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28 April 2012

Feel Too Much....

I was informed this week that I care too much about my patients. How do you respond to that?  I will admit that I go above and beyond what is required --- but for my own mental well being I will tack an extra 30min to the end of my day to be able to help out the patients and their families. 

Apparently I shouldn't talk to doctors or nurse practioners about my patients status changes.  I shouldn't allow physicians to observe my sessions (even when it is in no way affecting my treatment).  I should take coverage for my kids ---- but not get to choose which child or when.  I should allow a stranger to treat my teen with TBI on the same day that her mom won't be there all day because her brother is having brain surgery at the hospital a couple of blocks away.  I draw the line.  It is hard. It is fast.  I will not cross it.  These kids have enough to bear on a normal day.  Add on additional family trials and what these kids can really use is consistency.  When I can't do it.... that's one thing.  But when you want me to choose to not do it because it would be more convenient.  I think not.  I treat each child the way I would want my child treated.  I treat each family the way I would want my family to be treated.  Because of that ---- I have great relationships to with both patients and their families.  For kids and parents --- that can make all the difference in the world.  

I will never be someone who leaves early on a regular basis.  I will always be the girl who arrives early, helps the nurses, discusses concerns and ideas with other team members, and is willing to help in any way that I can.  It's who I am. It's who I've always been.  I take care of those I love....

21 April 2012

Compromise.... Negotiate?

I get it - Life often requires compromise or negotiation.  If I have a kid who doesn't want to sit on the disk but will sit on a large exercise ball --- do I fight him?  Do I demand he sit on the disk?  Why?  Sitting on the ball will accomplish the same goal.  One kid likes hockey another likes bowling... either works for me as long as we are in high kneeling working on motor control and strength.  Yet to some people this is me being pushed around or having no backbone.  Interesting.

I learned a long time ago that when dealing with children there is one requirement and then you expect the unexpected.  That one requirement? FLEXIBILITY.  It pains me each day to have details of my treatment plan analyzed, terrorized, and criticized.  Kids are not the same as adults and for those of you who think so --- you obviously have not worked with a lot of kids.  Last summer I would plan  each treatment in my head --- it looked something like this:

  1. moist hot pack
  2. stretching
  3. pendulums (10x2)
  4. wall crawls (10x2)
  5. isometrics in doorway 
  6. pully (15x2)
  7. ER/IR with theraband (15x1)
  8. AROM with bar (10x1)
  9. PROM with manual assist
For an adult -- this works ---they will go in each day and do what you ask just how you ask it.  Some get annoyed when things change.  The flexibility required is in progressing the patient --- whether in pushing AROM more, increasing weight, progressing an exercise.  You progress and they do it.

With kids --- It's different.  Each day finds the child wanting to play something different.  Oh there are some things that remain constant -- like my little man's love of hockey or my little girl's love of anything with princesses.  But everything is fluid.  The plans I'm required to give sound something like this:
  1. supine stretching of knee flexors (15sec x3 B) <-- I won't even go there...
  2. sitting on yellow egg for 8min working on sitting balance, equilibrium responses, and sitting posture.
  3. high kneel at high mat working on puzzles for 8min with assist for anterior pelvic tilt to work on posture, endurance, and strength of hip region
  4. Skin Check
  5. Don BAFOs
  6. standing at high mat with Sponge Bob connect four 10min with assist for ant pelvic tilt and knee ext to work on standing posture, endurance, and strength.
  7. Ambulation --- walking with pacer with BAFOs 100'x2.  Will require min-mod A at BLEs and modVCs for flat foot during stance and knee extension.
  8. Either doff BAFOs and skin check or advise parents of AFO schedule and check back later.
Stupid--- you know why?  Because I know why I am doing the things and because today she wants to sit on the giant purple therapy ball and paint by number.  She no longer wants to be a doctor and play operation she wants to play ant in your pants.  Sponge Bob Connect Four is being used by another child and standing today  requires more assist at the knees and no assist at the pelvis.  After 80'x1 pt is complaining that her feet are killing her and AFOs are removed and skin check performed.  We are now going back to paint more while we wait on the redness to subside and calm my crying patient.  This is what I do every day.  SO... In my head it is like this:
  1. Stretch
  2. Sitting Balance - egg'ish
  3. High Kneel with activity
  4. Standing with activity
  5. Walking
So much easier......

This week is an interesting negotiation.  I finally have my darlin' girl out of bed and walking but it's a struggle after being in bed for so long.  It's exhausting, it's painful, and mentally taxing.  And so.... the negotiation comes into play.  She works really hard this week and we really push it to make as many gains as possible and....... She gets to give me a makeover and make up lessons at the end of the week. Part of the negotiation is that I go out for drinks or dinner after work with my make up intact.  This could be interesting.  She tends toward the blue or purple hair, roller derby side of things..... but apparently is a whiz with eye make up.  I don't have much room to complain.  When I do my make up (yes - i do it---- approx 2x/year :) )  It either looks like I have nothing on or I appear to have two black eyes.  So we'll see how this goes.

