Saturday, April 28, 2007

Funny Hospital Story

Add this one to the books...

Here at the hospital, I'm on the "Surgery Team," so I see patients on any services where surgery is provided--transplant, abdominal, trauma, ortho, plastics, general, women's, etc--all except for neurosurgery, oncology, cardiac, and pediatric surgery.

One of my patients this past week was on the trauma service--after a bicycle crash she had lots of different injuries. One day this past week, I went into her room for a treatment session and found her gradually slipping down in her recliner. So I brought the recliner up to upright and helped her bring her trunk forward so that I could help her with a "hips backward in the chair" trick. Well, I really had to help her--we call it "max-assist" in PT lingo--, she couldn't help out that much because of her injuries, she wasn't really "all there" anyway, and the brakes on the recliner were not all that stellar.
NO, ...I didn't drop her!!
But we didn't achieve very much "hips backward," either, cause the chair was moving back with us.
Suddenly (dun, dun, dun, ...the plot thickens) a gentleman in scrubs, complete with cloth hat, walked in, said, "how's it goin'," then proceeded to ask my patient a few "mental status" questions. Which means, he asked her where she was, why she was here, what year it was, etc. After she tried to answer, I introduced myself and identified myself with PT, hoping he would also introduce himself. He didn't, but asked what we were working on, and whether I needed help.
Bingo... just what I needed. "Well, right now, we're just trying to get her hips back farther in the chair. Yeah...actually, would you hold the chair? It keeps moving," I said, glad that this would actually work now.
After a successful shift was accomplished, he started to leave. Determined to find out who he was, I said quickly, "And you are...?"
"John Ufmerk*," was all he replied.
"Oh, okay. Well, thanks for your help," I said. I had no idea who that was, I asked my clinical instructor later. "He said his name was Something-Oferk? or -Omferd?" I tried to remember.
She told me she had no idea who who that would be, and I assured her that I only had him hold the chair for me (anybody with two arms and two legs can do that, and at least he had scrubs on!). I told her I thought he was maybe a Neurology resident or something, because he asked my patient mental status questions. Very convincing, I know--everyone in the hospital asks those questions to patients!

A few days later, I went back to the step-down unit, and discovered that an MRI finally came back positive, that this woman had a subarachnoid hemorrhage, and that she'd been switched to the Neurology service.
I saw her chart, and there was her name on it with the name of her new attending physician: DOE,J / UFMERK
"Oh!!" I immediately thought to myself. "Ufmerk! That's what that guy was saying!" It also made sense that I hadn't known who he was, because he was an attending physician on another service in the hospital.

Only later did it hit me that I asked --not some intern or some random resident, not even a senior resident, no,... I asked-- the Chief of Neurosurgery for the hospital to "hold the chair" ...while this little student physical therapist does her "hips back in the chair" trick with a patient!!

The humor of this makes more sense --and is funnier-- if you are familiar with the hierarchy that exists among M.D.s in the hospital setting. Roughly, it goes like this, from lowest to highest:

1st, 2nd, and 3rd -year medical students (MS1, MS2, MS3)
Interns - this is where real clinical responsibility for real patients begins
Residents, numbered according to post-grad year (PGY1, PGY2, etc, ...up to even PGY6).
Attendings, who have the final say, and are responsible for the actions of all the residents and interns under them.

So there are not many attending physicians on each service--you can usually count them on one hand. Each of the attending physicians has plenty of residents working under them, and then a few interns. And the residents and interns all rotate on a regular basis. Here, all the interns rotate every four weeks, and the residents every few months.

The physical therapists usually communicate all of their needs for their patients to the interns, and naturally, the interns get a lot of pressure from above, as well. It's a high learning curve for them, since they're only on each service about 4 weeks. So in dealing with the interns, I've learned to respect the amount of stress they're under, and to try only to ask them for things that I really need.

I'm not hearing the end of this situation, though, from my CI.... She loves it: "Hey! Maybe you can get him to wash your car for you this weekend!"
"How about for this next week, we make it a goal that you boss around a few more Attendings..."

Can I just say that this truly is a teaching hospital, where the Attendings will stop and discuss patients with you, explain things to you, and even help you out (case in point here!). I'm so excited that I have a job here after I graduate in May!

*name has been changed

Friday, April 13, 2007

Grateful to be a PT

Before I left the hospital today, I checked up on one of my patients that I noticed had been transferred to the Medical ICU. I found his chart outside his room, and was looking through it to try to figure out what had happened to send him there.
While standing there, 2 residents coming from different directions stopped in the hallway almost next to me.

And this is what I overheard:
Resident Guy: What's this?
Resident Gal: Mr. [So and So]'s blood gases. ...
(silence as they solemnly review them together)
Then followed some unintelligible conversation, partly because I was doing my own thing, partly because I didn't see what they were talking about. Basically, they were discussing what they might do next.

Attending Physician (or Senior Resident, who knows which Big Shot) approaches.
Big Shot: What are you guys thinking about over here? ...looks at the paper they're examining. Who is this?
Resident Gal: Mr. [So and So]. I guess we have to [insert unintelligible phrase here]
Resident Guy leaves

Resident Gal, confiding to the Big Shot: I just hate it. I hate my job with him. I'm just basically slowly, ...slowly, ...
Big Shot: ...slowly letting him die?
Resident 2: Yes! And it's just awful. I feel so helpless.
Big Shot (sympathetic): It's a tough job. But it is your job. And you're doing really well. Sometimes the job is to let them die.

They slowly begin to walk away. I think Resident Gal noticed my thoughtful glance in her direction, because she quickly added, "Not this patient (referring to the guy whose chart I was holding), in case you were wondering!"

Grateful that "letting someone die" is not in the direct job description of a PT, I finished reading the chart, closed my binder for the week and headed home.