Physiotherapist or psychiatrist?

There is something I have noticed this week about neuro outpatient that hasn't happened before in my other placements. People want to talk. Mostly about themselves or their impairment.

In paeds the kids communicate with body and facial expression and aren't concerned or interested about the condition too much, they just want to play the game and learn the new skill or want to know that they are doing well and how many points they have in the game. Once in a while if they are really comfortable they will tell you about their family life (usually an embarrassing story the mom or dad cringes over)

In acute care a lot of the time the patients are pretty out of it or they just want you to go away. There is the odd one now and again who will divulge their entire history of how they came to be in the hospital. But usually the visit is so short that there is just not enough time.

But in outpatient rehab there is a lot of time the model we are set up with allows us to spend up to an 1 hour with the patients.

And so these patients who have usually been through the acute ward and rehab wards in which you see several health care professionals a day. Usually the staff doesn't have too much extra time to chat and sincerely ask the question how are you really doing and even when they want to they may not have time to hear the answer. They they are discharged and have appointments here and there with GPs and specialists who are very busy, so when they come to us they are really looking for someone to listen to them and to gain reassurance from.

That's where public out patient physios come in (an the rest of the out-patient team as well). Now that they have you to themselves for an hour. Many of them want to relay their story. I once asked my sister why people do this and she said its for a couple of reasons:
1. Maybe you have had a similar experience to them and will be able to share in your common experience
3. Many are looking for acknowledgement and validation of their experiences.
2. You know about their condition and will be able to assist them.

In the case of the physio its usually the latter 2 points the clients are looking for. And so I have had patients tell my preceptor and myself things beyond the scope of a physio's practice and beyond the scope of the team's practice (ie. psychiatric issues).

This is part of the job, right. Listening to the patient, validating their feelings, bulding rapport, establishing trust, letting them know what you can address and what you can refer them to for their other concerns. I am finding that this is part of the job, if it take a client 15 minutes to tell you all of the information that they want to tell you, you have often gained their trust. Afterwards the sessions flow more smoothly as the patient feels a connection and is more likely to buy into the exercise program because they feel like the physio understands them and is in tune to their needs and concerns and has their best interests in mind.

If physios aren't psychiatrists, they still can provide some comfort and reassurance simply by listening and providing thoughtful responses for the patient.

Barriers

While reading a paper on Parkinson's Disease this week, I came across this gem:

"Research demonstrates that people with disabilities are less physically active than people without disabilities, although the reasons for this are unclear." - 2009

Really?!

Thinking of my patients I can think of several reasons for each of the patients I have seen in the past few weeks as to why they would be less physically active than the non-disabled population. Maybe this is demonstrating a gap between researchers and clinicians. I am sure there are other researchers that are well aware of the barriers to activity for disabled people.

From these past two weeks alone I can think of several reasons
1. Fatigue - usually a symptom of brain injury like stroke or traumatic head injury. People with these types of injuries require more sleep and have barely enough energy just to get through their activities of daily life, let alone go for a walk or participate in a community exercise program.
2. Mobility - people with disabilities often have a more difficult time getting around from place to place. If they feel like they can't exercise or be active in their home or neighborhood for safety concerns it is an extra effort or expense or burden on a family member to get them to a place where they can participate in an activity.
3. Stigma - Firstly, there is the idea in many cultures and the older generations that once you are injured or sick that you should rest and take it slow. Secondly, there are the stares when someone with an impairment is in public.
4. De-conditioning - after an injury there is often a certain amount of time spent in hospital or physically unable to participate in usual activities. This leads to a decrease in cardiovascular capacity and a decrease in strength. This makes it harder to get back to doing the same thing you were doing previously.
5.Physical Impairment - its possible that the physical impairment itself is inhibiting participation and activity. For example, if a person has difficulties balancing, walking is going to be a lot harder for them and so they may not be able to walk as far as an able bodied person because walking even a shorter distance requires a lot of effort.

These are just a few examples.

As physios its our job to help the patient overcome these barriers. We can do this by minimizing the impairment, encouraging activity and participation.The optimal situation would be to help repair their impairment, however, this is not always possible, so we help them find ways to adapt activities so that they can fully participate and be active members of their communities.

Exam Week ... By Special Request

Imagine my delight as one clear autumn afternoon in October I was riding the #99 home with Krista and Alison when I got this email on my blackberry:
Needless to say I was overjoyed.... not.

