A LOVE LETTER TO THE SNF THAT RAISED ME

Welcome to my diary entry, stream of consciousness on the pain and grief felt having been given one weeks notice that my position at my first job was terminated due to a dissolved business agreement.


How do you say goodbye to a place that means so much?

How do you accept leaving a job not on your own terms?

But the terms of a dissolved partnership?

I thought I would get to decide when my last day was.

I thought this was my decision to make.

I thought I’d leave on my terms.

Not the terms of management.

I get it, life’s not fair.

I know.

How do I say goodbye to the coworkers that made each day better than the one before?

To the patients and residents that made me a better physical therapist?

More so, a better person?

More empathetic.

More patient.

A better communicator.

A better listener.

With improved confidence and conflict resolution skills.

How do I say goodbye?

I wasn’t given the chance or the privilege to say goodbye to those taken by the COVID virus.

I think about them everyday.

Jane,

Betty,

Lee,

Lupe,

Arden,

Rick,

Don.

I’ll feel that pain for rest of my life.

How they died alone.

So unnecessarily.

But remember,

Life’s not fair.

I know, I know.

I walked in a fearful new grad.

Scared out of my mind.

Into a building with a lot of heart.

And a lot to offer.

A team with so much to learn from.

And I leave a better PT.

I leave a better person.

From the bottom of my heart,

Thank you,

Meryn Frey, PT, DPT

SNF PT POV: COVID-19 JANUARY 2021 UPDATE

December 22, 2020

For the first time, in a long time, I have hope

I chose to get the COVID vaccine for myself, but more importantly, for my patients

I can’t bring back the 14 patients who have died unnecessarily at the hand of this virus

But I can do my part to protect myself and my patients, from this day forward

January 12, 2021

Today, 21 days later, I felt excitement and thrill receiving my second dose

I’m proud to stand with science

To trust the scientific process

To support the scientists and researchers who made this vaccine possible

In record time

I’m proud to advocate in my personal and professional lives

On the importance and impact of vaccination

Because I’m done with the heart break

The mourning

And the grieving

I’m ready to close this very difficult chapter

The tears I’ve shed have evolved over the course of this pandemic

First, in fear, with uncertainty and unknowns

Second, in happiness, as my patients started to recover

Now, in hope

Hope for new, better days ahead

I hold onto hope

Until tomorrow, Meryn


THANKSGIVING DAY REFLECTION: COVID-19

It’s Thanksgiving Day, 2020. Here is what’s on my mind:

I’ve spent a fair amount of time reflecting on the past few weeks and months living and working through the COVID-19 global pandemic. This public health crisis has brought forth a lot of change, for good and for bad – I find myself repeating this has been a transformative year, but more on that later. While there is much to be thankful for, including my health and the health of my loved ones, job security, a roof over my head and food in the fridge, I am not one to ignore the emotional pain and grief I’ve endured this year.

I take no shame in fully engrossing myself in my emotions. I promised myself long ago that I would never feel embarrassed for having or displaying my feelings, which, in the past few months, has manifested itself as sobbing at work, unapologetically. I sobbed as residents were discharged following positive COVID-19 test results, uncertain if or when I’d ever see them again. I sobbed as the positive cases grew, first it was 2, then 4, then 7, 13, 19, then it was 100% of residents. Finally there were moments of tears of joy when residents started to recover and were moved off the COVID unit.

Nothing has been harder than holding the hands of my dying Hospice patient, only to learn she passed alone 2 hours later. I felt hopelessness and fear watching a 31 year old receive CPR, to hear time of death called, then to see her lifeless body alone in her room. The tears have slowed down overall, but they visit me when someone asks how I’m doing or how work has been. Or now, when I spend intentional time thinking about the patients, the friendships, I’ve lost.

At this point, I’ve lost 13 patients, a majority of whom I’ve known and cared for since the first day of my career as a nursing home physical therapist. These are people who died unnecessarily at the negligence of others, my heart will always hurt for them. In an effort to honor them, I’ve kept a running list of their names alongside fond memories or stories I’ve shared with these special people.

