Last week one of my one o'clock patients cancelled, so I had an hour to spend tidying all the loose ends in my paperwork. Half way through I realized one of my office mates was doing the same. Casually I offered to let him practice dry needing on me if he ever needed, as he was recently certified in level 1 and needs to accrue practice hours before getting certified in level 2. I figured he was finishing an evaluation from later, which takes a good amount of time on our computer program. He jumped up. "Sure! Want to do it now?"
I paused as the reality of my offer set in. For me, that would mean needles in my butt - gluteus medius, glut minimus, piriformis, maybe even glut maximus. I have a tailbone that has been fractured twice and is now tilted to the left, rotated to the right, and the tip is bent and re-fused at a 90 degree angle; the larger muscles of my hips often develop the mysterious "trigger points" that are something of a controversy within therapy.
What are trigger points? They feel like knots in the muscle upon palpation with thready or stringy muscle fibers above and below that are supposedly held on tension from the knot. And yet when you press onto an area you are simultaneously pressing on hundreds of nerve endings, small blood vessels, and a significant amount of subcutaneous tissues and multiple fascial layers. Trigger points cannot be found during cadaver dissections. Who is to say you are palpating just muscle? Further, muscles do not sense pressure or pain - nerves send signals to the brain, which then decides what it is feeling and to what intensity. Pain and discomfort are interpretations.
This was my first time being needled. Not every state allows it - New York State does not so it never came up, but Colorado does. I've had my colleagues needle certain patients who had areas of chronic problems that didn't respond completely to other treatments. But this was my first time.
When the needle goes in you barely feel it. They are small needles, "dry" because there is no syringe attached. It looks more like acupuncture for those familiar (though the technique is not acupuncture as it is not eastern medicine, does not use meridians, etc). The size of the needle is determined by the tissues of the area being needled. Sometimes they place needles and attach a small electrical stimulation unit that the patient can control. Sometimes, like with me, they go for muscle twitching by pistoning or twisting the needle.
The sensation definitely increases to an intensity just beyond that of getting a tattoo. I had to tap my hand continuously on the therapy mat, since somehow this would prevent me from moving the area under treatment. There were also some mild verbalizations on my part amid laughing at myself. Laugh too hard and you'll move everything, so I had to stifle myself as well.
Then WHAMO. Your muscle twitches. That stringy line of taught muscle fiber is in repeated spasm and the sensation of a cramp feels like it takes up half your body. It isn't painful per say, but it is very peculiar and can be rather uncomfortable. I yelped more than a few times. The pistoning continues until the adequate muscle twitch is achieved, so the cramping goes on for what feels like five minutes but is probably about 10-15 seconds. I also started mild sweating all over, a tiny sympathetic response (as in sympathetic nervous system, or what many know as "fight or flight" physiological response) that luckily did not go any further than that. By now I was smacking the table with my eyes squeezed shut, probably sounding ridiculous to whoever was in the treatment room next door. "Whoa whoa whoa whoa...." My opposite knee was kicking, also feigning as help to hold still. My colleague had to use his elbow on my back to make sure I didn't buck. He needled three spots on my right hip/glut and two spots on the left. A mere twenty minutes.
At one point my colleague said "This is your ilium [hip bone]. Can you feel the tapping on your ilium?"
"Twitching! All I feel is TWITCHING!" Still smacking and kicking the table. But as awful the process probably sounds, we were both also laughing.
One of my colleague's patients previously said he was "screaming like a little girl" when his pectoralis muscles were needled. Those are super sensitive. I cannot even imagine. I planned to tell that patient that I was yelping most of the time, though I didn't go so far as to scream.
Afterward, the homunculus of my ass was gigantic. Every step felt like little rockets were pushing their way out through the skin. Flushing out the area with activity is recommended, so I hopped on a stationary bike and had the office staff send my next patient back to bike next to me once he arrived. I explained to my patient why I'd be dancing the wiggle worm and rubbing my bum throughout the session so he wouldn't think I was crazy. Supposedly the after effects wear off faster in those who are active. Since I'm more active that just about all our patients (aside from an occasional Adams State U athlete) they were very curious how it would go for me.
By the end of my second patient I stood up to walk her out of the clinic and realized I only felt the slightest, teeniest little pull on the lateral left hip. The right hip had been more pronounced before treatment, hence it receiving three needles. These spots have been there for years in fluctuating intensities that I try to keep under control by laying on a tennis ball or foam roller. It was weird to suddenly not feel them.
So what exactly does the twitching achieve? If nothing else, it gives a huge shot of sensation to the brain so that afterward the pesky little pulls probably don't even register anymore. Does the "knot" go away? It appears to. If the brain no longer interprets danger in an area then it won't tell that muscle to contract. Whatever the mechanism, I have not felt those areas on my two runs since.
Just after the treatment my colleague said, "If people didn't improve afterward then no one would come back."
Damn straight they wouldn't.
Showing posts with label physical therapy. Show all posts
Showing posts with label physical therapy. Show all posts
Sunday, August 10, 2014
Friday, June 6, 2014
"I get to set the pace. It's your job to keep up."
That was the response from a patient, who walked for the first time Wednesday since his stroke nine weeks ago, when I told him his head was moving forward twice as fast as his legs and thus twice as fast as me. His message came with a fist bump and a smile.
When told we would receive this patient directly after he spent four or five weeks in acute rehab and accomplished nothing more than hoyer lift and the occasional sliding board transfer, we all completely balked. We are not set up for high needs patients. We lack equipment. (How do we not have a single commode with a drop arm? How do we not have parallel bars?) We lack RN training for that level of mobility and the imperative of having the patient always doing as much work as they can. We lack the ability to schedule therapists to cover such high need patients due the complexity of set up, problem solving, the need for high repetition, and extensive family training. Our Swing program, meant to act as a short-stay pseudo rehab in an area where actual rehab facilities do not exist, is reserved for ambulatory patients who will definitely discharge home in no more than two weeks' time. So to take on a patient who was declared to be maximum assist/dependent for all basic activities seemed inappropriate, both for our facility and out of respect for the pt's needs.
We are now excessively happy to have been proven wrong.
Turns out that the therapist note from acute rehab did no justice whatsoever to the patient's presentation. They also seem to have done nothing with the patient during those weeks, wasting a very neuroplastic time frame with minimal to no functional training. Maybe they didn't know how to treat lateropulsion. Maybe they were kinda lazy and didn't want to do the work required for his level of need. Maybe they just didn't realize that the only way you get return into a flaccid limb is by progressive and supported weight bearing, and that you have to push the not-quite-ready activities in order for the previous steps to truly improve. Maybe they forgot that standing, someway somehow, is one of the most basic tenants of rehab.
Regardless, we received the patient with a still completely flaccid right arm and right leg, and his sense of balance and assistance during mobility was to strongly push himself over onto his flaccid side. After a mere two and a half weeks he has a good deal of functional tone in his leg, meaning when in a standing position his leg will accept weight even though it cannot control it and he cannot move his leg voluntarily, and he has walked with moderate assistance and the arm rails along the hallways of the hospital (which we cleared through maintenance prior to initiating). And he only pushes when he is tired or the activity gets set up funny and is extra challenging.
Yesterday morning, ambulation day #1, he/we did four repetitions of 12 feet. Yesterday afternoon was more of the same. This morning was two repetitions of 14 feet followed by transfer training with a freshly facilitated stand portion of a stand-pivot method.
Plus in outpatient I have recently acquired a slew of neurological patients: a spinal cord injury fresh out of Craig Hospital, a subdural hematoma, inclusion body myositis, what was assumed to be super severe diabetic neuropathy by the referring doctor but is more likely a spinal cyst....
Meaning? I'm totally geeking out. And even though I'm exhausted from the lack of infrastructure and lack of greater institutional support for providing an acute rehab do-over, I'm having a lot of fun.
As a neuro geek of a therapist who gave up a complex neuro caseload in NYC for a different extra-professional life (i.e. having a life outside of work), I though I had given up neuro by coming to such a small rural community that lacks a neurologist within two to three hours in any given direction. And until the last few weeks it has been 95% orthopedic.
Now I finally feel like my therapist self again.
When told we would receive this patient directly after he spent four or five weeks in acute rehab and accomplished nothing more than hoyer lift and the occasional sliding board transfer, we all completely balked. We are not set up for high needs patients. We lack equipment. (How do we not have a single commode with a drop arm? How do we not have parallel bars?) We lack RN training for that level of mobility and the imperative of having the patient always doing as much work as they can. We lack the ability to schedule therapists to cover such high need patients due the complexity of set up, problem solving, the need for high repetition, and extensive family training. Our Swing program, meant to act as a short-stay pseudo rehab in an area where actual rehab facilities do not exist, is reserved for ambulatory patients who will definitely discharge home in no more than two weeks' time. So to take on a patient who was declared to be maximum assist/dependent for all basic activities seemed inappropriate, both for our facility and out of respect for the pt's needs.
We are now excessively happy to have been proven wrong.
Turns out that the therapist note from acute rehab did no justice whatsoever to the patient's presentation. They also seem to have done nothing with the patient during those weeks, wasting a very neuroplastic time frame with minimal to no functional training. Maybe they didn't know how to treat lateropulsion. Maybe they were kinda lazy and didn't want to do the work required for his level of need. Maybe they just didn't realize that the only way you get return into a flaccid limb is by progressive and supported weight bearing, and that you have to push the not-quite-ready activities in order for the previous steps to truly improve. Maybe they forgot that standing, someway somehow, is one of the most basic tenants of rehab.
Regardless, we received the patient with a still completely flaccid right arm and right leg, and his sense of balance and assistance during mobility was to strongly push himself over onto his flaccid side. After a mere two and a half weeks he has a good deal of functional tone in his leg, meaning when in a standing position his leg will accept weight even though it cannot control it and he cannot move his leg voluntarily, and he has walked with moderate assistance and the arm rails along the hallways of the hospital (which we cleared through maintenance prior to initiating). And he only pushes when he is tired or the activity gets set up funny and is extra challenging.
Yesterday morning, ambulation day #1, he/we did four repetitions of 12 feet. Yesterday afternoon was more of the same. This morning was two repetitions of 14 feet followed by transfer training with a freshly facilitated stand portion of a stand-pivot method.
Plus in outpatient I have recently acquired a slew of neurological patients: a spinal cord injury fresh out of Craig Hospital, a subdural hematoma, inclusion body myositis, what was assumed to be super severe diabetic neuropathy by the referring doctor but is more likely a spinal cyst....
Meaning? I'm totally geeking out. And even though I'm exhausted from the lack of infrastructure and lack of greater institutional support for providing an acute rehab do-over, I'm having a lot of fun.
As a neuro geek of a therapist who gave up a complex neuro caseload in NYC for a different extra-professional life (i.e. having a life outside of work), I though I had given up neuro by coming to such a small rural community that lacks a neurologist within two to three hours in any given direction. And until the last few weeks it has been 95% orthopedic.
Now I finally feel like my therapist self again.
Monday, December 10, 2012
Making it up the stairs
Last Friday was a long day, with a caseload including two extra
patients and thus flying from one session to the next by the seat of my
pants. If there ever is a dull moment in a hospital it will surely be
made up for with massive chaos soon thereafter. As I laid down to sleep
one particular encounter replayed in tandem with memories from the
Montauk Century three (four?) years ago.
