Awesome video of children with Down syndrome, dancing….Liberty, a new OT student, sent it to me.

Today one of my UT teachers, Anita, came to observe me for 3 hours, as part of a class she is taking while getting her PhD. It was on clinical reasoning and some kind of mini-study. So she observed me and then we had an hour long interview on the tape recorder about pragmatic, narrative, ethical, and scientific reasoning. I had been stressing out over her visit for a week since I knew it meant I had to see some patients by myself and of course it also meant I had a teacher “judging” me. She is really nice and sweet and I am happy to help her, but that doesn't mean I wasn't scared, LOL. So we've kind of been working on getting me prepared for her visit…so in a way it gave me a jump-start because otherwise I would have more dragged out the timeline since I am so freaked out by phys dys.

This morning with Anita present I did two evaluations – one on a left total hip arthroplasty, one on a left total knee arthroplasty. Both patients were pleasant and cooperative and I think the evaluation went smoothly. Then I went to write up the evaluations and realized I had not asked them their pain levels or about the functional use of their arms, oopsies. So Anita and I went back to quickly ask just that, after I had written up the evaluations and my supervisor had double-checked them. I also did a few discharge summaries and showed her a few of my SOAP notes! Woot! The questions on clinical reasoning were interesting…I think it would be good for fieldwork supervisors/students to have a chat about the various types of reasoning and sometimes discuss what types of reasoning were used for a specific client, and why.

In the afternoon I saw one patient alone – a 15 minute ADL treatment where in all honesty I felt rather “otiose” OH MY GOSH MY CAT JUST SNEEZED ALL OVER ME THAT WAS DISGUSTING okay anyways OH HE IS DOING IT AGAIN okay but anyway, then it was time for an eval that had come in – on a very involved patient with about a thousand diagnoses – and I will admit I was like (but in more professional language) Yo Supervisor…I've really hit my max ability for the day to handle anything new and challenging…I would really like to not do this eval. Since it was not straight-forward and would take place in the ICU and also with a Level I student present (who is awesome btw), I was just like…this was my first day seeing patients alone…and I saw three of them…plus had my teacher watching for two…in other words, that I was slightly overwhelmed at the prospect of taking on another challenge of a complicated ICU eval with two people watching. My supervisor was actually VERY understanding and sweet about that. I think if I tried to beg off challenges regularly, she would not be thrilled and that would be inappropriate and unprofessional, but the occasional legitimate “I'm overwhelmed at the idea of a new challenge right now”, can be okay.

That last eval was a DOOZY – the ICU patient was an “unreliable historian” and SO involved – and it took the OT, two OT students, a PT, and a “Sara Plus” standing machine, to get her from her chair to the bed. Afterwards, the elevators wouldn't come and Cody (the OT student) and I tried two different elevators (because we had this standing machine) and they were all being crazy, so it took us at least 20 minutes just to get downstairs! And also, Cody got poop on his lab coat today! Yikes!

Ok back to seeing patients alone…It seems easy to watch the supervisor do it..then it's my turn and I'm just petrified of forgetting to do something that could be a safety risk or pain risk to the patient…like forgetting to put up the bed rail, or things like that. I'm also really scared of the nurses thinking I'm stupid. I struggled with a tray this morning (getting it pulled up) and I wish the nurse hadn't seen me! I had practiced with a tray, but not this particular type. The nurse helped. But I think nurses – even the awesome ones – are often a therapist's harshest critic – so I only want the nurses to see awesomeness!! Which so far I am not delivering! But it's only two days into Week 3, maybe awesomeness will come.

