I have been such a bad blogger lately. Ever since I started my internship at UAB, my free time has dramatically decreased. I am at UAB much later than I was at the school, and I have to get up much earlier so I'm trying to go to bed a little earlier so that I'm not just completely exhausted every day.
We start seeing patients at 7:45 every morning so I try to get there between 7:15-7:30 to get everything settled. I have to leave my apartment by 6:45 in the morning in order to have time to make it downtown, park, and walk to the hospital. For anyone that knows me, I have such a hard time getting up and ready in the morning. I've been waking up around 5:40.... and it is rough. Once I get there though, it is much better and I don't feel very tired... its just the process of getting there that makes it hard.
Overall, I am loving UAB so far. I am in the rehab section of the hospital, so its pretty different than what I did the last time I was at UAB. We see patients for only 30 minutes at a time, twice a day. Usually in the mornings, I go up to their rooms and then in the afternoons they come down to me. I like this setting because the patients aren't quite as sick or critical as they are in acute care (I did a lot of this setting last fall), but they aren't well enough to go home yet. I have such a diverse group of patients right now, but I am really enjoying working with all of them. I have an AWESOME supervisor too. I feel like I have learned SO much in just one week of being there. I really do feel privelaged to get to work with her. She has given me a lot of independence already, but is still helping to guide me along the way and is very helpful in explaining things and answering my many questions. She actually has a few OCD tendencies, which I think is PERFECT for me because I do too!! If you saw her office you would be amazed... it is soo organized. I LOVE IT! It makes it so much easier for me to find the stuff I need for therapy. She has actually been very lenient with me in letting me go watch other therapists every now and then when they are doing something other than your basic therapy, which I am very thankful for.
For example, yesterday I was able to go see my first patient with a trach! (For anyone that doesn't know, this is when the patient has undergone a surgical procedure creating a direct airway through the patients neck into the trachea. Therefore, the patient no longer breathes through their nose/mouth, but now breathes through their neck! It's usually only temporary until the patient is strong enough and alert enough to be able to resume breathing on their own.) I don't know how, but I have managed to make it through two hospital settings without seeing one. It was so cool to see.
Here are some of the things that I learned yesterday that we do when working with a patient with a trach: (Let me forewarn you that most of you will probably be bored out of your mind when reading this! You may want to stop now!)
We cover up the trach to see if the patient can breathe on their own through their nose and mouth and try to make some type of voicing sounds. (If you think about it, becauses the air goes in and out of the neck, it doesn't go up through the vocal folds and the patient is unable to voice or talk.) When we did this with a couple of patients yesterday, the family members of a patient started crying when they heard the patient produce a voiced sound. It was such a sweet moment.
When closing the hole, it is very important to pay attention to the patient's oxygen levels. After all, we are closing up the place where they gave been breathing! This will probably be too technical, but many of them have a cuff attached to the trach which, when inflated, completely seals off the windpipe surrounding the trach tube. If there is a cuff and it is inflated when we cover the hole, the patient won't be able to breathe PERIOD. It is critical to deflate the cuff!
We also perform swallow studies on the patients because many of them haven't had anything to eat/drink for a long time and are ready for real food! We start with a simple test in which we give the patient a little bit of water (dyed green). We watched to see if the water comes out through the trach, which would indicate that they had aspirated, or swallowed it down the trachea (goes to your lungs) instead of the esophagus (goes to your stomach). This is bad! We don't want any food/liquids to head to your lungs ever! During this simple test, we even suction down in the trach to see if there is any trace of green dye. That test is really just a screener. If they appear to pass with flying colors, we plan to do a FEES, in which a scope is inserted into the nose and down the back of the throat so that we can physically watch what is happening when the patient swallows. During this test, we give the patient several consistencies of liquids, to evaluate their swallowing abilities. If aspiration does occur, we recommend that the patient not be given anything to eat or drink orally at that time. We then recommend that the patient receive speech therapy to work on several strategies to help strengthen the muscles involved in swallowing, and retest the patient in about a week to see if there are any changes.
I must say, although it was so cool and so fun to watch all of this... it's not all quite as blissful as I'm making it sound. It can get pretty gross at times (you might not want to keep reading!). I wasn't quite prepared for that part of it. These patients are still really sick. Many of them that I saw had horrible deep coughs...and because there is a hole in their throat, whatever they cough up comes out through that hole. It is crucial that you not stand directly in front of the patient while they are coughing, or else you will get hit. yuck! There is a suctioning tube that catches most of it...but it is still kind of gross. There were several times that I had to turn around or not look at the patient while they were coughing....I guess I've gotta work up my stomach to handle that part of it, but for the most part, I think I did pretty well with it.
I know that was probably a jumbled mess to many of you that are reading (if you still are!), and most of you probably could care less about any of it. I just thought it was so much fun and so cool so I wanted to write about it. At least it gives you an idea of some of the stuff that a Speech Pathologist does... in case you didn't know.
So as you can see, I am really enjoying UAB. It's hard because its making me really confused on which area I want to pursue in looking for a job. I loved the preschool and now I'm loving this...should I pursue the kiddo world, the school world, the medical world, or the adult world? Decisions Decisions. I'm thinking I'll be one of those SLPS that just does both... I can't pick a favorite.
Anyway, as for now, I have lots of laundry and cleaning around our apartment that MUST get done today.
Hope everyine is having a great Saturday!!
Christen
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