Over lunch I got a call from the nursing care coordinator that my patient had been accepted to two different subacute rehab facilities, the first of which is apparently one of the best in the city, but the patient was refusing to go and was adamant about going home. By the history given by the patient and obtained in the social worker's notes I had assumed the originating nursing facility was his home. Turns out he was there for the last eleven months, having entered for subacute rehab but was never released for reasons we don't know (safety, being fully informed of a change in living situation, the facility reaping money from insurance...?).
"He won't listen to us. They have a bed waiting, and it only needs his agreement. Can you see him today? Talk to him, something?" I agreed to do what I could.
Mr. Y had been fun to see for the last two weeks. He is the hero of all patients in nursing facilities - many facilities neglect patients and leave them soiled in bed for half the day, and occasionally a jaded PT comes around for "therapy" consisting of hip flexion (no functional value those who have difficulty standing up, i.e. weak hip extension), knee extension, ankle pumps, and a return to a soiled bed. Many facilities don't encourage ambulating when it is difficult because they see it as "unsafe," thus leaving patients in bed or in wheelchairs and allowing them to become even more deconditioned over time. Not Mr. Y. His post-stroke mental faculties are relatively intact despite difficulty with expressing himself verbally and weakness/increased muscle tone in his left arm and leg. He is a fighter. I have seen inspired patients, but never the likes of this. He is a man determined to never let a nursing facility limit him. Instead of allowing physical regression and depression, he will argue for however long it takes until you let him do what he knows he can do. His survival in a sub-par nursing facility is guaranteed. But his survival at home, in a third floor walk-up apartment with no family or social support aside from a 70 year old neighbor who can open a can of food occasionally, and with the need to leave home three days a week for dialysis, is not guaranteed. He would at a home health aid and was borderline for requiring 24/7 care. The farthest he walked with me previously (and I had seen him five days per week, mind you) was 60 feet, and he hadn't performed stairs in a year if not more. And yet he refused to go anywhere else but home.
We met at 5:30 a.m. with intentions to head out by 6:00. Goal: 130 miles from New York City's Penn Station to Montauk, NY on the eastern tip of Long Island. Our rag tag group was having trouble hitting the road. One person went for a bagel. They came back 10 minutes later. Another said that looked good, and they went off for a bagel. Five minutes later a third member wanted to use the bathroom. Once back ten minutes later First decided they also needed the bathroom. Third waited five minutes before saying that maybe a bagel was a good idea. Yup, that kind of group, and that kind of morning. I'm trying to not play mom to the group and nag, but we need to leave soon because the day will take longer than others assume. I look at my watch, trying to be patient: 6:15, 6:28, 6:40. Finally everyone is ready to go.
First looks over at Youngin' (fourth person), says "Dude, where's your helmet?"
"Helmet? What helmet? Iyyy... aaaahh... errraaahh... We don't really need a helmet, do we?"
Fifth (for those counting, including me makes six) glares in response. After a bit of debate, we determine that his home is along the way to the Brooklyn Bridge and so we will make a pit stop. We ride down, pull over to the street's edge, take a few pictures and chuckle about previous rides. Ten minutes later Youngin and Dan (formerly referred to as Second) come back helmetless. His house keys went with his bag to the finish, and he is too nervous to ring up and possibly upset his father (Youngin' is 20 at this point). Dan offers his wife's helmet at home, and they take off to get it. First decides to make a stop around the corner for batteries while we wait. She and Third take off. Fifth and I wait another fifteen minutes, pondering what exactly we got ourselves into. Finally they arrive, the white helmet with hippie flowers works well with Youngin's skin tones, we take off to meet the battery search crew, and finally the day begins.
I have an aid with me, because I know Mr. Y will want to prove that he can walk. Just the day before he wanted to show that he used to walk without a walker, and after five solid minutes of arguing I gave in and agreed to a trial so long as we switch to the walker if he needs his hands on something. He needed to palm the wall or grab my hand, not to mention I had to give him minimum to moderate assistance for balance. We only made it ten feet out he still refused to use the walker on the way back, so the aid and I grabbed each hand to stabilize his return trip. So is the persistence of Mr. Y, bless his intrepid heart. It's hard when you want to maximize a patient's independence but their persistence, regardless if from baseline personality or from altered perception secondary to their condition, hinders their performance.
So today the aid and I enter, and I begin the conversation about where he may go. I want him focused, so that he knows that x, y and z must be achieved if he's able to go home. Two home care groups have declined him, saying they cannot offer 24 hour care and they find him unsafe as per the notes from the last week and a half. (I agreed and had been recommending even a short rehab stay.) Home care groups laugh at the notion of getting even 12 hour care. I tell him anyone who goes home must be able to walk up and down the hall twice, go up and down as many stairs as they have at home, and do it all without any of my help (all this is true, with fluctuating values according to their home setup). I describe his current need for assistance, and that with his progression and motivation if he got rehab then within a couple week's he'd be okay (which I also believe is true).
"No. You cannot push me. They all push me. Those places just want your money." He's already sitting up to show he could walk, with large gestures and pointing in our faces. "I kept asking to go home before and they kept telling me no because they wanted my money. They did not take care of me. They just took my money and ignored me. I'm going home. You cannot push me."
You can tell he retains the notion of safety and retains awareness of his abilities, because otherwise he would have been attempting to walk out of the hospital days ago and would have ended up with one-to-one supervision and been labelled as "impulsive." But instead he has waited for me, even with his anger and huge motivation building ever more. I try explaining that we have a different facility lined up, one that has very good feedback in terms of rehab and their outcomes overall. These people will help you get stronger. He hears nothing of it. It only makes him angrier.
Talking has hit a wall, so I switch to a plan. "Here's what we have to do." I give him parameters, same as before. I reinforce that at home he won't have us to help, so he's gotta do it on his own. He agrees, pops up, and refuses to use the walker. I'm guarding him while trying to persuade otherwise, and his level of assistance and balance are like before. We get to the door, eight feet out. He's still refusing to use the walker, but he has stalled, I think because he realizes how much he needs support.
"You can walk farther if you use the walker. It will help. You can go home with a walker. I need you to walk a long way with the walker so we can show the social worker what you can do." That finally gets through. He takes the walker without even looking down, starts marching down the hall with the aid and I flanking him, hands hovering six inches off his shoulders and hips, not knowing if or when he might go down, not knowing his endurance or his mental clarity once fatigued.
Fast forward through many hours of riding. Light rain. Youngin' takes a skid witnessed only by Fifth, comes out unscathed but a little hurt in his ego. Panda Portraits. Then pouring rain. Flat tire (me). Mercifully a sponsoring bike shop come along with a tube since there's no chance of vulcanizing fluid drying in this downpour. Multiple aid stations later, we are not the only ones who are seemingly "behind." More riding. The rain stops, but our socks are soaked and we've lost body heat. My feet are completely numb.
Next aid station I pull off my socks to wring out extra water. We've come about 70 miles, just over half way. Fifth uses a winter hiking trick and puts my foot on his abdomen. Wowza does that work well. While I recover and stuff my face, Dan decides to take off early so we can catch up in a short bit. We grab a bunch of food to stuff our faces while riding on, only to be intercepted by a race volunteer who reports that we have been cut off and must decide whether to continue on, without knowing if aid stations will still be open, or if we want to get on the sweep bus to be taken to the finish. My heart sinks, my face heats up, and I go completely stoic and cold to First, Youngin' and Third who don't seem to care either way "since we got a good ride in regardless." Completing a task is deeply imbedded in my genetics.
"Dan is out there. We need to decide and call him ASAP." My voice comes out hard and, unintentionally, with disdain.
One attempt fails, then another. Different cell carriers make no difference. Fifth turns to Youngin' and, since Youngin' didn't just have frozen feet, tells him to go pick up Dan and bring him back, but Youngin' hasn't moved an inch because their still talking about something. I'm was so angry I wasn't even hearing what their banter was about.
I should explain Dan a little more. You can tell he grew up an athlete. Pitcher, quarterback, and a history of acting (his current and now long term passion). But he also has epilepsy, the type that encompasses the entire brain in a way that is inoperable. In his daily life it manifests something like attention deficit disorder. But the man is pure teddy bear, and is wildly successful at everything he's done. You should see the way he glides through traffic. It's like watching a bicycling version of Stevie Wonder. You swear he's gonna die, and get in perfect, poetic fluidity he never even has to so much as flinch. But if you could boil down the human race to perhaps five souls whose heart, actions and life could make us seem actually redeemable to a hostile alien invasion and change their minds - he'd be on the top of the list. He holds nothing back, he hides nothing, and with more heart and positive joy than most others I know he can accomplish literally anything. He is so endearing that I am defensive of him and care deeply for his success. He learned from our two previous rag tag centuries that if he takes less time at aid stations and starts ahead, he can go at an appropriate pace and avoid over-stressing himself, and we'll eventually catch up. But there's a catch to that. Yes, we will catch up to him. But it takes a half hour to catch up to him at our normal pace when he only left five minutes before us.
They are still discussing something when I hastily don all my gear and helmet.
"While you all keep f***ing chatting Dan is getting farther away than you think. Don't f***ing underestimate him. He's going to be hard to catch. You DO NOT f*** with Dan."
And before anyone is able to respond I tear down the ramp and around the corner. Fifth yells for me to call once I've got him. I'm worried we won't make it back in time to catch the bus and our out-and-back jaunt will have been for naught while simultaneously wasting more time needed to get to the finish in time for the last train back to the city.
Mr. Y makes it fifty feet down the hall. The turn is a little sloppy, but we're trying to place hands on as little as possible.
"See? I can do it. The only thing stopping me before was being dizzy." Are you dizzy now? "Only a little dizzy. I can do it."
He makes it the fifty feet back, so I bring up the notion of stairs. Mr. Y's room is near the nurses' station, which is also next to the small lounge that has a mock four-step stairwell. As we turn to head in, I see the care coordinator and the social worker watching with their heads propped on their hands, in disbelief and with no clue what to do next. We get to the stairs, get his hands on the rails and move the walker out of the way. One foot on, second foot on, and both knees immediately buckle. The aid and I are still hovering, so we catch him and move even closer. Moderate assistance for the stairs. On the way down the aid spots from behind while I spot in front. Stairs remain a no go, a big red stamp on his chart marking unable to go home, but Mr. Y doesn't register this. Once safely back with the walker I ask his opinion of his performance. He asserts that he can do it, that he'll get stronger quickly and it won't be an issue. I point out that was only four steps and that he'd have to do closer to thirty at once.
He still shakes his head. "I can do it."
We swing down a second hallway. At this point the stairs already indicated that he's not safe to go home, but we're going to use the opportunity to go big. If he can't go home, I want him on paper to be seen as ambulatory so he does not get stuck for another 11 months at the new rehab/nursing facility. [For those who don't know, subacute rehab is usually offered by nursing facilities rather than as a stand alone entity or as part of a hospital. Distinguishing between short rehab stay, long term rehab stay, and simply requiring 24 nursing care are big differences.] The care coordinator and social worker alternate between shaking their heads and laughing thanks to the difficulty of the situation. How to persuade him otherwise when he is so determined to have his way? I cannot speak for others of the team, but I don't want to condemn him to a nursing facility the rest of his life. And yet I know he's just not quite ready. We cannot force him to go. He is still in charge of his care. But we cannot in good conscience let him sign a paper saying he understands the risks of declining our recommendation of rehab, only to then be readmitted 4 hours later from a fall on the stairs his first day home. And I wish we could have teased out this performance much earlier so that we could have made stairs into a goal. Sure, maybe he still would have needed rehab. But with what we currently have as his performance limitations I want him safe.