Overall I think I did well today…even when I'm very nervous I usually mostly look calm…and I think I talked slowly and loudly overall…and was more personable…

For the rest of the week I think my supervisor is mostly going to have Cody, and I'm going to be with the COTA who is great…so I'll be doing treatments…I'm not horribly nervous, but I have several big things to get done this week including getting student health insurance – which looks like it will be costing $573 dollars just for two months?!!! Plus need to get some important prescriptions filled, and a few other things that require phone calls and such, plus getting my twin sister's birthday present together, so I'm like augh! When do I do this?! Tommorrow with any luck we will get off somewhat early so I guess I can make my phone calls and send off my sister's present then.

http://www.cnn.com/2008/LIVING/10/10/o.warrior.mother.jenny.mccarthy/index.html

So…this lady is an AMAZING “mother warrior”…! It makes me slightly sad that although she had to have a TON of occupational therapy, only rehab generically, and physical therapy, is mentioned in this relatively long article…it should have been the OT that was making the biggest difference to her and allowing her to live her life as fully as possible, in wwhatever way that meant to her. 🙂 Question is…did she not get great OT…or….who knows….anyway, a very cool lady. But this is the kind of thing where AOTA needs to do a follow-up and be like YO! Here are ways OT could have or did help someone like this!

Today was a pretty good day…I helped with several sessions in the afternoon although the morning was odd…including an eval with a man whose chart says he had no plumbing or electricity….tomorrow I do an ortho eval – a hip – by myself, and a treatment, by myself…with one of my UT teachers, Anita, observing…for some research she is doing…scary!!! I then babysat all evening and now I'm going to bed!

A friend sent this on to me. Americans are welcome to contribute!

This link is for the Canadian Disability Studies Association's call for papers. It's the 2009 meeting in Ottawa and papers from occupational therapists that relate to disability studies (i.e. embrace the social model) would be welcome.

http://www.cdsa-acei.ca/conference.html

An active night of dreams, tossing and turning (guess I have good bed mobility at least). I dreamt about hemiplegia, “impaired ability to perform ADLs”, hip kits, ortho evals, surgeries, patients, hospitals, co-workers, scrubs, medical model, walkers, nurses, etc etc.

OKAY! NEW REMINDER of MONDAY GOALS!
SPEAK LOUDLY, CLEARLY, SLOWLY
UP CONFIDENCE, DOWN INTIMIDATION
ENJOY INSTEAD OF DREAD
CALL INSURANCE

So……..Mom just emailed me to remind me that my medical and dental insurance expire on my 26th birthday…which is in, oh, about a week, on the 21st. I *totally* forgot…I'm normally really good about staying on top of those things.

I guess that will be my new big goal for this week…getting student health insurance asap…

I did go from about a 100 emails to 40…and about 25 Facebook mails to like 10…..so I got some stuff done tonight….tomorrow I'm going to try not to stress too much…go to the gym…probably babysit…see some friends…and then prepare for a busy Tuesday with a lot of hip replacement evals (their surgeries are Monday, so Tuesday we should have at least six ortho evals to do)…

Really nice chick had these words of encouragement via e-mail after one of my particularly extra stressed posts on being scared on my phys dys rotation…
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I read your blog regularly and I felt compelled to offer you some reassurance. I just finished my last fieldwork and it was at a phys dys site. (acute inpatient rehab on the brain injury unit) Let me tell you….it was very stressful at first and there were plenty of times I was on the brink of tears because I felt so overwhelmed and incomptent! Trust me when I say this….it will get better!!! As you said…you're only in week 2!!! To be honest, I didn't really get in the groove until like week 9 and then for the last few weeks I was flying on my own and it felt great. Phy dys sites are just harder I think than others. Especially in a hospital setting. So don't be so hard on yourself….you are learning and it's expected you'll struggle a bit. If you picked everything up in just 2 weeks what would be the point of a 12 week internship?!? You'll get it…just be patient 🙂
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Cheryl suggested this in a blog comment….

Hey dude, if you have a computerized documentation system, create a word or text file and keep it either on your public network folder or a jump drive. Every time you write goals for a pt, just copy them into there. It's also great for ROM and other exercises that you do in a similar way each time. Saves you a lot of time to change small parts of your canned text.