  • Cynthia showed me the importance of gratitude and appreciation for those who help others
  • Beverly taught me you’re never too old to play video games, especially until 3AM
  • Don showed me a few words is was enough to let your needs to known
  • Lupe taught me the time is always right for a cup of coffee and a cookie, especially at the end of a PT session
  • Ed showed me how my words impact outcome and patient trust
  • Lee taught me the importance of knowing what you want and standing your ground – “but I don’t wanna” and “I’m lazy”
  • Arden taught me the only correct answer to the question “how are you?” is “finer than frog fur”
  • Richard showed me strong men cry
  • Betty taught me you’re never too old to appreciate a cute pair of shoes
  • Jane taught me the key to being simply the best grandma was to rest as often as possible
  • Rick taught me no matter how hard you try, the worst of circumstances can fall on to the best of people

I hope I don’t have to add many more names and memories to this list, but it is likely the number will grow. COVID cases are rising, expecting to get worse as we head into the holiday and winter season. In conclusion, wear a mask, wash your hands, distances yourself from others when able, and treat others with kindness.

Until tomorrow, Meryn


SNF PT POV: COVID-19 OCTOBER 2020 UPDATE

In short, it sucks.

I sob every day at work.

Seriously, I sob.

I sobbed at the first notice of positive patient cases.

I sobbed when I watched a newly positive patient leave by stretcher for our sister facility. The fear and confusion on her face was enough to lead me into a near panic attack. I only wish I was exaggerating.

I sobbed at the notice of our first COVID death, and every death there after. It’s up to 6 today.

But, for the first time this week. There were happy tears.

I got to finally cry tears of joy as a walked down the hallway and saw two previously positive residents had moved off our COVID unit and back to the ‘healthy’ side.

But the pain is far from over.

My fears from March are coming true and it breaks my heart.

I’ve had this fear since March, when everything was so scary, so new, so many questions, with so many new cases.

My fear was some unknown point in the future, I’d walk the hallways, glance left and right, and see the empty beds of the residents we’ve lost.

This is now the reality.

There are now 6 empty beds.

Beds that wouldn’t be empty if not for this virus.

We’re lucky to have made it this long.

Until tomorrow, Meryn


WHAT I’VE LEARNED IN MY FIRST 6 MONTHS, THEN 2 YEARS AS A PHYSICAL THERAPIST

Happy National Physical Therapy Month!

Long before I had the idea of starting this blog, I was working on a thoughtful and well-formatted running list of what I had learned in my first 6 months as a new grad physical therapist. I’ve made some minor tweaks, but the essence of that original writing rings true and can be found below.

I’ve also since added to the list, now that I officially have 2 years of experience under my belt in skilled nursing – oh how the time flies.


What I’ve learned in the first 6 months of being a new grad skilled nursing physical therapist:

1 | This work is not 9-5. I’ve literally had days as short as 2 hours and as long as 10+ hours.

2 | No one outside your immediate department knows your job title, your credentials, or your level of education.

3 | It almost doesn’t matter how good of an evaluator you are as long as the evaluation gets done so that the assistants can start treating the next day, if not later that day.

4 | Companies don’t want to pay a DPT to treat their patients when it is more cost effective to have therapists “do what therapists do best” (i.e. complete evaluations, progress reports, recertifications, and discharges) and have the PTAs treat.

5 | It is rare to find a job where you supervise only one building.

6 | My clinical skills aren’t progressing here and I’m afraid they never will.

7 | There are times when I feel that I am the only clinician who takes the time to truly listen to their patients. When others are quick to dismiss patient’s for being lazy or unmotivated, I’ve tried to uncover a cause for their behavior.

8 | Patients need the permission and safe space to own and feel their emotions. Some people’s entire lives are flipped upside down when they get admitted to our facility. It’s likely they’ve had a decline in their health and medical status, and at times have been uprooted from their routines and even their homes.

9 | Most patients aren’t MORE motivated with constant reminders about their lack of progress, ongoing refusals, and lack of participation. In my experience, this can lead to decline in motivation.

10 | Compassion and a true desire to connect with your patients will go farther than “bad cop intimidation.” Engaging patient’s in meaningful discussion about their hobbies and interests can lend to problem solving and finding motivating factors and ways to successfully hold your patient’s accountable.

