I think a big part of it is motivation.  If I asked my friends to come to a tour of religious and architectural influences in modern day Madrid (which exist, by the way), I'm sure they would be total assists as well, on that day.  But ask them to come with me for a day of shopping and sushi, and they would probably reach their max heart rate racing to the car. 

I guess it's one of those things you learn to love about physical therapy, how every day can bring something new.   It's just difficult, not knowing what to expect, how to prepare for a day of treatments when I'm not sure what my patients will need.  But then again, life is the same way.  You have to expect the unexpected. 

While I think it is good to work with other disciplines and have another set of hands, this co-treatment business has been hard for me to adjust to.  First, the treatment styles of the OT and PT must be compatible.  Second, there seems to be more wasted time with this method... OT obviously needs to assess things that aren't necessarily important from a PT perspective. I guess I haven't gotten into a real rhythm yet. 

Even more than co-treating with OT, I also have a plethora of nurses, doctors and social workers in this hospital setting, which is very different from an OP PT clinic or a privately owned clinic; where mainly PTs rule the road. 

What do you think?  What's the best way to handle co-treatments, or working with other disciplines?

I was mentally preparing myself for my day; trying to remember all of the lines and monitors of the ICU, and reviewing the charts of my patients. 

I totally wasn't ready for my first patient of the day.  I walked into her room, which was completely dark.  She was awake on the bed, in obvious distress.  She said to me, "I can't do therapy today, because I have to pick a day to die."  This patient had been told by her care team that she wasn't going to get better.  Her medical treatments were ineffective and there wasn't much time left.  I had no idea what to do or say, and I felt like a completely insignificant speck.   I sat on her bed and did my best to console her, but I still left helpless when I walked out of the room.  In reality, I really was helpless, and this was just part of the circle. 

It's situations like that which remind me of how lucky I am, how futile my petty problems seem.  Later I asked my step-mom for some advice, who told me the best thing you can do is reply to the patient, "Do you want to talk about it?  What can I do to help?" 

My question for you is the same- What would you do in a situation like that? 

The woman walks in, very pleasant and cooperative.  I asked all the related social questions regarding living situation/job/hobbies and then started to ask her about her left shoulder.  She had three recent incisions on the superior aspect of her shoulder, resembling an arthroscopic procedure. 

"What kind of procedure did you have on your left shoulder?"

"I don't know."

This woman literally had no idea what she had done to her shoulder.  She recited words like ‘dislocation' and ‘bony spurs', but truthfully didn't know.  She was actively moving her arm around, was motivated to make progress with PT, but couldn't tell me anything else.   I spent the remainder of the evaluation time trying to get in contact with her physician, who reported she had a rotator cuff repair.

Obviously, my patient wasn't following post-op precautions or protecting her healing shoulder in any fashion.   Who's to blame?  Did the surgeon not emphasize the generic post-op protocol followed by most surgeons?  Was the patient absent minded?  I can't even begin to imagine the amount of damage done to those healing tissues; but what frustrates me more is the lack of accountability some of our patients have.  If you cannot tell me what procedure you had done, how will I know you are compliant with a HEP?  With work limitations?

Have you seen this before as a therapist?  What did you do? 

My exam didn't start until 5:30, and I really hadn't eaten anything all day because I was so nervous.  (This is typical for exams, but even more pronounced for this board exam.)  Then, each time you check into the exam or leave to go to the bathroom, you are photographed, fingerprinted and asked to sign your name- just a little more pressure added to the pressure cooker. 

The exam is 5.5 hours long, it took me a little more than 4 hours to take it.  I'll be the first to admit that I'm not a great test-taker.  I can talk myself out of or into any variety of answers.   However, I think the hardest part of this test was simply its length- staring at a computer screen for that long takes its toll. 

I wasn't sure if I wanted to know my results or not- I walked out of the exam feeling like such a failure.  There were a lot of difficult questions with no clear correct answer.  I was tired and hungry through most of the exam which made concentrating difficult.  I was fairly convinced that I would have to take the exam over, and I was embarrassed just thinking about explaining it to my family and my employer. 

As it turns out, I couldn't wait to see my results.  The next morning I logged onto the FSBPT website and paid $57 to get my individual score report.  I PASSED! 

I'm so nervous.  I've basically been studying for this exam for 3 years- every single class, every lecture had compounded into this one exam I need to become a licensed physical therapist.  Obviously, this is more nerve-wracking and more weighted than any ACT or SAT or final exam I've ever taken. 

Things I need to remember: BREATHE.  Take my time in reading the questions.  Don't rush.  Even the littlest details in the questions will lead me to the correct answer.   

I've heard that I can go onto the FSBPT website the following day after my exam and pay $60 to get my score.  There's part of me that wants to know if I passed or failed as soon as possible, there is part of me that probably wants to postpone any chance of getting bad news.

Either way, you can probably bet I will be feeling both relieved and incredibly frustrated tomorrow night.  And, if you are reading this on Thursday, June 25^th, just send some good thoughts my way. 

1. Student loan payment;
2. Buy massive amounts of groceries;
3. Go to a Brewer's game;
4. Buy some work clothes!
5. Turn the lights on in my apartment, because I have money to pay my electric bill;
6. Pay someone to take my board exam for me;
7. Renew my APTA membership;
8. Go on vacation. I need one;
9. I think my stuff would look better in a Louis Vuitton purse;
10. Buy a house.

On the same note I also have benefits!!

