Update

All right guys. It's been a long time since I blogged and I must admit, a lot has happened. It's kind of lonely out here and I don't get to share my stories, so I'm going to write a lot, but I'll break it down so you don't have to read it all at once...especially those of you who can't read for very long (any guesses at who that is? :) ).  So, here the run down on the last few weeks of clinic. It has been good overall, but definitely challenging.

 

Curve Ball Number 1

 

So this clinic runs with a lot of PTAs and a few therapists (more on that later...or maybe another post). There is one PTA (who is awesome, young funny, I totally love him!) whose mother has been ill for a while. She rather abruptly went downhill and actually passed away within two days.  So sad guys. It was so so sad. That's a whole other story though- how this relates to clinic? He had a full schedule which was promptly distributed among therapists. No one minded picking up the extra work, but let me tell you...it's been a bit stressful. I was carrying almost a full load last week.  This week has been a bit more manageable, but this week (which is now last week) the hospital announced that it will not in the future be as big as it once was, or have as many employees. English translation, were laying people off.  105 to be precise.  Turns out that they are laying off people in management type positions and those who have been there the longest (they get paid the most). They laid off our main office person, we have two and that afternoon they laid one of them off. We were shocked. Unsure of how we were going to keep things running.  Even more weird is that the director of the department didn't know about it. The lady who got laid off called the other office lady, who called our boss and informed him.  The next morning, they laid our second office person off. Brilliant. With no indication of who was supposed to do their duties, it has been an interesting ride. I'm less than impressed with the company and would never work for them.  They have shown some very unfortunate qualities in the weeks since then. Clinic is still good, but I would not choose to work for them.

Midterm evaluation, curve ball #2

Midterms were a never ending nightmare for me. Mostly because they came in the middle of all that I just described. Between our coworker being out (and actually, two other coworkers had family members pass away the same week) and all the layoffs, things were crazy and stressful.  Then there is CPI web. My CI emailed DeLeo a long time ago with all of his information, but he never got a response from her. I thought our "assisting your CI" form was a form we could give them so they could send in the information. I sent it to him and was reminding him of it daily, but it just wasn't getting done. I didn't think it was a big deal. DeLeo called for my site visit and first was irritated because she couldn't reach me directly. I didn't think about it until that morning, but they have the number for the CCCE not my CI, but I never got an email or anything asking for more information, so I assumed it wasn't that big of a deal. When she got through she started the conversation by asking "first, were you aware before today that your CI wasn't going to be there today? Why didn't you tell us this, that your CI wouldn't be there the day of your site visit." Ummm.....my CI is here. He is standing at the desk right behind me right now....  ... "Oh. I was told that your CI isn't there today."  "uh. He is. he's standing right here." Let me just tell you, that is not the way to start the site visit. Scared me to death.  Then we talked about CPI web and DeLeo made it clear that I was supposed to give her all my Ci's info, that was now my responsibility. I think that's weird since I had to ask him for all the information before I could send her the email...whatever. I didn't get access to my eval until that Monday, didn't get to start it until Tuesday and then everyone got laid off. Both my CI and I had the vast majority of it complete Tuesday and finished it Wednesday, but hadn't signed off on each others. I was getting emails everyday from the program that were stressing me out like crazy about getting it done.  I was seriously starting to get afraid that they wouldn't let me pass this clinical or something. I finally sent an email to Dr. B telling her that the week was crazy due to unexpected curve balls (read previous section) and also asked if in the future, if they were sending emails like this if they could please include the CI because it was a lot of pressure on me to go in every morning for two weeks now and bug him about getting this done. She called me that evening and we talked it through a bit and all was fine (so glad it wasn't DeLeo I was dealing with at that point cause I don't know if it would have been smoothed) but let me tell you. It was more stress than it was worth.

And now: The patients...

Biceps rupture

"hello Mr. smith, I see you are in here for shoulder problems. Can you tell me what happened."

"Are you sure you wanna know?"

"Yep. Lay it on me, I need to know."