Anyways since Paeds is and Adult Neuro are tow different tests we technically wrote 6 exams in 4 days. That includes the infamouse OSCE on Tuesday.

So to prepare for exams, I basically became a hermit along with the rest of my classmates for the better part of 3 weeks... maybe more. I was certainly unpleasant to spend time around. Now, for those of you who don't know our class schedule is already pretty intense. We are in class from 5-7hrs on most days. Meaning we  start class at 8am and get off at 4pm with an hour for lunch on a longer day. Maybe get off at 3 on a earlier day. So this means you only have from 4pm onwards to study for 6 exams as well as eat, bathe, exercise, grocery shop, etc.

Busy.

One of my classmates pointed out that "studying" is just student and dying put together.

This is why I am cranky around exams. Lack of sleep, exercise and the overwhelming feeling that if you don't pass your exams you could potentially be kicked out of the program (or at least your year) wont get to go on placement, will have to repeat a placement and not get to go to Sri Lanka. And of course, endure the shame of failure.

So exam week came around:

1. Electro - good times. Its always great to open to the firs page and be like "oh man, I have no idea even what you are asking" for 2 questions. It didn't get better after that. Although I can say I nailed drawing a leg, however, the placement of my electrodes on my hand-drawn leg....

Then after that I studied like a demon for 10+ hours for the practical exam the net day. Studying for a practical is sort of fun? But it really drains the energy out of you. Thank goodness I had Disney Princess Alphagettis to get me through the evening... (note to self: alphagettis are not as good as you thought they were when you were 6).

2.  OSCE - Objective Clinical Standard Exam
When you get the email a week before telling you your time for the OSCE and you are shaking and your bowels loosen, its not a good omen. I am sure I made several mistakes during the test. I made up a name for a patient in one station. Actually I am going to go ahead and blame it on the first station, I opened up the card for the question/objective outside the door and it was Laser. I ruled Laser out definitely as a possibility to be on the test. But there it was, with its stupid clinical-evidence staring at me in the face..... I babbled on and on in the cardio station giving the patient  a million ways to avoid raising their heart rate too high I fumbled through sit to stand and for got that raising the plinth not lowering it made it easier for the patient. I was re-directed by the examiner a couple of times "Please, re-read the question." Nobody likes to hear that. So I was pretty anxious while stu-dying in the library for my net exams, waiting for the ominous email that I had failed and would have to come back on Thursday.

But the email came and I passed. So I was able to focus more on studying for the next 4 exams.

3. MSK -
I felt like a King writing this exam.

but after we studied for patho, not to fun.

4. Patho
not going to brag, but I wrote the answer key probably, just saying. It was nice to get a nice gentle lob during exam week.

5. Paed neuro
Thank sweet nectar of the gods that this was multiple choice, otherwise this could have been a trainwreck. This being one of the last exams of the session, I had not focused a lot on it previously and felt pretty nervous going in, but had the feeling that I did enough to pass walking out.

6. Adult Neuro
If your patient is struggling and getting frustrated doing up small buttons on his shirt after a brain injury and doesn't want your help, what do you do?
That was seriously a question, and that is why this was the best exam ever. It was really fair and sooooo practical. Who cares about specifics of pathways and exact location of this centre or that structure? I don't. I don't even care that much about clinical neuro, but this exam was really good at not focusing on the nitty gritty, but looking at practical application of knowledge.

p.s. I made him take a break, put on another shirt and try it later when no so frustrated. I also got a piece of cloth with bigger buttons to practice.


We ended exam week with a trip to the Bimini, where else, where after a looooong semester our very own Dill-Owl-Mouse-Killer Jen-WOO-WOO-Woo bought the Dillweeds a round of burbon. That pretty much sums it up.


Schools out!

I have never been happier to resume exercising and eating vegetables.

Next blog we get serious.

A semester in retrospective

I am so glad I survived that semester. It was a long one.

For those of you who don't know it has been an unusually long semester. We started school back up right after the end of our last placement. In July we had a few weeks of research and a case-based study week.  3 pretty intensive weeks, I don't know what it is about it, but those week long courses always seem to take the mickey out of me. (especially when you have a prof for one of them who tells you that there will be a few of you who will not pass the course on the very first day of class. Nothing like a good old spirit crush during the first lecture, but I digress.



Working hard, or hardly working? A much needed study break.

