer was no. The nursing staff was alerted and the emergency cart with life support kit and oxygen tank. Apparently the first tank they grabbed wasn't full enough so they plucked a full tank from a patient and used that instead. My CI yelled "Does she have a code?" over and over again. I didn't know what he meant and later found out he means does she have a DNR (do not resuscitate) status. As soon as he got his answer (which was a no), he started chest compressions. All the patients in the gym were evacuated. Morning PT sessions were all suspended. After what seemed like the longest 10 minutes, cries of relieve filled the room as my CI succeeded in restarting H's heart. Ambulance was called. After the stretcher arrived and the EMTs attempted to transfer her onto the stretcher, the second attack came. It was as though the grip of death let go and suddenly made another grab at H. My CI went back to his chest compressions. Another 10 minutes later, her heart started again and my CI asked the EMTs to get her to the hospital before another attack hits. All this time I stood my ground and watched from afar. I must've looked pretty bad because everyone I knew asked me if I were okay. I was fine. I was worried about my patient.

Week 3: Thursday

Today my friend S finally texted me back afte two weeks. We started talking about documentation at our sites and things started to go sour. I told her my facility doesn't do daily notes and her head kind of exploded on the other side of the phone. She said that it does not make sense that a facility like ours does not bill daily for its services. She was starting to make a lot of sense. I kind of just assumed my CI uses a magical program that bills for the entire week each time he enters the figures. Of course I didn't say the exact words, but S started to get agitated, saying that if she were me she would want to know everything. I told her that to be honest, I'm not very comfortable asking about everything. For me, I just don't want to mess up so bad that I fail the clinical. For her, she wants to be able to do everything a PT does right now. I told her I would try to push for some answers. With regard to my two patients. I tested Mrs. Y on ankle strength as well as H/S and quads. She is 5/5 in all. I assessed her static and dynamic balance, which were perfect. She is ready to go home. Mrs. H was able to walk both sessions today. Good for her.

Week 3: Wednesday

Today I IMed one of my classmates and told him I now have two patients on my caseload. He asked me what I do for the 5 hours that I'm not treating patients. That's actually a very good question. It's actually 3 hours that I'm not treating patients since we have 1 hour lunch break and I usually have 7 hour days. For some reason those 3 hours just go poof. I'm either walking back and forth from patients' rooms and the gym to check if they're ready for PT. A lot of times my patient is not dressed. I guess I could handle 4 patients if I had them. I'll probably have to work until 4pm though. I felt really tired today since I went and taught cello to 2 students after I left the site. I didn't get home until after 5pm. One of my other classmates must have had a great day in her clinical site because her status read "I am truly in love with the physical therapy profession. I am so blessed to have the opportunity to make this my future career <3". Well good for her. I felt so tired that cold seltzer on cold apple juice became what I'm truly in love with. I really don't feel like I'm making a difference in my patients' lives. One of my patients is so strong physically she could get picked up by her daughter and go home at any time. My other patient is so lazy that her condition has not improved since last Friday. As a matter of fact, her performance has gotten worse since last week. Last week we ended with more then 30 feet of walking per session. This week we're stuck with less than 30 feet per session. Last week we were doing all standing exercises. This week we're doing supine exercises. I don't know what's gotten into her but she's being really lazy. I try to be nice as always but she isn't improving.

Week 3: Tuesday

I'm not sure how today was. I think it wasn't bad overall. It was kind of a weird day though. I didn't have any trouble getting either of my patients to the gym for both of their sessions. However I had M help me evaluate Mrs. Y and had Y (PTA) help me with WC follow for patient H. Both M and Y have a lot to say. They both give really valuable advice. I taught cello after I finished seeing both patients. I was so tired I didn't take the service road instead of the LIE (which was heavy with traffic). Tomorrow I have 2 students so... eh. I observed a progress note today. Still don't remember which button my CI clicked to enter the program.

Week 3: Monday

Same number of patients today-still two. However, I still have to see both twice a day. I was able to get H in on time in the afternoon, but she was as uncooperative as Friday. We actually walked on Friday afternoon but we didn't walk this afternoon. Y gave me trouble today though. She was using Darko shoes as flip-flips so I had to take those away. She also didn't wait for me to come get her from her room-she walked to the gym while I was with H. The CI left before I treated either of my patients so he didn't see. I expect my caseload to double by next week since two of the students are leaving. That'll be more work for me, but I'm not excited. I got my hands full as it is. I'll probably be fine with one more patient, but two more may be bad. I think I can handle it but it won't be easy.

