Early mornings at Duke University Hospital are quiet, yet bustling. I step off the bus and walk toward the Duke Medicine Pavilion with an assembling stream of individuals—each of us playing a unique role in the operation of a world-renowned health system. Today is day 11 of my second full-time clinical internship. Alongside my fantastic clinical instructor, I work alternating months at the Duke Neuroscience Intensive Care Unit, and Neuroscience Step-Down Unit, evaluating and treating patients with a wide range of neurologic conditions, including stroke, brain tumors, traumatic brain injury, etc. At this early point in the internship, I have a growing confidence in my skills, but am acutely aware that I have so much yet to learn.
During this morning’s bus commute, I reviewed some neuroanatomy and read a research article on home exercise programs for people with ataxia; a few patients on my caseload have had cerebellar strokes and I am searching for new treatment ideas. I also mentally reviewed my goals for the week. For week 3, my goals include: get more efficient documenting in Maestro Care (Duke’s electronic medical record system), lead a treatment session for a patient who requires a mechanical lift transfer, and help teach second year Duke DPT students during their week-long STEPs rotation on the unit. Undoubtedly, this week will present additional challenges and opportunities for growth that I cannot anticipate. As I ride the elevator to the 8th floor, I feel a mild sense of nervousness for what the day may bring. With a deep breath, I remind myself: “If I’m not at least a little bit uncomfortable, I’m not growing…”
The workday flies. By the end, I’ve led an evaluation and two treatment sessions, including one involving a mechanical lift transfer. I am getting faster writing my notes. I helped the 2nd year students practice transfer techniques today, and tried my best to answer their insightful questions. On the bus ride home, I reflect on what went well today, and what I can do better the next: what could I do to advance or regress that patient’s treatment session tomorrow? How can I communicate more effectively with my co-workers? What will motivate this patient to perform his best during our time together? By reflecting at the end of my work day, I process all this new learning, and move forward to try again tomorrow.
Life as a third year Duke DPT student looks and feels much different than the first two years. No longer in the classroom and lab, or occupied with studying for practicals and mid-term exams, I am in the midst of applying and acquiring knowledge through hands-on training during full days in the clinic. It challenges me on a daily, hourly, and minute-by-minute basis--emotionally, physically, and mentally. Third year moves us all beyond the ready support of teammates and professors. Under the guidance of my clinical instructor, I direct my learning goals, meet productivity and performance expectations, and adhere to the rules and processes of a new work environment.
I was asked recently by a family member, “which has been more difficult, your previous internship in outpatient orthopedics, or this one?” I cannot give a good answer: “They are SO different, it’s hard to even compare the two”. And this is precisely what excites me about the profession of physical therapy! There is such diversity in our field in terms of practice settings, patient populations, skills to develop, and strengths required. Third year thus far has shown me there are also many common threads: in both outpatient orthopedics and inpatient neuro, physical therapists need keen observation skills, we have to read a patient’s verbal and non-verbal cues and respond appropriately. We must solve problems creatively, anticipate obstacles, and motivate our patients thoughtfully and effectively. In every setting, physical therapists must advocate for our patients to function at their highest potential and reach their goals. Here in my inpatient Neurosciences rotation, the concept of “function” can mean many things: for one patient, it is rising from a chair without assistance, or returning home and climbing the stairs to their bedroom; for another, function is returning to a full-time job and caring for their small children.
In every setting, we meet patients where they are, and help each progress to the next level of their rehab journey. In every practice setting, physical therapists are constantly learning and developing clinical expertise over the course of a career. With one more internship ahead, and 6 months until graduation, I am humbled by this new profession and the opportunities it offers me to grow, to care, to advocate, and contribute to the well-being of another.