After our spirits were most definately crushed, we had 2 glorious weeks of freedom, I almost went to Mexico, but instead ended up having a few relaxing days at home,

Then I went on an awesome bike trip with Levana and Karen (two friends from the program). We biked to Ruckle beach the first day and stayed the night. After traversing the island on day 2 we spent the second night at Ganges. We drank far to much wine and ate far too much cheese and our non-cyclist friend Levana vowed to never ride a bike again because "she almost died" at the summit of Salt Spring Islands many hills.

Karen and Chelsea drinking a bottle of wine @ Mistaken Identity Vineyards

 Then wen to Victoria to visit my very pregnant sister for a few days. It was nice to have a little bit of time with her before Levi arrived. We spent a lot of the time setting the final touches to the nursery to get ready for baby and watched a lot of Olympics :) We were enthralled by "Shuttle-gate".


Kristen at nearly 9 months!


After that we spent the August long weekend in the hospital as Kyro (Taura and Spencer's son) decided to keep everyone on their toes by playing peek-a-boo. Luckily though, he decided to stay in a little longer and make sure he was ready to face the world.

August 8th rolled around and it was time to head back to the class room. On the first day back I was hit by a car on my bike on my way to school. Ouch! I ended up not breaking any bones! But scared the living daylights out of my boyfriend and Mom as they both arrived at the ER looking for a bag of bones I think. Note to self: on next ambulance ride give injury details and LOC info to person you call.

The accident made August a bit harder I have since been attending physio 2 times a  week and massage 1 time per week. It ate into my recreation time and my studies.


In mid-August we had 2 new additions to the family. We welcomed Kyro Alexander on August the 21st. Kyro surprised us a a little by how quickly he came. I was on the way to the hospital when I got news from my brother that he had arrived. Taura did great and recovered well after the delivery, Spencer took a little longer to get back to normal.

Kyro 1 day old with Aunty Chelsea

Then 5 days later we welcomed Levi Atticus. Kristen ended up having a C-section after 24hrs of hard labour and a week of labour on and off. She took a little longer to recover, but is doing well now. Both babies are growing so quickly under the care of such loving and attentive parents.




Levi with Aunty Chels on his birthday :)

As August drew to a close it was time to get ready for the next incoming class of Physio students. Brooke (classmate) and myself were the head orientation officers. We organized a welcome potluck, a mid-week scavenger hunt and a BBQ (all in one week) for the incoming students. Needless to say it was a blast as well as being a gong-show. I believe our prof on the Thursday after the scavenger hunt were most of us stayed out long past out bedtimes said he was impressed how many of us showed up for an 8am class given what occurred the night before.




Chelsea and Brooke dressed up as "Social Sheriffs" for the scavanger hunt.


The semester started to get a lot more tough after the Labour day weekend. Electro picked up we learned how to safely apply electrical current and ultrasound and laser. We also had a pathology midterm that layed some serious smack down on the class.

A few weeks into September after I had been away for a bit and Cameron had been away for a bit, Cameron took me on a walk one afternoon. We never go for walks. I thought nothing of it though, just thought he wanted to spend some time together. We walked down to the water and talked for a bit about nothing in particular and then all of a sudden he was down on one knee! I said yes and since that day we have been engaged.


My beautiful ring :)

 
The semester continued to march on as we selected placements and were introduces to Adult Neuro, Peadiatric Neuro and Manual therapy. This semester was super practical and all of the classes added something to my physio tool belt. It was lots of hands on!

Then there was the Dillman. We spent almost every Monday afternoon working on our "research project" and pasting each other's heads on animals to make the time pass more quickly.



 This pretty much sums it up.


Exams came to quickly and as per usual the PT department put all of our exams in a 4 day period. Including our practical exam. 6 exams in 4 days. Studying was my world for 3 weeks. 3 weeks I will never get back.... I would like to take this opportunity to thank all of my friends, family and new fiance for putting up with me during these grumpy days.


Dark days of studying.

Then we started placement a mere 4 days after finishing exams.... more to come on that.

Cardioresp is awesome?!?!?!

Its been 5 weeks already.

At the beginning of the 5 weeks I was not pumped about being in the AMU. I was definitely thinking of strategies how to make it through and learn what I can to apply it to other areas of practice.

And the first couple of weeks were rough. I was not really liking it, and the skills and working through everything was challenging.