11 | Burn out is real and weekends should be treated as sacred time and space to recharge physically, mentally, and emotionally.

12 | Everything you’ve never done before is only scary the first time – at least that’s what I tell myself to ease my fears.

13 | And in the same vain, you only do something for the first time once. Each time you do that task again, you take the knowledge, successes, and failures with you from the first time to make each subsequent interaction better and better i.e. calling family members to discuss patients, discussing patient’s with physicians, calling insurance companies.

14 | Patients rude comments and stabbing words hurt, but they are not a reflection on you as a person, rather the patient’s outward expression of sadness, grief, frustration, etc. – try not to take it personally.

15 | Patients need help recognizing the small wins to keep motivation and morale high.

16 | Salary negotiation is scary (I wonder if it always will be).

17 | The patients you think or appear in the best health are some of the next to die. The patients you think are destined for the grave hold on longer than expected.

And finally, what I believe to be the most important thing I’ve learned in the first 6 months of work as a new grad PT:

18 | You won’t fix everyone. You’ll want to, you’ll feel like a failure when your best intentions don’t work out. Truth is, some people don’t want to be fixed. I remember a clinical instructor telling me this and thinking that was crazy, what do you mean people don’t want to be fixed? But now I know.


What I’ve learned in the first 2 years of being a new grad skilled nursing physical therapist:

1 | You tell yourself you won’t get attached. But you do. And you cry when you see their empty bed and their name removed from the nameplate outside their door. And you’ll think about them when you pass their room or their birthday comes and goes.

2 | Salary negotiation is exhilarating and makes me feel like a strong, determined woman.

3 | Sometimes you have to lie to patients. But not in crazy horrible ways. “Yeah, I’ll look for that book for you” or “I’ll be sure to follow up with maintenance about your tv remote being broken.” Hell no, I say these things and get out, if I happen to run into someone whose job is to handle these issues, I’ll mention it but I don’t go out of my way for non-therapy or health related issues.

4 | I’m not a stern enough clinician. I’m quick to take a patient’s refusal at face value and do a bad job of forcing a patient to participate, especially in an evaluation. I’m not here to force you to do something you don’t want to do. Should I be more direct with people? Probably, but I’m also not about being the bad guy from day one. I educate and provide rationale but if you want to lay in bed all day, that’s your god damn right.

5 | Patients can’t pronounce my name, but that didn’t take 2 years to figure out. So yes, I’ll respond to Mary, Marianne, Marilyn, Meredith, Meryl, Merlin, and Marnie.

Until tomorrow, Meryn


TOP 10 REASONS WHY I LOVE BEING A SKILLED NURSING PHYSICAL THERAPIST

In no particular order, the following are 10 reasons why I love being a skilled nursing physical therapist! For context, I graduated from PT school in 2018 and, at the time I’m writing this, have 1.75 years of experience working in the skilled nursing setting.

1 | Transition to Home
Nine times out of ten when I ask a short-term, rehab patient during the initial evaluation what their goals for therapy are, they respond with “to get back home” – to which I jokingly replay, I think I’ve heard that a time or two before (side note, also a great segue into discussing home set-up and prior level of function). As a therapist, I feel a sense of accomplishment and satisfaction in helping a patient achieve their goal in returning home. Home is where love and life happens and it’s a joy to help patients return safely to their home environments.

2 | Forming Lasting Relationships with Long Term Residents
I love being able to walk up and down the hallways, see the smiling, familiar faces of residents I’ve worked with time and time again. Because I’ve worked for nearly 2 years with the same long term residents, I have a good idea when someone is declining functionally – whether it be in the way that they walk, how they propel their wheelchair, or even how often they are out of their room. This allows me to screen, evaluate, and treat my patients to prevent further functional decline, to optimize functional mobility, and improve quality of life.

3 | Interdisciplinary Collaboration
I’m sure this makes me sound like a nerd, but I love interdisciplinary collaboration (my entire scholarly project in PT school was focused on interdisciplinary education for professional healthcare students). The other disciplines I have worked with include other members of the rehab team like occupational therapy and speech therapy, in house nursing and dietary, physicians, physician assistants, and nurse practitioners, and what I view as ancillary disciplines like orthotists, prosthetists, and wheelchair vendors/assistive technology professionals. Similar to the hospital setting, it is so beneficial having the ability to walk down the hall and get updates from nursing, express concerns, celebrate victories, and advocate for my patients, without leaving the building, usually without even having to pick up the phone.

