Monday @ Acute Rehab: This area of rehabilitation focuses on treatments from strokes, brain injuries, spinal cord injuries, amputations, neuromuscular disorders and orthopedic conditions. Which indeed I got to witness. First shadowing a physical therapist, we started by 'training' a woman with an amputated leg to move for and from her wheelchair, a man with a LVAD (Left Ventricle Assistant Device) use steps, a motorcyclist regain his balance after a stroke and played golf with another man who had a stroke. What was interesting though was that even though these last two patients both had had a stroke, one was impaired with his central and depth vision while the other in his speech (different effects depending on what areas of the brain were affected). I ended the day shadowing an occupational therapist who helped in daily activities like getting dressed.
Tuesday @ Brain Injury: This area was definitely my favorite rotation. I started with an occupational therapist who as I mentioned before is in charge of daily activities. Patients were required to write their schedule either in their binder or phone. We assisted in basic necessities with the patient as they prepared a quick coffee. I was also able to tag along as they walked a patient to Vons so he could buy his ingredients to make lasagna. Once back, I was able to participate in a group stimulation with all of the patients which focused on focusing. The patients were asked to focus on a card while moving their head in varies directions and balancing on unsteady objects. Even I had trouble! Later, I shadowed a speech therapist who together (with the patient of course) built a trivia game, but my favorite part was when I got to interact more with another patient as he described a picture while I attempted to draw it (that worked his speech ). Wednesday @ OP Neuro: Here, we only had outpatients (patients who don't stay in the hospital). I only shadowed physical therapists but since the patients weren't permanently in the hospital they were easier to have a conversation with since they were more alert. My highlight was a 96 year old male who was able to conquer all of his tasks and was firm on him not being old until four more years, once he was 100. Thursday @ OP Ortho: This site was not even in the hospital! It was across the street! OP Ortho is another outpatient department. I was with a hand therapist who surprisingly had a load of patients just with hand issues. Even more surprisingly, a lot of them had to do with scar issues which caused limited hand movement. They got to play with playdoh, rub their hands through rice and beans, and poke poles into holes. A hand therapist has to have their masters (6 years) plus 5 years of training on the job! That's 11 years before you can be an official hand therapist! If you truly are passionate, that won't matter! However, a hand therapist has to do more studying than other therapists because our hands are so complex! They are literally the ones who do everything! The student who was suppose to be in the ER was not able to go to her rotation because she went to go take a CPR class so I took her place. I shadowed a nurse. Nurses in the ER get up to 4 patients. We had one patient who apparently would constantly come to the ER due to some "pain" but in reality, she was addicted to the pain medication. Sometimes you just get crazy people, but everything else went normal.
Except when they called Code Blue (Medical Emergency/CPR). The ambulance was bringing in a 45 year old man who was spotted drowning by a lifeguard. Since they found him, he was given CPR nonstop. As he was wheeled in, they were still conducting CPR on top of him. The men nurses would take turns performing CPR and the patient kept spurting out yellow liquid which seemed to be composed of water, throw up, and sand. This CPR process went on for almost 5 whole minutes. The doctor then realized this was useless, he was dead. So everyone stopped and walked away. I was in complete shock. The guard looked at me and tried to make conversation but honestly I was in complete shock. My legs were wobbly and I didn't know if I wanted to cry or not. I somehow managed to go back to the nurse I was shadowing to tell her I needed a break. The guard walked with me to the lobby where I found another intern. She was so sweet and stayed by my side until our rotation was over. Honestly, this was such a crazy experience. 2 West is a department where they keep some more of the normal patients. They don't need critical care but they aren't ready to leave yet. I got to shadow nurses and CNAs (Certified Nursing Assistant). Each nurse gets a maximum of four patients and the CNAs get up to 10 patients. CNAs are the ones who do more of the cleaning. They help the patients dress, go to the bathroom, bathe them, groom them, and get the rooms ready. To become a CNA you only need about 3 months of schooling. I liked being with the CNA because I was able to interact more with the patients.
