Today I was presented with a situation I didn't quite know how to get out of. I was chatting with one of the clients who I get on really well with... He was sitting there waiting for his wife and we got chatting about his condition and her condition and how they met at rocky bay and have been married forever, and how their living arrangement works, and when the carers come in and stay the night and their decision about having/ not having children and blah blah blah... next thing I know he's asking me about my relationship history and as much as I wouldn't mind talking to him about it, I knew there was a line not to be crossed. I was struggling to find a middle ground between remaining professional vs. smiling and nodding and just letting him talk and give me all this advice about how "men will do anything to get in your pants". I didn't want to lie to him, but I knew it'd be wrong to get myself into a situation in which I felt compromised.
I think I did ok but I could definitely have found a way to nip it in the bud earlier. I was trying to steer the conversation towards more benign topics but I just felt so mean cutting him off because he is such a lovely guy and was just trying to impart some wisdom. In the end I just said "oh look at the time!" and that seemed to work well! I felt a bit uncomfortable because at the time I was unsure of how to react. It's not like he was having a crack (he's been married for 20 odd years and his wife was right there next to us!) - he just loves to chat and chat and chat... If it happens again with any client I'll try to change the topic immediately, or keep the conversation centred on him - not me! It was an interesting experience because I'll definitely be better prepared next time I notice the conversation heading down that road. The entire time I was thinking "this'll give me something to write on the blog tonight!"
Tuesday, October 28, 2008
Monday, October 27, 2008
mon wk 3
Today I went on a bit of a field trip to a couple of schools half way down south. First stop, we saw this gorgeous 8 year old with DMD and watched him in his PE class. It was heartbreaking seeing him failing to do simple physical tasks that the rest of the class just took for granted. And he was so aware of this. DMD sucks because the kids are so weak, but strengthening exercises just ruin the muscle even more. There's nothing we can do to 'fix' them, we just have to think of ways to maximise participation and safety, minimise fatigue and maintain what they've got for as long as possible. My supervisor assessed his gait, posture, scooter, hips and limited participation in PE. He was responding well to a new stretching programme for his hip IR and ER, and had a positive trendellenburg on the R which was influencing his gait and leading to compensatory IR posturing of his L leg. Problem is, you can't give him a targetted Glut Med strengthening programme for his trendellenburg because that'll only make things worse.
Second stop, we assessed a girl at school. She was being quite uncooperative and having trouble following instructions, and my supervisor was getting a bit exasperated after her 5th try on the vitalograph machine. At one point she started crying and we all had to calm down a bit. I've come to realise that physios can cause a lot of pain and can be pretty unpopular people (I was asked by another client today if we got our swastikas upon graduation or if I'd just got mine early). I thought I did all right with the assessment. Although I was only observing, we all played our roles in trying to calm the kid down and explain things in words she could understand. I felt pretty confident that I could have a go at most of what my supervisor was doing if I had to. I need to keep reading up on a few different conditions because their diagnosis really directs your expectations of the session.
Second stop, we assessed a girl at school. She was being quite uncooperative and having trouble following instructions, and my supervisor was getting a bit exasperated after her 5th try on the vitalograph machine. At one point she started crying and we all had to calm down a bit. I've come to realise that physios can cause a lot of pain and can be pretty unpopular people (I was asked by another client today if we got our swastikas upon graduation or if I'd just got mine early). I thought I did all right with the assessment. Although I was only observing, we all played our roles in trying to calm the kid down and explain things in words she could understand. I felt pretty confident that I could have a go at most of what my supervisor was doing if I had to. I need to keep reading up on a few different conditions because their diagnosis really directs your expectations of the session.
Saturday, October 25, 2008
fri week 2
The clinical services team (OT, PT, SP, RN, SW) meets once a month to discuss recent issues, make multidisciplinary decisions, and also for professional development lectures. Some of the young physios I work with (2 graduated last year from Curtin) told me before the meeting that "it sucks the life out of you" so I was really looking forward to a rivetting couple of hours in the boardroom....
