Returning to Clinical Practice After Brain Surgery

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I remember him waiting patiently as I shifted nervously in my chair. He had just presented me with a golden opportunity, yet I hesitated. Looking down at his feet, I was avoiding eye contact, hoping to hide my anxiety. I contemplated his offer, wanting desperately to find the courage to accept. Only two years prior, I naively sought this very opportunity, ignoring the obstacles that were in my way after I underwent a surgical procedure to remove a benign brain tumor. After that surgery, I expected to return home and recover followed by my eventual return to clinical practice. Instead, I became paralyzed and was admitted into rehab and thus beginning my journey of recovery. Despite the significant deficit I experienced from paralysis, I considered multiple job opportunities for physician assistants, my profession and passion. I could not fathom departing from clinical practice, despite being told that I could not work with patients for at least two years after suffering what the physician at rehab described as a traumatic brain injury.

Yet that day, two years later, while I was walking with an assistive device, driving, and already employed full-time in academia, I was afraid. Afraid that maybe I wasn’t ready or good enough to provide patient care. The man that waited patiently for me to consider his offer was my employer, Dr. Daniel Cervonka, the Program Director for the Physician Assistant program with which I was employed. In addition to his administrative responsibilities at the program, Dr. Cervonka was also the lead PA for a drug and alcohol rehabilitation program, Recovery Network of Programs (RNP), which was seeking PAs at that time. Eventually, with his persistent yet gentle encouragement, I decided to take the offer.

In so many ways, brain surgery has changed the landscape of my life. I feel stronger as an individual knowing that I am able to overcome such an obstacle yet weaker because I am now far more susceptible to the devastating effects of fatigue and stress that many healthcare professionals battle on a regular basis. I am more empathetic having been on the other side of the white coat, experiencing anxiety regarding one’s diagnosis and prognosis, and frustration with the lack of communication or what I as the patient deemed inadequate time spent with a health care provider during my patient encounter. I took these valuable experiences with me, nervous with anticipation yet excited with hope. A stethoscope in one hand and an ID badge in another, I entered the clinic and started a new chapter one year ago, exactly two years after my surgery as the doctor had advised.

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At first, I was slow, very slow. I fatigued easily carrying patient charts from one end of the hall to the other. Patients lined in the hallway, waiting to be seen by the nurses would shoot puzzled glances at the woman walking down the hallway with a cane in one hand and patient charts in another. The walk down was exhausting and embarrassing. After two years, I still struggled with a new identity of being “disabled”. In between patient encounters, I would rest my legs and my hand. We were still paper charting in the beginning and of all things fatiguing, writing was my nemesis. The physical exams were done without hesitation or difficulty. I had mastered my own technique and by following a regimen of head to toe, I developed a routine. After my first day I felt invigorated, thoroughly satiated by the experience. The fatigue both mentally and physically, would rear its ugly head the next day. I realized soon that I would need to space my shifts to accommodate my disability. After a while, I realized that I could also ask for help with carrying charts or calling on patients. Often, counselors would help in these areas or patient techs and I began to rely on them. This greatly minimized fatigue and helped speed up patient flow.

Interestingly, patients too are helpful and empathetic. These patients are undergoing detoxification from substances ranging from alcohol, opiates, to benzos and despite their own struggles, they never cease to amaze me with their concern for my well-being. These are underserved and underestimated individuals, many of whom grew up in and out of prison, suffered exploitation, years of physical and sexual violence and yet, when they see me, they are concerned for my health. Curious, they will stop me in the hallway to ask about my disability and how it came to be. I distinctly remember earlier on, one particular patient, emaciated and weathered by years of battling a heroin addiction and poor nutrition, appearing far older than “their” 50 or so years of life who was genuinely concerned about me. Seated in the hallway seeking comfort in solace, as many patients do, “they” rose to their feet as I was passing by and gently grabbed my arm . “Honey, what happened to you? How come you have a cane?” Caught off-guard, I hesitated. How much I should share, I wondered. Should I even share? Eventually, I thought, maybe it will help “them” see that there are struggles we can overcome.

