One of the things I have learned at school is you either trust your cast or you trust your measurements. I am not at the point where I trust either of these things (certainly not one more than the other), so I do my best to keep up the accuracy all around. Taking measurements is a very serious business.
And often involves help from a partner...a second opinion never hurt anyone.
Casting day!! Always the busiest, most stressful, and hands-down dirtiest day of the week. My least favorite part of casting day is the massive clean up that is required afterwards.
Something fun and different happened today in regards to my patient assignment - I had a woman!! This was the first time we have even had women patients come into the school for a project. I think the ratio of men to women patients was pretty equal. It was a nice change...and a smaller patient means less plaster :)
I will refer to my patient as Norma - she is a feisty 75 year old woman who brought in a reusable grocery bag full of cookies (not to share) and her own towels from home to cover our chairs. She has been a patient model at the school for the last 10 years and knew far more about what to do than I did. This was a blessing and a curse...she would either give me a helpful tip or glare at me and tell me I was doing it wrong. Norma speaks her mind, told me about the previous "idiot" students she had had in the past (namely a girl who did not speak English as her first language) and previous patients that she did not care for either (namely a man who wore a diaper). I have a henna tattoo on my hand from the wedding I attended last week and she told me it was ugly. I have to respect a woman who speaks her mind...and she was my patient (just like the customer, they are always right), so I just smiled and continued taking her measurements and prepared to cast her.
This picture tricks the reader into thinking I was having a really really fun time palpating Ms. Norma's ischium. I was smiling through the awkwardness. I also believe this was right after Norma reached around and grabbed my hand and placed it in the right spot. (One of the blessings I was talking about earlier of a well-versed patient.) I do feel for Norma, she had to endure four hours of this and four different casts being made. That is a lot of poking and prodding (often in the wrong places) and a lot of up and down from sitting to standing. I was exhausted before noon so I know she must have gone home and taken a long afternoon nap. I did the first cast on Norma and felt okay about it, but there is always room for improvement and, as to be expected, my second cast was much better. These castings are so much harder to do than they look when we are observing them being done by our instructors. Before lunch we filled the cast with the plaster to make the mold. A little lesson I learned about trans femoral today (and another reason to be thankful for a small patient) is that you have to lug this giant plaster mold to and from places and if I had had a patient that weighed more than Norma's 125 pounds, I might have needed a second set of hands. There were legs in the room that were far bigger around than my waist. I am going to have to go into pediatrics simply to be able to carry my molds around!!
These casts and these molds are not nearly as pretty as the ones for trans tibial. In trans tibial there are more bones and therefore more definition in the cast...in trans femoral it is just a big mess of skin and muscle that is very indecipherable when it comes out of the mold. I would be lying if I told you that I did not spin the mold around in my vice grip about three times trying to figure out which side of the leg I was looking at. I ended up marking the sides just so I would not get them wrong later on in modifications. We had a little bit of time at the end of the day to begin the modification process. The good news is that there are only 15 steps to be done to get this leg modified and ready to pull plastic over it (insert dripping sarcasm). We are used to about 5 steps in modification...I would be right on track if this was the case, I left school today at step 5. Our instructor only walked us through the first 9 steps today so we have not even covered how to finish it!! Tomorrow is a full day of only modifying and trying to get our molds to something that resembles an ischial containment socket. I think the goal is to get the plastic pulled and have a check socket by the end of the day, but I am setting my expectations a little lower - essentially, just being more realistic about the amount of progress I can make in 8 hours.
This is how I left my mold this evening. If you cover them in plastic bags it keeps the plaster from getting too dry and hard and makes it easier to make the modifications. I will take all the extra help I can get so I use every trick in the book!! I am still amazed that this ugly thing covered in a plastic trash bag is going to become someone's leg. I am even more amazed that I am the person turning it into a leg!! I really do not think this will ever get old for me - it is quite indescribable. This socket is definitely going to be the most challenging thing we have done thus far, but if I think back, everything previous to this has been the most challenging thing up until that point. If I can get through the modifications tomorrow I will feel really good going into the patient fitting next week. And if not, it is plaster - it can be added, it can be taken away, it can be re-made. It is all about failing forward and learning, both of which I plan on continuing to do :)
I leave you with a glimpse of what I look like after a day of casting (at least from the waist down). Although my actual casting technique has improved, I do not seem to have grown in the area of making any less of a mess. I tried to outsmart the plaster today and wear white pants, but it is plain to see that it got the best of me anyway. This is why I am currently doing all of my laundry - I need fresh, clean clothes that I can get plaster on tomorrow :)
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