I love what I do.  I wish I could start studying now for my boards and graduate soon so I can find a inpatient pedi (pediatric) job.  It is exhausting.  It is emotionally taxing on the best days and the worst.  But it's what I know I am meant to do.

This week a doctor said this "You have an amazing way with children.  I came into children through medicine and I love them.  But it is obvious that you came into medicine with an amazing love for children.  I'm look forward to learning a lot from you during your time here."  She now observes some of my sessions and asks me questions on dealing with kids.  I am a true believer that everyone has something to teach.  The student learns from the teacher and the teacher learns from the student.... as long as all involved are willing participants.

16 April 2012

Today one of my kiddos urged me to take my hair down from my ponytail.  The request was then to touch it and she declared  "oh... it's soft."  She was quick to tell me I should keep wearing it down and not put it back up.  There were a lot of reasons I could give for having my hair up... 
  1. One of my other kids is combative and pulls hair if she can get it
  2. It was put up when wet so there will be a funny "ponytail lump" if I keep it down
  3. It needs to be cut and it's rather obnoxious.
  4. The odd weather is making the baby hairs curly and frizzy.
  5. etc....
All of these reasons are true ---How many times have you kept your hair up for one or more of these reasons... but allow me to add in a tiny bit of insight into the situation.  My teenage kiddo with the request has no hair peach fuzz for hair.  She has a giant scar covering her scalp.  Every day is a struggle for her and the little tiny things most people take for granted are the most important.  And so as my girly talked to me about what it will be like with her upcoming brain surgery and their need to shave her head..... I very willingly wore my hair down the rest of the day and allowed her to touch to her liking.

I have been willing to try different hairstyles over the years ---- some very short and some very long.  It was all with the knowledge that it is hair and it will grow back.  As I watch multiple people close to me lose their hair to cancer treatments, brain surgeries, etc.... I am reminded how much hair matters... especially as a female.    You may not be overly concerned about your hair --- but there is something about you --- something that is "you" that you don't want to lose...... Imagine the struggle.... Imagine the heartache..... Now appreciate the fact that you not only have it --- but you don't have to give it up.

I have seen lots of brave kids the last 6 weeks. This kiddo is one of the bravest.  She started out hitting me and now we laugh each day.  I've learned a lot ---- and I've been reminded of values that my family has always held dear.  It's a wonderful time to be alive.
I am almost finished with school... (insert excitations here).  I've made it through the majority of my schooling and have just one semester left of class.  This last semester was a rough one --- We had a full semester of classes but in half of the time.  Add in the 3 days I was out with the NoroVirus and the 1.5-2wks  I was out with Shingles and life became hectic and a bit overwhelming.  However... a surprise ---  This semester resulted in my best grades.  One of my favorite quotes from the semester "Now Christa - I know this semester you got really sick and you ended up with really good grades..... but let's not use this as an educational strategy from now on."  I am in agreement. 

And so to now --- I am currently doing a 10 week full time clinical at Spaulding Rehabilitation Hospital (SRH). It's inpatient acute rehab.   I'm on the pediatric floor and loving it.  My kiddos range from 2mos old up to 21 years.  Some of the diagnoses I've treated include: Central Cord Syndrome (infant), s/p Selective Dorsal Rhizotomy (kids with cerebral palsy (CP)), TBI, failure to thrive, hypernaturemia, DeBarsy Syndrome, s/p tendon lengthening and osteotomies, various neurological changes (without a cause), brain tumors, brain injury from gunshot, brain injury due to falls from windows, neuro injury from surgery mistakes, overall delays, and the list goes on and on....  I love my kids.  They make each day for me a day worth working.  I look forward to working with them each day no matter their mood.  

Below is an example of what each day looks like with my kiddos.  Whether it is something funny said or a child who hasn't spoken in 3 months who places my hands in a prayer position --- babbles a little ---- and then says very clearly "AMEN"...  I love each one and it is hard to see them struggle.

One of my kiddos today asked me an interesting question... "Do you have a mommy on earth or in heaven?" I replied "I have a Mama on Earth in a land far far away called North Carolina." to which the child replied "She must be really pretty... because you are nice.. and my daddy says that nice people are some of the prettiest people..... She's pretty isn't she?" My reply..... "Yes she is --- inside and out.... and one of the nicest people you could ever meet.... She has a special place in her heart for little girls. She would love you." My kiddo's reply... "Your mommy sounds really nice Doctor Christa." and a giant hug with a little head on my shoulder.

Did I mention that I LOVE what I do?