Timothy von Behren
Physical & Respiratory Therapy Services
700 Oregon, Hiawatha, KS 66434
Community Medical Center
2401 Towle Street, Falls City, NE 68355
Falls City Fitness Center
1723 Stone Street, Falls City, NE 68355
Rachel Jackson
Dave Nachtigal founded Physical & Respiratory Therapy Services (PRTS) in
1975. The company has since then grown to include clinics all over southeastern
Nebraska. Headquarters are located in Hiawatha, Kansas. The basement includes a
fitness center open to the public. The first floor is divided into an outpatient
physical therapy clinic and a respiratory clinic. The second floor includes the main
offices and conference rooms. The third floor includes three immaculate apartment
style homes where visiting specialists or interns can stay. In all, there are fifty
employees and fifteen departments. Dave manages them all and spends much of his
time traveling as a result. Dave also provides therapy to inmates at Tecumseh State
Correctional Institution and works with kids in several schools in southeastern
Nebraska. He also has a passion for landscaping. He recently created a village at the
highest point in Hiawatha for retirees who need extra care. This golden village is
called Aztec Courts. One of my assignments was to repaint all of the mailboxes and
flagpoles in the village. It took a full day of hard work, but every duplex on that
drive looked pretty as a postcard when we were finished.
The majority of my time was spent working at the hospital and fitness center
in Falls City. The hospital provides both outpatient and inpatient physical therapy.
We have one especially talented surgeon who flies to work every week to perform
total knee arthroplasties. He cuts through the medial knee, so the quad is never cut.
This has resulted in reduced pain pill usage and quicker recoveries. I took both
traditional cut and medial cut knees through their therapy programs. I was allowed
to cue patients on proper form and was allowed to provide resistance via theraband.
However, any stretching or massaging was left to the overseeing therapist.
As a physical therapy aide, I completed quite a bit of office work in the
physical therapy department of the hospital. I copied charts for each patient on the
schedule weekly. Even thought the therapists can do this, having the charts ready to
go saves them time. I also made sure that the four booths outside of the office were
made up for new patients. When laundry was low, I either called the laundry
department to bring some down or walked over there myself. At the fitness center, I
learned several different ways of folding towels that make them more aesthetically
pleasing to clients. When I worked over there, I was in charge of completing the
laundry myself. The work was at the fitness center was mundane in general. When
patient load slowed at the hospital, I cleaned the equipment and made sure all other
work was completed. Other work included making certain the ultrasound gel
bottles were always full and the water in the hydrocollator was clear and the correct
temperature. When the water had a rusty tinge to it, I knew that it was time to drain
and clean the hydrocollator. The therapists had me set patients up on electrical
stimulation machines and give ultrasounds. I feel comfortable using both pieces of
equipment and know how to communicate well with patients to find the right
placement and intensity. I also prepared hot pack and cold wraps for patients. The
sensitivity of the patient to heat and position of the patient (sitting, supine, prone
etc.) determines how many layers are used when preparing hot packs. Older
patients have to be closely monitored because they can more easily get burned
without being aware of it. Some days, I was in charge of billing and preparing the
schedule for the following day. I often filed therapist dictation and doctor orders
into patient charts. When all office duties were completed and no therapists were
double booked, I read anatomy texts to keep myself occupied. Because this was also
the time when the other therapists were free, the office space often became
overcrowded. Being the only man most days, I left the office and read in another
room so as not to make the women moody.
With one exception, all of the therapists are women. There is actually a
pregnancy rotation so that no more than two therapists will ever be gone on
maternity leave. We currently have two pregnancies in the therapy department, but
one is physical therapy and the other is occupational therapy, so no one has to get
an abortion. Our department operates as a family and has fewer abrasive
personalities than other PRTS departments. The maintenance guys occasionally
make sexual innuendos toward the women in our department, so we all had to read
and sign sexual harassment forms.
Every once in awhile, I had to walk down to the nursing station to file
inpatient therapy notes for the doctors. The patient rooms wing off of the nursing
station. Sometimes, I escorted patients to and from their rooms. Some patients use
wheelchairs and some use walkers. The hospital has a policy where all patients
being seen for weakness or those requiring an ambulatory device must be wearing a
gait belt and must be closely monitored at all times. The therapy department has a
good record and only had one fall while I was there. I was occasionally sent to
patient rooms to complete exercise programs without supervision. I know both
standard physical and occupational exercise routines. The most challenging
patients to work with were those with dementia because they constantly were
trying to figure out who I was and what they were doing in a hospital bed. I learned
from the nursing staff that you have to be really authoritative with these people and
ignore complaints.
