This is week 18 of my 36 weeks of Clinical Fellowship. This means that I am exactly halfway to knowing everything. 😉 My CF has been wonderful so far. I was lucky enough to get a job in the setting I wanted (acute inpatient) and even luckier to end up with a superb CF supervisor and fantastic colleagues. Even so, I have had my share of humbling experiences so far. Never one to shy from self-deprecation, I thought I’d share some of my favorites, plus the lessons I learned from them.
The patient knows when you don’t know. A couple weeks ago I was preparing to be signed off on my trach/vent competencies. Part of this involved sterile suctioning via trach for the first time. My CF supervisor was there to walk me through it, and yes, I definitely needed some walking through. I returned the next day, ready to go at it independently. As I walked in, the patient looked at me skeptically and said, “You gonna actually know what you’re doing today?”
Sometimes you just need to ignore Lesson 1 and forge ahead anyway. Like with my patient who was adamant that I did not know anything, he was sure he would never swallow again. I actually seriously considered discharging this patient, as he had been NPO for 6+ months, he had refused to participate in swallow therapy for most of that time, and I had just completed an MBS with him that showed continued profound silent aspiration of all consistencies. Honestly, I didn’t even know if I could help him. I decided to try one more session to persuade him, placing all the responsibility on him for completing the therapy, not on my ability to “fix” him. Somehow, it worked. He actually started doing the exercises. A week later he was on a modified diet and a month later his only restriction was nectar thick liquids.
Consider the principles of the research carefully, but know that it cannot be perfect or apply to all cases. I have loved following Dysphagia Cafe, in part for the exposure to new research. However, I may or may not have had moments of mild panic when research hasn’t “jived” with what I’m seeing clinically. With calming reminders from the author of this blog, I’m learning to absorb the overall philosophies of the research, take away specific implications where possible, and never let it be an excuse for a cookie-cutter approach.
Those are the top three of approximately one trillion things I’ve learned so far in my CF. I am excited to keep learning, and perhaps I’m gonna actually know what I’m doing someday! 😉