1. I need a dental clean up;
2. New contact lenses would be bliss;
3. Start investing to my retirement fund.

I also bought a lottery ticket... tonight the numbers are revealed.  What would you do with a paycheck, or a lottery ticket? 

As a health care provider, I agree that changes need to be made.  Being forthright with our patients is key- transparency of costs, knowledge of available options, and determining the best provider based on outcomes measures. 

The beauty of the United States is the free-will and constitutional right every citizen has to make individual decisions.  By putting requirements such as forcing citizens to carry health insurance, or a government-based health care system, we are taking away a small part of our rights as American citizens. 

If everyone has health insurance, what's the point?  A MRI scan should cost the same regardless of the person, regardless if they are in-network or out-of-network.  Common sense. 

For the average person, health insurance companies are complicated and difficult to work with.  Finding answers to questions nearly requires persistence in knowing which questions to ask and who to ask them to.   Simplifying this process should be a priority. 

It will be interesting to see how this all unfolds.  I'm glad I don't have the job of finding a solution that will work for an entire country. 

I learned today that it is NOT an ideal way for a new grad to begin. 

First, there is no consistency of patient caseload.  I'm picking up odds and ends of other therapists.  (What this also implies is that my patients aren't receiving very consistent care--a separate topic to discuss.)  And, since I'm not in the same clinic each day, it's not like I am at least familiar with who the patients are and have a general idea of their plan of care.  And, since I'm not in the same clinic consistently, I don't know my coworkers that well.

I arrive to work in the morning and try to read up on as many patients as I can, but when my patients are back to back, I have 4 evaluations each day.... I don't have time to read all the notes of each patient--just the eval and most recent treatment note, if I'm lucky. There is a lot of stuff in between those two notes that happens, but I don't have time to read up on all of it.

In conclusion, I would never recommend a floating PT position to a new grad. Ever. 

Monday I begin with orientation at ProHealth Care, the hospital I will be working at for the next year. I'm excited to learn about everything I will have access to, all the opportunities I will have. I am really looking forward to working, to contributing to the physical therapy world. 

I've had a giant sense of relief the past week, knowing that I am done with school and my whole life in front of me.  I can't believe I'll have my nights and weekends free!  No obligations to flip through my notebooks, make note cards, or practice my skills on an unassuming bystander. 

Here are two quotes I find very fitting for this stage in my life. 

Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness that most frightens us.  We ask ourselves, "Who am I to be brilliant, gorgeous, talented, fabulous?"  Actually, who are you not to be?  You are a child of God. Your playing small does not serve the world. There is nothing enlightened about shrinking so that other people won't feel insecure around you.  We are all meant to shine, as children do. We were born to make manifest the glory of God that is within us.  It is not just in some of us; it is in everyone. And as we let our own light shine, we unconsciously give other people permission to do the same.  As we are liberated from our own fear, our presence automatically liberates others. 

~Marianne Williamson, A Return to Love: Reflections on the Principles of "A Course in Miracles," 1992 (commonly misattributed to Nelson Mandela, 1994 inauguration speech)

You have brains in your head.
You have feet in your shoes.
You can steer yourself in any direction you choose.
You're on your own.
And you know what you know.
You are the guy who'll decide where to go.

~Dr. Seuss

I'm hoping I can take my board exam the second week of June. If that's the case, I will have three weeks to study beforehand. That way I can set up a calendar and focus on different areas each day until the test comes. 

I picked up my cap and gown at our school union today. I hung it up in my closet and I'm going to stare at it for the next four days until graduation. I can't believe I'm graduating. 

Meanwhile, I had a chance to meet Allie, the PT I will be working with in the research lab at Marquette as part of the neurological residency program.  It was interesting to see how many opportunities I will have during this residency--working with neuro patients and some very nice lab equipment.  

Finally, I got to see my weekly schedule during the residency program; working at the clinic 30 hours a week, research five hours a week, TA in Neuro Rehab four hours a week, and one afternoon set aside for preparation time and other learning opportunities as they arise. 

Next week I have a boards review course at school for two days, and then a "mock exam" our school administers.  I haven't taken a standardized test since the ACT, so I really need to get into the swing of taking an exam like that.  You know, time management, etc.

Next week I will also be meeting a few of the people I will be doing research with as part of the residency program- I think the research is aimed at interventions for patients with strokes, but I could be wrong.  Either way, I will have some research experience throughout next year. 

I am still in disbelief that I'm graduating.  Six years later, wow. 

As I write this blog, I am kind of amazed at how much has happened in the last two months since I arrived in Phoenix. As far as physical therapy goes, I have met and worked with some amazing patients, learned a lot from my CI and had some memorable moments with my coworkers. Personally, I met people in Arizona who have blessed my heart.  

It is going to be very weird adjusting to having a real job. I don't know how to explain it, but thinking about "asking off" for vacation, or being responsible to go to staff meetings and in-services just seems so very grown-up. 

But for now, I need to finish packing and listen to some good music as I get ready for the long drive home. 

(I know a lot of these things sound ridiculously cliché, but trust me in that they are all genuine.) 

• Late nights studying
• Early mornings studying
• Midafternoon studying
• Practicing techniques on my classmates
• Laughing and laughing with my classmates
• Great professors
• Even better friends
• Typing countless study guides
• Watching patients conquer the impossible
• Learning that the best parts of being a PT can't be taught in a classroom
• Meeting great people, great therapists on each of my clinicals

And, for the record, I'll warn you that my next few posts may be a little emotional or sappy or something.  It's not really my style.  But, a lot has happened over the past six years, and I cannot believe it is finally coming to an end.