The Adjustment Period (Month 1 in review)

"It takes a lot of courage to release the familiar and seemingly secure, to embrace the new. But there is no real security in what is no longer meaningful. There is more security in the adventurous and exciting, for in movement there is life, and in change there is power." – Alan Cohen

     There is a difference between thinking something will be difficult and experiencing the difficulty.  All changes in life - moving, a new job, graduating, etc - require an 'adjustment period.'  My adjustment period for this rotation lasted about a month and was pretty rough!  Difficulty managing paperwork, miscommunications with coworkers, and just generally adjusting to grown up life (you know, bills, bills, bill!).  
      I would love to say I handled this all gracefully, but that would be a lie. I'm eternally grateful to the friends and family who have listened to me complain endlessly about my job, how stressful it is, and how tiring it is, and how frustrated I am.  And I'm also so so grateful to my coworkers who have supported me, put up with my tears and frustrations and taken the time to teach me.  And lastly, to the clinical specialist with my travel company, who has been wonderful at listening to me complain and helping me develop strategies!
     Over the last month I have cried, complained, and swore. I've had trouble getting myself to come into work.  I've had days where my boss seemed honestly completely surprised when I walked in the room in the morning because she wasn't sure if I would return.  I have called up plenty of people sobbing on the phone, feeling like I can't do this job.  Here is the great part though - I've learned that I can do this job.  I feel more capable than I thought I would and I get better with every patient I see.  I also feel like having a rough start to travel jobs makes me extra prepared and hopefully will make me really appreciate more comfortable travel jobs in the future.
     I've been really challenged in this setting for many reasons.  I think any first job has it's stressors, and time management will always be one for me.  Learning to management my time to maintain productivity has been difficult when I would much rather focus on patient care.  I think that I'm finally getting the hang of it and have reached a point where I'm managing to both give great care and be productive for my boss!  Another challenge for me is just the sadness of working with the elderly population and especially with those who have dementia.  I'm also challenged by seeing patients who are much more disabled than I am used to seeing outside of a hospital setting.  Lastly, I find RUG levels and the pressure they create really challenging.
     I think that an adjustment period will always be part of being a travel therapist, but I hope that I get better at it as time goes on and that it takes me less and less time to adjust.

     Though work is still difficult sometimes, and there are long days, I am handling it better and some days even like it!  I'm doing something important and helping people and at the end of the day that is what is important.  With any luck, I will title the next period of time "The Honeymoon Period" (though knowing me, soon to be followed by "The Boredom Period")

Bay Region Bucket List

One of my ideas is to make a bucket list for every place I visit.  It's amazing how much there is to do even in unexpected places!  I'll keep adding to this over time as I find out about more things to do...

1) Visit Dow Gardens  (& Dow Gardens Christmas Walk)
     Dow Gardens is a 110-acre botanical garden located at 1809 Eastman Avenue, Midland, Michigan, USA. It is open to the public, and currently contains over 1700 varieties of plants hardy in mid-Michigan.
2) Visit the 'Tridge" (3 way bridge)
3) Walk the Chippewa Nature Trail (3.5 mi) - possible for their Birds & Bagels hike, or the full moon stroll!
4) Bike the Rail Trail
5) Visit the Largest Antiques Mall in Michigan 
6) Attend an event at Midland Center For the Arts
7) Watch the Midland Symphony Orchestra
8) Visit the Historical Museum of Bay County
9) Attend Sundays in the City at the State Theater for Christmas movies
10) Visit the Fall In Art and Sol Exhibits (Solar Art Installations)
11) Get my palm read at "Gypsies Espresso, Gifts and Fortunes"
12) Go to the Delta College Planetarium & Learning Center
13) See something at the Prime Event Center...cage fighting?? haha
14) Visit  the Forest of Radiant Light Exhibit at Creative 360
15) Midland Santa Parade and Santa's arrival/Courthouse lighting. Self explanatory 
16) Bay City State Recreation Area
17) Ted Putz Nature Center
18) Frankenmuth - Zender's Snow Fest
19) See a show by the Bay City Players

Exploring Bay City

First weekend with nothing to do, and lots of time to explore!

     I was so excited to be joined by my amazing friend Maria for this adventure into downtown Bay City, who was sweet enough to spend part of one of her few precious weekends off visiting me!