Week 2: Friday

Yesterday was bad. Messed up with my new patient. Didn't memorize her room number right away and didn't bring her in with her wheelchair. Today I went in determined to fight. I had trouble seeing both my patients both in the morning and in the afternoon, but I did it. H was dressed today when I went to get her but it took quite a bit of persuading to get her in for her afternoon session. I took the new patient earlier and OT snatched H right before I finished with the one before. There was a surprise party for Mike during lunch break, who is leaving the facility and whose wife is expecting. We held the party on the top floor, in the large conference room. There was not enough seats for everyone, so me and the other students stood by the door. I felt tired after the party from standing the whole time. I felt so tired that after I finished for the day, I forgot to get the dish I brought from the refrigerator in the OT room. I only have 2 patients and I feel like I don't have enough time. I can't imagine having to fit 8 patients on my caseload. I mean, I was free from 11 to noon, and from 3pm to 4pm, but that's only two hours, which is only about two 60 minute sessions. This world is kind of crazy. I wonder what happens when you don't finish treating by 4pm... To be continued...

Week 2: Wednesday

This morning was not so good. I went to see my pt just after Mr. Schmo finished his PT session and she was still in bed and not dressed. I checked back at 10:15am. An OT was dressing her neighbor but she still wasn't dressed. At 10:30am I went looking for her CNA, found her, who told me she won't dress her. I remembered how Chris put her socks and shoes on for her on the first day, so I asked my pt if I can help her get her clothes. It took 30 minutes but I helped her get dressed. At 11am I had her wheelchair set up for her but I had to get another person to help me transfer her to the WC. I was about to hunt down the CNA again when my CI came into the hallway. While I was treating my pt, M came over and said "no more talking" because my pt was talking more than exercising. I felt embarrassed because I wasn't strict enough with my pt. In the afternoon, same thing happened and M came over. After we walked and I put her back into her room, M told me to stop doing sitting exercises and do standing exercises next time. To be continued...

Week 2 Monday

Woke up feeling pretty good. I said a prayer in the car after I parked. Day was kind of boring. I had my one patient. The PT who was helping me picked on my guarding. My CI left before lunch, so I didn't even get to give him the weekly summary planning form. I'm pretty sure I'll get to talk to him on Thursday because my patient's progress note is due that day but this Thursday will be halfway into week 2, which is kind of late to get feed back on week 1. What's more, that will only leave 2 days until I ask for feedback for week 3. Since my CI wasn't around, things were uneventful. What's my goal gonna be for week 2? Well my patient complained that I wasn't communicating well enough. I'll admit that my communication isn't the best, but then again, she had put cotton in her ears.

Day 6: TGIF

Surprisingly dad didn't come out of his room until 7:20am in the morning (instead of the usual 6:30am). I woke up on my own at 6:30am, and happily went back to sleep until my alarm rang at 7am. Dad came out as I was having breakfast. I felt a lot better than the morning before. When I got to the site, I wrote down a prayer to God in my Journal, asking that I will survive the week and not do anything horribly wrong. My CI gave me the new patient from yesterday. My pt heard Mr. Schmo yelling in the morning and got agitated. She has asked for a room change. Mr. Schmo's room is two doors down and across from hers. His yelling is actually quite hilarious when it's not too early in the morning. I talked to her at 10am and she said she was dizzy. I talked to OT and they couldn't get her to do much. Chris talked to her half hour later and said he'd wait until social work or case management (I forgot which) talks to her about the room change. We ended up checking on her again after lunch. She was on the phone when I walked by her room. I waited for her to finish her call by hanging out with Alfred when was getting his patient across the hall. She spotted me and told me to come in and talk to her daughter on the phone. She wanted me to tell her daughter that she had tremors in her hands. A few minutes later my CI joined us and she asked him to talk to the daughter this time. This time he got a wheelchair, put stockings on her legs, her shoes on her feet, and put her in the wheelchair. We finally got her to the gym for the first time. We didn't do much. She talks too much and she goes on and on. It's the same story over and over again. After telling the same thing twice, she asked me to repeat her story back to her. She was also chatting up a storm with another pt, who was sitting next to her. I gave her long arc quads, seated march, heel slides, and ball squeeze. I was asked by a staff member to take her BP, but the cuff they had was broken so I didn't hear anything from he stethoscope. We ended up not taking her BP. I'll have to remember to bring my own cuff on Monday. We stoop her up near the end and she seems steady. She simply complained of dizziness. I dropped her off at OT because they came to the PT gym and asked for her. She didn't complain, so good for us. To be continued...

