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Physical Therapy: Anjali Shah
51 Plays4 years ago
Season 1, Episode 19: Anjali Shah is an acute physical therapist at St. Joseph Mercy Hospital in Ann Arbor, MI. Listen to Anjali discuss the interdisciplinary approach to critically ill patients and the experience of working with patients who have uncertain prognoses.
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Transcript
Introduction to 'The Wound Dresser' Podcast
00:00:09
Speaker
You're listening to The Wound Dresser, a podcast that uncovers the human side of healthcare. I'm your host, John Neary.
Guest Introduction: Angelie Shaw
00:00:20
Speaker
My guest today is Angelie Shaw. Angelie is a physical therapist at St. Joseph's Mercy Hospital in Ann Arbor, Michigan. She received her doctorate in physical therapy from Emory University. Angelie specializes in
Role of PTs in Acute Care and Patient Mobility
00:00:35
Speaker
acute care, helping patients gain mobility after surgery or trauma. Andra Lee, welcome to the show. Thanks, John. Excited to be here. So can you just walk me through after a patient undergoes, you know, major surgery or experiences trauma? What is the progression of rehabilitative care and where do you kind of fit in to that roadmap for a patient? All right. Big question to start off.
00:01:02
Speaker
Basically, what is my job in a nutshell? So what I would say is, so I'm a PT, and I work inside a hospital. A lot of people can't conceptualize what that is. 99% of my patients don't know what that means.
00:01:24
Speaker
So essentially how I describe it is we are like the first line of defense when anyone who's like admitted into a hospital, whether that's in the emergency department or when they get admitted a bed into the hospital and
00:01:43
Speaker
A
Post-Surgery Patient Mobilization
00:01:43
Speaker
lot of times we're the first people that after someone's had like a major surgery, whether that was planned like a hip surgery or a knee surgery, or whether that was not planned like open heart surgery or a car accident. We are the first people that can help patients mobilize. So we specialize in
00:02:12
Speaker
Um, basically helping patients learn how to regain their function again after they've lost that. So how stable do these patients have to be before, uh, you can step in and start working with them on mobility?
Assessing Patient Stability for Safe Mobilization
00:02:29
Speaker
That is a great question. Um, and that is probably the number one thing you learn like on the job is what we call like red
00:02:40
Speaker
basically screening a patient and looking for the red flags. Because what will happen is your doctors will order physical therapy on a patient, but that doesn't necessarily mean that that patient is medically stable to have you see them. So we abide by our protocols and our parameters, our clinical parameters,
00:03:10
Speaker
And we determine, apply that to our patients to determine if they're medically stable. So for example, you have somebody coming in with a heart attack, right? Patient comes in with chest pain and this patient might be a little deconditioned or we don't really know how they're mobilizing. A lot of times the protocol-based doctors may order physical therapy, occupational therapy right away.
00:03:36
Speaker
So,
Collaborations with Medical Specialists
00:03:36
Speaker
it is my responsibility in my scope of practice to review that patient's chart and understand if there's anything going on that would make them not stable enough for me to work with them and as a therapist we're inducing activity we're putting
00:03:51
Speaker
stress, further stress onto that patient. So we look at lab values. We look at, you know, if certain lab values are trending upward, we wouldn't want to see somebody for therapy. For a trauma patient, you know, we look who might be experiencing
00:04:10
Speaker
you know, a lot of imaging that needs to be done to rule out fractures. So we look at to make sure that's been completed. And then there might be a lot of consultations that need to take place. So your patient that comes in with a car accident, you know, they broke their leg and now you have all this imaging that needs to be done. You have the respective specialized doctors that need to be, um, consulted like orthopedics or neurosurgery.
00:04:39
Speaker
They have to take a look at the patient, then they have to make their recommendations. So as a PT, we're synthesizing all of that information and arriving at our conclusion on if this patient is stable or not stable. So sometimes it's based on lab values, looking at hemoglobin, troponins, potassium levels. Sometimes it comes down to imaging.