One of the more interesting parts of the meeting was when one of my supervisors gave some feedback about some spinal surgery she'd seen the previous week at PMH. It was a little DMD boy with a massive scoliosis who was having spinal fusion surgery. I didn't realise this but they actually chop off all the spinous processes (in this case T4 to L4) and sprinkle all these shreds of bone over the back to induce bone growth and grafting. The idea is to make the body think that it's one long bone cut into 13 pieces and needs to fused again. The surgeons took almost 3 hours to just put in central lines and drips because apparently it was very hard to find his veins etc. Because of the DMD, his muscle was really poor quality and full of fatty globules... apparently the incision was 15cm deep (from skin to spine)!
I got to see a girl later on in the week with Friedreich's ataxia who'd just had the same surgery. I saw the photos of what she was like pre-op compared to what was sitting in front of me, and it was amazing. It was like she was a different patient, her spine was so unrecogniseable. A bit wierd running your finger down her back and not feeling any spinous processes though...
One of the more interesting parts of the meeting was when one of my supervisors gave some feedback about some spinal surgery she'd seen the previous week at PMH. It was a little DMD boy with a massive scoliosis who was having spinal fusion surgery. I didn't realise this but they actually chop off all the spinous processes (in this case T4 to L4) and sprinkle all these shreds of bone over the back to induce bone growth and grafting. The idea is to make the body think that it's one long bone cut into 13 pieces and needs to fused again. The surgeons took almost 3 hours to just put in central lines and drips because apparently it was very hard to find his veins etc. Because of the DMD, his muscle was really poor quality and full of fatty globules... apparently the incision was 15cm deep (from skin to spine)!
I got to see a girl later on in the week with Friedreich's ataxia who'd just had the same surgery. I saw the photos of what she was like pre-op compared to what was sitting in front of me, and it was amazing. It was like she was a different patient, her spine was so unrecogniseable. A bit wierd running your finger down her back and not feeling any spinous processes though...
Tuesday, October 21, 2008
tue week 2
Today was another interesting and varied day. I was given patients at 10, 10.30 and 11am. The first bloke was great and his stretches were really quick so it took me less than half an hour. The following client's stretches were going to take an hour (and I was on my own) so there was no way I could help my supervisor with the third client at 11am. When she realised this she got a bit pissed off with me because she needed to teach me the third client's neck stretches so that I could take over treating him later on in the week. I felt like she was pretty disappointed in me and thought that it was my lack of time management that had created this situation... even though it was physically impossible to see all three of them for 30 min each. Anyway, we compromised and I took 5 mins out to learn the neck stretches.
At the time I had no idea it would be a problem because I don't know the clients well enough to say how long I'll need to spend with them, and I never know if I'll have a supervisor with me or not, and if they're expecting me to stay for the entire treatment session or not. I assumed that if they'd given me those patients at those times then it'd be manageable. In the future I'll ask for specific clarification at the start of the day and not assume that the physios are 100% aware of my timetable - especially if I suspect there could be a clash in timing or miscommunication between all the physios. On a more positive note, she said I picked up the neck stretches really well and I felt more confident stretching out the second client's entire body by myself.
At the time I had no idea it would be a problem because I don't know the clients well enough to say how long I'll need to spend with them, and I never know if I'll have a supervisor with me or not, and if they're expecting me to stay for the entire treatment session or not. I assumed that if they'd given me those patients at those times then it'd be manageable. In the future I'll ask for specific clarification at the start of the day and not assume that the physios are 100% aware of my timetable - especially if I suspect there could be a clash in timing or miscommunication between all the physios. On a more positive note, she said I picked up the neck stretches really well and I felt more confident stretching out the second client's entire body by myself.
Monday, October 20, 2008
mon week 2
Saw a pretty amazing woman today who was born without arms and legs (tetra-amelia), but otherwise has no other medical conditions at all, and is completely switched-on upstairs. She has this custom-made wheelchair that she manipulates very skillfully with her chin, back and mouth. She has a wicked sense of humour, is an amazing landscape painter and also happens to have chronic back and neck pain. Brendan my supervisor asked her to do a few movements, combined with inspiration and/or coughing, to confirm his suspicions of costo-vertebral pain. It was pretty interesting to see the clinical reasoning going through his head, and the way we then went about treating her...
