Well… I’m back at Uni for my last year of Physio.
The “I’m back” part of that sentence alone gives me mixed feelings. On the one hand, it means ALL THAT TRAVEL, getting up at 6am, perma-tiredness and multiple stupid group presentations. As always, they’ve made Mondays 8am-5pm solid by cramming all the lectures into it. Not sure why they love doing that so much… but Mondays have always been hell at my campus. On the other hand, Uni makes my brain stimulated, which helps me with all my Holiday Crazy, and I really like a lot of what I get to learn, especially in the practical tutes.
The fact that this is the last year of my Physio degree has pros and cons as well. We’re now learning all the really interesting, most dangerous treatments. I feel like the lecturers and tutors are trying to instill in us the old Spiderman values, ie- ‘With great power comes great responsibility’ because over the past few days I’ve heard so many phrases like, “By now you all will be experts at [insert Physio skill here]”, and “You’re on the home stretch now!”, but there’s also zingers like, “Next year, when you’re practicing Physios, there will be times when a small error on your part could cause your patient severe damage or death”. Those statements are pretty exciting and make me feel like I’m getting somewhere important, but at the same time, they scare the shit out of me!
Ima tell you about some of the scary stuff that can come up for Physios on the odd occasion, but I don’t want to give you the impression that it’s this crazy all the time. Being a Physio is mostly made up of safe, routine treatments that are much less interesting than this stuff!
The lecturers are trying to ensure that we have a healthy fear of making dangerous mistakes that will effect our patients, and that we respect the danger involved in what we do. There are so many things that a Physio does, that are almost always fine, but can sometimes cause tremendous harm. And then there are things which can just be easily forgotten in a busy day, and if so, can have terrible consequences.
For example, this semester we’re learning Manipulations of the inter-vertebral joints. To give you some idea of what they’re like, the Physio arranges the patient on the plinth into a position that puts particular joint in the spine on stretch, stabilises one vertebra with one hand and then gives a short, sharp push to the other bone in the they’re targeting. That normally will cause a crack or click. We’ve done loads of stuff involving moving spinal joints before, but these are the back and neck-cracking ones which Chiropractors are famous for. I find it quite amusing when the lecture notes repeatedly describe them as thrusts. Anyway, they’re a way of treating spinal stiffness or pain of mechanical origins when the symptoms occur only when a particular spinal segment is right at the end of its range of movement. They’re only meant to be used if the normal, milder spinal mobilisations have not solved the problem completely. There’s a list of contraindications to Manips in my Unit Guide that’s about 5 pages long. So, if you have any of these exclusionary criteria, it’s more dangerous for you to have Manips as a treatment. This is partly because Manipulating the spine can cause vertebrobasilar accidents (damage to or rupture of the artery that connects the spine to the brain), stroke, death, spinal disc herniation, vertebral and rib fractures, and cauda equina syndrome (a neurological condition in which the nerved below the end of the vertebral column are compressed, causing leg weakness/paraplegia, pain/anaesthesia around the groin, incontinence, and sexual dysfunction).
So. I can see why they want us to be careful. I’m not sure I’d cope with my treatment having any of those effects on a patient! Also, they kind of want us to consider not using Manips at all, even though we’re licensed to use them as Physios. Fair enough! They have especially emphasised the dangers of neck Manips, so don’t let anyone do those to you unless they’re super qualified and experienced y’all!
Another time a Physio will have to do things that are dangerous for the patient is in Cardiopulmonary Physiotherapy, especially in Intensive Care. A lot of the time, a Physio will be in charge of the lungs of the seriously ill patients in Intensive Care. That means interpreting the patient’s daily Chest XRays, adjusting the ventilator settings appropriately, changing the patient’s position to minimise lung problems caused by being intubated, ventilated and supine, suctioning the sputum from their lungs to prevent pneumonia, deciding when is the best time to insert/remove airways and doing that, cleaning them when they get blocked, helping the a patient to cough, take deep breaths and sit/stand/walk as soon as it’s safe to do so, etc…
All of these things are made much more difficult in the case of a patient with a brain injury. The problem for Physios here is that almost all of our treatments for the lungs lead to in increase of Intracranial Pressure (ICP). A healthy person, with a normal ICP can withstand these increases easily, but a person with a brain injury has a raised ICP to start with (because of a bleed, inflammation, tumour etc), so any small increase in ICP can result in stroke, permanent brain damage and/or death if the higher pressure inside the skull causes the brainstem to herniate down through the foramen magnum (hole at the bottom of the skull through which the spinal cord and blood vessels enter the spine). In some cases a Physio could cause this to happen just by suctioning a patient, changing their position, percussing their chest or asking them to cough. Most of the time a Physio can avoid chest Physio in these patients until they become more stable, but if you are the Physio for the Intensive Care Ward and a patient cannot breath because of a sputum plug in their airways or ventilator tube, you have to decide whether or not to suction it out – allowing them to breath but risking their brain! WAT.
Another thing which could kill a patient or cause brain damage is if the Physio forgets to adjust the height of the Extraventricular Drain (EVD).
EVDs are typically attatched to the wall or a something behind the patient’s head. They’re really simple tubes which are placed into the brain (!) through drilled holes in the skull (!!) and positioned on the wall at the current height of the patient’s brain ventricles (!!!). If the pressure in the skull rises beyond a certain point, the cerebrospinal fluid within the ventricles will move out of the patient and into the tubes, just because of the gradient. So, they are used to lower elevated ICPs before they reach a dangerous level. The only problem is if the Physio moves the bed or patient down or up for treatment without also moving the drain accordingly. That could kill them.
It would just be so easy for things like that to happen. In Intensive Care, the patients always have so many tubes and wires attatched to them, that one of these would be really easily overlooked. I am so petrified of something like that happening because I’m tired or working on autopilot! I think my first year as a Physio will induce more than a few stress-nightmares for me… Responsibility for someone else’s health and safety: I fear it. I don’t know how I’ll ever manage to have kids!
All of those situations are situations that Physios have found themselves in. Our educators want us to be as prepared as possible for things like that because they don’t want us to make the same mistakes that they and their colleagues have made! I’m so glad, but I’m gonna have to study real hard before I start working so that I have all of these things in the front of my head.
The flip side of all that fear though is that all of those frightening possibilities are rare. And, I am really excited about becoming a Physio. I love that I can do something in my daily work to save someone’s life, or to help improve their quality of life. I find it so rewarding seeing people get better. It also makes me feel really good that I will eventually be an expert at something. Someone who is turned to by other health care workers, including doctors, for professional advice about a particular aspect of the patient’s care. It gives me real pride that I will become someone who has a valuable, irreplaceable role in a hospital ward. Also, I just find medical stuff totally fascinating, and I want to be in hospitals ALL THE TIME so that I can be exposed to as much of it as possible!