Unsure, I responded, “I had surgery for a brain tumor and became paralyzed. As you can see, I’m still recovering, but have come very far.”

“Honey, I’m going to pray for you. I’m so sorry, too young for that. God bless you. That’s amazing.”

I remember feeling stunned by this response as I was not expecting such kindness. If anything I thought it would satisfy “their” curiosity. A few others had gathered and also echoed their prayers and well wishes. I looked around at their sympathetic smiles, overwhelmed by their acknowledgement.

“I guess we’re all recovering from something” I said.  I remember this statement striking a chord with them. I realized too the power of what I had just said. It was true, in life, we are all recovering from something. I stood there in the hallway with them for that brief moment not only as the clinician, but as a patient myself. One of my favorite quotes comes to mind as I often remember that moment, “Be kinder than necessary, for everyone you meet is fighting some kind of battle.”

Since my return to clinical practice, I have successfully recertified my boards this fall and have been able to share my many patient care experiences with my students, in hopes that all the things I am blessed to have experienced can one day guide them into becoming more sympathetic and well-rounded clinicians. After practicing again, I feel validated teaching young aspiring PAs the values I hold dear in regards to patient care and also, I feel complete. For two years, something was missing, something which I only found upon returning to clinical practice. As I continue to grow in my profession, benefiting from the help and support of my colleagues, I make sure to remember to take each step down that hallway and in life, one step at a time or as we say in medicine, “all things in moderation”.

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Last Minute Gift Ideas for Someone Recovering from Surgery in Rehab or at Home

‘Tis the season and my favorite time of the year. To be blessed with the love of family and celebrate the holiday season in good health is truly a wonderful gift and a luxury afforded to many, but sadly, not all. When thinking of what to gift those recovering from surgery, I have a few suggestions which may lessen the stress associated with their transition from life before surgery to the “new normal”. These are just some of the things others were kind enough to provide me with or that I was able to obtain eventually that made life a little easier, more entertaining, or more manageable. 

1.      Netflix

  Most that know me well know that I do not own a TV. I catch what I need on YouTube and Google, the movies, or when I visit with friends. Once I had surgery, life became stagnant and a little boring so my dear friend Christina was kind enough to provide me the gift of Netflix. I will forever be grateful to her as I caught up on some gems that I haven’t seen in ages and formed some new addictions. If you asked the nurses where my room was they would tell you just listen for the Cheers’ theme song or Law & Order, SVU and Criminal Intent. Seriously you can’t go wrong with this.

2.      Crossword Puzzles

  My favorite. Initially after surgery, I had great difficulty with reading and comprehension. I would have my brother respond to text messages as I could not formulate the responses myself. One day my therapist provided me a photocopy of a crossword puzzle, elementary level, and I remember feeling very frustrated as I could not understand how to complete it. It was extremely challenging and humbling but by my second month in rehab I was able to do them without covering the letters. It’s a great way to pass time in rehab or at home and extremely rewarding to progress in terms of level of difficulty. Many local Dollar stores even carry them so they are reasonably affordable and can be included in a gift basket.

3      Toiletries & Undergarments

   One can never have too much of either. Truth is when you are disabled, temporary or otherwise, these are hard to come by on your own. I’m not saying go out and get Victoria’s Secret thongs but the Hanes 10 in a pack cotton underwear are the best when you want comfort over style. As for toiletries, pharmacy stores like CVS or Walgreen's have a travel section which sells travel sized shampoos/ conditioners, body washes, toothpaste, deodorants, skin creams/ lip balms which would be great in a gift basket. 

4.      Electric Heating Pad

   Many people recovering from surgery can feel sore not only from pain at the surgical site but from surgery itself. Laying on an operating table under the effects of anesthesia is extremely stressful for the body and can be fatiguing. I myself have benefitted from a heating pad for sore muscles in my legs or back related to overuse or spasticity/ tone and it has served as a suitable alternative for days I do not have therapy. They’re very affordable and will be appreciated by anyone who is in need of them. If within your means, consider the alternative of massage therapy and treat them to a session. You can find great deals on Groupon.