I've been peddling in as high a gear as I can tolerate, whipping around corners, hoping with each turn to see any semblance of him. So many turns. I think they are all reasonably marked, but if you look around to watch the view you could easily miss one. I see someone up ahead, scream his name and sigh relief, only to roll up on a different lone rider I don't know. Crap. Lone Rider probably thinks I'm crazy by the way I pass like a frantic bat out of hell. I keep trying to call Dan's phone, keep failing.
It takes ten minutes of sprinting to catch him, steady as ever.
"DAN!"
"Bucky! Where's everyone else?" I slow to a stop, Dan stopping in suit.
"The sweep wagon caught us. The group is waiting back at the last aid station. We have to turn around."
"What?!? You're serious?"
"Yea dude. We gotta go before they leave without us."
We take off, maintaining the fastest speed Dan is capable of. My phone rings. It's Fifth. "Where are you [static] ...trying [static] leave [static] ...fast..."
I scream into my phone. "Three minutes. Give us three minutes. Stall." The call drops. I mutter obscenities.
Dan looks over, worried. "Is this because of me? Because of my epilepsy? Damnit. I knew it would hold us back. I'm so sorry. Damnit."
"NO. It is NOT because of you. You've been one of the steadiest riders today. It's because people kept screwing off, wasting time, and because of Youngin's helmet shenanigans that we've run out of time. It has NOTHING to do with you. Those a**holes put YOU in a predicament."
I get another call, again with lots of static. "Two more turns and we're there. Thirty seconds!" We race into the lot, all waiting on the bus except Fifth, who has loaded his bike onto the truck but has refused to get on the bus and let it pull away. We throw our bikes on top of the pile, and as I walk onto the bus out of breath I don't dare look at First, Youngin' or Third, who are relaxing like its a party. My hands are shaking I am so angry. They try to re-enact Fifth's manipulation of their rule, how funny it was to hear the bus driver yelling at him to board and yet have him taunt by standing 100 feet away and make the walk to the bus last for minutes, repeating "Yes I am getting on the bus. I'm walking there now."
I'm fighting back tears. You joke around for an hour and a half, THEN admit to forgetting a helmet, then pull some I'm-afraid-of-my-dad crap (wouldn't he be glad you wanted to be safer with a helmet??), then put Dan at a HUGE risk. And you find the situation laughable. My response? "That's nice," without even pretending to take my eyes away from the window. Dan's response? He sits next to Youngin', and plays thumb war with him. Dan doesn't take things personally, nor does he hold grudges. I take note, try to breath, try to stop the waves of anger pouring from the throbbing veins on my forehead. Third sits next to me. I stay facing the window. The bus pulls out. I close my eyes.
One hundred fifty feet. Two hundred feet. We pass by the nurse's station yet again. By the time he gets back to his room and into bed he has walked 250 feet with contact guard. Time to talk reality again.
"We need you to be safe. I know you will get stronger soon, but for now you need help because of the stairs." Mr. Y is nodding. Maybe the opportunity to prove something has made him more agreeable to compromise?
I tell him my recommendation, that he only way he can go home is if he has a walker and, more importantly, he has an aid. "You HAVE to have an aid. If we cannot get you an aid, then its too dangerous and you need to go to rehab for a SHORT stay." He nods after each statement. "I want you to be safe. No falls!"
He smiles as I say no falls. He understands. I think he just wants as much independence as he can get. And I can absolutely respect that. He shakes and verbally repeats that he must have an aid to go home or else rehab is okay. I leave his room exhausted, and find another home care rep and the social worker in the hall outside the room. I describe what he just did, and my assessment of needing help for stairs.
The home care rep repeats that even twelve-hour care would be near impossible to get, and brings up the issue of how he will perform self care. Cooking, bathing, dressing. I sigh and inform her that while I can infer such things, they are properly assessed by occupational therapy; that I can only assess and recommend for gross physical activities. The social worker brings up the need for stairs three days a week for dialysis, at which I repeat that he'd need an aid. My official recommendations will be: home PT with 24/7 home health aid for safety and assistance with stairs, otherwise patient will require short term stay at subacute rehab. Beyond that, from what he's given me to work with today, I can say no more.
We all sigh and nod the unspoken understanding that it all boils down to what Mr. Y wishes. I trudge off to find a computer so they have the note to fax to whoever. If more home care companies deny him, then that will be presented by the social worker to help reinforce the need for rehab. We shall see.
After a while of watching the horizon swell and fall, the clouds roll past in gray lines, I start to calm down. I glimpse over at Third, who has brown dots all over her face. I hadn't noticed before. I asked if she had been drafting. The head wind was taking its toll, so Fifth offered to pull her ("pull" meaning take the heat and shield the person behind). It was her first draft experience.
"Did it help?"
"Yea, but it was hard to breath and hard to see where I was going what with all the dirt thrown in my face." I hadn't the heart to tell her that the draft is pretty wide behind a guy his size, and that he could have fixed his rear fender alignment.
We chatted a bit longer until the bus pulled up to another aid station. Turns out this one was 30 miles from the finish, and any able rider was instructed to complete the rest of the route. We hit the port-a-potties (much more efficiently than this morning), and upon regrouping realized that by the end of the ride we would have accumulated a full century, one hundred miles. Seems the day was salvageable after all. I was the first to the ride's finish, collecting and greeting the others as they rolled in. Dan's face was just as much of a big smile as the other two centuries we'd done before. I've said it before and I'll say it again. Never. Doubt. Dan. Dan the Century Man.
At work Saturday I pulled up my patient list for some logistical documentation stuff, and saw the Mr. Y was discharged. A quick peek into the social worker's notes revealed that Mr. Y agreed to rehab. They left him all sorts of information, lots of people he could talk to himself. Even after he agreed, they left information on how he could appeal the decision should he change his mind. Mr. Y then stated he would not appeal, that he was okay with a short rehabilitation stay. I found myself smiling.
Whether he had to prove it to himself or to the rest of us, the man was going to illustrate the full depth of his independence, both physically and cognitively. I think he needed to know that we were not ignoring him or looking down at him, that we were on his side yet albeit overly controlled with his safety. I only hope that from the moment he landed at the new subacute facility that he verbalized his game plan of working on stairs, lots of stairs, and, oh yes, more stairs so that he could go home. And hopefully they have some good occupational therapy there too, to get his activities of daily living bumped up a notch too. He remains in my mind someone who, despite all odds, will never let life take away his ability to try.
Over lunch I got a call from the nursing care coordinator that my patient had been accepted to two different subacute rehab facilities, the first of which is apparently one of the best in the city, but the patient was refusing to go and was adamant about going home. By the history given by the patient and obtained in the social worker's notes I had assumed the originating nursing facility was his home. Turns out he was there for the last eleven months, having entered for subacute rehab but was never released for reasons we don't know (safety, being fully informed of a change in living situation, the facility reaping money from insurance...?).
"He won't listen to us. They have a bed waiting, and it only needs his agreement. Can you see him today? Talk to him, something?" I agreed to do what I could.
Mr. Y had been fun to see for the last two weeks. He is the hero of all patients in nursing facilities - many facilities neglect patients and leave them soiled in bed for half the day, and occasionally a jaded PT comes around for "therapy" consisting of hip flexion (no functional value those who have difficulty standing up, i.e. weak hip extension), knee extension, ankle pumps, and a return to a soiled bed. Many facilities don't encourage ambulating when it is difficult because they see it as "unsafe," thus leaving patients in bed or in wheelchairs and allowing them to become even more deconditioned over time. Not Mr. Y. His post-stroke mental faculties are relatively intact despite difficulty with expressing himself verbally and weakness/increased muscle tone in his left arm and leg. He is a fighter. I have seen inspired patients, but never the likes of this. He is a man determined to never let a nursing facility limit him. Instead of allowing physical regression and depression, he will argue for however long it takes until you let him do what he knows he can do. His survival in a sub-par nursing facility is guaranteed. But his survival at home, in a third floor walk-up apartment with no family or social support aside from a 70 year old neighbor who can open a can of food occasionally, and with the need to leave home three days a week for dialysis, is not guaranteed. He would at a home health aid and was borderline for requiring 24/7 care. The farthest he walked with me previously (and I had seen him five days per week, mind you) was 60 feet, and he hadn't performed stairs in a year if not more. And yet he refused to go anywhere else but home.
We met at 5:30 a.m. with intentions to head out by 6:00. Goal: 130 miles from New York City's Penn Station to Montauk, NY on the eastern tip of Long Island. Our rag tag group was having trouble hitting the road. One person went for a bagel. They came back 10 minutes later. Another said that looked good, and they went off for a bagel. Five minutes later a third member wanted to use the bathroom. Once back ten minutes later First decided they also needed the bathroom. Third waited five minutes before saying that maybe a bagel was a good idea. Yup, that kind of group, and that kind of morning. I'm trying to not play mom to the group and nag, but we need to leave soon because the day will take longer than others assume. I look at my watch, trying to be patient: 6:15, 6:28, 6:40. Finally everyone is ready to go.
First looks over at Youngin' (fourth person), says "Dude, where's your helmet?"
"Helmet? What helmet? Iyyy... aaaahh... errraaahh... We don't really need a helmet, do we?"
Fifth (for those counting, including me makes six) glares in response. After a bit of debate, we determine that his home is along the way to the Brooklyn Bridge and so we will make a pit stop. We ride down, pull over to the street's edge, take a few pictures and chuckle about previous rides. Ten minutes later Youngin and Dan (formerly referred to as Second) come back helmetless. His house keys went with his bag to the finish, and he is too nervous to ring up and possibly upset his father (Youngin' is 20 at this point). Dan offers his wife's helmet at home, and they take off to get it. First decides to make a stop around the corner for batteries while we wait. She and Third take off. Fifth and I wait another fifteen minutes, pondering what exactly we got ourselves into. Finally they arrive, the white helmet with hippie flowers works well with Youngin's skin tones, we take off to meet the battery search crew, and finally the day begins.
I have an aid with me, because I know Mr. Y will want to prove that he can walk. Just the day before he wanted to show that he used to walk without a walker, and after five solid minutes of arguing I gave in and agreed to a trial so long as we switch to the walker if he needs his hands on something. He needed to palm the wall or grab my hand, not to mention I had to give him minimum to moderate assistance for balance. We only made it ten feet out he still refused to use the walker on the way back, so the aid and I grabbed each hand to stabilize his return trip. So is the persistence of Mr. Y, bless his intrepid heart. It's hard when you want to maximize a patient's independence but their persistence, regardless if from baseline personality or from altered perception secondary to their condition, hinders their performance.
So today the aid and I enter, and I begin the conversation about where he may go. I want him focused, so that he knows that x, y and z must be achieved if he's able to go home. Two home care groups have declined him, saying they cannot offer 24 hour care and they find him unsafe as per the notes from the last week and a half. (I agreed and had been recommending even a short rehab stay.) Home care groups laugh at the notion of getting even 12 hour care. I tell him anyone who goes home must be able to walk up and down the hall twice, go up and down as many stairs as they have at home, and do it all without any of my help (all this is true, with fluctuating values according to their home setup). I describe his current need for assistance, and that with his progression and motivation if he got rehab then within a couple week's he'd be okay (which I also believe is true).
"No. You cannot push me. They all push me. Those places just want your money." He's already sitting up to show he could walk, with large gestures and pointing in our faces. "I kept asking to go home before and they kept telling me no because they wanted my money. They did not take care of me. They just took my money and ignored me. I'm going home. You cannot push me."