00:05:04
Speaker
You know, if they've looked at the, if they've, you know, ruled out a fracture in the arm or leg, cause that's going to then change someone's weight bearing status. And then sometimes it's like, if they have the equipment that they need. So my craniotomy patients, like sometimes, um,
00:05:23
Speaker
you know, if there's not a bone flap, then they need to get a helmet. And has anyone ordered that helmet? So it's kind of like a giant checklist that we create for, and as you get, as you work in the more sicker populations with like very, who have more complicated medical diagnoses, that checklist gets longer and longer of all the things you have to make sure, because, you know, as,
00:05:47
Speaker
PT is like we do induce a lot of stress onto these patients and we need to make sure that their body is able to initiate that. So with that checklist, right? I imagine there's a interdisciplinary care team. Can you describe some of the people you work in tandem with to kind of get the patient moving in the right direction? Yeah. So like in a given day, I probably work with like
00:06:15
Speaker
seven different types of health care providers, sometimes on a given patient. So I'm always collaborating with occupational therapists. Generally, speech therapy as well. And then because speech therapy will provide us insight on someone's cognitive function or
00:06:37
Speaker
if they've been able to look at their swallow function, gives us insight further on planning the patient's care needs. So those two therapy disciplines always. I usually work with a team of residents or APPs, which is an advanced, like the mid-level provider, like a PA or an NP.
00:07:04
Speaker
who usually works underneath the attending or the surgeon. Work closely with the nurses, like the bedside nurses and the techs, the patient care techs, because the techs can give us information on how the patient has been mobilizing, if they've tried to do anything, has their vitals been stable, anything about their mentation. Nursing can give us really good intel about more of the broader plan of care, what medications the patient was just given.
00:07:34
Speaker
And then when it comes to discharge planning, we work closely with social workers and case managers to help set up, you know, making sure the patient, um, has a good plan in place once we evaluate them. So it's pretty interdisciplinary in the hospital setting, I would say more than any other setting I've, I've come across. Yeah, that, that certainly sounds, um,
00:08:00
Speaker
especially with the sicker patients, right? That there's a lot going on and that you have a lot of people. Can you tell that patients who are already in distress because of their medical condition are just sort of overwhelmed by this large number of people as part of their care?
Navigating Patient Overwhelm with Multiple Providers
00:08:14
Speaker
Oh, absolutely. And like we kind of joke to that. So like there, it's an ongoing joke that like nobody will ever remember like their, their initial physical therapist because, you know, patients that are in a hospital setting, they, um, can develop delirium very easily. Um, and I, mind you, like my caseload is like really, really sick patients who are either
00:08:40
Speaker
Um, you know, on medications to make them very, um, you know, not really with it more, you know, who are on sedation or they're just so sick with
00:08:51
Speaker
with the amount of medications that they're on and the amount of treatment that they need. So there's an ongoing joke that they like won't ever remember us, that we are just like a blur to them. And so every time I meet a patient, even with I've been working with them for an entire week, I will reintroduce myself, reintroduce my role, remind them like, Oh, I did work with you on Tuesday and this is what we did, you know, because you have every patient, you have to like basically expect them to have this degree of amnesia.
00:09:21
Speaker
you know, because they meet so many people in a given like eight hour shift, they will meet multiple nurses, multiple doctor, team of residents. Um, they won't even know like their main doctor from their like, you know, consulting doctor who's helping them. I mean, it is probably so overwhelming from a patient perspective of the amount of people that come into your room that, you know, they, it is really confusing. And I think,
Building Relationships with Patients
00:09:50
Speaker
the one advantage that we have as therapists is like, I do get to spend a lot of time with my patients because, you know, I do spend up to like 45 minutes with a patient, you know, whatever their time that they need. So I do have the ability to work on, um, you know, a relationship with them, which is something that I, you know, have the ability where other care providers don't necessarily have that period of time with each person. Um,
00:10:19
Speaker
you know, to do so, but yeah, every time I'm always like reminding the patients, like you find it, you do it in a very like subtle way, not, you know, like, oh, you don't remember me, but you know, you just kind of just comes with your spiel when you, when you see a patient again.
00:10:36
Speaker
So you said 45 minutes, which is definitely a nice chunk of time, but from there, how many different episodes of that would you have, or how many times would you see them? Or would it really just depend on how long they're in the hospital? Yeah, so our treatment frequency, so our favorite word to use in medicine is it just depends, right? Right.