5.      SAS Orthotic Shoes

      I’ll admit, not the sexiest pair of shoes, but hands down the most comfortable and safe. I have tried multiple brands of shoes as I tried to hold on to a sense of style only to find myself dangerously close to losing my balance and sustaining an injury. For anyone that requires the assistance of a leg and foot brace, you can understand my frustration. Often I felt like the two step sisters from Cinderella trying to fit my brace into a sexy pair of Nike or Puma sneakers, but alas, they were not for me. SAS though costly, are practical, safe, and giftworthy. 

6.      Electric Razors/ Toothbrushes

      First of all I’d recommend anyone going in for surgery to pack these as the surgical course one can take is unpredictable and these come in handy for rehab. There are many to select from and are very affordable. As someone who lost function of an entire side of her body, this was one of the first things I purchased on eBay from rehab. Gifting it would avoid the hassle for your loved one. Of course you could bypass the need for shaving and buy a Groupon Deal for laser hair removal, they could get four to five treatments in for around $100. 

7.      Hands Free Hair Dryer Stand

      This Holiday season I give thanks for the relief afforded me with this simple yet amazing invention. My lion’s mane is much more manageable with a hands free stand that fits most hair dryers. I have purchased mine on eBay, but please use caution as not all stands are made equal. I personally have found the Tripod shaped stands to be most convenient. My hair may not look perfect most days but there is something to be said about the confidence one has in being independent and self-sufficient, even if only a little. 

8.      Apps Subscriptions

    Great stimulating games which help pass the time when everything is a little too quiet. Here is a list of apps shared with me which stimulate brain activity by improving memory, attention, and ability to complete problem solving activity. Farmville for fun is great, but perhaps in addition to these:

       i.     Lumosity, Elevate Brain Training, Word to Word, Sudoku -some are free and can be combined

       ii.     My favorite, anyone recovering from weakness or a stroke, Dexteria. Only $3.99 for the app but it’s great.

      iii.     Bundle: Motor Skills Medley- Visual and Fine Motor Skill Apps $8.9

9.      Candles/ Diffusers

 Aromatherapy is very calming and uplifting, especially when combined with classical music. These are relatively inexpensive items which can be purchased at a variety of retailers in stores and online. Take caution with candles and gauge appropriateness for the individual and or residence.

10.      Food

   Cooking after surgery is the last thing anyone wants to do. Having groceries delivered to the home of an individual recovering is a great gift and easy with services such as Stop & Shop Peapod for example. You can even help pick items which are nutritious and supportive of healing and recovery. 

11.      Laundry Service

      I was very fortunate that my family would do my laundry for me and it was a huge relief. To not have to wear a hospital gown and wear regular yoga pants and t-shirts allowed me to feel “normal”. This would be a tremendous gift for a loved one or friend recovering from surgery. If you are unable there are online services which you can use to schedule a pick up and they will get it done. For example has housekeeping and other services which would be useful for someone in need. 

12.      Flowers/ Balloons/ Cards

   I absolutely loved coming to my room after therapy and finding a beautiful vase of flowers delivered. This never got old and even after rehab I have kept my cards and rosaries my friends and family sent me, some in my office at work. It is a beautiful reminder that I was not alone in this journey. 

13. Company

 Of all the things aforementioned, company is the best gift you can give someone who is recovering. Some of my favorite memories from rehab and then home involved watching movies with my brothers or sitting with my friends or father in the courtyard of rehab. I feel blessed to have had family and friends who made the experience less difficult, so if that is all that is in your means then trust it is enough and far more valuable than anything retail. 

One year work anniversary

Blessed to celebrate my 1 year anniversary today. Four seasons of growth, laughs, and support by an amazing group of colleagues and students. As I sit here with my colleagues enjoying tearful laughs, I think of last year and I am grateful I took the chance and applied. One of my favorite quotes my cousin shared with me, 'If your dreams do not scare you, they are not big enough.'