You can tell he retains the notion of safety and retains awareness of his abilities, because otherwise he would have been attempting to walk out of the hospital days ago and would have ended up with one-to-one supervision and been labelled as "impulsive." But instead he has waited for me, even with his anger and huge motivation building ever more. I try explaining that we have a different facility lined up, one that has very good feedback in terms of rehab and their outcomes overall. These people will help you get stronger. He hears nothing of it. It only makes him angrier.
Talking has hit a wall, so I switch to a plan. "Here's what we have to do." I give him parameters, same as before. I reinforce that at home he won't have us to help, so he's gotta do it on his own. He agrees, pops up, and refuses to use the walker. I'm guarding him while trying to persuade otherwise, and his level of assistance and balance are like before. We get to the door, eight feet out. He's still refusing to use the walker, but he has stalled, I think because he realizes how much he needs support.
"You can walk farther if you use the walker. It will help. You can go home with a walker. I need you to walk a long way with the walker so we can show the social worker what you can do." That finally gets through. He takes the walker without even looking down, starts marching down the hall with the aid and I flanking him, hands hovering six inches off his shoulders and hips, not knowing if or when he might go down, not knowing his endurance or his mental clarity once fatigued.
Fast forward through many hours of riding. Light rain. Youngin' takes a skid witnessed only by Fifth, comes out unscathed but a little hurt in his ego. Panda Portraits. Then pouring rain. Flat tire (me). Mercifully a sponsoring bike shop come along with a tube since there's no chance of vulcanizing fluid drying in this downpour. Multiple aid stations later, we are not the only ones who are seemingly "behind." More riding. The rain stops, but our socks are soaked and we've lost body heat. My feet are completely numb.
Next aid station I pull off my socks to wring out extra water. We've come about 70 miles, just over half way. Fifth uses a winter hiking trick and puts my foot on his abdomen. Wowza does that work well. While I recover and stuff my face, Dan decides to take off early so we can catch up in a short bit. We grab a bunch of food to stuff our faces while riding on, only to be intercepted by a race volunteer who reports that we have been cut off and must decide whether to continue on, without knowing if aid stations will still be open, or if we want to get on the sweep bus to be taken to the finish. My heart sinks, my face heats up, and I go completely stoic and cold to First, Youngin' and Third who don't seem to care either way "since we got a good ride in regardless." Completing a task is deeply imbedded in my genetics.
"Dan is out there. We need to decide and call him ASAP." My voice comes out hard and, unintentionally, with disdain.
One attempt fails, then another. Different cell carriers make no difference. Fifth turns to Youngin' and, since Youngin' didn't just have frozen feet, tells him to go pick up Dan and bring him back, but Youngin' hasn't moved an inch because their still talking about something. I'm was so angry I wasn't even hearing what their banter was about.
I should explain Dan a little more. You can tell he grew up an athlete. Pitcher, quarterback, and a history of acting (his current and now long term passion). But he also has epilepsy, the type that encompasses the entire brain in a way that is inoperable. In his daily life it manifests something like attention deficit disorder. But the man is pure teddy bear, and is wildly successful at everything he's done. You should see the way he glides through traffic. It's like watching a bicycling version of Stevie Wonder. You swear he's gonna die, and get in perfect, poetic fluidity he never even has to so much as flinch. But if you could boil down the human race to perhaps five souls whose heart, actions and life could make us seem actually redeemable to a hostile alien invasion and change their minds - he'd be on the top of the list. He holds nothing back, he hides nothing, and with more heart and positive joy than most others I know he can accomplish literally anything. He is so endearing that I am defensive of him and care deeply for his success. He learned from our two previous rag tag centuries that if he takes less time at aid stations and starts ahead, he can go at an appropriate pace and avoid over-stressing himself, and we'll eventually catch up. But there's a catch to that. Yes, we will catch up to him. But it takes a half hour to catch up to him at our normal pace when he only left five minutes before us.
They are still discussing something when I hastily don all my gear and helmet.
"While you all keep f***ing chatting Dan is getting farther away than you think. Don't f***ing underestimate him. He's going to be hard to catch. You DO NOT f*** with Dan."
And before anyone is able to respond I tear down the ramp and around the corner. Fifth yells for me to call once I've got him. I'm worried we won't make it back in time to catch the bus and our out-and-back jaunt will have been for naught while simultaneously wasting more time needed to get to the finish in time for the last train back to the city.
Mr. Y makes it fifty feet down the hall. The turn is a little sloppy, but we're trying to place hands on as little as possible.
"See? I can do it. The only thing stopping me before was being dizzy." Are you dizzy now? "Only a little dizzy. I can do it."
He makes it the fifty feet back, so I bring up the notion of stairs. Mr. Y's room is near the nurses' station, which is also next to the small lounge that has a mock four-step stairwell. As we turn to head in, I see the care coordinator and the social worker watching with their heads propped on their hands, in disbelief and with no clue what to do next. We get to the stairs, get his hands on the rails and move the walker out of the way. One foot on, second foot on, and both knees immediately buckle. The aid and I are still hovering, so we catch him and move even closer. Moderate assistance for the stairs. On the way down the aid spots from behind while I spot in front. Stairs remain a no go, a big red stamp on his chart marking unable to go home, but Mr. Y doesn't register this. Once safely back with the walker I ask his opinion of his performance. He asserts that he can do it, that he'll get stronger quickly and it won't be an issue. I point out that was only four steps and that he'd have to do closer to thirty at once.
He still shakes his head. "I can do it."
We swing down a second hallway. At this point the stairs already indicated that he's not safe to go home, but we're going to use the opportunity to go big. If he can't go home, I want him on paper to be seen as ambulatory so he does not get stuck for another 11 months at the new rehab/nursing facility. [For those who don't know, subacute rehab is usually offered by nursing facilities rather than as a stand alone entity or as part of a hospital. Distinguishing between short rehab stay, long term rehab stay, and simply requiring 24 nursing care are big differences.] The care coordinator and social worker alternate between shaking their heads and laughing thanks to the difficulty of the situation. How to persuade him otherwise when he is so determined to have his way? I cannot speak for others of the team, but I don't want to condemn him to a nursing facility the rest of his life. And yet I know he's just not quite ready. We cannot force him to go. He is still in charge of his care. But we cannot in good conscience let him sign a paper saying he understands the risks of declining our recommendation of rehab, only to then be readmitted 4 hours later from a fall on the stairs his first day home. And I wish we could have teased out this performance much earlier so that we could have made stairs into a goal. Sure, maybe he still would have needed rehab. But with what we currently have as his performance limitations I want him safe.
I've been peddling in as high a gear as I can tolerate, whipping around corners, hoping with each turn to see any semblance of him. So many turns. I think they are all reasonably marked, but if you look around to watch the view you could easily miss one. I see someone up ahead, scream his name and sigh relief, only to roll up on a different lone rider I don't know. Crap. Lone Rider probably thinks I'm crazy by the way I pass like a frantic bat out of hell. I keep trying to call Dan's phone, keep failing.
It takes ten minutes of sprinting to catch him, steady as ever.
"DAN!"
"Bucky! Where's everyone else?" I slow to a stop, Dan stopping in suit.
"The sweep wagon caught us. The group is waiting back at the last aid station. We have to turn around."
"What?!? You're serious?"
"Yea dude. We gotta go before they leave without us."
We take off, maintaining the fastest speed Dan is capable of. My phone rings. It's Fifth. "Where are you [static] ...trying [static] leave [static] ...fast..."
I scream into my phone. "Three minutes. Give us three minutes. Stall." The call drops. I mutter obscenities.
Dan looks over, worried. "Is this because of me? Because of my epilepsy? Damnit. I knew it would hold us back. I'm so sorry. Damnit."
"NO. It is NOT because of you. You've been one of the steadiest riders today. It's because people kept screwing off, wasting time, and because of Youngin's helmet shenanigans that we've run out of time. It has NOTHING to do with you. Those a**holes put YOU in a predicament."
I get another call, again with lots of static. "Two more turns and we're there. Thirty seconds!" We race into the lot, all waiting on the bus except Fifth, who has loaded his bike onto the truck but has refused to get on the bus and let it pull away. We throw our bikes on top of the pile, and as I walk onto the bus out of breath I don't dare look at First, Youngin' or Third, who are relaxing like its a party. My hands are shaking I am so angry. They try to re-enact Fifth's manipulation of their rule, how funny it was to hear the bus driver yelling at him to board and yet have him taunt by standing 100 feet away and make the walk to the bus last for minutes, repeating "Yes I am getting on the bus. I'm walking there now."
I'm fighting back tears. You joke around for an hour and a half, THEN admit to forgetting a helmet, then pull some I'm-afraid-of-my-dad crap (wouldn't he be glad you wanted to be safer with a helmet??), then put Dan at a HUGE risk. And you find the situation laughable. My response? "That's nice," without even pretending to take my eyes away from the window. Dan's response? He sits next to Youngin', and plays thumb war with him. Dan doesn't take things personally, nor does he hold grudges. I take note, try to breath, try to stop the waves of anger pouring from the throbbing veins on my forehead. Third sits next to me. I stay facing the window. The bus pulls out. I close my eyes.
One hundred fifty feet. Two hundred feet. We pass by the nurse's station yet again. By the time he gets back to his room and into bed he has walked 250 feet with contact guard. Time to talk reality again.
"We need you to be safe. I know you will get stronger soon, but for now you need help because of the stairs." Mr. Y is nodding. Maybe the opportunity to prove something has made him more agreeable to compromise?
I tell him my recommendation, that he only way he can go home is if he has a walker and, more importantly, he has an aid. "You HAVE to have an aid. If we cannot get you an aid, then its too dangerous and you need to go to rehab for a SHORT stay." He nods after each statement. "I want you to be safe. No falls!"
He smiles as I say no falls. He understands. I think he just wants as much independence as he can get. And I can absolutely respect that. He shakes and verbally repeats that he must have an aid to go home or else rehab is okay. I leave his room exhausted, and find another home care rep and the social worker in the hall outside the room. I describe what he just did, and my assessment of needing help for stairs.
The home care rep repeats that even twelve-hour care would be near impossible to get, and brings up the issue of how he will perform self care. Cooking, bathing, dressing. I sigh and inform her that while I can infer such things, they are properly assessed by occupational therapy; that I can only assess and recommend for gross physical activities. The social worker brings up the need for stairs three days a week for dialysis, at which I repeat that he'd need an aid. My official recommendations will be: home PT with 24/7 home health aid for safety and assistance with stairs, otherwise patient will require short term stay at subacute rehab. Beyond that, from what he's given me to work with today, I can say no more.
We all sigh and nod the unspoken understanding that it all boils down to what Mr. Y wishes. I trudge off to find a computer so they have the note to fax to whoever. If more home care companies deny him, then that will be presented by the social worker to help reinforce the need for rehab. We shall see.
After a while of watching the horizon swell and fall, the clouds roll past in gray lines, I start to calm down. I glimpse over at Third, who has brown dots all over her face. I hadn't noticed before. I asked if she had been drafting. The head wind was taking its toll, so Fifth offered to pull her ("pull" meaning take the heat and shield the person behind). It was her first draft experience.
"Did it help?"
"Yea, but it was hard to breath and hard to see where I was going what with all the dirt thrown in my face." I hadn't the heart to tell her that the draft is pretty wide behind a guy his size, and that he could have fixed his rear fender alignment.
