first day back

First day back... first day on the surgery floor.

It's hard returning from vacay anyway, but trying to get a feel for a brand new floor at the same time is double hard. Added into that is a factor I had not previously considered- July 1 marked the transition from classroom medical students to residents. So not only do I not know the ropes, but the people who are writing the orders don't know the ropes either. I didn't realize when I accepted a job at a teaching hospital that part of my job would be teaching doctors. But we are all teachers, and we are all students...

I had a sad realization today when I realized that a PT student who was present before I left must have completed her rotation. Already in just three months there have been 3 different OT/PT students in the office that have come and gone, I've had minimal contact with any of them. I've never had my own fieldwork student yet since I hadn't been licensed long enough to take one at my previous job and now at my current job they have a (needed and appreciated) requirement that you have to work a year in the facility before taking a student. I have had several job-shadows before, but it's different, being that they were all just for a few hours and all high school students except for one pre-OT.

Anyway, first day was a comedy of errors and minor misfortunes. First eval of the new rotation, a (thank goodness) cotreat w/ PT was of a gentleman who was quite agitated and upset, who basically tried to run down the hallway away from us and was working very hard at pulling out his IV and chest tube. He later left AMA, though he did allow someone to remove the tube properly before running off. Second guy kept having low O2 sats and no rebound despite cranking up the oxygen. Saw a lady before lunch who was quite limited in cognitive and physical abilities. Mod assist for feeding, Max assist for grooming. Nice though, and later walking by I saw her son, which was crucial since no one has been able to get ahold of family members. So I had to go on a mad dash to find the MD and case manager so that discharge plans could be made, but that actually worked out well.

Last guy, I had tried to see multiple times throughout the day to no avail. Half started an eval twice and had to leave for different reasons. Finally came back to finish it following a wound vac replacement, at which time the new docs announce that he has to go to the OR tomorrow for surgery. I say, what are you doing? and the response is "we don't know yet." It apparently will start as a wound debridement and then based on the amount of muscle loss and damage to the fascia may have to be an ampuation of his leg. Which is, of course, majorly distressing for him and effectively renders my evaluation useless, since he will need new orders and a reassessment once he's medically stable following the procedure. Pretty impossible to make reasonable goals or discharge plan when you don't even know the impairments yet.

Hopefully it'll get a little easier tomorrow.

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