Wait, hold on. Is it November already?
I cannot believe it. I feel as though I came back from Europe last January, and then woke up, and here I am. Another year has passed, and here we are, again, getting ready to put up the Christmas tree, making Thanksgiving plans, looking for gifts for everyone, wearing sweaters. Life has changed a good deal since graduating and starting work. I'm so incredibly startled by how much I have had to learn over the course of a couple of months as a full-time therapist on my own. I've been very humbled, frankly. To be honest, work hasn't been easy. I learned very shortly into my time there that my company had been bought out by another one, and November 1st was the official transition date. Learning a new documentation system has been rough. On top of that, my facility is severely understaffed. Last week was rough - it required discharging every patient, and then re-evaluating them in the new system, while maintaining a patient caseload during this time also, and trying to bill and write notes on a system that requires a huge learning curve. It meant a lot of 10-11 hour days and a list of paperwork longer than I could ever hope to finish. It meant coffee and rushed lunch breaks and being in a daze and my eyes blurred from staring at a computer. I'm tired, and being a new grad, it's been hard to learn the ropes. I work in a very fast-paced skilled nursing facility, and the days are a rush. One of the down sides to a SNF is that management pushes getting your minutes a lot. Productivity expectations are also very high. This means that 80-85% of my day should be treating patients even if I have 2-3 hours worth of paperwork. I have to try to reconcile providing what I feel is good patient care with getting my paperwork done on time. I have to be clever with getting minutes because a lot of patients are agitated, cognitively impaired, feeling sick, or just plain don't want to do therapy on a given day.
I think that nursing homes get a bad rap sometimes, though, and for the wrong reasons. A lot of people shy away from working in this setting. You lose your manual skills. It's not challenging. Old people are too hard to work with. I've heard it all. And the honest to God truth is, it is hard. I am a very positive person, but I've left work in tears some days. I've felt so down it's hard to paste a smile on my face. I've left work at 8 pm somedays, tired and someone asks me to help them and I'll stop and help them because they need it. Residents need help and demand things of you even if they aren't your patient and I believe it your moral duty to help if you are able bodied. One of my patients today was really mean. "I think out of all the therapists here I hate you the most," she said. "You're so damn pushy. How much more of this f****** exercise do we have left." I walked out of her room and heard her turn to her roommate and say, "I hate her. She bugs me."
She has psychological deficits, but I still take it personally, even if she can't help it. The fact is, you get beat up verbally by a lot of patients in a lot of ways. This stems from the simple fact that you treat a lot of patients at their worst. You have meetings with family members who can't buck up and tell mom they don't ever want to take her home. You get yelled at and told to get out of patient's rooms. My job is not glamorous. I hold a doctorate but if a patient needs assistance with changing, I'll be the one to change that diaper or empty that catheter. I wear a white coat that gets stained with God who knows what kind of fluids. I listen to sadness and carry the weight of it in my heart sometimes, and it is heavy. Patients go in and out of the hospital. I've had more than a few suddenly pass, one day there, one day gone. Some are just very needy and suck your mental energy away. Sometimes you have to sit the patient walking across the dining hall with her pants down and help her dress again because she doesn't know better. I've been hit by a patient. Something I do appreciate is that I get to use a variety of my skills. Ortho - neuro - prosthetics/orthotics - vestibular/balance; I measure wheelchairs, prescribe cushions, coordinate with clinics for orthotics, see patients with spinal cord injuries, pulmonary and cardiac conditions, ortho injuries, various strokes, amputations, diabetes, cancer, etc. - and every patient's treatment is different. Some won't do outright exercise. They're bored or have dementia and you have to keep it interesting. Sometimes you have to trouble shoot how that patient with the L sided hemiplegia and fractured proximal humerus on the right arm with aphasia, a PEG tube, catheter, and oxygen is going to walk again. Hunt down nurses and report if a patient is doing poorly and always keep an eye out and catch patients from falling and always be on the lookout. I help make decisions on when patients can go home, determine if they can walk in their room safely, have difficult conversations with family, call doctors, hunt down CNA's. I have to be loud and affirmative and stand my ground. I have to have a lot of patience and act confident even when I'm unsure and still learning things myself. It's very rewarding though, when you have a breakthrough. When a patient looks at you and thanks you for how much better they feel. When they walk 100 feet and when you evaluated them they couldn't even stand. When they walk in the gym because they've come back to visit after discharging and they look amazing. Playing Johnny Mathis per patient request and helping a patient to dance. Learning lessons from their life stories. It's a really special setting and I love it, despite the fact that it can be very draining and difficult sometimes. Being a new physical therapist can be hard, but it's a very rewarding field, and I'm glad for the ways in which this profession is changing me for the better and teaching me new things.
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