00:11:06
Speaker
I would say that in my setting, I probably have the fastest turnover of patients because an average stay in a hospital is like two nights. So sometimes I will only see a patient one time ever, and that's it, like I just evaluate them. And then sometimes I will follow up, the patient will be hospitalized and remain on my caseload for like two weeks, so that's
00:11:36
Speaker
And then probably I've visited, I've had maybe in that time period, like maybe six to eight visits with them.
Impact of Shorter Hospital Stays on PT Roles
00:11:44
Speaker
Um, and that's if they're really, really complicated and need to stay hospitalized that long because, you know, the big thing here and in modern medicine is that we want to help patients through the healthcare system as fast as possible.
00:12:00
Speaker
Gone are the days of staying in the hospital as much time as you need. And now the whole thought process is the shorter hospital stays and you get them to the next level of care is the focus. And so it definitely ranges, but I mean, I'd probably say on the shorter side, I would see an average patient for like maybe two to three visits. And then like, I would never see them again, unless they're readmitted, but
00:12:30
Speaker
So do you find that the emphasis on shorter hospital stays that kind of impairs your ability to kind of get where you want to get with the patients? No, I look at it as like are my focus as a PT in the hospital setting is different than the PT who like is going to inherit my patient. So.
00:12:51
Speaker
Like the PTs who come after me that when the patient moves to the next level of care, like they're gonna have that longer duration length of stay. Like my job is very different. Like my skillset that I provide for the patient is different than the next therapist. And I think all aspects of this continuum of rehab are really important. So we're the first people to see the patient and we will evaluate, assess, create a plan,
00:13:21
Speaker
get them to that to that level. Right. So like that's where our focus is. So what is so what is that level though like for I know we always say like it depends but where are you trying to get like a lot of your your patients before they go to the next level of care.
00:13:39
Speaker
Yeah.
Evaluating Discharge Options and Care Levels
00:13:39
Speaker
So that's, see this, that's like the, this is why I like love my job. So, so a patient comes in the hospital and in my setting, I can, I can recommend that they discharge to like four of four different places. So I will evaluate a patient and I will say, yup, they can discharge home. And I think a home therapist should follow them, or I can evaluate them and say, you know what? I think that they are going to need a more extensive rehab.
00:14:08
Speaker
So I think that they should go to a nursing facility, or I can evaluate them and say, you know, they actually would meet criteria to come to an extensive inpatient rehab program, which is a more specific criteria.
00:14:25
Speaker
and population that meets that criteria. Or I can say, you know what, this patient did really well. Let's go, I recommend that they follow up an outpatient PT. So where I sit, I'm the first one in the continuum of rehab. So I essentially have like all the rest of the rehabs that I could recommend for that patient, which is a really unique position to be in, right? Or I can also say that the patient doesn't need anything, that they do not need skilled therapy.
00:14:55
Speaker
So our assessment skill is what's really important in this setting because you're setting up that patient for what they will need at that next level. And that could be a whole plethora of different things.
00:15:14
Speaker
you know, different types of rehab. So what are the, uh, if you're making a discharge decision to like one of those four options that you described, what are kind of the, to me, the thing that would stick out, like what, like how well can they walk out? Uh, but like, are there other mobility, uh, you know, factors you look at when making that discharge decision besides just walking? Yeah. Um, so this is why I like, I love collaborating with my occupational therapist.
00:15:43
Speaker
my speech therapist because we will often, you know, a lot of it is like a very integrated decision. So, you know, just things are always easier to explain with examples. So I have a patient, you know, a trauma patient came in, you know, car accident. Let's just start with something easy to understand. So car accident patient,
00:16:06
Speaker
Um, a lot of musculoskeletal injuries had some surgery, you know, so when I evaluate them, I'm not just looking at how well they walk. I'm looking at, okay, how is their overall function now that they've had these injuries and these complications. And now their mobility is limited and maybe their doctor has specific restrictions for them. Like.
00:16:31
Speaker
They can't lift a certain amount or let's say they can't bear weight on their leg a certain amount. So how is that gonna affect their overall independence?
