A woman, crabby, was stuck with an extended stay at the hospital after developing a condition called ileus, a very unfortunate side-effect of her surgery. Her back hurts from her back surgery. Her abdomen is distended and hard and nothing in there is working right. Now, I come ask her to get up and walk with me. Every time she moves she poops, involuntarily (ileus, again). Rolling over: Poop. Sitting up: Poop. Standing up. Walking. Yep.
So, though I help her clean up (I’m getting good at this, not that I really wanted to), she is mad at the world. I’m the representative of the moment.
She asks me: “How long have you been doing this [job]?” And in response to my answer: “Yeah. I figured. I could tell you were new.”
Then:
“You had garlic for dinner last night, didn’t you? I can tell.” I just laughed and said I did and it was really good and that I figured it was my coffee breath that would have knocked her over so I was glad she told me.
It was no secret how she felt that day.
I made her laugh by the end (dumb joke collector, me), and I heard her tenderly tell her daughter on the phone that she loved her, and she walked and moved well even though she complained the whole time and she’s lucky she was strong before this because if you are not, it is even harder.
Hospital stays will take your energy and motivation. And mess (ha) with your ability to poop right.
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Young man (boy) with two head injuries in a row. When I first saw him, lying still in his bed, it looked like a makeup artist had been working to creating an alien head on his body – an enlarged cranium – but stopped halfway. The swollen half of his head pushed his eye out to the side with great pressure from inside. Bone had been removed from his skull to allow his brain to swell safely.
On my most recent visit, he looked different; the swelling is gone. He now looks like a Halloween pumpkin that has caved in on one side. His eye is partly obscured, now, dragged inward. The bone they removed is waiting for him; it will be put back on eventually, once all the pressures have stabilized.
Both times I saw him, he didn’t respond much. He opens his eyes, yawns, occasionally grimaces. He cannot follow commands. He does not speak. He’s so delicate, and wasting. Childlike.
Except that last day, he was blinking in code. Twice for yes.
His mom came in, and opened an over-sized Christmas card that her son, lying there, had once given her. His voice recorded inside. A deep, manly voice says “I love you, Mom.” She plays it again for everyone who enters.
—–
I met a woman who is in the States from another country; here visiting family. While here, she starts having back pain that moves into her leg after a few weeks. It gets so bad, she goes to the emergency room.
She doesn’t speak English.
When I see her, she is just moving out of bed for the first time in a few days. She has had multiple diagnostic tests and a surgery because it turns out the back pain was because one of her vertebrae had collapsed: Cancer has destroyed it and gotten into other parts of her spinal column. It is also in her thigh.
It may also be in another organ – that was an “incidental finding” on on one of her diagnostic tests.
She has to wear a special brace, made just for her, anytime she’s not lying flat. The brace must be cinched tight for protection of her delicately healing spine when she moves. Turns out, when they checked the success of the surgery with a plain film (X-ray), it showed she also has a broken rib. Cinching that brace tight makes it hard to breathe.
I learned how to say “breathe deeply and slowly” (respira profundamente, despacio). I am glad I’m good at talking with my hands.
—–
This patient is scared. He knew he was in the hospital, knew he was having problems, but he didn’t know why and he couldn’t express himself. He could understand most things, but couldn’t get sensical words out, because sometime in his past he’s had a stroke affecting that part of his brain. He also gets hung up on something, perseverating, asking urgently, “Why? Why? Why?” or repeating something over and over (perhaps the stroke’s fault, too).
Then, we’d have some more typical back and forth type conversation in whatever way that we could. Unencrypt, decipher, combine choice words and other cues that made sense to him.
He’s young, maybe in his thirties. Our whole therapy goal was to get him safely sitting on the edge of the bed to try to work on his balance. Just to sit on the edge of the bed, helping him figure out how to contribute to keeping his own balance. The less he moved the more stiff he was the more painful he was the less he wanted to move.
He was also scared. The stroke may have affected that part of his brain, too, but he was scared to move, because he was also weak and so very, very stiff. It was almost like trying to get a tree branch to bend. He would alternately try to do it and then resist hard. He’d roll onto his side and start to push up, and then grab the railing and pull back down. Two of us could not encourage or support him through it this day. In his garbled way: “Sorry! Tomorrow tomorrow tomorrow! Promise!”
He was trying. He was a jumble of scared, confused, pain.
The next day when I heard the “Code Blue, Room ___” announcement, I realized it was his room. He was resuscitated, but his very difficult journey continues.
——
My new best buddy is the guy who said, “Yes! I know you are the PT. I can tell because you are in shape.” Doesn’t matter that he was just really happy to show off his medical knowledge and talk to someone, anyone, so he was trying to impress me so I’d stay. Works for me.
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Acronyms and Abbreviations. Argh.
I have always preferred to use the full names for things rather than shortening them. I am too sensitive; afraid of leaving someone out of a conversation. Just in case there is someone out there who may not know what LOL or “natch” means, or where “Willy Street” is.
(Truth be told, that person is usually me.)
Medical terminology and documentation is full of them. Abbreviations and acronyms. You think there would be standardization, but not so much. We have an approved list of abbreviations at the hospital. Many of those I learned as standard are not on the list.
I mean, “Stat” means “RIGHT NOW!” in most places, and “ROM” means “range of motion” almost everywhere.
But there are multiple ways to say the same thing. For example the leg wraps they put on you in the hospital that cyclically inflate and deflate to keep you from getting a blood clot? They can be called Venodynes, or intermittent compression devices or sequential compression devices or other things. We use “SCD”.
When I was first documenting I wrote that the patient was wearing SPDs. Clicked “submit”.
Smiled at how awesomely I’d written that note. So very pleased with myself.
My supervisor, reviewing my draft: ” What are SPDs?”
Oh yeah. Bike pedals. SPD’s are bike pedals.
—–
In praise of electronic medical records: Doctors’ handwriting really is that bad. That alone is reason to embrace electronic documentation. No more deciphering.
0.000000
0.000000
Barely Sitting Still 