Also, I got a stethoscope! All 6 (even though 4 of us showed up) of us interns were able to go to the morgue, (where they keep the dead bodies) but there were no bodies currently there. We were also able to go see the helicopter landing area which had a stunning beach view. The Emergency Room isn't as chaotic as the movies claim, but it was my favorite. The first day I shadowed a resource nurse who pretty much just goes around assisting all the nurses. So we got to see a little of everything. Everything was calm and we spent most of the day discharging patients. We did go to a rapid response which was called due to a patient who had a fast heartbeat but with a shot, went back to normal.
The second day I got to shadow an ER Physician! Physicians in the ER usually get up to 10 patients that they have to check in on. He explained to me an x-ray of a foot that was broken, a cat scan that showed patches in a patient's brain that had been effected by a stroke (area was black), and an x-ray of a broken hip. The physician I got was incredibly sweet and explained so many things to me. He asked me to translate some basic stuff to a patient that had a limited understanding of English to Spanish. I also helped bring blankets and food to patients and even researched patient's family member's contact to be able to get a hold of them. The days in the ER went by incredibly fast. The surgery department was one of my favorites. Getting there, I had to change scrubs and put on a hair net, shoe covers, and goggles. They had a huge calendar that would show what each surgery room was going to do at what specific time with what specific staff. I was able to see:
Spine Surgery A uterus removal through the vagina (using scissors that would burn off the uterine tube) Another uterus removal where they slit open the abdomen Gallbladder removal Knee Replacement Scar Removal The environment in the ER was so mellow. The staff were cracking jokes and listening to some music on the radio. I was only in the surgery room for three days because I did not have a rotation in the Emergency Room so I switched with another intern so he could be in surgery and I could be in the ER. This week, I was in the Intensive Care Unit which is where they keep the sickest patients in the hospital.
Everyday at 8:30 they do rotations where the physician, pharmacist, respiratory therapist, social worker, and case manager goes around the department to each room where the nurse of each patients reports how the patient is doing. Family members can listen and ask questions to all the staff. The physician then determines what the next action plan should be in the care for the patient. Each nurse in the ICU gets a maximum of two patients. They are incharge of giving them medication and helping with their basic needs (rotating them, bathroom, explaining things to family). As an observer, the day went by slow since the patients spent most of the time sleeping (all the medication they get dozes them off) and I got to see only one maybe two patients a day. However, I was able to experience some neat stuff. I was able to listen, through a stethoscope, the stomach of a patient to make sure a medication went into the stomach and not into the lungs. I also got to see a heart ultrasound, a bladder ultrasound, and a blood vessel ultrasound to determine where the IV could be placed. Usually, nurses just feel around and place the IV but the ultrasound provides more of a precise visual. This week was also the first time we had an EAP (Employee Assistance Program) meeting. Our counselor will start meeting us interns on a weekly basis to make sure we are doing okay and have an opportunity to express our feelings. It's really nice to break down and be able to mention our most memorable moments whether good or bad. IT FINALLY HAPPENED! I was able to witness a birth! It was a c-section (caesarean section)! The whole cutting and removing took less than 5 minutes! The parents had waited to be surprised on the sex of the baby so when they took the baby out, the doctor pulled him up to his bellybutton and after some suspense, pulled him out to reveal that it was a boy! Such a healthy baby! This moment was one that I would definitely remember, such a beautiful moment. The father was in tears!
During the ICU patient reporting, a family member of a patient reported that it was best to remove the patient from the ventilator and let him rest in peace. It was devastating seeing the family members of the patient. This patient happened to be the same one I talked about two days ago before that was given CPR and revived a few times.
I was able to finally go into the NICU (Neonatal Intensive Care Unit) where they keep the babies! Still no births though. Other than that, today was an incredibly slow day. I realized it be a good time to talk about what a typical schedule looks like for me.