00:16:39
Speaker
And I look at that piece and then you have the occupational therapist that says, well, look, now they can't, you know, they're not allowed to use their right arm. So how are they going to function in terms of, you know, their self care? So that's going to be a problem because this patient lives alone and doesn't have anybody to help them. And then the speech therapist comes in and says, well, look, I did a good, you know, their cognitive evaluation reveals that they're really struggling and having a lot of
00:17:05
Speaker
concussive symptoms. And, you know, I'm worried about money management and pill management. And, you know, I really don't think they can be alone on a cognitive level. So together, we will put that, you know, put those pieces together and say, you know, we think that this would be the best rehab for this course for this patient. And so it's truly a collaborative looking at the full like, you know, you look at the
00:17:32
Speaker
the forest, not just the tree in front of you to make that decision. And we take a lot of responsibility and we take a lot of pride in that because we do feel like we get to spend a lot of time with the patient. We're afforded that opportunity to spend that time with the patient. Whereas
Creative Solutions and Patient Engagement in Therapy
00:17:52
Speaker
your case managers, social workers, and doctors may not be able to spend that time to arrive at that conclusion.
00:18:00
Speaker
So just to back up a little, we did say that you spent a good amount of time with patients. What are kind of the tools you have at the bedside? Because immediately I think your patient might have limited mobility. There's limited space kind of in these hospital rooms. So what kinds of things are at your disposal to at least start pushing them towards a discharge plan or something else? Yeah.
00:18:26
Speaker
This is the part where I wish I could put on my resume that I am a giver because we often have to like make things up in the room to like make it a therapy tool.
00:18:41
Speaker
So I don't have access to like hand weights, right? Like my patients aren't in a gym, like they're in the hospital room or sometimes they're in a stretcher because if we see them in the ED. So I don't have access to hand weights, but what I do have access to is flashlights in the room.
00:19:00
Speaker
with which equate to like one pound. I don't have parallel bars, but what I do have is a patient using a bed rail to pull up on. And I use that a lot, especially in like the ICU. A patient will be sitting in the recliner chair and then we'll turn them. So we're constantly moving the room around or like using what we do have in the room to make it, you know, like,
00:19:29
Speaker
use it as a therapy tool. I don't have TheraBand accessible to me immediately. But I do have a tourniquet band that the nurses use whenever they're drawing blood. And that's a great bedside TheraBand. So we use a series of things. We try to get creative. And that's the fun part is just you realize that you don't actually need all the bells and whistles
00:19:59
Speaker
do to help people, you know, work on those things that you can truly like use what's in front of you and it challenges you to be creative, which is another, you know, fun part of the job.
00:20:14
Speaker
As we said, they see all these different providers during their stay, your patients. How do you really get the patients to buy in what you're trying to make them do and be enthusiastic when you're the 75th person who's walked in their room that day? Well, not only am I the 75th person, but I'm the person that's going to bring pain to anybody.
00:20:39
Speaker
So nobody wants to work with us. And sometimes we always joke to speech therapy because they get to use graham crackers and pudding and jello to get their patients to work with them and their patients who haven't like eaten food in like a week. So they're just like so excited to see the speech therapist. So sometimes I tease that I'm just going to keep saltines in my pocket and like that's how I'm going to convince them. But
00:21:06
Speaker
Um, no more serious level. Honestly, what it takes is just like, you just have to be charismatic. Like that's the basics because literally you have to think about the fact that like, okay, so like 90% of my patients did not plan to be in the hospital, right? And the hospital sucks. Like nobody wants to be in the hospital, right? Like that's your, especially during COVID when there's like no one allowed to visit and all this.