4 | Chronicity and Acuity
Working in skilled nursing provides the opportunity to work with short term rehab patients with acute concerns and medical instabilities, but also with long term residents with chronic impairments and various comorbidities. When new admits come to us after lengthy hospitalizations with extended period of bed rest, they are often times very deconditioned and weak, and require extensive physical assist for rolling in bed, sitting without support, even repositioning their legs in bed to optimize comfort and to preserve skin integrity. It is often these patients who challenge my goal writing skills and creativity when forming plans of care. This juxtaposition and variability has helped me refine my skills as a relative young physical therapist.

5 | Variety in Age Range
When I was a physical therapy student, I had the misconception that the only patients in skilled nursing facilities were going to be old people, like 65 or older. I quickly learned during my SNF clinical rotation in Nebraska that this was not always the case. Yes, generally I’d say my patient population is 65 years or older, but it’s not uncommon to work with patients younger than 65. The youngest patient I have had was 27 years old (just 1 year older than me at the time), while the oldest has been 101 years old. I like being able to work with such a wide age range, it keeps topics of conversation varied from life during WWII to Taylor Swift.

6 | Custom Wheelchairs
I have a confession: when I was in PT school and we were learning about wheelchairs, I literally thought it was pointless and that I’d never use that information in my career. Jokes on me because I love, and I mean LOVE, collaborating with wheelchair reps to get my patients custom wheelchairs with custom seating. Wheelchair delivery day is such a satisfying day in the therapy world. It feels like such a win after the long process of evaluating the patient, designing the wheelchair, completing the medical justification paperwork, and waiting for approval from the health insurance companies. It has been a learning process with trial and error, successes and failures, but it is so satisfying to see a patient in their new, custom wheelchair. At the time I’m posting this, I’ve successfully had 6 custom wheelchairs approved and delivered.

7 | Autonomy
Never in my career have I had a physician deny my plan of care for a patient (can’t say the same for insurance companies). In my experience thus far, the physician’s I work with will sign off on anything. Want to pursue a custom wheelchair? Signed. Want to start PT to negate a functional decline? Done. Does nursing staff need re-educated on a restorative program i.e. walk to dine or PROM program? Sure thing. To be honest, I can’t even be sure that the physicians do more than skim the top of the eval to see what discipline it is before signing. I don’t know that this can be said for all skilled nursing facilities, but I feel that I have a lot of autonomy, more so than what I experienced in the outpatient orthopedic setting.

8 | It’s Fun!
In what other setting can you dance with patients to ‘Celebration‘ and ‘It’s Raining Men‘ and bill for it? With some creative wording, dancing in during a PT session becomes challenges to static and dynamic standing balance without upper extremity support with focus on lateral and anterior weight shifting in addition to side stepping and forward stepping to challenge balance reactions for reduced fall risk. Every day may not be fun, but there definitely is fun in every day.

9 | Income to Hours Ratio
Let’s be real. I have two college degrees that were not cheap, so pay is important. Now on a personal level, my work set-up is unique in that I work 10-20 hours a week at a full time, hourly rate at one building and 10-20 hours a week at a PRN rate at the other building (because I work for 2 different entities of the same contract company). The down side is that I don’t accrue PTO as quickly as standard full time employees, but I manage just fine, and honestly it doesn’t much matter right now with travel restrictions in place due to the COVID-19 global pandemic. For comparison, in 2019 my gross income was just over 72K working 1,610 hours in a calendar year. Based off of my own research and conversations with my classmates working in the outpatient setting in my same state, annual salaries can range from 70-85K but as salaried employees, they are most likely dedicating 2,080 to 2,600 hours in a calendar year – a possible difference of 1,000 hours! There definitely is good money to be made in skilled nursing, especially with a couple reliable PRN gigs on the side.