Day 5: Downward spiral

Having been sleeping in the living room, I've been disturbed in my sleep at 6am every morning, but I forgot about it since during the two week wait period, I wait until he's gone and sleep until noon. Now that I can't go back to sleep-having to leave for clinicals at 7:30-7:45am, I've been sleeping less and less each day. I've been helping out more than the day before. Today I helped with treatment of three patients instead of the two from yesterday. I almost set of one of the pt's alarm by forgetting to unclip it from her body. I almost tripped over a leg rest (I didn't put it there, it was moved by someone). At the end of the day, I couldn't keep my eyes open when I was shown the documentation programs on the computer by the director of rehab herself. In my defense, she was going through it very fast. I was told by a staff member to think about balance exercises for a patient. I failed to communicate the ideas that I had to her and as a result I made myself look like a fool. Tomorrow I will work on communicating my ideas more successfully to the people I work with.

4th day

This day went by like a blur. The stroke patient showed a lot of improvement, but Mike said he was at that level before but declined shortly after. It appears that this pt has a lot of of ups and downs, good days and bad days. Mike is leaving the rehab by the end of next week as well. It's too bad the first person I met at this SNF is leaving before my stay is done, but I'm glad that he got a new job at a good facility. Chris gave me a review on insurance today. I even got handouts. I'll have to review that lecture from Dawn's class. During lunch some of the guys as well as all the other students went to the nearby park to shoot some hoops. I went along as well. "21" with six people is so weird. I only scored one point. We played in our scrubs. Nothing interesting happened that afternoon. I cotreated with two other staff members, but one of them was rescheduled so that the two pts' treatments overlapped. I had to stay with one and leave the other for the other staff member to treat. My CI was not present during those times. It kind of feels like the staff I'm cotreating with are my mini-CIs. To be continued...

The Third Day

I woke up a couple of times during the night due to the temperature drop, but instead of putting on my long sleeve PJs my groggy mind simply told my fingers to clutch my blanket tighter. When I awoke, I felt exactly as tired as yesterday morning, except this time, I don't have a full week of stored glycogen to keep me energized. I got to the site at exactly the same time as yesterday, and immediately regretted having done so for I felt tired and had to wait in the car until it was time to go in early. I then decided it was a good time to set my daily goals, and made myself think hard enough to come up with one single goal: take special note of interesting cases (upper motor neuron lesions and joint replacements). When the one stroke patient came for his session, I gave him my full attention. We didn't work on standing today. Today Mike had the pt transfer from chair to table via sliding board. The pt knew what to do, but it took him at least 5 minutes with mod assist to transfer all the way to the table. We started with NMES using premod setting. Mike explained that NDT as well as other approaches didn't have the same effectiveness as NMES for this particular case. The pt had his eyes almost closed so it was hard to tell if he was trying to voluntarily contract at all. I did ask him to contract whenever the stim ramped up though. After about 15 minutes of NMES, we switched to knee extension on the table in supine, with a roller under the knees. Mike asked the pt to extend the good leg, then the affected leg. Mike tapped the rectus femoris from the knee to the body in succession, and successfully facilitated the muscular contraction. He said he was incorporating the muscular reflex into the exercise. At one point during the knee extension exercise, the pt farted. A few minutes later we realized there was more than fart to that expulsion. After we finished he knee extension, Mike had the pt do bridges, then hip & knee extension ("Push me away. Get rid of me! Get rid of me like your neighbor Frank!") The pt's wife came to see him during therapy. Wife: He needs to be changed. The pt's doctor came to see him during therapy. Doctor: He needs to be changed. When we finished, Mike had the pt transfer himself to the wheelchair via sliding board again. When he was in the chair, Mike wasn't happy with the way he sat. Mike: You're slouching. Lean forward for me. *Grabs pt by the pants and helped him sit back more Mike: Sorry I ripped your Diaper... Shortly after the pt was wheeled back to his room, I was called by another staff member. Yolanda told me Chris wants me to treat a pt with her. Yolanda: This is her name *points to name on PT schedule, and her room number. Go get her from her room. Me: What's her room number again? Okay. Go get her now? Okay. When I got to the room, I asked a nearby CNA "Excuse me, who is um, in charge of this patient?" CNA: You are! Me: *Totally confused* But is she doing alright? CNA: Yeah! I was so frazzled by the lack of a chart and the strange conversation with the RN that I forgot to introduce myself. I knocked on the door and mumbled "Um... therapy?" I wish I had handled that better. The pt didn't seem to mind. The RN apparently had told her that I was coming. Right when I wheeled her out of her room I see Yolanda walking toward us. She probably thought I got lost. Basically Yolanda told me exactly what to do. "Pick a machine. Have her stand up and walk to the machine with the walker. Guard her like you mean it!" While we were walking in the hallway, I saw that the pt was walking well, so I only performed contact guard. Yolanda told me to grab a fistful of her pants from behind because "she lost her balance on me yesterday." Yeah well I wasn't told about that. By the way there was no written progress note to look at because daily progress notes were only done by the nursing staff. PT staff only perform documentation for initial eval, discharge, and bi-weekly notes for medicare patients. My pt was very high-function who needed PT because of her deconditioned stastus after her fall. She had plenty of energy for all the sitting exercises. We knocked out four different sitting exercises under 15 minutes. After the sitting exercises, Yolanda decided to have me come up with a standing exercise. I thought about some balance training and said "weight shifting exercises" when I actually meant side stepping exercises. She was walking fine so it was obvious she didn't need weight shifting training. I didn't remember the right words so I decided to go to the next one on my list "Hip abduction by the parallel bars." That turned out to be a piece of cake for my pt. She performed that exercise perfectly without flexion compensation that so many other patients have. I spoke with a fellow student about my high-functioning patient. We decided that she is here due to her deconditioned strength and endurance. I suppose tomorrow we'll walk a bit more as well as progressing her with more standing exercises. To be continued...