But near the end of the placement things got a lot better. Firstly, the hospital itself became a lot less intimidating. I feel more confident interacting with patients from a therapist-patient relationship. As I gained more confidence in my skills I noticed my confidence with the patients also improved. If a patient is putting up resistance to my questions or treatment I have strategies to work around it and deal with it without becoming flustered and thrown off.

Over the 5 weeks I have also gained a lot of medical knowledge. I am comfortable with a patient's chart and getting the medically relevant information to physio from it. I am also more comfortable with some of the more common conditions and the contraindications to treatment that go a long with them.

My charting has vastly improved and what was once a struggle to get all the patient's information from the session down on paper after has become much much easier.

My suctioning and chest physio skills have also greatly improved. I remember seeing a suctioning on my second day and being worried that I would never be able to do one that quickly and effidciently. And I remember having to suction a patient on my own for the first time. I was pretty hesitant and worried that I was missing a step or doing it wrong (I wasn't), but now I am suctioning without a hesitation.

The main theme here is that with more exposure to the environment and situations I was able to build my clinical reasoning skills, technical skills and general confidence. By doing so a whole new world was opened up. I was in the camp previously that thought all acute care was just getting somebody up to walk and subsequently that doing that day in and day out would be pretty monotonous and boring. But after having a rock-star-physio preceptor, it so much more. Yes, patients that come in can be pretty boring and all they need is a balance assessment and a walk.  But there is a lot more to be involved in. The complicated patients are the best because there is no protocols to follow in the AMU. Basically if you can reason it out that the treatment you are doing for the patient would be beneficial then you can go ahead and do it. There is a lot of problem solving and applying knowledge in clinical reasoning, which makes it way more interesting.

Beyond that there is chest physio. Before this placement I had about zero interest in it. I didn't like the though of pounding on chests and sucking out gunk from people's lungs. But there is something about it that is pretty satisfying. Its awesome to see the difference immediately you can make with a treatment. for example you hear coarse crackles when you listen to a chest then you do some percussions and suction and Voila! they are breathing better their chest sounds better and their oxygen levels have increased.

I am not sure if I want to work in the AMU when I graduate, but this clinical placement has shifted my perspective on acute medicine.

Beyond the AMU

This week my preceptor arranged for me to visit other areas in the hospital.

BPTU = Burns, Plastics and Multiple Trauma Unit
Wednesday Morning
 As the name suggests they handle the burns, plastic surgery patients and those who have experienced multiple traumas. And sometimes a patient may have a burn and a multiple trauma and requires plastic surgery to graft skin to their burn sites.
This is a really awesome unit. Maybe just because its something totally different then what I have been seeing for the past couple of weeks.

The physios are responsible for getting the patients up and out of bed and making sure they maintain their mobility like they do on the floor I am currently on. In addition they also get to do a bit of wound care and wound education. I got to see a couple of burn patients with pretty significant 3rd degree burns and a faciaotomies (when they cut open the fascia (the connective tissue that wraps the skin and the muscle together) to let the pressure off from all of the swelling. So it was pretty awesome to see people's muscles moving around (not awesome for them because this means they have lost a ton of skin) and to see the new skin grafts starting to grow where they had been placed.So we bandaged a few people up and took them for a walk and one patient we just did some passive range of motion (read: we moved his arms and legs around for him while he lay there in pain and agony) to make sure that when the sores healed that the skin wouldn't be tight and constrictive like Freddy Kruger and limit their future potential for range of motion.

Also the BPTU patients have the most interesting HPI's (history of present illness). Just sayin'. I was reading some of the charts and the scenes were playing out in my mind of how they managed that. The people that end up in this ward also end up in the headlines a lot of the time because of their crazy stories. (Note: nobody that I saw that day was in the news)


ICU
Wednesday Afternoon
I think a lot of people are familiar with ICU = intensive care unit. This place was how I used to imagine hospitals to be like. It looks like what hospitals on TV are made out to be in terms of how many doctors and nurses and other staff are involved in their care and how many machines are in the room and the general hustle and bustle and beeping and other noises going on. As for the patients its sort of like TV a bit in that there are some rooms that have the glass walls like in"House" and some are just curtained off. At VGH there are 27 beds in the ICU and that day they had an extra 2 ppl in the auxillary area.