We had to help her out of the chair and use a slide sheet to move her across the bed. I was worried she might feel a bit uncomfortable with us mucking about with her clothes and undies and asking her things like "do you have a scapula?"..... but it became pretty clear that my concerns were unfounded because she's had people's hands all over her for 45-odd years and she's very open about her abilities and limitations. The ideal treatment for this back pain would be full-on mobilisations (they've probably got a special name but I didn't ask) but there were a few precautions/contraindications. Firstly, the client has a Harrington rod in her spine (been ther since the mid-70s!), and secondly she's likely got ostepenia so Brendan could break a rib or two with his mobs. Anyway, he ended up doing grade 2 mobs and massage half-way along her rib.... She was in heaps of pain and has been for 6 years but hasn't complained until recently.
I thought this was a really good learning experience for me becasue the client was pretty unique and the treatment and assessment had to be greatly modified in light of her abilities. Initially I felt a bit out of my depth because I had no idea where to start. I was terrified she was going to fall flat on her face, until I got a good look at the plastic corset she was strapped into. I was pretty happy with how I spoke with the client because I really listened to her positioning requests and she seemed comfortable enough to talk openly with me as well. A few things I could have done better would be asking Brendan more questions about what he was doing and why. Next time I see her I'll be more confident with handling her in her chair and using the slide sheet. Overall, another really varied and interesting day at the Bay - plenty of amazing clients to chat with which makes the day fly by.
We had to help her out of the chair and use a slide sheet to move her across the bed. I was worried she might feel a bit uncomfortable with us mucking about with her clothes and undies and asking her things like "do you have a scapula?"..... but it became pretty clear that my concerns were unfounded because she's had people's hands all over her for 45-odd years and she's very open about her abilities and limitations. The ideal treatment for this back pain would be full-on mobilisations (they've probably got a special name but I didn't ask) but there were a few precautions/contraindications. Firstly, the client has a Harrington rod in her spine (been ther since the mid-70s!), and secondly she's likely got ostepenia so Brendan could break a rib or two with his mobs. Anyway, he ended up doing grade 2 mobs and massage half-way along her rib.... She was in heaps of pain and has been for 6 years but hasn't complained until recently.
I thought this was a really good learning experience for me becasue the client was pretty unique and the treatment and assessment had to be greatly modified in light of her abilities. Initially I felt a bit out of my depth because I had no idea where to start. I was terrified she was going to fall flat on her face, until I got a good look at the plastic corset she was strapped into. I was pretty happy with how I spoke with the client because I really listened to her positioning requests and she seemed comfortable enough to talk openly with me as well. A few things I could have done better would be asking Brendan more questions about what he was doing and why. Next time I see her I'll be more confident with handling her in her chair and using the slide sheet. Overall, another really varied and interesting day at the Bay - plenty of amazing clients to chat with which makes the day fly by.
Wednesday, October 15, 2008
wed week 1
Today I was asked to take a young boy in the hydro pool for his weekly session. From what I can gather, he is what you might call a typical rocky bay paeds patient (actually they're all called 'clients'...) - a 10 year old boy with Duchenne Muscular Dystrophy (DMD). Although he's a long-time client he doesn't actually have a hydro programme written up - the instructions given to me were just "Oh he does his own thing, just play with him, he'll let you know what to do..." I was on my own except for the bloke who runs the pool- there was no physio with me.
Although at the time I didn't really feel like I'd been thrown in the deep end, I guess in hindsight I really have no idea if what I did with him was right, approproate to his level of function/disease stage, or even if it was beneficial. I read his notes on the computer beforehand but they didn't give any indication as to his abilities or difficulties. His physio was unavailable at the time. We mucked around for an hour, did some balancing, diving, throwing and catching, and cycling on the noodle... He was really happy and loved a chat, and said he was looking forward to seeing me next week. But at the same time, I think a little more direction would have benefitted both of us.
If I'm presented with the same situation next week I will definitely talk to his physio beforehand. A strategy I've been using from day one with all the patients is simply asking them what they do normally, or what is 'normal' for them. They're all very knowledgeable about their own bodies, which you've got to respect, they've taught me a lot already. Overall, today was another great day at the bay... and I've pretty much been told not to wear my uniform again!!
