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On this particular Monday morning, I find myself smiling with glee as I'm riding the bus to the hospital for my acute-care rotation. Most people will tell you that they don't enjoy spending time at a hospital because going to one usually means that someone you love is sick or injured. I admit that for this reason, I have dreaded stepping foot into a hospital; however, going as a care provider definitely brings a new and different perspective. I also admit that I was equally excited and apprehensive about this rotation of my orthotic residency. One of the reasons I was drawn to the University of Michigan (UM) residency program is that, as a resident, I have the opportunity to spend time at the University of Michigan Health System (UMHS) University Hospital for my rotation in O&P acute care.
Acute care is an interesting niche in O&P. I am excited about this rotation because it is an opening into an orthotic population that typically does not come into the office for outpatient care. But I also feel apprehensive because the required care can take you from bedside to the emergency department to the operating room all in one day. A colleague fondly referred to acute care as the "Ground Zero" of O&P. This type of care is atypical from the common office visit, and no one ever expects to find him or herself ill or injured and requiring a hospital stay. When a person's basic health status is in question, it tends to remove all pretenses, and the fundamental human nature of that individual and his or her family members is exposed and vulnerable. Whether you observe how a patient deals with his or her own pain and diagnosis, or how families choose to deal with crisis, you can get a glimpse of people at their worst and at their best.
When we get the call that a patient needs a halo, let's face it, it's probably one of the worst days of his or her life. But as the eager new resident, getting a chance to participate in applying a halo is one of the most exhilarating things that I've done so far. In our profession, a halo is certainly one of the most invasive treatments that we provide. It's kind of analogous to the Superbowl of orthotics—minus the football and million-dollar commercials. The mechanics involved in a halo for cervical stabilization are not that difficult, but because it treats a very critical injury, the halo is at the pinnacle of spinal care for an orthotist. During my month at the hospital, I became quite familiar with our halo mannequin, "Manny." I spent hours in an exam room dissecting the halo into its smallest pieces and then assembling the system back together bit by bit. No matter how much confidence I tried to gain by becoming familiar with each upright and bolt, I wondered if the phrase "lefty-loosey, righty-tighty" would ever cease to plague me when taking the torque wrench to the patient's pins.
I know that acute care is not for everyone. Just like our patients and their families, you never know how you will respond to such a situation until you are directly faced with it. You may think you can handle it, but you never know if you are suited to this type of care until you are directly faced with the sights, smells, and emotions of the hospital. Meeting patients in various states of illness or injury can really tug on your heartstrings. No one wants to get the call to fit a pediatric-sized anything. The moment I knew I could manage it was as I was holding the hands of a teary-eyed halo patient while my colleague was continuing the torque sequence on her pins. As I watched the procedure and followed along with my mental checklist, I heard myself saying, "You're doing great. We're almost done. How old did you say your dog, Coco, was?"
Sometimes it takes a certain amount of strength to remove my feelings from the room and do the job that the patient needs me to do. Part of my resident training in acute care is not only to learn how to fit the orthoses, but also to develop the professional maturity to do so with respect and integrity—for the benefit of the patient and the profession.
Sara Pschigoda is a graduate of the master of science in orthotics and prosthetics program at Eastern Michigan University (EMU), Ypsilanti. She is a resident at the University of Michigan Orthotics & Prosthetics Center (UMOPC), Ann Arbor, and will be sharing her experiences as she completes her residency.