The ICU is unique from the rest of the wards as most of them are on ventilators getting help with their breathing and  oxygen intake. The nursing is 1:1 because a lot of the patients require a serious amount of care as suggested by the name of the ward. A lot of the patients are also on dialysis requiring that little bit of extra help to clean out their system. A lot of them also are trached (tube in their neck to help them breathe). And a large amount have Foley catheters to drain the urine from their bladders.

Lots of people wonder what can a physio do for people in the ICU? Pretty much the same as what they can do for people in other parts of the hospital. They mobilize the relatively "healthier" and more stable patients and get them sitting up in bed or sitting at the edge of the bed. Some are even able to go for a short walk down the hall. And yes, apparently you can walk while you are on a ventilator if your conscious enough. They also do chest physio: percussions, vibrations and suctioning for those with chest pathologies.


CESEI
 Thursday Morning
I am not sure what this stands for I think something like "Centre of Excellence in Surgery and blah blah". Its not important. The important thing is that there are human robots that can be programed to react to your interventions. We weren't doing surgery but we were suctioning the robots in a few different ways. We suctioned them via  a trach tube, mouth and nasaly and we also listened to their fake breath sounds and we bagged them too. (Bagging is getting that air bag thingy like on tv and pushing some extra air into their lungs to help dislodge a mucous plug, thats the hope anyways.)

This was done with several of my classmates. It was good to see some of them again and talk about our experiences. Of course the conversation came down to the grossest stories, and I am glad to say that I didn't win that one. Lets just say I haven't been pooped in yet... yet. They day will come I am sure. knock on wood.

Pulmonary Rehab Lab
Thursday Afternoon
I spent an hour in a Pulmonary rehab class. People with COPD (emphysema, chronic bronchitis etc.) or who have recently undergone transplants come here. A physio teaches the class which consists of strength exercises and cardio. My main job was to teach a few exercises and run around with the SpO2 monitor to take readings of peoples blood oxygen levels. I am happy to report I have a great SpO2 baseline!

The class was really fun. It was nice to be in the rehab setting and see people who are committed and motivated to making their lung function better. The instructor was also hilarious and had a great rapport with the patients. That was really good to see for me because sometimes on the ward I think I get a little to serious.


All in all it was a great week getting to explore the other bits of the hospital somewhat. I think that my preceptor was sucessful in proving her point that even if you don't want to work in internal medicine there is a lot more you can do as a physio in the hospital!

Moving Quickly.

This past week, I almost pulled out an IV. Almost.

How did this happen? I was setting up a patient to sit in their wheelchair for a bit as I usually do after walking some of them and was moving quickly. I was trying to take vitals with the dynamap and sort out the call bell and make sure the catheter bag was clipped on and the IV was plugged in while talking to the patient. It was at that point my foot got tangled in the IV tubing and I tugged on the patient’s IV line and cause them to scream out in pain. I apologized profusely directly to the patient of course and thanked my lucky stars that it had not come all the way out which would have made me a marked woman as far as nurses are concerned. 

After finishing up with the patient and hurrying out of the room I began to reflect. What events lead to me tugging on an IV line and causing a patient undue pain.

I realized it all comes back to what my mom used to say, “A stitch in time, saves nine.” Words of wisdom I am sure her mother passed on to her as well. 

When I was with the patient, I was hurried and unfocused. I was focused on being quick as to be done with the patient so I could move onto charting or see another patient. But would I really be saving any time if I pulled out an IV. Indeed not. I would have to find the nurse, explain what happened, possibly write and incident report and probably have a lengthy debrief with my preceptor.

I sometimes have found myself rushing since then, bumping into things or walking too fast with equipment. It’s better to slow down and take a moment to avoid a dangerous situation rather than rush ahead and try to do something quickly while compromising safe practice. 

I think I have improved since the IV incident and I am lucky that it only was a close call and not a complete disaster that caused me to take a step back and reflect, because now when I am with patients and I find myself moving too quickly I think back to the patient with the IV and my mom’s voice pops into my head.

Acute Medical Unit

So what actually do physios do in the hospital on the AMU?

Miracles.

Just kidding. We leave those to the doctors and nurses.

Basically when a new patient comes to the unit they come with a medical chart. The physio on that unit will look over their chart and gather what is called a “Database”.

This includes:

Diagnosis

-what the Docs have decided that they have in term of illness

Relevant Information

-usually looking for Dr’s orders for either ‘Bedrest’ or AAT (activity as tolerated)

HPI (Hisotry of Present Complaint)

-a lot of the time the patients on the AMU come through the ER and so we get things like “Head ache for the past 3 days accompanied by shortness of breath and fever. Patient also complains of blah blah blah…..”