00:21:34
Speaker
So you have to put yourself in their mindset of like, I'm here. I didn't plan to be here. I'm really uncomfortable for whatever reason. Like, why would I want to work with you? You're telling me that you want to rip me from, rip me out of my bed underneath my covers and you want me to do work. Like that sounds like a terrible deal, right? Like who would want to do that? So, I mean, there's like a million strategies that, you know, we utilize
00:22:03
Speaker
to help be more successful in patient engagement. But I mean, what I found in my experience is like, you know, sometimes like, you just like trying everything. And there's those times where you can really read a patient and like, you know, you're always trying to be empathetic towards them, of course, like,
00:22:25
Speaker
you know, when they're really telling you they're in pain or they're really telling you that they're really upset, you know, like we, obviously we read into that, you have to have really good awareness. And, you know, I have like, I will never forget this. So this was actually a recent story. So it was Christmas Eve this year. And I had a patient who had COVID for,
00:22:51
Speaker
He had been diagnosed like he's been in the hospital for over a month with COVID. He was no longer infectious. So he was taken out of the COVID unit, but he suffered so many complications, respiratory complications, heart complications.
00:23:10
Speaker
His body is just fighting this constant infection. And it was Christmas Eve. And the doctors were really pushing us to work with this patient because he has not gotten out of bed. And the reason he hasn't gotten out of bed is because every time he sits up in bed, he has to put on a bypass, which is basically a very,
00:23:37
Speaker
It's a respiratory device that's the last thing you can put on before someone's intubated, right? So it's like very, you know, it's very aggressive, so to speak. And so he essentially can't tolerate a lot of activity. And so we knew that. And so we, you know, approached it really low key and collaborated with our respiratory therapist and said, hey, like,
00:24:02
Speaker
Is this appropriate? Like, you know, he's been needing BiPAP on and off. Like we really don't know if he has enough activity reserve to work with us. And so the respiratory therapists adjust the settings and everything. Like we made this like all work into place. And then we went in and work and introduced ourselves to the patient. And
00:24:22
Speaker
You know, he looked at us and he told us like, you know, I really appreciate you guys being here, but I really can't do therapy today. And I get that response like 70% of the time. So like that to me doesn't carry a ton of weight when someone says they can't do therapy.
00:24:39
Speaker
So we're just, you know, we kind of gently continue and like, we're like, well, you know, we'll just kind of share, this is what we do. And like, so how's your day been going? And, you know, we just try to be a little more casual with him and, you know, just chat with him and then try to like build a little bit of a relationship, you know, within 60 seconds or so. And then he's like, no, I mean, I'm serious. Like, I really can't, you know, I appreciate you guys. Like, can we do this tomorrow?
00:25:07
Speaker
And that's a course, like 90% of patients will tell you to like come back tomorrow, you know? And so we're like, you know, it'd be really good for you. Like we really are here to get you stronger. Like what if we just try a little bit and if you can't tolerate it, we'll just lay back down. And then he got really emotional and he was like, you know, I really, my wife is coming today. It's Christmas Eve and she's coming in a half an hour.
00:25:37
Speaker
And I fear that if I work with you right now, that I will have to put that breathing mask on and I won't be able to see my wife and it's Christmas Eve and I'm here all by myself. And he's like, so please, can I, I'm not trying to get out of this, but can I do this another day? And
Empathy and Emotional Challenges in PT
00:25:57
Speaker
my OT and I partner just like immediately looked at him. We're like, I, we completely understand. Like we hear what you're saying.
00:26:04
Speaker
Absolutely. Like that's more important than what we're going to do with you, you know, because you need that. And, uh, you know, it's just, it, it's like reading the situation and like hearing what someone says, and then, you know, trying to be as compassionate as you can, I guess. But, but that was like, we hear that excuse all the time that patients are too tired or whatever the reason, and they want to do it tomorrow. But like, that was the first time that I've heard someone like,
00:26:33
Speaker
say it and they didn't really have to say it that many times for us to like you know gather that like yeah you know what okay I'm gonna take this cue and absolutely like you deserve that.
00:26:47
Speaker
Yeah. It sounds like most of the time you have to put on your, your traveling salesman face, Dunder Mifflin paper salesman, right? To get them moving. But I guess, yeah, that, that certainly sounds like a circumstance where you just kind of had to be there with the patient and understand the situation.
