My Mrs. B is off to acute rehab. Despite the PTA's view that "it won't make any difference," I think that she is capable of great recovery. This week, she was able to don her bra independently using a clothespin to hold it to her pants, participate in the modified pilates for neuromuscular reeducation, and complete a shower with more ease. We did the resistive clothespins on her second to last day, and she was able to independently seek and manipulate all but the hardest pins, a drastic improvement from Day 1 (which I did get to see). I got to say goodbye and give her a hug, and she was so appreciative of me... it was so sad because I formed a strong bond with this strong lady. In retrospect, she reminds me very much of a patient I worked very closely with at the end of my rehab fieldwork- Mrs. S. They are different in diagnosis (Mrs. S had a FOOSH which resulted in a R wrist ORIF and R hip replacement) but both have a great drive to get better. Even though the healing takes longer, since they were both in their 80s, I believe that they both did quite well with rehab, and do miss their special personalities. Thinking about it also makes me wish I was back in the intensive rehab world again, and makes me worry about whether I have the chops for that anyway.
Sadly enough, as my dad would say there's always an object lesson. Mrs B was the patient who alerted me to how my changed pediatric schedule and personal focus has affected the inpatient environment. I was able to work with her less often than I wanted due to my peds schedule and the responsibilities that come when working on a small staff. I was only in inpatient all day 2 out of my 4 workdays, and one of those was often spent entrenched in acute care evaluations. Not only was I working less w/ Mrs B, I was also working less with the patients down "my" hallway. The division of hallways was setup about a year ago, and obviously is still in play, though my peds schedule has had a strange effect on it. Since I was not around to constantly direct care for "my" patients, they got fewer ADLs and less personalized care from the rest of the staff. I found weekly updates hard to complete, and little attention was paid to the altered treatment plans.
I feel terrible about the decreased level of care that I feel these people have gotten, but it's hard to understand how others' complacency let it get to this point. I will have to spend the next month (until school starts) advocating louder for their needs and paying greater attention to their treatments and developments, even if I never get to see them. Who knows what effect the school year schedule will have... I've been adding kids left and right since June and will have to make spots available somewhere, while still carrying a full hospital caseload.
I hope I can get all this worked out... I am trying to worry about it less so that I have more mental peace. But good luck Mrs B- may those at the county rehab recognize your special light and help you achieve all that is possible.
I used too many abbreviations today, here are some explanations if you're unfamiliar with any of them: PTA- physical therapy assistant; FOOSH- fall on outstretched hand; ORIF- open reduction internal fixation operation.