 Ahh yes, you can always be a bit surprised.  Turns out the man was having sex last year and he torn/ruptured a tendon. He couldn't remember which one, but I am pretty sure it was his biceps. So he says, I was having sex and it just started to hurt, but I just kept going anyway. He starts to demonstrate the movement for me. Wow. Didn't really care to have that part. It wasn't graphic or anything, but this 70 something year old man, big tall, burly, black, is showing me how he's having sex. And he keeps saying "I just couldn't stop. I just kept going anyway."  hahaha.  My CI still cracks up about it every time. It was so funny guys. How you rupture your biceps having sex...I just don't know. And why the man  couldn't control himself...well...yeah. It was quite the eval.

A Tattoo to remember

Shoulder eval. The incident gives you a good idea of what this guy is like. Mind you, he's gotta be in his 40s. I can't remember exactly his age. He tells me that he was drunk this night and his friends convince him (while he's drunk of course) to drive his motorcycle up this flight of stairs without a board under it. He manages (I don't know how) to get all the way up the stairs, but biffs it on the way down. He falls off the bike face down, the bike falls on his back, fractures his ribs in 9 places and fractures his scapula. Brilliant.

Its now 4 or 5 weeks out and he's cleared for therapy. Honestly, he's not that interesting of a patient, but this is the part that is worth talking about. I tell him to take his shirt off during the eval so I can look at his shoulder and scapula etc. He stands up to do it and kind of slows down and says...uh...I hope you aren't offended by my tattoo.  Right. Chances are I'm not going to be too impressed if he starts off like that, but whatever. Not my body, not my husbands back I have to look at (he is married), I have to see his shoulder so whatev. turns out on his back he has this huge tattoo. Covers both shoulders. There's a castle in the background. A wizard on his left and a naked woman on his right.  Why he thinks it's cool enough to get a tattoo like that I don't know, but I'm focused on the eval so I don't pay much attention.  He comes in for his second visit and I start doing scapular mobility and soft tissue work. I'm not doing a lot of active stuff with him since his fractures aren't fully healed so I have a lot of passive stuff I'm doing. I didn't really realize at the eval, but the naked women in right on his R scapula so I'm staring at it while I'm doing this work. And then I see the whole thing together and realize what it is. Left side, wizard with wand sending smokey magicness out of it that flows over to the woman on the right and bursts into flames, right under the naked woman who is tied to a stake. The guy has a tattoo of a naked woman burning at the stake. wow. And that's what I get to look at every treatment. fabulous. I don't know.  Maybe it's just me, but really? Weird. Ugghh.  Nope turns out I don't really appreciate it.  My CI cracks me up sometimes. First time he said "You should have said to him, why do you have a tattoo of a naked man on your back?" because he can't see it. Maybe you could freak him out and he'd think its wrong. yeah....not. But it would be awesome if it worked out that way. The other thing he teases me about every time I treat this patient is making the woman dance. He's like, you can just play with his tattoo.  Make the wizard move and talk and she can move back.  So I get to imagine a dancing woman burning at the stake. Wow.  I just don't understand some people.

Is this patient appropriate for physical therapy? (Halvaksz would be so proud!)

This is by far my favorite story so far. I wish I could have taken a picture because it was wild. So this patient comes in 1 week following a fall...actually multiple falls.  First of all, we're working with a new person at the desk who transferred over from the outpatient rehab unit that's in the hospital itself, they do all the neuro stuff (got to be honest. Wish I was there. For some reason, the program told the hospital I had to do OP ortho, which is weird to me since I'll be doing OP in SC and I did OP ortho in VA and I don't even want to do OP...but so it goes). So anyway, she's over on our side now. I went out to the front 2 or 3 times to see if my pt was there, but they kept telling me no. She wasn't there. Finally, about 30 minutes late, I get a page that my pt is ready. What? 30 minutes late and i still don't have the chart. I go out to get it and see who my patient is. This woman and her daughter have been sitting there since I arrived, which is 45 minutes ago. Guys. I felt so bad for this woman. They just sat there for 45 minutes and I was in the back the whole time, just doing random stuff because it was my first patient of the day so I didn't have any new paperwork to be doing.  Anyway...