10 | Opportunity to Work in Other Buildings
Working for a contract rehab company affords me the opportunity to work in my ‘home buildings’ (where I serve as the supervising physical therapist) but also other SNFs in the area. This gives me the opportunity to pick up extra hours during the week and on weekends – which equates to more money in my pocket. Aside from the obvious benefit of earning additional income, working in other buildings has exposed me to hundreds of other patient cases, which really helped me gain confidence and improve my skills my first year as a clinician. Now, I’m well known in my company for being a reliable, flexible, and professional physical therapist. My willingness to work at other buildings has helped me network with other directors of rehab and has in turned helped me leverage my worth as an employee, resulting in multiple raises.

Until tomorrow, Meryn


COVID-19 QUARANTINE UPDATE: TAKING THE GOOD WITH THE BAD

Facts and Statistics
As I type this, it is June 14, 2020. It has been 5 months since COVID-19 was declared a pandemic in the United States. As of May 27, 2020, the US had the most confirmed active cases and deaths in the world and its death rate was 285 per million people, the 9th highest rate globally (source). According to John Hopkins Coronavirus Resource Center, there are 7,893,700 total global cases with 432,922 global deaths – 115,732 of those US deaths. According to the Ohio Department of Health, Ohio has 38,188 confirmed cases (or 41,148 total cases) with 2,327 confirmed deaths (or 2,557 total deaths).

Work Life
I can thankfully and joyfully share that both of my buildings are still COVID-19 free. While there has been administrative staff that tested positive, I am so fortunate to say that we haven’t had a single long term care resident test positive for the virus, nor have we accepted a short term patient who has been positive. From what I have been able to gather from the administration department, as long as there are other skilled nursing homes, with positive cases, with open beds, my buildings can continue to refuse to take COVID-19 patients to limit the spread of this virus, especially to our vulnerable and highly susceptible population.

This past week both my buildings were visited by a health department surveyor who examined our PPE and sanitation protocols. Up until this point, the CDC and health department’s recommendations had been changing weekly – N95 one day, face shield the next, nah you don’t need either, just wear a surgical mask, on and on and on, different week to week (of note, I was given an N95 and a face shield, only have worn them once in the past 8 weeks). The latest protocol is any new admission to the facility or resident who returns from a medical procedure (i.e. dialysis) must be quarantined in their room, preferably in an isolation unit, for 14 days, and staff is required to don gown, gloves, and surgical mask (last I heard not an N95, but again, that could change tomorrow).

My hours have been steadily rising over the past few weeks. On June 1st, I went back to my ‘normal’ schedule and started traveling between both my buildings each day, except that I requested to continue to have Wednesdays off for the time being. Because of the limitations in use of PRN staff and limited ability to pull other full time PTs to our building to cover weekends, I’m basically on call every other weekend, so I wanted to build in a day off into my schedule mid week in the event I have to cover both days of the weekend, and it has worked out so far.

Personal Life
While I am very fortunate to have retained my job, I found myself with a good chunk of extra time on my hands during the week since the start of this quarantine. With this time I was able to knock out some big goals, form healthy habits, and (hopefully) create lasting change in my life related to weight loss and hobbies. It goes without saying the privilege I have to be in a position of freedom with minimal responsibilities. I live in a one bedroom apartment with my partner, I have no children and no pets to care for, a sizable emergency fund, and solid support system. If there ever was a time to focus on myself and personal development, this is it.

This quarantine has allowed me to focus my time and energy on meal planning, meal preparation, and working out at home, which resulted in a 20 lb weight loss (read more about that here.) I also became quite the bookworm in quarantine. As of today, I’ve finished my 11th book (nearly four thousand pages) since April 5th with a new found appreciation and love for ebooks, the Toledo Public Library, and Book of the Month (which I joined in June). I’ve read more in the past 10 weeks than I had my entire senior year of AP lit. And lastly, this quarantine pushed me to do something I’ve thought about for years, starting this blog. It’s been so much fun brain storming topics to write about and drafting blog posts. I especially have liked working on my currently/monthly favorites posts and my book review posts.

