Saturday, December 26, 2015

Courage, not

How do I know anything of enough value to speak up on it?

I went back to school at age 35 after stints in the Merchant Marine and General Engineering contracting and took approximately 4 years of schooling. I graduated summa cum laude with a physical therapy assistant license from a junior college.  Like most careers it took about 5 years of on the job training to become experienced. However, if I switched to a new discipline like Spinal Cord as compared to Acute Inpatient I would not know as much as someone right of school who had spent 6 months on that service.

Patients can tell quickly by hundreds of clues which therapists had experience with their injury type and who did not. An easy give away is how much pain was caused.  As a therapist working with spinal cord injuries one of the hardest task was to maintain a patient's range of motion in their joints while minimizing unnecessary pain.  I spent around 4 years on on the Spinal Cord Injury service but I was never once satisfied with my technique. Several times I lost the battle of maintaining ROM.  At the time, most patients after the initial injury would be put on the rotating bed to prevent pressure sores. They would sometimes wait of upwards to a month for the spinal cord cervical fusion operation. They were almost always in a cervical halo unable to move their bodies and in significant pain in the regions that they had sensation. Many times their shoulder joints would be the most problematic and that was the area I had to put the most attention. Even with premedication for pain, I frequently felt more like a torturer than a benefactor. The most discouraging experiences I had as a PT assistant was to watch a patient lose range in their shoulder's daily while suffering under my hands.

I did learn and improve my technique over time but that learning was mostly an internal sense of what would would work and not work with that individual. Sometimes the most obvious beneficial thing I could do was to ask for help from other members of the team. Heterotopic ossification is big problem with spinal cord patients. It would greatly increase pain if present during ROM plus limit motion. Often therapists would be the first one to 'feel' the problem. For the most part experience was learned on the job with trying to distinguish what worked, what didn't and why not. That was true in all three careers that I had. Because I did not know something it was often useful to ask but the self search for an answer was in a sense the 'truer knowledge'. It was not mine for good or bad until I experienced the trial and error process. That does not mean I couldn't also be dead wrong.

 On occasion that search would stand up to substantial knowledge, experience and position of authority. My first job on a tanker as a very inexperienced third mate by I stopped both the chief and second mate from opening the wrong sequence of valves in loading the tanks. It's possible they were testing me. However from their reactions I don't think so. The courage to say something came from the act of spending hours with the ship's piping diagram trying to figure it out by myself.

Today, by chance met an old friend and colleague and the thought crossed my mind to tell her about this blog. I thought for a minute but took the easy way out like the guy in this video. Sometimes, I just want to fit in.

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