00:27:04
Speaker
Yeah. Kind of, kind of tangent to that, uh, you know, with, with the trauma cases, uh, that you have, I'm sure you see some, some, some pretty, you know, overwhelming things, right. And my question now would be just, do you kind of have a routine or something you do to sort of recenter yourself? Uh, if you see, uh, you know, between patients or after work, uh, if you've seen, uh, some not so fun stuff. Yeah. Um,
00:27:33
Speaker
You know, I think that for each person, it's really different. I think when I first started my job, it was hard to disconnect a little bit.
00:27:45
Speaker
Um, and I think that's pretty natural. Like, you know, you, it just kind of weighs on you more. I was a little more like emotional or like, I would notice things affect me a little bit more certain cases, or just even like reading someone's, like how they came into the hospital. And you're like, that is just so awful. Um, I think that, um, part of the job.
00:28:10
Speaker
itself like trains you to, to kind of compartmentalize a little bit. And I think that has been my biggest asset, I think. So it's a combination of, you know, compartmentalizing my work and keeping my work
00:28:32
Speaker
within the four walls of the hospital and like when I'm there, I'm present and I'm, you know, completely devoted. And then as soon as I leave the hospital, I have kind of trained myself to kind of turn that off and like, and now I'm this person and this is what I do outside of work. And these are the hobbies that I joy.
00:28:54
Speaker
Um, so that's a big part of it for me personally. And, um, some of my coworkers just have a hard time, have a harder time with that. Um, and I mean, it makes them great clinicians because they have a hard time detaching a little bit. Um, I don't have that issue. I have like pretty good at compartmentalizing. And so I would say that's part of it. And then the other piece of it is. I think definitely having other things to focus on. Um,
00:29:24
Speaker
to keep yourself distracted. So, you know, I, working on house projects, you know, taking care of my fitness and wellbeing, keeping up with like, you know, cooking and making good meals and, you know, things like spending time with my dog and my husband. So I think those, I view myself as like two very different people, like my daytime self and then like my go at home and disconnect from all that.
00:29:54
Speaker
Um, but everybody has different strategies. Um, and some days are much easier to compartmentalize some other days. Um, you know, I, I have a harder time and my husband knows like, when I come home and he's like, how was your day? Like I pretty much reset my brain every day. So like, I will not, I don't usually talk about cases that I've seen. Um, I don't usually talk a lot about the patients that I treat.
00:30:21
Speaker
because it's like, I think it's a protective mechanism to be honest. So I'll usually just summarize it as like, good, it was eventful or it was productive or I would say something very generic because I actually like think my body's trained to like turn off all those things so that like I can maintain now who like the rest of my body, the rest of my mind, if that makes sense.
00:30:44
Speaker
Yeah, absolutely. In terms of going back to the clinical, some clinical nuggets for a sec. What kind of types of cases to you are the most interesting, the most difficult, you know, what kind of conditions do patients present with where you go, Hmm, this'll be interesting.
00:31:03
Speaker
So
Interest in Trauma Cases
00:31:03
Speaker
I gravitate, so in the hospital you see everything, right? You see oncology patients, you see cardiopulmonary, musculoskeletal, spine, you know, just about everything under the sun, abdominal surgeries, like everything. But I think what fascinates me the most is
00:31:27
Speaker
is truly like the trauma on critical care because trauma patients, um, they have so many people who are working on that case. Like trauma patients tend to be the most collaborative because, and it's very fascinating to me how many different expertise in medicine, um, are called upon.
00:31:50
Speaker
Um, it feels like a giant, like, like it feels like the Avengers are like summoned to like help each trauma patient. It's like, okay, we, where's our like orthopedics doctors and what are they going to say? And what does our neurosurgery doctors say about their brain bleed? And like, all right, we better get ophthalmology in so that they can help us understand about somebody's like.
00:32:12
Speaker
eye functioning and plastic surgery can help us figure out this. Like, I mean, it is sometimes like a patient, one patient who's like an ICU patient, like a trauma ICU patient can have up to like seven different consulting services. And that part is like fascinating to me because it's like, wow, there's so much specialty that's like brought up onto this one case just to like,
00:32:39
Speaker
make sure that we're doing everything that we can, you know, so I, that, that piece, I always find like the most fascinating, I think. For a lot of those intense patients, I'd imagine that, you know, once they get stabilized, maybe you start working with them, there's still perhaps a chance of, of permanent disability, correct?