Daily Life
Ohio has continued to re-open with Governor DeWine permitting the following to open effective June 10th: aquariums, art galleries, country clubs, indoor sports facilities, indoor movie theaters, museums, outdoor playgrounds, trampoline parks, zoos etc. From personal experience I can say the percentage of people wearing masks to grocery shop is quickly declining, though I still continue to wear a mask. My local gym reopened at the end of May but I opted to freeze my membership for 3 months, I figure I’ve managed to lose 20 lbs without the gym, maybe I don’t need it after all. In an unexpected turn, public health superhero and Ohio’s health director Amy Acton’s resigned on June 11th after continued backlash against Ohio’s lockdown protocols.

Reflection
While it feels like we are shifting into a ‘new normal,’ the coronavirus is still very much a threat and likely to be around this time next year. Some speculate that nursing homes won’t allow visitors until a cure for COVID-19 is found. All I know is that this has been the strangest period of my life. I am so blessed and privileged to be coming out on the other side of a global pandemic with a job, my health, and all of my loved ones unharmed.
*knocks on wood*

Until tomorrow, Meryn


SNF PT POV: COVID-19

Note: this initial post was written March 25, 2020. An update with more recent statistics can be found prior to the conclusion of this blog post.

I knew there would be obstacles in my career a physical therapist – people will fall, mistakes will be made, people will die – but nothing could have prepared me for COVID-19, the viral pandemic that has done so much damage with no end in sight.

As of 3/25/2020, according to the Center for Systems Science and Engineering at John Hopkins, more than 420,000 people have contracted the novel coronavirus and at least 18,915 have died.  What initially started in mainland China has spread globally, continent to continent, to every US state. The Ohio Department of Health reports 564 confirmed cases in Ohio across 49 counties with 8 confirmed deaths.

As a healthcare worker, this is hard, in so many ways. I came to the realization that there would be a point that I may have to make the decision to step away from my patients and residents for fear of exposing them to this virus. I had a particularly hard day, where the reality of the danger of my job in combination with Kyle’s started to set in. A sense of identity crisis fell over me because as healthcare workers, all we want to do is help. And to come to terms with the fact that continuing to do my job with the intent to help others could result in spreading of this virus, or worse, is heart breaking. And on top of that, the ethical dilemma this presents as a supervising therapist is hard. I have assistants that work under me that could effectively lose their jobs and be forced into an unpaid leave of absence if I can no longer work and/or supervise – assuming another PT can’t fulfill my position for the time being. That has weighed very heavily on me.

What is so upsetting is that no one seems to be talking about the implications of traveling building to building as I have done daily for the majority of my career. I made the personal decision (and what I consider to be the socially responsible decision) mid March to stop traveling to more than 1 building a day, which honestly isn’t even enough. It’s infuriating to me that other therapists aren’t speaking out on the dangers of traveling building to building. While I understand everyone’s caseloads are low and they are desperate to find work, this has to stop.

According to article published by the LA Times on March 18, 2020, “Limitations in effective infection control and prevention and staff members working in multiple facilities contributed to intra- and interfacility spread” per a CDC report. The CDC confirmed 129 COVID-19 cases among people linked to Life Care Center of Kirkland – 81 residents, 34 staff members, and 14 visitors. The CDC investigation into the Kirkland facility found that infected healthcare workers had a broad range of occupations: doctor, nurse, nursing assistance, physical therapist, occupational therapist assistance, environmental care work, health information officer and case manager.

April 2020 Update
Today is now April 18, 2020, and according to worldometers.com, there are 2,330,986 COVID-19 cases globally with 160,757 deaths and 596,687 of cases have recovered. The US has had 30,104 deaths, 401 of those from Ohio.

I was deemed ‘high-risk’ by one of my job sites after Kyle had his first positive COVID-19 case transport and was I mandated to take a 14 day unpaid leave from that facility. Thankfully I was able to work in two other buildings (one building per day, I have continued to refuse to between buildings day to day) for that time, though hours have been low, 10-20 hours a week. After 14 days of symptom and temperature monitoring, I was able to return to the building that previously had not permitted me to work. That week I returned to sad news, 5 resident deaths, none COVID-19 related (or so I was told). That same day, our 14 year old therapy cat was laid to rest, which was the saddest ending to an already sad day. Things have been calm otherwise since then. Still no positive cases at either of my buildings, but that could change any day.

Until tomorrow, Meryn