Clinical # 2

I realize that it's been almost a month since I last posted a message. A quick update on the events to this point are as follows: I had my photo shoot for the ACL injury prevention manual, was asked to come back and interview for a job at CHOA sports med, moved back to Nashville for the remaining clinicals, watched Vandy lose its last home game to UT, and watched Lipscomb lose its chance to go to the Big Dance to Belmont.

On Monday, I started my second of these last three clinical rotations at NHC Place at Cool Springs. Although this is a skilled nursing facility (SNF), I am only doing wound care and working with the director of the clinic. Although this place is quite different from the sports medicine clinical I just finished, I know that I will have just as many stories if not more! Here is the first of what I assume to be many to come:

There is a patient here that is having changes in his/her mental status. I don't know exactly what the specific diagnosis is and what brought this individual here to this SNF, but here's the story that he/she gave us. This individual was outside his/her trailer working in the garden when it felt like someone pushed him/her from behind. All he/she knew to do was to call 911. This individual has supposedly had such a bad experience in the hospital(s) recently that he/she thinks he/she ought to sue them. The patient also claims that his/her legs were not swollen or red when he/she came to NHC, and the lack of care given to him/her has caused his/her legs to become this way. Well, my CI and I looked in the chart and read that the MD diagnosed him/her with cellulitis in his/her legs at the hospital and the NHC admitting papers noted the cellulitis as well. So, this patient has had the leg swelling, redness and pain for who knows how long! The patient told us that he/she blames his/her brother for all that has happened and claims that calling 911 caused him/her to be in this "mess". "That's the last time I call 911!" has come out of his/her mouth several times over the last couple of days. I have no idea what has actually happened...

Today, we had an order to apply a lymphedema wrap to his/her legs to help decrease the swelling. We called someone from WMC who specializes in this area to help us. It took us at least 2 hours to wrap his/her legs. When we walked back to the PT gym, only 5 minutes passed before a tech. came up to us and told us the patient wants them removed! We spent another 30 minutes (along with the nurse practitioner) trying to convince him/her that he/she needed to continue wearing them. The patient claimed that he/she couldn't breathe with them on, yet he/she was able to yell and scream at us to take them off. I think you can breathe well when you are able to yell and scream. Not to mention his/her vitals were taken and he/she was over 90% O2 sat. The end of this story is that once he/she was able to tell us the prognosis that would result from removing the compression wraps and was still adamant about removing them, we spent 5 minutes unwrapping his/her legs. 5 minutes!! It took 2 hours to wrap them, and only 5 minutes to remove them! Needless to say it was slightly frustrating. The patient will soon start complaining about his/her legs in a few more days. Maybe then he/she will be more willing to wear the compression wrap.