Rather blurry candid of Maria

     So far the Bay Region has got to be one of the most friendly places I've been.  All the locals are welcoming and very helpful!  Our first stop was to check out the Chocolate Lounge at The Sweet Boutique.  We were so fortunate to be greeted by the owner, who was not only helpful in picking out chocolates but also gave me a map and suggestions of places to check out in downtown Bay City! We picked out some gorgeous truffles - I tried strawberry and apple, and Maria tried raspberry and traditional dark chocolate.  I also had a special drink called "Aztec Love Potion" which I chose purely based on its fun name. Everything was amazingly delicious!  And in true Halloween spirit, Maria even ate a chocolate covered mealworm (eww!!) - and she pronounced it "Not bad!".  That must be some chocolate.

OMG SO AMAZING!!  I'm definitely going back to The Sweet Boutique again!!

    With hot drinks in hand to comfort us against the harsh Michigan winds, we ventured out again to see what there was to see.

Whenonah Park

Appledore Tall Ships Adventures

City Hall

City Hall Again

City Hall Front

Seriously I'm obsessed with this beautiful building

Bay City is well known for its plethora of antique stores! To be explored at a later date.

 Antiques found here!

    Bay City definitely seems like a fun town!  And along the way today I picked up a bunch of flyers for different local events and such things to check out in the future.  After walking around for a few hours, we were cold again and decided to go home and have lunch.  See ya later, Bay City!

Apartment tour

Now that my apartment is cleaned, I'm excited to start getting myself moved in!

So I thought you might enjoy a photo tour of my set up so far.

Kitchen, completed with ''health food'' on the fridge

Living room with rental furniture and sale pillows/rug from World Market

The long entry hallway

Nice big windows!

Cupboard with glasses that remind me of some of you! (Kacy, Adam, & Amber especially!)

On day 10, you will check karate chopped in the neck

     Ok, this is probably NOT going to happen to you.  At least, probably not on day 10.  But most people who work with the elderly, specifically the population of elderly with severe dementia, will probably experience a combative patient at some point in time.

     This week I had my first experience with one of these patients.   I was not touching her, but was gently talking to her to try to get her to do a little bit of exercise with me. My coworkers had warned me that she was having a bad day and had scratched the nursing staff earlier, so I may want to watch my shins in case she decided to kick me.  I moved to her side and engaged her in conversation.  Suddenly she yelled “I hate you, go away!” and karate chopped me hard in the neck.  It brought up so many emotions in me.  Shock. Anger. Sadness. Frustration.  The biggest thing was an overwhelming sadness.  Sad that this woman was so far along in cognitive decline that she couldn’t realize I was trying to help her.  Sad that I couldn’t communicate better with her.  Sad that all of these elderly people are just waiting here, in this place, this limbo, until their time comes.

     I knew that working with the elderly, especially in Skilled Nursing, would be challenging.   I knew that at times it would be devastatingly sad.  I knew that the patients might be difficult to work with.  But it’s impossible to prepare yourself for how much it honestly truly hurts to realize that you are useless.  You cannot help everyone.  No matter how much you want to.  I think this is something that will be a particular challenge as a new grad, because we are so excited to go out and change the world.  I don’t want us (or myself) to lose that drive, that sense of purpose.  So we have to find a way to keep our positive attitude while at the same time accepting that not every patient will respond to us and not every situation will turn out how we hope it will.

     I’m fortunate that a great deal of the patients I see are Medicare A – which means they are temporary stay with a goal to go home or return to living with their family.  These patients are generally highly motivated and tend to be more advanced in their functional abilities.  I love my Med A patients.  They are basically, to me, like the elderly you would see in an outpatient facility except I get to see them every day.  I’m not saying that I don’t love my Med B patients (permanent residents).  I love them in a heartbreaking way.  We can only do so much for them, sometimes all we can do is try our best and hope that it benefits them in some way.  When someone has dementia, they have good days and bad days, and it’s difficult to know how they will react.  They have no filter, and will tell you exactly how they feel about you.  They may verbally berate you and say they hate you, or tell you that you are beautiful, or that you have too many freckles. 

     As I continue this journey I hope that it gets easier for me to manage my emotions.  Many people have told me I need to build a wall to keep myself self.  However, I think that not having a wall is one of my strengths when it comes to patient relations.  Only time will tell what method ends up working best for me.  For now, I will simply work on accepting that even the very best therapist has bad days, as does the very best patient.