PMHx (Past Medical History)

- this includes things like if they have had surgery before, if they have been hospitalized before, hypertension, heart disease, stroke, diabetes, spinal cord injures

SHx (Social History)

-who they live with, where they live etc.

Once that is all gleamed from the patients chart its time to actually meet the patient. Sometimes you have to get all dressed up to go see a patient. This includes putting on blue gloves and a yellow gown. This is done for patients with diarrhoea or something infectious. If they are coughing and infections you get to put on surgical mask with a shield. The shield is also handy if you are doing some suctioning.

 

Less like this

more like this

Then you go in and have a chat with the patient while taking blood pressure and measuring their oxygen saturation levels. You find out how many stairs they have to get to inside their house and if they have any within their house and if they live alone. You also want to know if they used a cane or a walker prior to admission and how far they can usually get around on their own.

After that you might assess their range of motion and strength based on their previous level of mobility and the state they appear to be in now.

Then after that you get them sitting at the edge of the bed if they are able. Then standing then maybe transfer them to a wheelchair for some sitting upright time or go for a little walk for some exercise.            

Sounds pretty easy but there is actually a lot of clinical reasoning involved in knowing what exactly to do with the client. Should this person just sit at the edge of the bed or should you get this person up and out for a walk and if so what sort of equipment are you going to use if you do want to move them.

Then there are the “chest” patients. With these ones are tops priority. They may require suctioning. This is when you stick a tube with suctioning power down their trachea via trach tube or nose or mouth to get the gunk out of their lungs that they cannot cough out themselves. Its really awesome to see someone do better and breath better after a good suction, but man does it look uncomfortable then its going on. 

 <--This guy looks a little more comfortable than my patients

There is also the percussions. Which is the drumming on the chest of a person who has secretions in their chest and this helps to loosen the mucous from the small airways and get it out. The percussions are sometimes followed up by suctioning to get the gloop out.

percussions

Now I can say that I am fairly proficient in describing the gunk that comes out of the lungs. I can describe texture, color and amount. Also its important to note if it appears to be bloody or infected. This week alone I have seen several types of mucus, including an entire mouthful of yellow thick mucus into my (gloved) hand.

Everybody's working for the weekend

In a recent study.

This was the first time in a long time that I have had to work a weekend. Actually most of my former jobs have been with kids and camps and strangely enough they usually never involved working both Saturday and Sunday 8-4.4

My preceptor gave me plenty of warning about working the weekend. Like, a month I think so I was prepared mentally... people work the weekend all the time, I am not sure why I am making a big deal out of it.

Its really different than working during the week though. First of all there is just a lot less staff at the hospital so only really emergent test get done. So the patients are all in their rooms so that is awesome. The less staff also means easier access to the charts! Also my preceptor was covering 4 wards so we only had to see the high priority patients. 

I was also given a lot of responsibility this weekend. Which was a great learning experience. I was given patients and told to assess them and make decisions about there care and where they stood on the priority list and what they should receive as treatment. When you are left on your own you are forced to think things through critically and rationalize your actions because there is no preceptor to bail you out or correct a misstep. My preceptor didn't give me anything I couldn't handle in terms of patient complexity. But its always (for me at least) a bit unnerving stepping into a room collecting a social history, ausculatating or doing a balance or walking assessment and knowing that your findings are going to effect their treatment. I always worry that my assessments are wrong or invalid or I am finding something that is not there or missing something important. And without that piece of information am making sub-par decisions for their treatment. I sometimes wish my supervisor would follow me around to confirm everything. But in a way its good that she doesn't as this really makes me OWN my clinical findings and subsequent decisions.If she was checking up on every little thing I did I might feel like I was being micromanaged, I also might not become as confident in my clinical reasoning skills. 

Barillium Swallow Assessment

My preceptor is pretty into getting me into other wards and units. So she sent me down to Radiology.  

The "BAS" is to see how people are forming the ball of food or whatever that they are going to swallow and see how co-ordinated their swallow is and also to see if any is tricking down the wind pipe. Because (fun fact) some people are eating as though their lungs are a second stomach and don't cough it up...

