The New Job

I'm on my second week at my new job and I love it. I love how fast-paced it is, how many resources are available, how we can do community outings with patients, the mentorship, and the entire rehab team. I am especially excited to be working with two of my ex-classmates from grad school. I am excited to learn and grow together. I found this one and only picture of us three together. Now looking at this picture, how can rehab NOT be fun?! Apparently the staff outside the rehab team call us the triplets since no one can quite get our names straight just yet.

The setting is definitely challenging, but I have learned so much within the first week and a half. This setting feels like a mixture of a whole bunch of settings. It feels like acute rehab in that we work on ADLs in patient's rooms, it feels like inpatient rehab with our gym to bring our patient's to, and it feels like outpatient rehab with our community outings and home evaluations. I am never bored or complain that the day is dragging.

My schedule pretty much starts at 6:45 AM. I get the list of patients that I need to see. I visit my patient's rooms to schedule when to see them that day and then I start my treatments at about 7:00 AM (if I'm lucky and fast enough). Treatment usually involves assisting patient's with showering, dressing, transfers on and off the toilet -that sort of thing. If a patient does not need a shower that day or has been showered already by a CNA at the crack of dawn, we usually go into the gym to work on endurance in standing while doing a functional activity in dynamic standing. That could be anything -a puzzle, a board game, cooking in the kitchen, theraputty exercises. Or we'll do bilateral upper extremity exercises with theraband, weights, the machines -depending on the patient's goals, of course. Then there's always energy conservation or home safety education with patient's and families. I'll take a 30-minute lunch break, catch up on paperwork, see one or two patients more, finish my paperwork (daily notes, weekly progress notes, eval reports, discharge reports), bill, and clock out. Some times we'll get new admits around noon. If that's the case, then I'll do an eval for fifteen minutes. I go home, get to bed some time between 9:00 and 9:30, and start my day all over again.

So far I have had some pretty good experiences. My first ever patient with an orthopedic injury happened to be a simultaneous bilateral total knee arthroplasty. Yes, SIMULTANEOUS. Both knees. Toe-touch weightbearing on the right, weightbearing as tolerated on the left. I walked in, planning to evaluate for fifteen minutes and then treat for another sixty, but walked out a little short on my time because of my patient's pain level. We agreed on a treatment session at 7:00 AM the following day once his pain is properly managed. I prepared that night, thinking of how to exactly assist this patient in transfers from his bed to his wheelchair to the toilet to the shower. I'm surprised I didn't wake up at two in the morning re-thinking the scenario in my head. When I walked in that morning, the CNA tracked me down and told me he was waiting up in his bed for me. Here we go! Every transfer was going successfully with assistance from one of the CNAs, up until we got the patient out of the shower in his wheeling shower chair to the side of the bed. He looked at me and said, "I don't know how you expect me to do this transfer. I have never tried standing up from a surface as low as this." Well, shit. I stood there thinking I need to figure this out QUICK, I have to make it seem like I know what I'm talking about, and I need to actually KNOW what I'm talking about so that he doesn't fall flat on his face and traumatize me from bilateral knee patients for the rest of my life. So I figured, ok, it's all about body mechanics. I had him scoot to the edge of the chair, bring both legs out straight as far as he could, push off of the shower chair arm rests (that would NOT come off, which is why we did not do a sliding board transfer onto his bed. That would have been nice), grab a hold of his walker and push down into it to lift himself up after the CNA and I pulled him up far enough under his armpits with max assistance. From a standing position, we did a pivot, raised his bed to his butt, and had him ease onto the edge of the bed. Success! He looked at me and said, "That went a lot smoother than I thought". I think I gained his respect that day. Before I left, he asked me what my name was since I did not have a name tag yet. I told him Katharine. He said, "Can I call you Kathy?" That was fine with me. Since that day, he has been making slow but steady progress. He performs his transfers with contact gaurd assistance now, some times stand by assistance. Today, after working out in the gym, showering, donning his very uncoorperative ted hose, and discussing potential adaptive equipment he may need at home, he was ready to transfer from his wheelchair to the bed and call it a day. I bent down to help lift his legs, but he put his hand out and said proudly, "Nope nope! Just watch!" He did the transfer on his own. I was so excited for him! Then he asked if he could go home Saturday. Aw crap. Double shit. In our meeting yesterday we decided he needed another week. I did not tell him that because I was advised not to just yet, but I did tell him that I felt Saturday is too early and that I want him to be 100% safe in being alone at home. He wasn't happy. But he didn't give me a hard time about it. Thank goodness.