Deja Vu

On my final fieldwork, I was helping a woman work on standing tolerance while doing her laundry in the teeny tiny rehab laundry room. This room was not large enough for Ms. C's extended width wheelchair, and barely wide enough for her walker. We had walked the 2 steps from the wheelchair and turned to face the laundry machine when Ms. C started saying "I'm gonna fall!" in an increasingly hysterical fashion. At this point, she could not or would not respond to instructions to turn to get closer to the wheelchair. All I could do was push her up against the wall and help her slide to the floor. After adjusting her legs, I was stuck in the back of the laundry room with her on the floor in front of me and her wheelchair in the doorway. I remained calm, managed to get attention of a passing nurse, and couldn't do much to help as a posse arrived to lift Ms. C back to her wheelchair. At this point, my supervisor walked by and ordered me outside for a break as my hands were visibly shaking.

I did recover, my supervisor empowered me, as did a PT coworker who had a similar incident with the same woman in the following week. But patient falls are never fun. Not only is there a heap of paperwork, but there's a personal 'second guessing' which can undermine your professional confidence. Even though there's factors in a fall that you might have been able to foresee or change in some way, usually, it's no one's fault. It's just hard to remember that at the time.

I hadn't had to think about Ms. C for awhile, since that incident was over a year ago. But there's always something that takes you back to those situations you'd rather forget. Last Friday, I was seeing Mrs. W for ADLs. She had been doing progressively well that week, and had even taken a shower the previous day, so I figured that we'd have no difficulty with a basin bath and walking to the sink to do grooming. We were doing fine at the sink, brushed teeth, brushed hair, and were ready to return to the bedside chair for the actual bathing/dressing activity. As we turn she cries, "I'm going down!" I couldn't get her to stand up any longer, and lowered her to the floor with the gait belt. She can't hold her torso up while sitting, so I sit down behind her to help prop her up. We get her roommate to use her call bell, and sit there on the floor having a very nice chat. Eventually, I get the attention of the nursing staff through the 4 inch opening left in the door and they help her back to her feet and to her chair. We did the rest of her bath, and though she was tired later in the day, she walked again w/ PT and didn't have any major problems. By Monday, however, she wasn't allowed out of bed and went into A-Fib from renal insufficiency. She was discharged upstairs to the cardiac telemetry floor. I felt pretty cruddy about that turn of events, but she is doing better now and will probably be back down to our SNF floor soon.

Of course, the worst part of Friday came later, when another patient lost control of the front wheels of her walker while I was helping her to the bathroom and almost fell. If I would have had 2 falls in one day when I hadn't had any for a year, I probably would have gone home early. Sheesh.