Patients and Patience

Today we got to see patients!!  And wear lab coats!!  And pretend to be prosthetists!!  We thought we were pretty special in our lab coats (I obviously just grabbed someone else's for this photo op, it is clearly way too large for me).  Seeing patients was definitely the best thing we have thus far.  These sweet veterans came in and let us practice on them for about four hours this morning.  I was very nervous going into the day, but after meeting my patient...Mr. R, I knew it was going to go smoothly.  Mr. R is older than my grandfather and despite a few bumps in the road - mainly me trying to be super cheery and friendly and him thinking I was giving him the grand inquisition when I was just trying to obtain his patient history - we had a nice time.  Well, I had a nice time, I am not sure being casted by three different students for a total of six times in a four hour period is nice for anyone over the age of 85.  He was very patient as long as we kept the Diet Cokes coming :)  School takes on a whole new meaning when there are patients around.  It becomes a completely different environment where we, the students, are expected to be in control, and we do our best to pretend that we are!  The truth of the matter being that we were nervous, anxious, unsure, but certainly really jazzed to be allowed to touch plaster and people.  And did I mention the lab coats??

The patient appointment involved a half hour conversation to get the patient's history - how did they become an amputee, do they have any other health issues, are they currently experiencing any issues with the prosthesis they are wearing - those sort of things.  Mr. R was a little short with his history, claiming he does not remember the details of events that happen 4 decades ago, but I managed to get enough information out of him (with only mild prying) that I felt as though I had a decent grasp on everything.  Although, there were definitely surprises that came out during the assessment phase, but I guess that just keeps it interesting :)  Assessing the patient means taking off their prosthesis and making general notes about their residual limb.  We measure circumference of different places on the limb, find all of the anatomical landmarks that would be affected in a socket, measure their range of motion.  It is just basically to get an overall idea of the limb you will be casting and to make note of things that could possibly need attention or modification in your cast or mold.

Then it is go time!  Ladies and gentlemen, get out your water buckets, roll up your sleeves and lets get down and dirty with plaster!  Is there a way to do this in a neat fashion?  I do not think so.  I think even when I am casting for the 300th time, it is going to be just as messy as it was today on my 3rd time.  Professional attire is fun to put on in the mornings, but a bummer to look down and see your nice pants covered in crunchy white flecks of plaster.  Not to mention spending my lunch break picking it out of my hair.  Still...totally worth it.  Casting is FUN!!  I got to make two casts today and although Mr. R mentioned something about peeing on me during the second round, I still really enjoyed it (and thankfully, did not get peed on).

After casting, we thanked our patients profusely and sent them on their merry ways.  The next step in the process is to make a mold of your plaster cast.  This, of course, involves more plaster.  A bucket of plaster to be exact.  And sticking a metal rod down into your mold.  We poured our molds and were free to rid ourselves of plaster and take a mental break for lunch.

Ahhhh the modification.  My kryptonite at the moment.  Making this darn hunk of plaster look like the beautiful limb that I cast is the most tedious task you can possibly imagine.  You have to go through and find all of the things that you tried to mark when you were casting - fibular heads and patellar tendons and somehow they all seem to magically disappear into this giant plaster mold.  It all kind of looks the same when you are staring at it in this form.  After much examination (and strong guidance from my professors) I began to shape out the form of the limb.  It even started looking like something resembling what I was aiming for :)  I am finally getting the hang of using the Sureform (essentially a giant nail file type of thing that shaves off your plaster) and adding on the extra plaster today did not give me near the trouble that it did last time.

So, we spent the last four hours of the day standing over these molds and trying to get them down to a perfect shape.  Making them smooth, getting the same measurements on them that we got on our patients actual residual limb earlier in the day and adding plaster to create reliefs for specific muscles or bones that tend to be poked or pushed on by the plastic of the socket once it is on their limb.  Tomorrow we will continue working on these molds and eventually sand them down to a smooth, shapely hunk of plaster :)  We will then do the whole hot plastic vacuum thing over them again to create the socket.  The rest of the week is dedicated to making these sockets and going back to the grinding room (which I will conquer and defeat) and completing a finished test socket that is worthy to be fitted onto our patients again next week when they come back.

I learned a lot today - about interacting with patients (this is a new age group for me and I definitely have to adjust my pediatric mindset and disposition to accommodate that), about time management (it gets stressful to keep looking at the clock and panicking because you have so much to accomplish and an end time in mind), about having the confidence to just go for it when working on your mold (plaster can always be taken away and can always be added...mistakes can easily be fixed so it is okay to make them), and about myself in general as a practitioner.  I felt natural sitting with my patient, that part does not stress me out or make me nervous or anxious in any way.  I felt much better about my casting techniques so I know that the more I do it the better I will continue to get.  I felt like I at least had some idea of what I was doing when it came to modifying my mold.  I definitely feel like I have made big strides even just from last week making my first project to this week.  Stay tuned tomorrow after I spend another 6 hours with this mold and I might feel a little differently...or I might just have a beautiful socket on my hands.  Let's hope for the latter!