 The assessment was run by the radiologist and the SLP. The SLP makes up the food. The food is interesting as it ranges in textures from water to honey to pure to chunks of fruit to a sandwich to a  cookie. Then he adds radioactive substances to them so that on the X-Ray they show up black. Then the machine is positioned so that the area of interest is visible like the pharynx or the esophagus or whatever. It was awesome to see all the bones in the head and the teeth working to chew and swallow. And then to see the bolus move from the mouth to the throat and hopefully into the correct tube. On the one I got to watch a little bit of food was hanging out near the windpipe but then it didn’t enter.

It was awesome to see the mouth and throat in action and the epiglottis moving to cover the windpipe! It was a huge geek moment.

Taking your work home with you

So my placement is at VGH. The biggest hospital in BC. Many people from  all over the province go to this hospital for care.

I am working on the Acute Medical Unit or “AMU”. My preceptor refered to the ward as a leftover pile, basically if you don’t fit into any of the other wards like: surgery, cardio-pulmonary, transplant, spinal cord, stroke, orthopedics or the ICU you get place in a bed in the AMU. So its awesome that I have been exposed to a lot of different patients. I have seen a wide variety of medical conditions, even though its only been a week.

However, patients are not only a set of vitals, or lab results or a pair of lungs or a low white blood cell count, they have complex social histories to go along with their illness. I found this hard to deal with at first working Peds in Penticton too; the foster kids who had a low chance of being adopted, the kids exposed to alcohol in utero, the kids who were born to really young parents who were trying to give their kids everything they could.

The patients at VGH are causing me to empathize as well. A lot of them have been dealt an unfair hand in life. They are just going a long doing fine and a series of really bad things happened to them and that’s how they ended up in hospital. That is not always the case though, they sometimes bring it on themselves through lifestyle choices, but still its hard to judge when you don’t know their entire life history and what had cause them to make those decisions.

Anyways, I guess it’s a part of my personality. Scratch that. I know it’s a part of my personality to care and to empathize. That is one of the reasons I chose health care and physio chose me.

Going home after the day is done I am finding it hard to switch off the empathetic part of my brain. Maybe its because its early days and I am naïve and un-jaded. Maybe also its because its all new to me and its sort of overwhelming. When my mind is not actively engaged in something else I am just thinking about the patients I saw that day and thinking about their social situation or their medical status and functional capabilities and how these things are going to play out for them for their future quality of life.

I think if this was to carry on for any length of time that I would burn out.

Hopefully it would end after becoming a little more seasoned, more experienced and less naïve.

In the meantime I am going to try a few strategies to see if I can have some brain time that’s “off” from physio.

·      Allow myself to talk about placement only until I have eaten dinner if my brain wants to go there.  After my dinner I will not dwell on any thoughts by bringing them up in conversation. I will let them go.

·      Cardio vascular exercise after placement hours to clear my head.

First week at the biggest hospital in BC

So the week didn’t start out so good. It was rainy all week and sort of stressful to be back in Vancouver knowing that I had to move on the weekend. Just ask Cameron, I get pretty stressed when it comes time to move.

Also at the beginning of the week I didn’t have my usual supervisor (she had a couple of days off in lieu of working weekends). The other supervisor I got was great though, she is one of our TAs in class and she is a fantastic teacher. That was fine, but the director of Physio for the hospital wanted me to know that once my regular supervisor showed up if I needed anything to let her know. Basically my supervisor is really smart and is very respected and wants her students to be top notch physios and sometimes her high expectations can be a little much, so I was stressing on Monday and Tuesday about having her and not being able to meet her standards and having a whole other “UVic Water Lab Incident 2007” again.

But so far its been awesome. She is super smart and a great critical thinker and had been working for a decent amount of time so she has consolidated a lot of knowledge. Her clinical reasoning skills are tops. I am really excited to learn from her. Sure, it might be a bit more stressful or not as laid back and I will be kept on my toes and busy, but its so much better than having a preceptor who doesn’t care.

Also for me too I think its good to have a preceptor with a different personality type than I have. Its good to have an assertive, very energetic, take charge type of preceptor so that hopefully I can learn some of her communication skills and use them when my usual approach fails.

Also I really hate presenting and public speaking, and my preceptor has her students do either a patient education project or an “in-service”. So I chose In-service. Really. I am trying to grow here. So in week #5 I will be delivering a presentation to all of the hospital’s physios who want to attend and the 5 of my peers who are also at the hospital on placement. I haven’t picked a topic yet, but its probably going to be some sort of acute medical condition that I will research and deliver the information on.