Managing Patient Expectations and Progress
00:33:00
Speaker
Like some of them definitely have a, you know, a hard road ahead.
00:33:04
Speaker
Yeah. Oh yeah, absolutely. I mean, especially cause like, um, you know, the patients, like we don't get called upon for every single patient in the ICU. Um, at least in my hospital setting, but, uh, so the ones that we do get called upon are going to need some long road of rehab, very likely. Um,
00:33:25
Speaker
And that can be kind of a blessing and a curse, I guess, in my setting because I get to see like the huge gains that they make in the beginning. So, you know, a patient who's on a ventilator, having them like stand up for the first time or like get out of bed for the first time or take steps.
00:33:47
Speaker
those things are pretty impactful and then they'll move on to the next level of care and then I don't even know what happens to them. I saw them as far as walking five feet, but then I don't know what the rest of their journey looks like.
00:34:07
Speaker
You know, it's very rewarding, but it's also like you have to be okay with letting go of that, like not knowing how the story ends. Sure. I guess my, my bigger question would then would be like for, for the patients who, you know, you don't know if they're going to walk again or, or, or you don't know if they're going to, you know, Regain a lot of their, their mobility. Like, how do you, how do you comfort them? Uh, you know, the best you can.
00:34:33
Speaker
Yeah, I mean, that's a good question. So where that comes into play a lot.
00:34:40
Speaker
So there's kind of two things that happen in this setting. So a lot of patients, like when I see them, they don't even like, they can't even comprehend what has happened. So they're kind of in this state of shock that like the reasoning and the rationale that like you and I can have right now about this conversation doesn't really set in with them, right? Because they're still like experiencing this degree of shock
00:35:08
Speaker
of like, wow, my body is so different than what it is, than what it used to be. So it, it doesn't actually like, it allows us to like focus truly on the present and they don't really have these like, like philosophical, like questions. They don't present with these types of thought process or questions because their mind is truly focused, like still focusing on what is happening at this exact moment. If that makes sense.
00:35:36
Speaker
sense if I'm explaining that correctly. Yeah. They're like, they're, they're so just like that their world's just been rocked to the point where they can't even like think a day or two down the road. It's like, wow, like I can't move my legs that well right now or something. Yeah. And they don't even know that they can't move their legs like that. They're, they're like even two, like negative two steps, right? Like they don't, they haven't even realized that they can't stand up very well or things like that. So.
00:36:00
Speaker
When we come and we talk about the next level of care, even that's like feels really rushed to them because they're like, wait, what's going on? So they're not even thinking about the recovery at this point. But then there are the patient populations.
00:36:14
Speaker
So the hardest population to work with when it comes to your question about prognosis essentially is spinal cord injury, acute spinal cord injury, because generally this population can be very cognitively intact.
00:36:32
Speaker
And so they can completely, whereas a lot of the other patients may not be, so that's another factor into this. But with the spinal cords, they are cognitively intact. They see this drastic loss of mobility overnight. And they can't...
00:36:52
Speaker
they don't know what's going on. And they, their first question is like, am I going to be able to walk again? Like what you see in the movies? Absolutely. That is what people like ask. And I think that as healthcare professionals, like we have so much room for improvement of how to explain that to a patient and how to be thoughtful in our response when a patient asks that because
00:37:17
Speaker
It doesn't come up very often. Cause like I said, majority of my patients are like what I first described to you, but there are subset of like a, you know, this population that comes to mind where this is a very common thing that we see. And I just think we have still a lot of room for improvement of like learning how to articulate.
00:37:37
Speaker
and having those tough conversations about prognosis. And a lot of times, you really don't know what someone's gonna regain. It's a very gray area and the whole, it depends answer, it's provided because that is how it is. You could always tell someone,
00:37:55
Speaker
you know you don't know if someone's gonna what what function they're gonna regain like you there's only so much evidence out there to show like okay and so many months you can regain this or if you don't regain this within the first month and you're likely set up for this but like each case is so different and um i don't know there's just so much like variability that
00:38:16
Speaker
Those are tough conversations that I've had to have with patients where they're like, I don't understand why, or amputations are another population like this where they can't quite fathom what is actually happening and if they're going to be able to walk again and things like that.
