The Jackson Clinics

6/14/11

Today was a really long day. I got up and went running again around the neighborhood, but the elevation is a killer! We had our routine breakfast at the cafeteria in the hospital. They have the most amazing croissants! I am going to miss them.

The first group brought in a new patient today, presenting with shoulder pain and weakness. The resident had already filled out the mentoring form that we initiated last week, so we had a good head start on learning about this patient. However, it became apparent rather quickly that there were gaping holes in the history and understanding of this patient’s needs. We soon discovered that this patient had actually dislocated his shoulder 9 months previous and he was also complaining of tingling in the hand. Only some of the neurological screen had been performed and we were missing a lot of range of motion and strength data. I put the residents to work and within twenty minutes, we had our information. With my guidance, we improved his cervical range of motion and shoulder elevation before leaving the clinic today. We also structured the rest of his plan of care to emphasize range of motion and strength, rather than primary focus on pain management. The biggest problem that I saw with this case was that the resident had not considered the effect of this dysfunction on his life. As we gathered more of our data, we learned that he had not been working for the last 9 months because he could not function as a mechanic without the strength in the shoulder. I hope I was successful in driving this point home, that identifying his functional limitations helps to guide treatment, establish goals, and ultimately, get the patient better.

Unfortunately, the second and third groups did not have patients for the clinic today. So instead, we reviewed cases that residents were seeing and learned several manual techniques to address thoracic and capsular dysfunction. I’ve noticed that the residents are good at learning new skills, but they don’t always know the appropriate times to use them. On the other hand, we discussed desensitization for hypersensitivity during our second group today and Lili reported that she saw some really good techniques for desensitization while shadowing on the pediatric floor this afternoon. This was exciting to hear, that the topics of discussion are applicable and they are being used in the clinics.

After class today, we had to wait quite a long time for our driver to pick us up. It was a good opportunity to enjoy the nice weather outside, although cooler today than usual, and watch the most interesting individuals as they walked to and from the rehabilitation building. I have seen the most interesting and creative assistive devices during my time here, but I am also becoming numb to it as well. It is quite common to see people using sticks in a rowing like fashion to ambulate with only one lower extremity down the street. I have also noted that the hospital has done a really nice job of creating job opportunities within the hospital for people with physical disabilities.

We were dropped off at the Hilton this afternoon so we could get some emails out. When we finished, we sat for a few minutes in the bar and enjoyed nice cold tonic water. We noted that this wasn’t much different than sitting in any hotel in the U.S., which was nice for a change. We asked the front desk about restaurant recommendations and we were pointed in a direction to try a new restaurant. However, when we had gone past the 100m that was indicated, we decided to turn back to look elsewhere. A very nice Ethiopian man stopped us and wanted to direct us to the restaurant. After following him through a poorer section of the block, I started to become very anxious about where he was taking us. I suggested to Lili that we just try somewhere else tonight, especially since we seemed to be drifting far from the hotel and any signs of safety. She agreed despite the man’s insisting that we were safe and the restaurant was just up the road. As we turned back, my heart stopped racing and I felt much more at ease with our situation. We caught a cab and headed back for the Canadian embassy.

We decided to try Loti’s, a French restaurant, for dinner tonight. This was a very cute restaurant set back in the middle of all of the large mansions. We were the only ones in the restaurant from 6:30-8pm, but it was delicious! I had stuffed ravioli with spinach and cheese with vanilla ice cream for dessert. Lili had very delicious tilapia and caramel brulee. We both left very satisfied and ready to go to bed tonight.

We are planning to take a trip back to Alert Hospital tomorrow to do some shopping from the local patients who apparently make homemade crafts. I’m hoping for another great day… only 3 more to go!