I think the saying goes: “You can’t always get what you want, but if you try sometimes, you just might find, you get what you need.”

In transition...

I had my last day at the Penticton placement this week, and I was very sad to leave. I will miss getting to spend some time with Cameron's parents, the daily routine I had going, the people at the placement especially my preceptors, my regular clients, the beautiful Okanagan scenery and weather. However, I wont miss the commute to Penticton from Westbank every day.

I feel like I learned a lot and solidified some of the skills I have learned in school so far. I hope that these skills continue to improve in my next placement.

The drive home was bitter sweet. We kept remarking how we couldn't believe that it had been 5 weeks already. 5 weeks ago we were nervous and excited to begin. Now we were driving off with 1/6 placements done. It was weird when we entered Vancouver again, sort of like a dream... I commented that I was going through winery sign withdrawl. But its more than that. There is a different vibe in Vancouver. People may be a little less friendly, the city is a lot bigger. There are people and cars everywhere. It didn't really feel like I was home either. I mean, I wouldn't ever call Vancouver "home" exactly, its sort of just where I am living where I am going to school. Don't get me wrong, its great to be back with Cameron again after being apart for a while and good to see family and friends, but there is something about living here that feels temporary. Maybe that Cameron and I keep talking about moving away if he doesn't have a really attractive job by the time I graduate or maybe its that we are moving, or maybe its that I have only lived in Vancouver for 9 months now.

The weekend was great. We made some pizza on Friday night and watched a movie. Its great to do some familiar things with Cammy. We biked to PoCo on Saturday and visited my parents. I haven't seen them since I left so it was great to catch up! They even fed us dinner!

On Sunday I got the chance to meet up with an roommate from UVic. It was fantastic to see her and her boyfriend again. Its been a while. I feel like I am getting to that age when you have friends that you can go a few years without seeing if you are not careful!

And Monday morning I will begin my 5 week journey on the 10th floor at Vancouver General Hospital. What a change. I am more nervous about this practicum than the last. Wish me luck!

Summative reflection:

Overall I thought the placement went well. And apparently so did my preceptors. Last week I was honored to receive an “exceptional pass”. I want to take a moment to reflect on what made this possible.

Firstly, of course it had to do with my preceptors. They allowed me opportunities to demonstrate my communication, professionalism and my ability to work with children. Without them giving me room to perform sessions with clients on my own, I would have never been able to show them what I was capable of. In addition, they also were excellent at providing feedback and guidance. We always debriefed appointments afterwards in the office or on the car ride home. This afforded me the opportunity to learn from what I had done and gain an experienced perspective on what I had done correctly and what I could improve on. They both were so encouraging and positive I felt like I was always being set up for success. 
I have worked for supervisors who were the opposite of Dan and Jackie, people who tear down what you do, are over critical and accusing and who micromanage. In these situations I was always felt like I had to watch my back and was worried about taking risks or thinking outside of the box in case I made a mistake. I felt like in those situations I was really limited in my capacity to grow and learn. Therefore, my performance was average.
I think the second thing that allowed me to have such great success was my past experience with children. Its hard for me to think of a summer job or a part time job that I have had that didn’t involve working with kids. Maybe my 4 co-op terms and when I worked painting houses. Other than that I have worked at summer camps, cycling camps, skating lessons and as a behavioural assistant etc. Experience working with children was a huge asset. According to my final review I am good at communicating with kids at all age levels, don’t get flustered when children don’t listen to me and am a good motivator.  I found it easy to communicate with these clients. Of course when you have past experience in something it allows you to draw on those experiences to apply them to what you are doing at that moment. So even though I had never worked one-on-one with a child to improve their hand strength before I was able to draw on my past experiences of making up fun games and getting children to be interested in what we are doing to make the experience enjoyable for the client while meeting the goals of the session.
The last thing that really helped my case doing the thing that I love doing every day. Its great waking up in the morning excited to go to work and excited about what you get to accomplish for the day. I feel like this excitement and interest in what you choose to do as a career brings another element to what it is that you are doing. Your clients can tell when you are excited to be there and they feed off that and follow your lead. I found it easy to get my clients interested and motivated when I was interested, motivated and excited.

I really enjoyed my time working in early intervention pediatric physio and could see myself doing this in the future after graduation. I hope to gain more knowledge and experience to become even better in this field. I also hope that my placements to follow live up to the high standard that this one set.