Travel and Living Minimally

Anyone that knows me probably laughed at the title right away, because I am not, nor have I ever been, much of a minimalist.  Honestly I fit more into the pack rat category (I swear it’s an inherited trait!).  It’s an issue on both ends – I attached sentimental value to a lot of physical ‘things’ so find them hard to get rid of, and also, I really enjoy shopping!  This week may have been the first time I entered a target and did not buy any clothes.  Seriously.

My pile of stuff so far

     So I believe that traveling is a great opportunity for me to explore living as a ‘minimalist’.  The one, major and most obvious benefit to having less stuff is packing/moving/dragging around less stuff as I explore different places.  As I’m starting this journey towards minimalist living, I’ve noticed a few other benefits so far:

1.     With less things, I can actually keep track of and appreciate the things that I do have.

2.     I need less things to hold and organize my things. (Less boxes, drawer organizers, plastic tubs, etc)

3.     I can actually see my things on a daily basis and enjoy them.

     This is going to be a difficult and probably never ending journey for me.  It makes me ask myself the hard questions like “How many pairs of dress pants do I really need?” (I have eight.  3 black, 2 khaki, 1 brown, 1 white, 1 grey.  More work pants than days of the week seems unnecessary.) and also “Which of these shoes do I actually wear and which do I just like having around?”

     Especially a challenge for me will be decorating with less.  One cool idea is to decorate with the things you already own – hang your shirts, coats, lamps, pots & pans, etc.  Another is to create your own art, and that way you haven’t spent a lot of money on it and you’ve had a fun time in the process.

     My goal is to only have things in my apartment that are 1. so cherished I can’t live without them, or 2. cheap/reusable/standard things that I can get anywhere and can leave behind without a second glance.

     One of the funny parts about this was that in my attempt to bring less, I completely forgot a towel… so yet again I “had” to buy something, because when I asked myself the question “Do I really need a towel or can I use something else like a sheet?” The answer was Yes.  Yes, I need a towel, really.

     Another challenge for me is going to be clothing.  I have endless clothing.  I love clothing.  I love the way it feels soft, the new colors and styles with every season, I love the personas it plays and the person I might be if I wear just the right thing.  I went through a phase recently where I felt like I had to buy a lot of “work clothes” so that now makes up a huge part of my closet.  “Workout” clothes are also a particular weakness of mine, though this has started to blend with my work clothes thanks to a sporty career!   I’m trying to start to view my clothes as I view the rest of my stuff – Is it useful?  Is it beloved?  Is it meaningful?  Is it comfortable?  Does it fit?  Can I live without it?

“Have nothing in your house that you do not know to be useful, or believe to be beautiful”

-William Morris

"Life lessons" in renting...

Most travel companies give you the choice of having housing provided or receiving a generous stipend.  Being close enough to home to check out a few places, and sufficiently broke, I decided to take the stipend.  I was excited to find a cute apartment complex with heat included in the rent.
Since I was eighteen I've lived in at least seven different apartments, all of varying quality.  Some were new, some older, some in a bit of disrepair or worn.  But never have I come to move in to a new place that was not clean.

Until now.

So excited to get out of hotel living and into my temporary home, I was speechless when I was first confronted with this:

Management assured me that it will be taken care of ASAP.... Keep your fingers crossed for me.

So, lesson learned. Never, never, never, NEVER sign a lease until you've gotten a walk through of your intact, CLEANED apartment!!!!!!

Update: Just got a call that they had the cleaning crew come and scrub it. hopefully it'll be better by the time I return.

Update update: IT'S CLEANED!!!!   Didn't realize how very extremely important that was to me until today...

Diving in: Week One as a Travel PT

Phew!

It's been a fast-paced week.  I knew that as a traveler I would have to jump right in to treating patients on day one.  What I didn't know was that at this location, I would get minimal training on the fairly complicated EMR systems! (That's right - there are 2 systems I have to access.  Oh and there are also hard charts.  So I write an eval out by hand and then type it in, also.  Yup.)  Luckily, I'm a hands-on learner and I'm pretty good at clicking around to figure things out. Also, I have super awesome coworkers who are always willing to answer my questions and lend a hand!

Working in a SNF gets a pretty bad rap, but honestly so far I love my patients and look forward to working with them.  So far all of my patients have been temporary stay with a goal to return home, and a decent number of them have goals to be mostly or completely independent.  This means I get to work a LOT on balance, which is super fun!  I also have been doing higher level gait training and obstacles.  And of course, working on transfers, strengthening, etc.