We chatted a bit longer until the bus pulled up to another aid station. Turns out this one was 30 miles from the finish, and any able rider was instructed to complete the rest of the route. We hit the port-a-potties (much more efficiently than this morning), and upon regrouping realized that by the end of the ride we would have accumulated a full century, one hundred miles. Seems the day was salvageable after all. I was the first to the ride's finish, collecting and greeting the others as they rolled in. Dan's face was just as much of a big smile as the other two centuries we'd done before. I've said it before and I'll say it again. Never. Doubt. Dan. Dan the Century Man.
At work Saturday I pulled up my patient list for some logistical documentation stuff, and saw the Mr. Y was discharged. A quick peek into the social worker's notes revealed that Mr. Y agreed to rehab. They left him all sorts of information, lots of people he could talk to himself. Even after he agreed, they left information on how he could appeal the decision should he change his mind. Mr. Y then stated he would not appeal, that he was okay with a short rehabilitation stay. I found myself smiling.
Whether he had to prove it to himself or to the rest of us, the man was going to illustrate the full depth of his independence, both physically and cognitively. I think he needed to know that we were not ignoring him or looking down at him, that we were on his side yet albeit overly controlled with his safety. I only hope that from the moment he landed at the new subacute facility that he verbalized his game plan of working on stairs, lots of stairs, and, oh yes, more stairs so that he could go home. And hopefully they have some good occupational therapy there too, to get his activities of daily living bumped up a notch too. He remains in my mind someone who, despite all odds, will never let life take away his ability to try.
Friday, September 28, 2012
The Party.
I walked into a calm room, my patient asleep, roommate and roommate's husband quiet. I gently wake the patient and take my time navigating the patient into our ambulation session. Due to personalities of the morning that had to be seen due to impending discharge, I was not able to get to her room at the late morning hour which had previously worked well. People with Alzheimer's do better with consistency, and they do better in the morning due to what is called a sundowning effect. I was pushing my luck with 1:30pm, so I strove to make the transition as calm and easy as possible. The orientation phase going smoothly as previous days, a good sign.
A PT popped his head in to the room. "Are you seeing the other patient in this room?" I respond a simple no.
I again work towards re-orienting my patient to the fact that she is in the hospital, and that it why her room seems different and messy. That the footsteps she hears outside are other nurses and doctors. That we don't need a coat because we will be staying inside. I have to lean in to speak close to her ear so that she hears and understands everything.
An OT comes in to see the roommate, who is on the other side of the dividing curtain. She has a brassy voice in the first place, but the roommate is also partially hard of hearing. Loud discussion between the roommate, OT and husband ensue.
"Who is that? Who is there?"
"It is the OT to see your roommate."
"Someone should tell them that this is not an appropriate time to have a party."
I re-orient to being in a hospital. She mentions the coat again. I re-orient to our staying inside.
The roommate's nurse enters. Apparently there is some question that is now involving multiple opinions. Four voices go back to being three, then the PT comes in again to consult, then two doctors pause within five feet of the door to discuss something from down the hall. My patient has a hard time hearing me over the others, but we are able to get up to start our walk.
But once vertical, the visual of an unrecognizable room meets the audio of unrecognized voices. She begins to get frustrated about the clutter in her room. The noise has surpassed her threshold, and I can tell that this won't end well, nor will the path run smooth. At this point we have not walked, only stood, but for the sake of her safety I will run with whatever direction she gives be it a walk or a return to bed or something else entirely.
I offer a handhold assist, which we have used successfully for the last two days.
"No. I don't need it. I take my privacy seriously. No one let's you have your privacy anymore. I can't move when you hold me back."
"I'm only here to make sure you stay safe."
"Oh, good. Thank you."
"You're very welcome."
"Oh, sure, [mocking tone] you're very welcome." She sticks her tongue out at me. Bad sign.
"Would you like to go back to bed and get comfortable?"
"I can't get comfortable. I don't want give up that easily." She starts to walk toward the door, so I follow and guard, cautious that yesterday she was minimum assistance for balance but today rejects any offer of assistance.
We come within two feet of the door, and the nurse practitioner walks up. "It's good to see you up."
"What?"
"It's good to see you up."
"Oh, okay." She fiddles with her hospital bracelet on the left arm, and with the wound dressing on her right arm. Both arms and legs show signs of slight edema, just enough that her socks and bracelet and all other apparatuses fit tightly, so she fiddles with them out of noticing their presence but not understanding what it is. The NP notices, takes her hand.
"This looks a little tight, does it feel okay?"
"Does what feel okay? This room is a mess."
The NP quickly realizes that she added too much on top of the activity at hand. But instead of a gentle apology and exit she attempts to explain herself. I keep my sigh to myself, waiting, still guarding. After a full minute of bumbling discussion that does nothing to soothe the patient, the NP goes to check on the situation with the roommate. Five voices. A joke, followed by laughter. My patient takes one step to the right diagonal. Pauses. Turns and takes a step to the left. Pauses. She doesn't know where to go, or what to make of the scene. I'm dying to get her back to her bed. She doesn't deserve to be bed bound, but the usually succinct OT session is obviously not going to end any time soon. To have her ambulatory while riled up could become dangerous if she doesn't allow me to continue guarding. Last thing I want is for her to become so upset or so fearful that she falls.
"There's just too much. Too much people. People with their parties." I offer to go back to her bed. I try to emphasize that there is something home-like about it to draw her interest. She has none of it.
One of the nurses who was already one of my favorites looked up from a nursing cart. The nurse has had my patient before. She gives a knowing face of the difficulty when the patient is confused. I motion for help, saying that it's too loud to get her back to her room safely. We are a mere 15 feet away from her bed.
The nurse takes her hand, begins anew with re-orienting the patient. It takes a dozen exchanges and a full minute for each step, but this nurse understands the safety issue and is very patient with keeping the patient on board with the return to bed. At this point I let the nurse guide verbally. Because of the time that has now passed in an agitated state, I have become associated with the offending noise and privacy invasion. I don't fight it. I'm only glad the nurse is able freshly re-achieve a voice of calm separate from the rest of the chaos, despite having been another addition on top of everything else. You use what works.
Slowly, eventually, we get to standing next to her bed. The "party" is down to three voices, but it is still loud enough. I move myself to standing behind my patient where she cannot see me, because having the nurse in front is enough to keep her upset about sharing a small space. We re-orient her to the fact that this is her bed, that this is a hospital. Eventually she sits on the side of the bed. I am still there in case she needs assistance with sit-to-supine, since I'm not sure if/how her function changes when agitated.
The OT calls over to me, asking if I have the roommate on my caseload.
"No," I say softly.
OT. "Is everything okay?"
Nurse. "It's the party. It's a little too noisy."
OT. "Party? Hah! What party?!" Still brassy and loud. They are walking toward the door, passing by the foot of my patient's bed.
Nurse. "The noise is too much for her. We'd like to keep it quieter, if we could."
OT. "Okay." Still brassy. They pause as a group, all within view of my patient, all looking. "I just wanted to see if Laura has this patient on her list."
I shake my head. "No, sorry."
OT. "Okay. Thanks." They continue walking out, continue talking. Pretty sure they failed to realize that the noise was an issue.
Patient. "Why does she have to be here?" Pointing at me.
I can take the hint. "I'll leave you with your nurse." The nurse nods that she's okay. I take my leave.
Forty minutes. That's how long it took to orient the patient, by happen chance get her agreeable to stand, have things go south, and then the time required to return the patient to safety. You cannot predict, but it still weighs heavy on my heart to have contributed to the exact opposite of what this patient needed. Would she have become agitated by the "party" had I not woken her, had I not added physical activity to the list of offending overstimulation? Logic says possibly. My heart says probably not.
PT fail.
Tomorrow she goes early, come hell or high water. The other patients can simply wait their turn.
A PT popped his head in to the room. "Are you seeing the other patient in this room?" I respond a simple no.
I again work towards re-orienting my patient to the fact that she is in the hospital, and that it why her room seems different and messy. That the footsteps she hears outside are other nurses and doctors. That we don't need a coat because we will be staying inside. I have to lean in to speak close to her ear so that she hears and understands everything.
An OT comes in to see the roommate, who is on the other side of the dividing curtain. She has a brassy voice in the first place, but the roommate is also partially hard of hearing. Loud discussion between the roommate, OT and husband ensue.
"Who is that? Who is there?"
"It is the OT to see your roommate."
"Someone should tell them that this is not an appropriate time to have a party."
I re-orient to being in a hospital. She mentions the coat again. I re-orient to our staying inside.
The roommate's nurse enters. Apparently there is some question that is now involving multiple opinions. Four voices go back to being three, then the PT comes in again to consult, then two doctors pause within five feet of the door to discuss something from down the hall. My patient has a hard time hearing me over the others, but we are able to get up to start our walk.
But once vertical, the visual of an unrecognizable room meets the audio of unrecognized voices. She begins to get frustrated about the clutter in her room. The noise has surpassed her threshold, and I can tell that this won't end well, nor will the path run smooth. At this point we have not walked, only stood, but for the sake of her safety I will run with whatever direction she gives be it a walk or a return to bed or something else entirely.
I offer a handhold assist, which we have used successfully for the last two days.
"No. I don't need it. I take my privacy seriously. No one let's you have your privacy anymore. I can't move when you hold me back."
"I'm only here to make sure you stay safe."
"Oh, good. Thank you."
"You're very welcome."
"Oh, sure, [mocking tone] you're very welcome." She sticks her tongue out at me. Bad sign.
"Would you like to go back to bed and get comfortable?"
"I can't get comfortable. I don't want give up that easily." She starts to walk toward the door, so I follow and guard, cautious that yesterday she was minimum assistance for balance but today rejects any offer of assistance.
We come within two feet of the door, and the nurse practitioner walks up. "It's good to see you up."
"What?"
"It's good to see you up."
"Oh, okay." She fiddles with her hospital bracelet on the left arm, and with the wound dressing on her right arm. Both arms and legs show signs of slight edema, just enough that her socks and bracelet and all other apparatuses fit tightly, so she fiddles with them out of noticing their presence but not understanding what it is. The NP notices, takes her hand.
"This looks a little tight, does it feel okay?"
"Does what feel okay? This room is a mess."
The NP quickly realizes that she added too much on top of the activity at hand. But instead of a gentle apology and exit she attempts to explain herself. I keep my sigh to myself, waiting, still guarding. After a full minute of bumbling discussion that does nothing to soothe the patient, the NP goes to check on the situation with the roommate. Five voices. A joke, followed by laughter. My patient takes one step to the right diagonal. Pauses. Turns and takes a step to the left. Pauses. She doesn't know where to go, or what to make of the scene. I'm dying to get her back to her bed. She doesn't deserve to be bed bound, but the usually succinct OT session is obviously not going to end any time soon. To have her ambulatory while riled up could become dangerous if she doesn't allow me to continue guarding. Last thing I want is for her to become so upset or so fearful that she falls.
"There's just too much. Too much people. People with their parties." I offer to go back to her bed. I try to emphasize that there is something home-like about it to draw her interest. She has none of it.
One of the nurses who was already one of my favorites looked up from a nursing cart. The nurse has had my patient before. She gives a knowing face of the difficulty when the patient is confused. I motion for help, saying that it's too loud to get her back to her room safely. We are a mere 15 feet away from her bed.