Once a week, we work with kids at a private pool in Falls City. We spend
time making them feel comfortable around the water and engaging in activates that
enhance their motor skills. This may be a rudimentary form of swimming or a game
of catch and throw. Each kid has a special condition that can benefit from therapy.
One boy had a seizure while I was working with him. His speech become incoherent
and his pupils remained constricted in less intense light. He fell asleep shortly after
the seizure and was sent home. I worked with a blind boy and discovered that he
had excellent kinesthetic awareness. I described to him the exact positioning and
timing of the American crawl and he performed it fairly well. I was pleased.
Department manager Rachel Jackson was my supervisor. As she was on
maternity leave during the first half of my internship, we never sat down to discuss
any training objectives. She spends much of her time making Home Health visits
and working in the Falls City and Auburn schools. I learned primarily from
observing and by putting myself in a position to help. This summer was unusually
slow, so there were times when I took the afternoons off. This was the most
common type of problem. Other problems occurred when therapists were late and
patients were patiently waiting. Since I was familiar with most patient plans, I was
able to guide most patients through their programs. The only requirement is that
every patient be seen be a therapist so a daily note can be written. Occasionally, a
therapist forgets to write the note. I simply put a sticky note on the chart reminding
the therapist that a note is needed. Being written up by the safety inspector is
another potential problem. She checks all of the cabinets to verify that they are
locked. When first cleaning the equipment on the carts, I left the cabinets unlocked
to save time. When this was drawn to my attention, I made sure that the cabinets
remained locked at all times. The most serious problem occurred when there was
poor communication between a patient, her insurance company, the billing
department, and the therapy department. The incident resulted from the patient
neglecting to get precertification from her insurance company. She was denied
coverage after accruing over $10,000. Our tech had told her to call and verify
coverage, but the patient instead called the billing department who gave our
department and the patient the green light for treatment. We decided that
designating one of the back rooms for phone calls to insurance companies might
prevent a problem this costly from happening in the future. The hospital CEO
agreed.
When the only guy in our clinic broke his thumb playing softball, I became his
personal secretary for a while. One of my personal accomplishments was figuring
out how to keep emotional women in a good mood all day. When I first get to work,
I get the women coffee, tea, or water without them having to make any orders. The
other part of it is making small talk and showing empathy when they complain,
which rarely happens anyway. I also learned how to palpate for and release trigger
points. I practiced on the therapists and got free massages as payment.
My work environment is generally fun and cooperative. Unnecessary
negative remarks are made infrequently, except when stress at home transitions to
the working environment. This happened to our tech, so we made her take some
vacation time to relax. Although I found some of my work to be quite monotonous,
there were moments that I really enjoyed. I thrived on the opportunity to work with
an older couple wanting a general strengthening program at the fitness center. I
love applying knowledge! The patient load seems to be lightening more and more.
The therapy department is unsure why except that patients are not being referred
as much by home doctors. I believe this is because our doctors are sending patients
to other clinics, where the therapy approach is evolving with the advances in
therapeutic research. Our clinic is, in my opinion, lagging behind because of fear to
implement change. Dave and Rachel are aware of this and are requiring all
employees to read a book about penguins and a melting iceberg. I read the book. It
actually quite accurately depicted how I was feeling. I have been a patient at the
clinic where I work and none of the modalities have been successful, albeit the
occasional temporary relief. The reason for this is a lack of multidisciplinary
understanding and communication. I plan to write a book on the subject in the
future from an autobiographical point of view. Stay tuned! If you want to send
students to a clinic that focuses more on helping the really tough cases than on
building a golden empire, send them to Hruska Clinic in Lincoln. Ron Hruska is one
of the most brilliant men I know. His philosophy is cooperation among all medical
professionals. Talk to me in person sometime if you want to know more.
None of my classes thus far have prepared me for an internship such as this
one. However, some of my experiences will make future classes more meaningful.
Although I enjoyed my internship experience, I prefer to work in an environment
that utilizes a more holistic approach that rides on the wave of incoming research.