Leave house: 6:00 A.M. Dropped off: 7:00 A.M. Study SAT: 7-8:00 A.M. Check in @ Hub: 8:30 Then we (all 6 interns) walk over to the hospital together and branch off as soon as we get to our location. I'm the last one left since Respiratory Therapy is the farthest. All the interns are incredibly friendly and we've bonded so well! Leave Hospital: 2:00 P.M. Head over to dad's work: 2-3:00 P.M. From there I just work with him to get a little extra money over summer! That's what my day looks like and will look like for the rest of my internship. I'm excited to keep learning! Side Note: I found out today that I don't have a rotation in the ER! I'll somehow manage to sneak in a couple of times though. It is quite fascinating in there. Oh and code ADAM means someone was kidnapped or escaped which did happen today but it was just a patient who decided to walk out to smoke a cigarette. Second day was pretty exciting! (I'll leave that till the end.) I observed the ICU patient reports which is where all the RNs (Registered Nurses) give reports of their patients' symptoms to the whole crew that works in the ICU (only one doctor). I shadowed a different RCP but with her I did pretty much the same thing I did yesterday, check in on patients and observe the withdrawal of blood from their arteries.
As we went around the hospital, there was a blue code (Emergency/CPR) signal so we had to immediately go to the room to respond. RCPs have to respond to this since they're in charged of the breathing of a patient so it makes sense that they would go to a CPR where they need oxygen or just in an emergency. When we got there, we found out that the patient had fainted when they attempted to go to the bathroom. As soon as it was taken care of, we went back into checking in. Shortly, the same room reported a blue code twice but this time another RCP took care of it. Now for the good stuff... or should I say the not good stuff that brought some eye-opening insights There was nothing much to do so my mentor took me over to go check out the ER. As we passed through we noticed that in a room there was about 6 cops. Why? The patient had carjacked two cars and kidnapped someone. He had been tazed and was chained to the hospital bed. The patient kept tugging and turning trying to free himself. Not the sanest sight. Across the hall, a man had been taken to get a CT when he had a heart stroke. An intern in the ER and I both stood in the hall as we watched about 10 different employees (RNs, Doctors, RCPs) perform CPR. I've never seen a live CPR besides the one you do on a dummy to be come certified and boy did the chest compress! The patient practically died but was revived over three times. The RCP was manually giving him oxygen and the blood being coughed up was visible through the tube. The worst probably was seeing the family member's emotions... I am definitely excited to be able to spend my whole week in the ER. There are just so many things happening! Not two cases are ever the same! The first day is always exciting yet nerve-racking. We started with a tour of all our rotations we would have throughout the 5 weeks. As we talked to a Respiratory Care Practitioner (RCP) a bird flew right in between us; very nice greeting to start the internship. I shadowed an RCP (in Respiratory Therapy) around the whole hospital, back and forth, up and done, pretty much everywhere checking in on patients. From the rehabilitation, ER (Emergency Room), ICU (Intensive Care Unit), to patients who were ready to go back home.
However, respiratory therapy isn't just about doing quick check ups. I witnessed a patient being transferred to the ICU whose scope (tube connected to the ventilator) was going through his neck. And when it goes through the neck, it means the tube will be there permanently, for the rest of his life and since it goes through the vocal cord, he will not be able to talk. (If the scope had gone through his mouth/nose, he would only have the ventilator for a short period.) Another duty that RCPs have is to draw blood from the artery to check the patient's oxygen and carbon dioxide level. If the patient has a high dose of carbon dioxide, they will be knocked out. Oh and my mentor was cool enough to let me observe both the CT (Computer Tomography) and the MRT (Magnetic Resonance Tomography)! Without a doubt, I've learned a whole lot this day. One more thing, ABC stands for All Bed Crisis which means there are no more open spots available for patients. Even though today was considered to be a "slow day" I almost never got the chance to sit down! This first day was definitely a successful one and I'm excited to see what new things I'll learn down the road. Today was the day where this internship finally started to align. We were given our scrubs and badge! The orientation went smoothly, we received a binder with our roles, policies, some patient education, and resources with a journal to log our daily experiences. We learned what to expect and what not to do. Key quote that I was able to establish, "Hello, my name is Shany, a student intern and I am here to observe and support the positive environment here at Scripps." I am feeling confident and am stoked to start this internship on Monday!
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