The nurse takes her hand, begins anew with re-orienting the patient. It takes a dozen exchanges and a full minute for each step, but this nurse understands the safety issue and is very patient with keeping the patient on board with the return to bed. At this point I let the nurse guide verbally. Because of the time that has now passed in an agitated state, I have become associated with the offending noise and privacy invasion. I don't fight it. I'm only glad the nurse is able freshly re-achieve a voice of calm separate from the rest of the chaos, despite having been another addition on top of everything else. You use what works.
Slowly, eventually, we get to standing next to her bed. The "party" is down to three voices, but it is still loud enough. I move myself to standing behind my patient where she cannot see me, because having the nurse in front is enough to keep her upset about sharing a small space. We re-orient her to the fact that this is her bed, that this is a hospital. Eventually she sits on the side of the bed. I am still there in case she needs assistance with sit-to-supine, since I'm not sure if/how her function changes when agitated.
The OT calls over to me, asking if I have the roommate on my caseload.
"No," I say softly.
OT. "Is everything okay?"
Nurse. "It's the party. It's a little too noisy."
OT. "Party? Hah! What party?!" Still brassy and loud. They are walking toward the door, passing by the foot of my patient's bed.
Nurse. "The noise is too much for her. We'd like to keep it quieter, if we could."
OT. "Okay." Still brassy. They pause as a group, all within view of my patient, all looking. "I just wanted to see if Laura has this patient on her list."
I shake my head. "No, sorry."
OT. "Okay. Thanks." They continue walking out, continue talking. Pretty sure they failed to realize that the noise was an issue.
Patient. "Why does she have to be here?" Pointing at me.
I can take the hint. "I'll leave you with your nurse." The nurse nods that she's okay. I take my leave.
Forty minutes. That's how long it took to orient the patient, by happen chance get her agreeable to stand, have things go south, and then the time required to return the patient to safety. You cannot predict, but it still weighs heavy on my heart to have contributed to the exact opposite of what this patient needed. Would she have become agitated by the "party" had I not woken her, had I not added physical activity to the list of offending overstimulation? Logic says possibly. My heart says probably not.
PT fail.
Tomorrow she goes early, come hell or high water. The other patients can simply wait their turn.
Tuesday, July 10, 2012
Big news!
AAAHHHHH! I PASSED THE BOARDS!!! I have no idea what my score is, but pass/fail results are available online today and I PASSED!
Trust me, I'm a licensed doctor (of physical therapy). Hah!
I didn't say much following the actual exam because it was so absolutely wretched. I've never before left an exam so upset with myself and so angry and everyone and everything. I truly thought I had failed.
In fact, the whole process was so draining that I don't even have the energy to bounce around the room. Instead it is a celebratory sigh and slump in my chair, hands fixed on the sides of my face in disbelief. I almost don't know what to do with myself.
Then again, Sadie is whining for her breakfast. Guess I'll start there...
Trust me, I'm a licensed doctor (of physical therapy). Hah!
I didn't say much following the actual exam because it was so absolutely wretched. I've never before left an exam so upset with myself and so angry and everyone and everything. I truly thought I had failed.
In fact, the whole process was so draining that I don't even have the energy to bounce around the room. Instead it is a celebratory sigh and slump in my chair, hands fixed on the sides of my face in disbelief. I almost don't know what to do with myself.
Then again, Sadie is whining for her breakfast. Guess I'll start there...
Tuesday, June 26, 2012
A job (!!) and other news
In order of most to least exciting news...
1) I got a job!
NewYork-Presbyterian Hospital/Columbia University Medical Center. It's a great institution for numerous reasons. I had my first student rotation there, so I got to experience what I call The Machine first hand. I swoon. Therapists rotate yearly as well as sub-rotate within a given area every couple months. I'll be in acute care, though which area will be determined closer to my start date (could be orthopedic, medical, neuro...). My estimated start date is not until July 23rd, so I have time to get licensed and twiddle my thumbs. Won't see a paycheck until August, but it is nonetheless amazingly reassuring to know that I have a job -- a GOOD job -- secured. It's also a 20 minute walk from home.
ABC News is putting out a documentary of NYP called "NY Med" on July 10th at 10pm eastern/9pm central. Here's a link to the preview (~two minutes). The cameras were allowed to go anywhere and everywhere over a period of months. I've not heard of a project like this before. They had full access and full rights to anything so long as those caught on camera volitionally agreed and gave written approval (HIPAA laws somehow fully respected, so blurred faces of those in the background).
2) Soon to meet Nathan's mama
In the just over two years Nathan and I have been dating I have not yet had the pleasure of meeting Nathan's mom. Looks like we'll get to use the days following my licensure exam for a visit upstate, so long as the pre-employment stuff (physical, fitness test, etc) required by NYP does not impede. Get ready, May, a storm's coming your way!
3) Visceral mobilization course.
It was as literal as it sounds: finding and then releasing restrictions in the esophagus, stomach, duodenum, greater omentum, large intestines, liver, gallbladder, diaphragm, bladder, many sphincters, and a discussion though not full training for the uterus. It was kind of incredible. Huge changes in people without touching their musculoskeletal system. The course instructors like to use people who have actual symptoms rather than just poking at another healthy body, and there is never a lack of someone in the room who could use the technique at hand. Previous whiplash injury - esophagus restricting neck and chest range of motion. Asthmatic on chronic steroids - difficulty utilizing the diaphragm for breathing rather than his shoulder muscles. GERD (acid reflux) - particular dysfunctional sphincter and restricted stomach. Difficulty digesting fatty foods - dysfunctional gallbladder output. Low back pain (especially right sacroiliac) with difficulty extending the right hip when walking - cecum (start of the large intestines in the lower right portion of your abdomen, neighbor to the appendix) adhered to underlying musculature and the right pelvic bone. Very cool stuff.
4) Merus's and her seven extractions.
Her initial good progress became a nose dive into worse and worse state of pain despite Buprenex 3x/day. Recovery food from the vet helped (super smooth texture, high calorie so her ability to eat very little went much further than normal food). Just as I was starting to wean her from 3 doses per day of Buprenex (an opiate pain med) down to 2 per day, she hid for a solid 36 hours without eating. Great... I started to worry, only for her to skip and meow at my side for food. She had effectively stopped cold turkey from meds, so I took a chance and gave her food without meds for the first time in a month and a half. Took 15 minutes and two or three bouts, but it worked! She's been off meds for at least a week now, and eating more easily and normally every day. Not 100% yet, but I'll take it. So will Sadie. She's had it with Merus getting all the extra attention, much like a two year old acting out once their sibling is born. I tell you what -- Sadie (a.k.a. Little Miss Princess, a.k.a. Spiderrabbitdolphinsealworm) may make everyone swoon but she sure as heck can cause A LOT of trouble....
5) First heat wave of the season.
It barreled into town on the actual first day of summer. NYC didn't get into the triple digits, but we sure were close. That was when Merus hid for 36 hours. My guess is her spot was a magical 5 degrees cooler than our sweltering apartment (we have two fans, no AC). I know much of the rest of the country experienced it too. (If you haven't already heard, much of Colorado has been burning for some time with more than one area evacuated. Check out the Denver Post for a map of all the fires, and I found this link to a handful of photos of the fires. Amazing to think how harnessing the power of fire opened humanity's window into modernity, and yet I too forget that it can occur spontaneously and, as evidenced in CO, doggedly.) I had to be particular as to what kinds of fluids I was constantly ingesting, though I'd say it was the first time in years that I wasn't completely miserable during a heat wave. We still have July and August though, so I'm not delusioned into thinking this year will be easier as a whole.
6) Obsession with Reese's
Give me a Reese's peanut butter cup and I'll be gone in one bite. Give me a bag of mini Reese's and there'll be a pile of foil and wax wrappers the size of my two fists put together. A few weeks ago we discovered that Breyers has started a line of ice cream involving name brand cookies and -- lo! -- Reese's. It's usually only carried at our local grocery store in half gallon size instead of pints. Very bad idea. Very, very bad... At a different grocery I found Reese's ice cream cups. I stared for about half a second before running away. You saw nothing. Nothing at all. Frozen okra, that's what it was. Pathetic. Then a week ago I found a recipe online for something I have no idea what to call aside from monster cookies. It uses pre-made refrigerated cookie dough formed into the bottom of a muffin tin, an upside down Reese's placed on top, then brownie batter over the top until each tin is 3/4 full. Bake at 350 for 18-20 minutes. I stood in front of the brownie mixes at the store for a solid five minutes, first considering brands, later considering if it was a good idea. I choked and walked away. *sigh*
7) T-minus 6 days and counting...
The licensure exam is July 2nd at 8am. Something like 6-8 hours per day have been spent studying for this thing. Banging my head against study guides and coffee shop tables, jabbing holes in my skull with pens and highlighters, slicing myself like Edward Scissorhands with my stack of 350 flash cards and counting. You know, quality studying time. Luckily my cohort from school (also named Laura, a.k.a. Subconscious) has needed someone else to study with. We study our own things aside from questions or venting, but we commit to a location and stay there for a set number of hours.
The TherapyEd study guide by O'Sullivan is thorough, though has pissed me off numerous times. I almost chucked my laptop through the wall on Thursday of last week after one of the practice exams left me infuriated. I'll stick to one example: placenta previa. During pregnancy the placenta attaches itself incorrectly and could end up separating from the uterine wall. Study guide: no pelvic floor exercises (i.e. kegels), no abdominal exercises; any pelvic muscle exercise could induce uterine contractions and further placenta separation. Practice exam A (made by the same TherapyEd group): that answer is wrong. Continue pelvic floor exercises, discontinue abdominal exercises. *sigh*
1) I got a job!
NewYork-Presbyterian Hospital/Columbia University Medical Center. It's a great institution for numerous reasons. I had my first student rotation there, so I got to experience what I call The Machine first hand. I swoon. Therapists rotate yearly as well as sub-rotate within a given area every couple months. I'll be in acute care, though which area will be determined closer to my start date (could be orthopedic, medical, neuro...). My estimated start date is not until July 23rd, so I have time to get licensed and twiddle my thumbs. Won't see a paycheck until August, but it is nonetheless amazingly reassuring to know that I have a job -- a GOOD job -- secured. It's also a 20 minute walk from home.
ABC News is putting out a documentary of NYP called "NY Med" on July 10th at 10pm eastern/9pm central. Here's a link to the preview (~two minutes). The cameras were allowed to go anywhere and everywhere over a period of months. I've not heard of a project like this before. They had full access and full rights to anything so long as those caught on camera volitionally agreed and gave written approval (HIPAA laws somehow fully respected, so blurred faces of those in the background).
2) Soon to meet Nathan's mama
In the just over two years Nathan and I have been dating I have not yet had the pleasure of meeting Nathan's mom. Looks like we'll get to use the days following my licensure exam for a visit upstate, so long as the pre-employment stuff (physical, fitness test, etc) required by NYP does not impede. Get ready, May, a storm's coming your way!
3) Visceral mobilization course.
It was as literal as it sounds: finding and then releasing restrictions in the esophagus, stomach, duodenum, greater omentum, large intestines, liver, gallbladder, diaphragm, bladder, many sphincters, and a discussion though not full training for the uterus. It was kind of incredible. Huge changes in people without touching their musculoskeletal system. The course instructors like to use people who have actual symptoms rather than just poking at another healthy body, and there is never a lack of someone in the room who could use the technique at hand. Previous whiplash injury - esophagus restricting neck and chest range of motion. Asthmatic on chronic steroids - difficulty utilizing the diaphragm for breathing rather than his shoulder muscles. GERD (acid reflux) - particular dysfunctional sphincter and restricted stomach. Difficulty digesting fatty foods - dysfunctional gallbladder output. Low back pain (especially right sacroiliac) with difficulty extending the right hip when walking - cecum (start of the large intestines in the lower right portion of your abdomen, neighbor to the appendix) adhered to underlying musculature and the right pelvic bone. Very cool stuff.
