Clinic Week Re-Cap: Acute Care Physical Therapy

As part of my DPT program, we spend one week in the clinic at the end of every semester.  In a program that’s split into two years of didactic learning and one year of clinical intensives, it’s a good way to get our feet wet and remind us of why we’re doing all this schoolwork in the first place. We do these clinicals in teams of 3-4, and we go to the same site for an entire year.  My first year, I was placed in an outpatient neuro-pediatric clinic.  This year, our team switched to acute care, on the oncology floor.

As you may have guessed, given that we all know my interest in endurance sports….we don’t get to choose these sites like we choose our third year rotations. I’ll be 100% honest, while I learned a ton in neuro-peds and really got to hone my movement analysis and clinical reasoning skills, it was SO not my thing.  It was my first time being surrounded by sick and/or severely impaired children, and I just couldn’t emotionally handle it – I will admit to going home and crying the first three nights. So…you can imagine that I was not thrilled about my next placement in acute care oncology.  I was fully expecting to see patients who’d been admitted to the hospital because they were dying.  I fully expected a patient to die while I was there. Right before we started, a professor jokingly told me that someone might poop on my shoes (Full disclosure, this was my “oh HELL no, there’s a reason I didn’t go to medical school!” moment).  I was not looking forward to this rotation AT ALL.  As I rode the bus in on my first day, I’m pretty sure my heart rate was sitting at about 150.

Damn was I wrong.  I had the BEST time last week on this rotation, and it was 1000000000x more positive than I expected it to be.  Here are some of the amazing things I discovered at the hospital:

1  Patients are People.

When you’re a student, it’s really easy to get caught up in “what’s the diagnosis?” and “what’s the home set up like” and “god dammit why are the lines and leads STILL tangled I’m tryna walk here!”.  It’s easy to think in terms of “leukemia patient, ambulatory, may not need PT”, or “lung cancer, needs contact guard assist and quad cane”.  But you know what? The guy in room 48 isn’t a “leukemia patient”*, he’s a former wrestler who’s married to a nurse and his main complaint is that his shoulder is weak and he can’t lift weights.  The woman in room 15 isn’t a “humerus fracture, history of MS”*, she’s a retired CEO who’s still sassy AF and isn’t afraid to dictate her own care. (*room numbers are not accurate and I mixed the diagnoses around a little….not tryna violate HIPPA here) Treat people like people.  The awesome thing about working in a hospital is that you don’t have a schedule, and you can spend as much or as little time with a patient as you like, and bill for all of it.  Spend some of that time getting to know the person, and make sure you know, just like in outpatient, what THEIR PRIMARY CONCERN is.  9 times out of 10, their primary concern is not the same as their oncologist’s or attending physician’s primary concern.  Address what THEY want, and you’ll get much better PT outcomes.  Oh and your patients will feel more empowered, regardless of what stage their cancer is.

2  Your CI can actually make or break your experience.

Shoutout to my CI, you know who you are.  She was truly the best.  It really helped that her personality matched my team’s personality, and that she was willing to let us smile and joke around.  Creating a happy environment for your students allows your students to create happy environments for the patient! Further, she challenged us by letting us take complete lead of a patient session.  It was completely safe – she was right there the whole time, and with four of us, no question was left unasked and no patient was ever going to fall.  This allowed us to fail miserably, check our egos at the door, and give us a good idea of where our skills were.  Also, four brains = four new things for the patient to try, that maybe no one else had ever mentioned.  Getting the experience of taking the lead this early I think is crucial – when you accelerate the process like this, you can quickly move from focusing on your own performance to actually focusing on your patient.  I like to think that I moved a little closer to that this week.

3  You get real comfortable with being uncomfortable.

There’s never a dull moment in acute care.  I had one patient who was at high risk for falls and who was not allowed to go anywhere without assistance (despite being fully ambulatory without an assistive device).  I was about to get her up and do some laps around the hall with her, but she needed to use the restroom first.  I was all like “okay go ahead, we’ll walk when you’re done!” but no….my CI looked at me and said, “well, go with her!” ….yeah. To the bathroom. To make sure she didn’t fall.  I might be pretty socially liberal, but I am a VERY modest person and this was just mortifying for me (probably for the patient too).  But yeah. I had to stand there while this patient did her business. But hey, I guess if in my future practice I ever find myself having to work on an athlete’s glutes or adductor insertion, I probably won’t even bat an eye thanks to this experience.

4  The human spirit is an incredible thing.

I mentioned earlier that I was fully expecting to see patients who were nearing death.  And indeed, many of the people I saw last week had terminal cancer.  And yet…they weren’t “resolved”.  A lot of them weren’t even depressed.  They were STILL FIGHTING for every ounce of life they could get.  They were feisty.  They were cheerful.  They were optimistic.  They were ready to get up and move around!  I don’t even have words for how inspiring that is. I’m inspired to make more of a conscious effort to be grateful for everything I have, but if catastrophe were to ever strike me….I want to have that fighter attitude right up till the very end.

5  MOVEMENT IS POWERFUL

And to be powerful, it does NOT need to come in the form of a squat, a marathon, or a century ride.  All but two patients I saw last week got up and walked around the hallways of the hospital with me.  Some walked a hundred feet, some waked for five minutes.  Some were really hurting during the walk, some wanted to do more. But 100% of them felt more energetic, more invigorated, and more motivated after walking than they did when I first walked into their room.  I could see it on their faces, hear it in their voices, read it in their words.  And all we did was walk! Everyone who works out regularly knows this to be true, but movement is so powerful to change our outlook and our energy levels.  Even just a little walk.  I’m so thankful I was able to give that to people this week.

Overall….I still don’t want to be an acute care PT as my main gig.  But now I see why it’s so important for our profession to be there in hospitals, to be there with those who are ill.  We may not be changing their disease course much, but we ARE giving them quality of life…and that’s everything.  So, though I never thought I’d say this, I cannot WAIT to go back for our next clinical week in April!

 

 

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