Although at the time I didn't really feel like I'd been thrown in the deep end, I guess in hindsight I really have no idea if what I did with him was right, approproate to his level of function/disease stage, or even if it was beneficial. I read his notes on the computer beforehand but they didn't give any indication as to his abilities or difficulties. His physio was unavailable at the time. We mucked around for an hour, did some balancing, diving, throwing and catching, and cycling on the noodle... He was really happy and loved a chat, and said he was looking forward to seeing me next week. But at the same time, I think a little more direction would have benefitted both of us.
If I'm presented with the same situation next week I will definitely talk to his physio beforehand. A strategy I've been using from day one with all the patients is simply asking them what they do normally, or what is 'normal' for them. They're all very knowledgeable about their own bodies, which you've got to respect, they've taught me a lot already. Overall, today was another great day at the bay... and I've pretty much been told not to wear my uniform again!!
Tuesday, October 14, 2008
tue week 1
I haven't really had any major 'incidents' or problems so far, it's all been quite positive. I've had a really wide range of experiences already - hydro, stretching, balance work (I finally found out what rhythmic stabilisation actually is and I got to do it!!!), tilt-tables, hoists, giving food and drink to a patient with dysphagia, and doing plenty of research on all the different types of muscular dystrophy, Friedreich's Ataxia, and some really rare neuromuscular conditions.
One of the things that is really standing out to me so far is the diffrence between all my supervisors. There are four physios at Rocky Bay and several PTAs. Some of the physios have already shown a lot of confidence in me and let me do a lot of hands-on work, while others tend to think I'm only there to observe. VARK tells me I am a kinesthetic learner so I tend to get a lot more out of working with those physios that trust me enough to treat a patient myself (whether they should or not!).
I think I've done all right over the past two days, but I also think I can improve on speaking my mind a bit more. It all really depends on the supervisor I'm with. There was an instance today when I thought of something but didn't say it out loud because I guess I wasn't sure if I was right (which in hindsight is a really stupid attitude to have).... anyway, a minute later the physio asked me to do the exact thing I had thought of before. Funny that.
One of the things that is really standing out to me so far is the diffrence between all my supervisors. There are four physios at Rocky Bay and several PTAs. Some of the physios have already shown a lot of confidence in me and let me do a lot of hands-on work, while others tend to think I'm only there to observe. VARK tells me I am a kinesthetic learner so I tend to get a lot more out of working with those physios that trust me enough to treat a patient myself (whether they should or not!).
I think I've done all right over the past two days, but I also think I can improve on speaking my mind a bit more. It all really depends on the supervisor I'm with. There was an instance today when I thought of something but didn't say it out loud because I guess I wasn't sure if I was right (which in hindsight is a really stupid attitude to have).... anyway, a minute later the physio asked me to do the exact thing I had thought of before. Funny that.
Sunday, October 12, 2008
pre-placement
I'm a little unsure of what to expect tomorrow... Everyone I've spoken to is more excited for me than I am myself! Rocky Bay seems to be a very popular organisation so I guess I should just believe people when they say I'm going to love it, but I suppose it's just too early to say how you're going to go. I am excited to finally get out there - I'm sure I'm going to learn so much about physio and also about myself. I kind of feel like this prac has crept up on me coz I've been concentrating so hard on everything else! I'm looking forward to getting to know the patients and the therapists as I'm sure they've got some pretty inspirational stories to tell. I'm not nervous but I just hope I don't make a fool of myself!
When I went to Rocky Bay for orientation last month I got a bit of an idea about the types of people working there. It's a very collaborative environment with OTs, physios, speech pathologists, nurses, parents and teachers.... I've also been told that I might be going to see orthotics fitted off site and travelling to community homes to treat patients (mainly kids). These patients have life-long conditions like muscular dystrophy so I think that continuity of care would be very important to everyone involved.
When I went to Rocky Bay for orientation last month I got a bit of an idea about the types of people working there. It's a very collaborative environment with OTs, physios, speech pathologists, nurses, parents and teachers.... I've also been told that I might be going to see orthotics fitted off site and travelling to community homes to treat patients (mainly kids). These patients have life-long conditions like muscular dystrophy so I think that continuity of care would be very important to everyone involved.
Subscribe to:
Posts (Atom)