00:38:36
Speaker
when those are never like easy conversations but you know you just kind of try to focus on you support what they're saying and you try to comfort what they're saying and then you also want to bring them back to like the present and be like well right now we just have to focus on today like we only have control over today we don't know what tomorrow will look like so you know and you try to keep them like hopeful in that way because you truly don't know what what tomorrow will look like and I've
00:39:03
Speaker
I've seen those like huge changes like, you know, and, and stroke patients and spinal cord patients, like what, you know, your body's neurological responses is wild with from case to case. All right. Now
Angelie's Personal Insights and Opinions
00:39:19
Speaker
it's time for a lightning round, a series of fast-paced questions that tell us more about you. So first year.
00:39:28
Speaker
I'm going to paint a picture. Anjali is driving to St. Joe's hospital on our morning commute. So what's, what's on the radio? Oh God. If I say NPR, how does that make me feel? I don't think I could do NPR in the morning. I'd fall asleep. They talk to you quietly. Well, my commute is only like 12 minutes. So it's a good like flash briefing of like what's happening. Stay connected.
00:39:51
Speaker
Oh, there you go. I guess one thing I failed to mention is that you're also a Michigan Wolverine, you're an alum. So my question is, biggest change in Ann Arbor since your college days? Oh, man. Is it fair to say that I don't know if it's changed or just that we didn't never knew that things were there?
00:40:17
Speaker
either way. So I, I would say the biggest thing is like my husband and I, my husband who also went to Michigan, there's so much to Ann Arbor that we never realized is like a full functioning awesome city. Like when you go to school there, you're kind of like in this engaged in this campus and everything college lifestyle. But Ann Arbor as a city is a awesome city, like the amount of parks and trails and
00:40:46
Speaker
like culture outside of the university is wonderful, which is why we haven't left yet. What did you binge watch during COVID? I would have to say Narcos. What's that? Is that what is that?
00:41:07
Speaker
Um, should I know this? Yeah. Well, it's about, um, basically the whole cocaine like epidemic and Pablo Escobar. And I'm really fascinated on the, on the war on drugs. I mean, there's so much to learn about money laundering and cocaine. And now I've like pivoted into breaking bad, which is about production. So yeah, fascinating stuff. Could come in handy at work too, right?
00:41:38
Speaker
Uh, what do you always forget at the grocery store? Um, whatever was on my list because I'm an exploratory shopper. And so I can just wander the aisles. And then my husband usually has to call me and be like, are you, are you okay? Are you coming home now? So if you generally like most things on my list, I will forget. All right. Uh, lastly, one change you'd like to see in healthcare.
00:42:07
Speaker
Oh my gosh, one. That's it. I'm giving you one. Your top, your numero uno. Oh my gosh. I guess I would say, oh man, that is really hard. All right, give us the couple that you have then.
00:42:30
Speaker
Well, I'm just going to like broaden it because there's like, okay. So I would say overall, I'd like to see better education and training. Um, and that kind of like goes along the lines of like treating, um, patients with different diverse, like race, religion, ethnicity. Um, I think that we could, we don't have enough training.
00:42:56
Speaker
in that regard. So understanding, I mean, it just, if you live in a city that's pretty diverse or you live in a city that's pretty progressive, then you will get like, I feel like I'm going off on a tangent. So I'm just going to keep it at that. So education and training. And then I think that each, that goes without saying that each discipline could also learn a lot about what other disciplines do.
00:43:25
Speaker
you know, so that, because we're sometimes so focused on, you know, what it is that we do, but we work collaboratively. So really understanding what other professionals do and what service they can provide. So overall education and training is my answer. Yeah, you want to move that open office feel out of Silicon Valley into our healthcare system, right? No cubicle walls. Yeah, exactly. I mean, I don't even have an office. I roam around the hospital anyway. So that's pretty much my lifestyle.
00:43:52
Speaker
All right, Anjali Shah, thanks so much for joining the show. Thank you, John. Appreciate it. Appreciate your time. Thanks for listening to The Wound Dresser. Until next time, I'm your host, John Neery. Be well.