This poor woman is in all kinds of pain post fall(s), but I was supposed to treat her neck. She's a bit older, in her 70s and she has a lot going on. She lives alone, but her daughter lives near by and does a lot to take care of her. The woman fell a week before at home and her daughter was out of town until...a day or two before she came in to therapy. The lady was taken to the ED by a friend that night and then fell again (I think) that weekend so she was back to the hospital.  They sent her home both times. They looked at her neck and nothing was fx'd.  She had had multiple spine surgeries if I remember correctly, so her spine was their primary concern. That and a head injury. The CT was clear, but I'm pretty sure based on what they told her that she had a minor concussion. This is all manageable.  she really had a loooong history of stuff, but I was still feeling good about everything.  I finish all that and have her change in to a gown.

I go back in and start doing a posture assessment.  First thing I'm drawn to, her R shoulder is sloping down. Now, pretty much everyone who comes in for this kind of thing has a sloping shoulder, that's not surprising. That's the side of her neck that hurts, but man alive. Her shoulder is more like a ski slope type sloping. It's way down. So I note that and keep going. I have her raise her arms to watch her move. Remarkably, she's able to get the right one over her shoulder, but not her left (hx of RTC injury). So then I just have her stand and I start looking at her clavicle.  There's a big bump sticking out so I start to look at it. The daughter sees and says, oh yes. We forgot, she had a clavicle fracture years ago. She never did anything about it.  Later she was told that she should have had surgery and it just didn't heal right so there been this big bump there ever since. But I keep looking at it and the daughter says...huh. That looks different than the last time I saw it. That doesn't look right. Even compared to what it was before.  At this point I am quite concerned. My next question reflects why. I ask "so when she broke it, did they remove a part of the clavicle then or later when she had shoulder surgery. Did they take a piece out?" The answer is even more concerning. "No, she never had any kind of surgery on it."  As I look a little further I realize what has happened. Her clavicle is broken in half.  I assume that is where the fracture was. But now, post fall...the clavicle is in two totally seperate pieces. I can see the fractured medical part of the clavicle. It's still in the skin, but it is sticking out in a wicked way.  The medial portion is completely displaced, which then explains the ski slope of a shoulder. Her shoulder is no longer connected to the sternum by the clavicle.  That piece of the clavicle is now hanging out somewhere in her brachium.  You can sort of make it out, but not exactly. At this point my brain is screaming "not appropriate for PT, not appropriate for PT."  I have a very clear picture in my head of what's happened, the woman isn't having any signs of nerve damage, she's maybe got a bit of vascular problem, but nothing really significant. I'm pretty sure I don't want to evaluate her neck, but I have the woman look in the mirror at her shoulder to tell me if it is different than the last time she looked at it (she hasn't really looked in the mirror since she fell.)  When she does she sort of freaks out. It's not like it was before at all.  There used to be an indentation between the two pieces of bone, as in, she used to be able to hook her bra strap on the lateral piece of the clavicle to keep it up, but she said she had noticed her bra strap kept slipping this week.  ( note: a. I think it's awesome that she could hook her bra strap on her clavicle b. yeah, no wonder her bra strap is slipping, her shoulder is depressed a good 4 inches, it's like she doesn't have a shoulder connecting to her arm. straight slope down.) So I explain to them that I think that she needs to have her shoulder x-rayed and looked at by the physician. I'm concerned about moving her neck around because if that bone moves, it could damage some vessels and cause serious problems. However, before we proceed like that, I want to go get my instructor (I am a student, I could be wrong) and make sure that what I think is correct. He's seen a lot more than I have.  I go and try to find him and of course I can't. I'm in a hurry- not that worried about the patient. I am really pretty sure of myself, but this woman has been here well over an hour and now she's not even going to get treated, she's getting sent somewhere else. I honestly feel bad for her. I finally find him. He looks and her and agrees. We call the doctor (who is in the same building, but of course all they can do for her is leave a message for the doctor. They have to go all the way home and come all the way back). Really, I need to find out if there's a way to actually send urgent cases more directly to the doctor. I should have been more assertive. We let the daughter call and then I talked to them, but I should have called to see if I could directly get a hold of a nurse cause frankly. if that bone did move and hit those vessels we are talking serious emergency. Anyway. We asked the patient to call us and let us know what happened, but we haven't heard anything. Wow. I realized the importance of yes, no, yes with referral. 2 ER visits and a visit to the PCP and I was the first one to even look at this. You couldn't miss it if you looked.

The end.  i have more stories, but don't feel like writing anymore. Plus I know that Rach isn't reading. :)