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On my first ever clinical rotation, my Clinical Instructor assigned me to a patient who he claimed to be “very impatient and grumpy.” He handed me his folder and I looked up his history and learned he was admitted in the Acute Rehab Unit (ARU), had Open Reduction Internal Fixation on his right distal femur, left Below Knee Amputation (BKA), a known hypertensive and diabetic patient, hard of hearing, receiving dialysis and had renal pressure ulcer. This was not exactly the first experience I had hoped for.
My initial encounter with my patient was very challenging. He refused physical therapy because he reported a pain rate of 10/10 on assessment. After many failed attempt at persuading him to cooperate with me for treatment, he finally obliged. I managed to do as much therapy in just a few minutes. At the initial stage of rehabilitation, my patient could not ambulate more than 12 feet with a Rolling Walker (RW), he could only do 2 sit to stands before giving up due to pain in his right Lower Extremity (LE). He had difficulty avoiding obstacles during Wheel Chair (W/C) propulsion, a safety precaution for his left LE. Every therapy session with my patient was tough. Sometimes, he complained of excruciating pain at the left BKA and patellar tendon area which prevented him from walking. Also, I had no in-depth knowledge about prosthetics and amputations prior my encounter with my him, so I had to acquaint myself on management procedure. He had dialysis every MWF, and that meant I constantly had to don/doff socks depending on his pain level on his right LE when standing or ambulating.
About two weeks into rehabilitation, my patient was sent to a Skilled Nursing Facility (SNF) right next to his house. Before he left, he could perform sit to stands Min A with RW for steady balance and verbal cueing, and ambulate 65 feet X3 with RW. Wheel chair propulsion was 80 feet X 3 with standby assist for verbal cueing on sequencing. On his last day of therapy, he said to me, ” Vince, I want to thank you for all your hard work and always putting up with me when I was being difficult and didn’t want to try.” I felt really encouraged to know my persistence was acknowledged. We said our goodbyes and parted.
On the last day of my clinical rotation, I was told there was someone on the line who wanted to speak to me. So, I hurried over to the phone in the call room and to my surprise, it was the “impatient and grumpy” patient. He told me he had bad review about the hospital, B*****, that he hated the food, the service, and the nurses that attended to him, and that it was generally a bad experience for him. This pretty much explained his uncouth behavior on our first meeting. He was quick to add that the only thing good about his stay at B***** was the ARU. He then told me he was now walking Mod I with RW. I joked and asked him if he wasn’t running yet?!” He replied, “Not yet, but hopefully one day. I wanted to tell you good luck in your career and I hope somehow when you get a job, they send you to my house.”
I finished clinical rotation at B***** a few weeks ago feeling pretty confident and excited about my career choice. This first experience made me glad about my decision to be a PTA. I gave hope to someone who did not believe he could ambulate before leaving ARU. Even though ARU involves basic bed mobility, transfer training, gait training, and W/C propulsion e.t.c, I have come to understand how these basic functional mobilities play a huge role in patient rehabilitation.
I’m glad I get to help people with their difficulty in functional mobility and build their confidence. It is an amazing feeling knowing you have managed to impact and changed a persons mindset positively by showing care.
Here is a consented image of me(right), a colleague and and my patient.