4) Merus's and her seven extractions.
Her initial good progress became a nose dive into worse and worse state of pain despite Buprenex 3x/day. Recovery food from the vet helped (super smooth texture, high calorie so her ability to eat very little went much further than normal food). Just as I was starting to wean her from 3 doses per day of Buprenex (an opiate pain med) down to 2 per day, she hid for a solid 36 hours without eating. Great... I started to worry, only for her to skip and meow at my side for food. She had effectively stopped cold turkey from meds, so I took a chance and gave her food without meds for the first time in a month and a half. Took 15 minutes and two or three bouts, but it worked! She's been off meds for at least a week now, and eating more easily and normally every day. Not 100% yet, but I'll take it. So will Sadie. She's had it with Merus getting all the extra attention, much like a two year old acting out once their sibling is born. I tell you what -- Sadie (a.k.a. Little Miss Princess, a.k.a. Spiderrabbitdolphinsealworm) may make everyone swoon but she sure as heck can cause A LOT of trouble....
5) First heat wave of the season.
It barreled into town on the actual first day of summer. NYC didn't get into the triple digits, but we sure were close. That was when Merus hid for 36 hours. My guess is her spot was a magical 5 degrees cooler than our sweltering apartment (we have two fans, no AC). I know much of the rest of the country experienced it too. (If you haven't already heard, much of Colorado has been burning for some time with more than one area evacuated. Check out the Denver Post for a map of all the fires, and I found this link to a handful of photos of the fires. Amazing to think how harnessing the power of fire opened humanity's window into modernity, and yet I too forget that it can occur spontaneously and, as evidenced in CO, doggedly.) I had to be particular as to what kinds of fluids I was constantly ingesting, though I'd say it was the first time in years that I wasn't completely miserable during a heat wave. We still have July and August though, so I'm not delusioned into thinking this year will be easier as a whole.
6) Obsession with Reese's
Give me a Reese's peanut butter cup and I'll be gone in one bite. Give me a bag of mini Reese's and there'll be a pile of foil and wax wrappers the size of my two fists put together. A few weeks ago we discovered that Breyers has started a line of ice cream involving name brand cookies and -- lo! -- Reese's. It's usually only carried at our local grocery store in half gallon size instead of pints. Very bad idea. Very, very bad... At a different grocery I found Reese's ice cream cups. I stared for about half a second before running away. You saw nothing. Nothing at all. Frozen okra, that's what it was. Pathetic. Then a week ago I found a recipe online for something I have no idea what to call aside from monster cookies. It uses pre-made refrigerated cookie dough formed into the bottom of a muffin tin, an upside down Reese's placed on top, then brownie batter over the top until each tin is 3/4 full. Bake at 350 for 18-20 minutes. I stood in front of the brownie mixes at the store for a solid five minutes, first considering brands, later considering if it was a good idea. I choked and walked away. *sigh*
7) T-minus 6 days and counting...
The licensure exam is July 2nd at 8am. Something like 6-8 hours per day have been spent studying for this thing. Banging my head against study guides and coffee shop tables, jabbing holes in my skull with pens and highlighters, slicing myself like Edward Scissorhands with my stack of 350 flash cards and counting. You know, quality studying time. Luckily my cohort from school (also named Laura, a.k.a. Subconscious) has needed someone else to study with. We study our own things aside from questions or venting, but we commit to a location and stay there for a set number of hours.
The TherapyEd study guide by O'Sullivan is thorough, though has pissed me off numerous times. I almost chucked my laptop through the wall on Thursday of last week after one of the practice exams left me infuriated. I'll stick to one example: placenta previa. During pregnancy the placenta attaches itself incorrectly and could end up separating from the uterine wall. Study guide: no pelvic floor exercises (i.e. kegels), no abdominal exercises; any pelvic muscle exercise could induce uterine contractions and further placenta separation. Practice exam A (made by the same TherapyEd group): that answer is wrong. Continue pelvic floor exercises, discontinue abdominal exercises. *sigh*
Thursday, May 31, 2012
To name a few
One more graduation-related post, I promise.
The last three years were, aside from affiliations, spent holed up in a basement classroom set with 26 others on a daily basis. We were unique from previous classes with a more distinct grouping of social circles, which made us something of a difficult group to lead. But by the third year I had the pleasure of watching some of the straight-outta-undergrad kids grow up, and to see some of the older career change folk blossom to renew their self in more ways than one. We lost no one along the way, despite some grueling semesters and estrogen-laden social strata.
Here's a rundown of those who made a particular impact on my graduate years, in alphabetical order by first name:
Amanda was in my research group. We had to put up with a lot. Make something from nothing. Make something from what I will refer to as a rather sticky situation. Amanda also did this while balancing an uber hectic affiliation at NYU's Rusk rehabilitation center that required all notes and writings to be performed at home rather than at work (including all daily notes, all evaluations, and a daily critically appraised topic based on current literature). She was also the sole member of our group to figure out the hospital's impossible self-created, non-intuitive software program. Basically, if chaos was present then she could figure it out. Her job during days locked into a computer lab for 13 hours straight was to correct all phrasing and citations into APA style (three parts vs. 3-part, number of authors names present within citations, certain headings present or absent for tables, etc). For perspective's sake, had you seen our paper then you'd have smashed your head through the wall and run away screaming.
Danielle managed to complete school while raising two little girls, the second of which spent almost our entire first year with us in the classroom while gestating. School was ridiculous enough without having to raise kids; hers are now four and two. She's incredibly loyal and will defend those she cares about tooth and nail. She never hides who she is or her opinions, and is proud of who she is. Danielle was a massively supportive ear whenever I needed to quietly express my life stressors, and during our second year I definitely had my fill. She, like a few choice others, would recognize subtle changes in my affect and, amazingly, always offer just the amount of support I needed. And, even with potty training and ear infections and other mom-stuff distracting her, she always remembered and followed up as weeks went by. For that last point I was amazed. Her little girls are very lucky to have such a caring mom, and her future mini-patients are lucky to have such a goofy yet on point therapist caring for their future.
Erin was another member of my research group. We alternated at inadvertently leading/organizing our group throughout different phases of the project. Reliable, incredibly so. She also had patience at those points when I was about ready to throw in the towel. (Hello, dysfunctional Institutional Review Board and CUNY administration system!) She and a small group of others who were straight out of undergrad came in to the program very smart though young. By the time third year started, she was very smart and had grown into quite a standup and independent woman. It was great to see that transition first hand.
Heather skipped graduation because she and her husband now live in CA with their ~9 month old son. Heather lived in Harlem near me, and we studied just about every weekend that school was in session until her son was born during our last year. Her quirkiness, her constant humor and positive outlook, and her selfless nature only begin to describe how pinnacle she was to my graduate life. She brown-nosed professors after an exam because it was funny (not to get a different grade). She chopped off those anatomical structures she didn't recognize during our cadaver lab so they could not be used on a practical exam. She'd come up with the most random mnemonics and phrases to remember terminology. And she was the most capable of everyone at maintaining a full personal life when not within the walls of our Brookdale school campus. I wish she were not so far away, as she became one of my closest friends. But she is also the type for which the moment we do visit each other it will feel as though we never left off.
Katarina was the oldest of our class and worked as an EMT throughout the entirety of school, even when in an affiliation 40+ hours per week. As we neared the end of our second year she decided to take drastic steps to reconcile a major aspect of her personal life. That is significant, because second year was when we all wanted to pull out our hair, gnaw off our arms and drop out because we were so ridiculously overstressed. Not an easy time to keep your personal life sane, let alone to make such a drastic change. I am SO very proud of her. She has stuck to her guns, and it shows. And she sticks up for herself in those situations when others would let themselves get walked all over. She is also recently became a US citizen (originally from Sweden, came for undergrad and stayed ever since).
Katie was nicknamed our class's "secret weapon." She is tiny, yet managed to transfer/lift/whatever the six foot gorilla that is Phil whenever requested mid-lecture. She'd get herself into those situations thanks to a super spunky, don't-give-me-crap-cause-I'll-call-you-out personality. She'd bring up -- mid-class -- those discrepancies that the rest of us felt were touchy, usually resulting in a string of one liners between her and the huffy prof. Her best line to a prof during an exam feedback session: "No, you're wrong. But that's okay." I still snicker for a good five minutes when I think of that one. Awesome.
Laura I., a.k.a. Subconscious. (Get it? Two Lauras who are good friends...?) There's a reason why Laura ended up playing the program secretary in our faculty roast -- they are both endlessly caring and selfless, and are genuinely concerned about all those around them. She is of the older crowd, and her personal life went through a 180 for self-reconciliation following a faltered relationship. If you have not already heard the theme, we barely had time to remember to brush our teeth let alone to juggle emotional aspects of our life. What I saw was an incredible transformation, the willingness to be vulnerable and take steps independently, finding and learning to be unapologetic of her self. It started our first semester with the two of us going from cadaver to cadaver until the repetition made its way through the formaldehyde headaches and nausea and the overwhelming endless list of practical exam possibilities. It ended with her manual skills becoming so acute that her former affiliation sites want to keep her around, with pay. I am SO PROUD of her.
Meaghan is the one we all wish were our younger sister. Absolutely pure sweetness, incredibly smart and on point, the most humble person you know. She also played rugby in undergrad. She was another of the straight-outta-undergrad crew, though you'd never have known. She'd be nervous when asked to demonstrate or when presenting, only to speak calmly, eloquently, in a way that puts my speed talking excitement to total and utter shame. Oh, and did I mention she played rugby -- competitively -- in undergrad? A hard worker with a full arsenal, made no less effective by her completely sweet demeanor.
Myriah and her boyfriend own and operate a wine shop in Brooklyn (Big Tree Bottles), which they opened a merely a few months prior to the start of school. She is witty in a way particular to other smart New Englanders I have befriended throughout the years, heightened by an undergrad degree from the New School -- i.e. she is very good at ideas, at working with intangible entities, of making something of nothing. She is very unique, absolutely unapologetic, assertive. She wants things to be credible, though if something/someone is flawed yet knows it and has a sense of humor about it then she happy accepts it/them with open arms. She and I went through similar patterns of being overwhelmed by the massive amount of estrogen in our class, of wanted a break from being around people all the time (especially the same group every. single. day.) She was always very perceptive at noticing when I pulled back (even when I tried not to let it show) and, like a few particular others, became a very, very dear sounding board.
Phillip always gave his most at every test, every opportunity to study, every discussion. He is physically something of a gorilla, and over the course of three years his manual skills came full circle. He'd try to absorb every detail, to get it to mesh with everything else he'd learned. His presentations were smooth, articulate, very clear and engaging. He never complained, never balked, never let himself get caught up in the social politics prone to our decidedly female class. He also had a job lined up at his first affiliation weeks before graduation. That speaks worlds about his focus and attention to detail.
Ron (I somehow missed getting a solo shot of him) is known as our technology hero and class co-president. But he was also my partner for numerous papers as well as shared the same site for affiliation 2, the incredibly fun outpatient neuro affil of last summer. His background is in athletic training, and he ended up creating quite a unique repertoire of exercises for his neuro patients. I loved treating my own patients within earshot so I could hear the exchange of banter between Ron and a certain athlete-level patient with cerebral palsy: "You want me to do WHAT? Did you even read my chart?" He also introduced the lot of us to what I semi-fondly call crack-coffee, a stupidly strong coffee dressed just so with milk and sugar. A few sips left me buzzing for about 8 hours while we attempted to speed talk our way through midterm and final exam studying.