Much delayed first clinical internship: Day 2

I woke up and immediately regretted having watched game 2 of NBA finals. I don't know if it's just me not being used to waking up at 7am but not having 8 full hours of sleep didn't help one bit. I managed to get up, think about how much time I have to get ready, got dressed and went to the site. I got there before it started to pour. I got there, said hi to the people I met on the first day, and while the rest of the staff had their backs turned toward me and speaking Spanish to each other, I managed to learn their names as well. Goal 1 of 3 achieved: Learn all the PT staff's names. It took my CI about two hours to tell me what to do: same thing I did on my first day. He did give me enough time to ask three questions, and I wrote down the answers he gave me. One thing that struck me as kind of odd was that there was no code for pt passing out in the gym. There is a code for cardiac arrest, a code for fire, but no code for passing out in the gym. I think I should ask for that student manual he said he keeps somewhere on the floor. What to do in case of a pt passing out: continue to monitor the patient and call for a staff member and a nurse on the floor. Goal 2 of 3 achieved: asked questions that I should have asked on the first day. As I observed the staff members do their sessions, I realized the theme of the facility's rehab was lower extremity exercises. Stepping, heel slides, ball squeeze (adduction), hip abduction, knee extension/long arc quads were part of almost every patient's treatment. Usually after 20 minutes of sitting LE exercises, the staff takes the pt for a walk. After the walk, if the pt has enough energy, take a second walk. If the pt is tired, pt takes a rest and if time permits, more sitting LE exercises. There was some standing exercises done using the parallel bars, but all the pts were going into hip flexion before hip abduction, therefore glute medius was not activated. Only one staff member asked his pt to "go straight to the side" to avoid hip flexion. All the pts on oxygen tank via nasal canula were half asleep and not very responsive. The staff members would set them up on the portable stepping device, say "move your legs" and walk away. The pt on oxygen would open his eyes, move his legs twice, and go into standby mode with eyes closed. I watched one such pt for fifteen minutes. The pt did not seem to notice I was right next to him. The staff in charge of the pt seem not to care. My CI turned around and found me in a half kneeling position, observing the pt, and said "En, what are you doing on the floor?" Me: I'm observing. CI: Get off the floor. That's bad body mechanics and unprofessional. Me: *frowns due to failing to see how I have bad body mechanics. I wasn't guarding the pt (he's sitting in his chair). I wasn't picking up objects. My back was pretty straight. CI: And don't make faces. That's also unprofessional. And get off the floor. Get a stool to sit on or something. At lunch time, I followed some of the staff to the cafeteria. The staff members I followed sat down at a table and filled that table's chairs. I had to sit by myself. Interestingly, my CI joined me at the table I sat, so I had lunch with my CI. After lunch, I observed a fellow first year student treat a pt. The pt is a tiny old white lady who simply adores my fellow little blonde PT student. The student introduced me to the pt and at one point I asked the other student how to pronounced her last name. She then attempted to pronounce my last name, at which point the pt says "I know someone whose name is Yi. He works at a Chinese restaurant. Do you know where [insert Asian sounding name] is?" To which I replied "Nope." At 2:30pm, I went observing the said student & pt above while they walked in the hallway. Upon my return to the gym, my CI had left the facility.