Basically, it's like acute care with less sick patients and better equipment. Oh, and more time with your patients. :)

Be more prepared than me!

Day One was not full of disaster, but also wasn't as super duper smooth as I could have desired.  I did bring a minimal things necessary but could have benefited from preparing with much more!

What to bring on your first day:
Gait Belt
Watch
Measuring Tape
Pen(s)
Clipboard
Notebook/Paper
Cheat sheet for commonly used ICD-9 codes and CPT codes for your setting
Copy of all your paperwork including TB test & professional license
Copies of any of your favorite standardized tests (tinetti, berg, or whatnot)
A lunch
A smile :)

Be ready and excited to see patients on day one.  There will probably be some amount of mandatory paperwork and a bit of time to get you into the EMR if they have one, but once that is settled, off you go!

"I made it! ...Now what?"

I packed my bags and headed out today for hopefully my first of many adventures as a Travel PT.  By this time tomorrow, I will have completed my first day!

So my first week will be spent living in a hotel, as my apartment isn't ready yet.  Pros: Free breakfast is included daily (YES!) and an indoor, heated pool.  Woo!

Now that I'm here, I found I have a great amount of free time this afternoon/evening that I didn't really plan on...  Here are some of my recommendations for things to do when you first arrive:

1. Prepare for your first day of work:
     Pick your clothes out (easy peasy if you get to wear scrubs), read over your contract again, and make sure you have a copy of any documents that your placements requires a hard copy of (like your your license).  I also like to drive over to my new work place just to make sure I know how to get there and to look out for any unexpected obstacles like construction.

2.  Relax!
     You are going to have to be awake and ready to go tomorrow at your new post.  Take some time now to relax and rest your mind.  Read a book, take a bath, or call your mom (Hi Mom!) :)

3. Get some local fare!
     I love to ask where the locally owned restaurants are.  You can eat in a chain anywhere, but you can only get local food where you are!  I'm not saying the food is going to be spectacular or anything, but it's part of the adventure. (tip: use yelp.com or urbanspoon.com for reviews, or just ask a neighbor/coworker/housing manager!)

Now I'm off for a bit... about to do #3 myself, and then enjoy that swimming pool!

Hotel home away from home for the week

Travel Jobs & Compromise

Want to be a Travel Physical Therapist as a New Grad?

Tip #1 - Decide what you are and are not willing to compromise on.
     There are a wide variety of opportunities with travel companies and you will see jobs in amazing, desirable locations advertised on any travel company website.  Here's the one thing a not-so-good company might not tell you about - a lot of employers don't want a new grad.
      Don't be scared! I know this is frustrating - why did you spend X$ to be a Doctor just to be told you aren't trained enough?  Well, a travel therapist has to be able to "hit the ground running" so to speak, and placements are worried about a new grads ability to do this (see upcoming post on preparing for travel PT: diversify your clinical experiences!) The good news is, as soon as you've completed your first job, you lose the "new grad" label and everything becomes much easier.
      So this is why this first post is about compromise.  Think about your goals and what you are, and are not willing to do for a short 13 weeks in order to get where you want to be (a rockin travel PT!).  You might end up taking a first placement that isn't in your ideal location, or ideal setting, just to get your feet wet and to start to establish a track record.  And you might surprise yourself by loving it!

Here are some questions to think about:
Are you willing to work in a SNF?  Home Health?  Acute?  Outpatient?
Are you willing to work in an urban, suburban, or rural setting?
Do you have dependents or family that you need to be close to, or are you willing to go anywhere?

     A larger company will have a wider variety of placements, but overall the majority of PT jobs (in general!) are in geriatrics so you have to be prepared for that.  My advice? Be flexible for your first assignment.  Be picky once you have some experience and know what you want to do.  I know I want to end up working in outpatient orthopedics, but I decided that I was willing to compromise on my first placement because I wanted to work as soon as possible, because I enjoy treating a wide variety of patients in a wide variety of settings, and honestly because the Director of this particular rehab center was so super nice!  (However, I personally drew the line at Home Health - for the safety of myself and my patients, I really felt this was pushing it for a new grad with no experience in this area.)
     And remember - this is your life and your career.  Even when you are being flexible, don't be a push over.  You not only need to know what you are willing to compromise on, but also what you are NOT willing to compromise on.  A good recruiter will respect that.

"Minds are like parachutes. They only function when they are open."
-Sir Dewar