Sarah had super strong academics, but that's not why we love her so much. It's because she was our resident hippie. We ended up slapping our foreheads in speechlessness at least twice a week. Exhibit A) "My boyfriend and I are eating vegan now too," followed by Myriah: "But you're eating sardines for lunch." Exhibit B) following a compliment from a prof that she looks nice for her appearance at their clinic, "Thanks. I changed in the elevator." Exhibit C) Prof: "I said everyone MUST use WHITE paper so no one could TELL whose was WHOSE!" Sarah: "But I just needed some color in my life!" We loved her more with every new quip.
Yami was in my anatomy cadaver group, and ever since we floated in the front row but on opposite sides of the room. If anything remotely funny happened, obvious or not, my side-glancing eyes would catch hers and we'd soon enough have to stifle ourselves. On the estrogen overflow days, I could look over with wide eyes for a reciprocal "I have no idea!" She came from a former career as an accountant at a major firm here in NYC, was fully credentialed as a CPA. Even if the entire rest of the class was asleep during your presentation, she was listening and nodding the whole way through. She introduced me to peanut butter filled pretzels. And she spent just about every break from school volunteering at a variety of local camps and international sites for kids with specific conditions. Inspiring? Yes'm!
The last three years were, aside from affiliations, spent holed up in a basement classroom set with 26 others on a daily basis. We were unique from previous classes with a more distinct grouping of social circles, which made us something of a difficult group to lead. But by the third year I had the pleasure of watching some of the straight-outta-undergrad kids grow up, and to see some of the older career change folk blossom to renew their self in more ways than one. We lost no one along the way, despite some grueling semesters and estrogen-laden social strata.
Here's a rundown of those who made a particular impact on my graduate years, in alphabetical order by first name:
Amanda was in my research group. We had to put up with a lot. Make something from nothing. Make something from what I will refer to as a rather sticky situation. Amanda also did this while balancing an uber hectic affiliation at NYU's Rusk rehabilitation center that required all notes and writings to be performed at home rather than at work (including all daily notes, all evaluations, and a daily critically appraised topic based on current literature). She was also the sole member of our group to figure out the hospital's impossible self-created, non-intuitive software program. Basically, if chaos was present then she could figure it out. Her job during days locked into a computer lab for 13 hours straight was to correct all phrasing and citations into APA style (three parts vs. 3-part, number of authors names present within citations, certain headings present or absent for tables, etc). For perspective's sake, had you seen our paper then you'd have smashed your head through the wall and run away screaming.
Danielle managed to complete school while raising two little girls, the second of which spent almost our entire first year with us in the classroom while gestating. School was ridiculous enough without having to raise kids; hers are now four and two. She's incredibly loyal and will defend those she cares about tooth and nail. She never hides who she is or her opinions, and is proud of who she is. Danielle was a massively supportive ear whenever I needed to quietly express my life stressors, and during our second year I definitely had my fill. She, like a few choice others, would recognize subtle changes in my affect and, amazingly, always offer just the amount of support I needed. And, even with potty training and ear infections and other mom-stuff distracting her, she always remembered and followed up as weeks went by. For that last point I was amazed. Her little girls are very lucky to have such a caring mom, and her future mini-patients are lucky to have such a goofy yet on point therapist caring for their future.
Erin was another member of my research group. We alternated at inadvertently leading/organizing our group throughout different phases of the project. Reliable, incredibly so. She also had patience at those points when I was about ready to throw in the towel. (Hello, dysfunctional Institutional Review Board and CUNY administration system!) She and a small group of others who were straight out of undergrad came in to the program very smart though young. By the time third year started, she was very smart and had grown into quite a standup and independent woman. It was great to see that transition first hand.
Heather skipped graduation because she and her husband now live in CA with their ~9 month old son. Heather lived in Harlem near me, and we studied just about every weekend that school was in session until her son was born during our last year. Her quirkiness, her constant humor and positive outlook, and her selfless nature only begin to describe how pinnacle she was to my graduate life. She brown-nosed professors after an exam because it was funny (not to get a different grade). She chopped off those anatomical structures she didn't recognize during our cadaver lab so they could not be used on a practical exam. She'd come up with the most random mnemonics and phrases to remember terminology. And she was the most capable of everyone at maintaining a full personal life when not within the walls of our Brookdale school campus. I wish she were not so far away, as she became one of my closest friends. But she is also the type for which the moment we do visit each other it will feel as though we never left off.
Katarina was the oldest of our class and worked as an EMT throughout the entirety of school, even when in an affiliation 40+ hours per week. As we neared the end of our second year she decided to take drastic steps to reconcile a major aspect of her personal life. That is significant, because second year was when we all wanted to pull out our hair, gnaw off our arms and drop out because we were so ridiculously overstressed. Not an easy time to keep your personal life sane, let alone to make such a drastic change. I am SO very proud of her. She has stuck to her guns, and it shows. And she sticks up for herself in those situations when others would let themselves get walked all over. She is also recently became a US citizen (originally from Sweden, came for undergrad and stayed ever since).
Katie was nicknamed our class's "secret weapon." She is tiny, yet managed to transfer/lift/whatever the six foot gorilla that is Phil whenever requested mid-lecture. She'd get herself into those situations thanks to a super spunky, don't-give-me-crap-cause-I'll-call-you-out personality. She'd bring up -- mid-class -- those discrepancies that the rest of us felt were touchy, usually resulting in a string of one liners between her and the huffy prof. Her best line to a prof during an exam feedback session: "No, you're wrong. But that's okay." I still snicker for a good five minutes when I think of that one. Awesome.
Laura I., a.k.a. Subconscious. (Get it? Two Lauras who are good friends...?) There's a reason why Laura ended up playing the program secretary in our faculty roast -- they are both endlessly caring and selfless, and are genuinely concerned about all those around them. She is of the older crowd, and her personal life went through a 180 for self-reconciliation following a faltered relationship. If you have not already heard the theme, we barely had time to remember to brush our teeth let alone to juggle emotional aspects of our life. What I saw was an incredible transformation, the willingness to be vulnerable and take steps independently, finding and learning to be unapologetic of her self. It started our first semester with the two of us going from cadaver to cadaver until the repetition made its way through the formaldehyde headaches and nausea and the overwhelming endless list of practical exam possibilities. It ended with her manual skills becoming so acute that her former affiliation sites want to keep her around, with pay. I am SO PROUD of her.
Meaghan is the one we all wish were our younger sister. Absolutely pure sweetness, incredibly smart and on point, the most humble person you know. She also played rugby in undergrad. She was another of the straight-outta-undergrad crew, though you'd never have known. She'd be nervous when asked to demonstrate or when presenting, only to speak calmly, eloquently, in a way that puts my speed talking excitement to total and utter shame. Oh, and did I mention she played rugby -- competitively -- in undergrad? A hard worker with a full arsenal, made no less effective by her completely sweet demeanor.
Myriah and her boyfriend own and operate a wine shop in Brooklyn (Big Tree Bottles), which they opened a merely a few months prior to the start of school. She is witty in a way particular to other smart New Englanders I have befriended throughout the years, heightened by an undergrad degree from the New School -- i.e. she is very good at ideas, at working with intangible entities, of making something of nothing. She is very unique, absolutely unapologetic, assertive. She wants things to be credible, though if something/someone is flawed yet knows it and has a sense of humor about it then she happy accepts it/them with open arms. She and I went through similar patterns of being overwhelmed by the massive amount of estrogen in our class, of wanted a break from being around people all the time (especially the same group every. single. day.) She was always very perceptive at noticing when I pulled back (even when I tried not to let it show) and, like a few particular others, became a very, very dear sounding board.
Phillip always gave his most at every test, every opportunity to study, every discussion. He is physically something of a gorilla, and over the course of three years his manual skills came full circle. He'd try to absorb every detail, to get it to mesh with everything else he'd learned. His presentations were smooth, articulate, very clear and engaging. He never complained, never balked, never let himself get caught up in the social politics prone to our decidedly female class. He also had a job lined up at his first affiliation weeks before graduation. That speaks worlds about his focus and attention to detail.
Ron (I somehow missed getting a solo shot of him) is known as our technology hero and class co-president. But he was also my partner for numerous papers as well as shared the same site for affiliation 2, the incredibly fun outpatient neuro affil of last summer. His background is in athletic training, and he ended up creating quite a unique repertoire of exercises for his neuro patients. I loved treating my own patients within earshot so I could hear the exchange of banter between Ron and a certain athlete-level patient with cerebral palsy: "You want me to do WHAT? Did you even read my chart?" He also introduced the lot of us to what I semi-fondly call crack-coffee, a stupidly strong coffee dressed just so with milk and sugar. A few sips left me buzzing for about 8 hours while we attempted to speed talk our way through midterm and final exam studying.
Sarah had super strong academics, but that's not why we love her so much. It's because she was our resident hippie. We ended up slapping our foreheads in speechlessness at least twice a week. Exhibit A) "My boyfriend and I are eating vegan now too," followed by Myriah: "But you're eating sardines for lunch." Exhibit B) following a compliment from a prof that she looks nice for her appearance at their clinic, "Thanks. I changed in the elevator." Exhibit C) Prof: "I said everyone MUST use WHITE paper so no one could TELL whose was WHOSE!" Sarah: "But I just needed some color in my life!" We loved her more with every new quip.
Yami was in my anatomy cadaver group, and ever since we floated in the front row but on opposite sides of the room. If anything remotely funny happened, obvious or not, my side-glancing eyes would catch hers and we'd soon enough have to stifle ourselves. On the estrogen overflow days, I could look over with wide eyes for a reciprocal "I have no idea!" She came from a former career as an accountant at a major firm here in NYC, was fully credentialed as a CPA. Even if the entire rest of the class was asleep during your presentation, she was listening and nodding the whole way through. She introduced me to peanut butter filled pretzels. And she spent just about every break from school volunteering at a variety of local camps and international sites for kids with specific conditions. Inspiring? Yes'm!
Monday, May 28, 2012
Thursday, May 24, 2012
PT department party in pictures
Graduation is nigh!
Mom and Dad are here. Big bro's flight was delayed multiple times yesterday while en route through Chicago. Hopefully at the time of this post he is sleeping soundly at the hotel with my parents. Little bro and his wife arrive tomorrow afternoon.
Last night was the physical therapy department celebration. Gave my parents a chance to meet my class and our faculty. They also got to see the city from across the river in Long Island City in both daylight and in its much prettier sparkly night views. (For those unfamiliar, LIC is the westernmost part of Queens/Long Island that borders the East River directly across from the United Nations.)
Lots of pictures from the night. Here's a whole bunch:
Mom and Dad are here. Big bro's flight was delayed multiple times yesterday while en route through Chicago. Hopefully at the time of this post he is sleeping soundly at the hotel with my parents. Little bro and his wife arrive tomorrow afternoon.
Last night was the physical therapy department celebration. Gave my parents a chance to meet my class and our faculty. They also got to see the city from across the river in Long Island City in both daylight and in its much prettier sparkly night views. (For those unfamiliar, LIC is the westernmost part of Queens/Long Island that borders the East River directly across from the United Nations.)
Lots of pictures from the night. Here's a whole bunch:
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