Branching Out: Work and Observation Outside the Classroom

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 The final days of my week have been overwhelming. I began the project and completed more office work, although once my confidence escalated and my relationship developed with the teachers I have been given more autonomy to teach the students in the Hospital School and work in hospital rooms with students. The breadth of information available at Dornbecher is staggering, and through this project I have been able to begin to take advantage of the other opportunities in the hospital outside the Hospital School. 

This morning I ran through the halls of Dornbecher that over look the wide expanse of the Willamette River as I hurried to make the grand rounds seminar that started at 8am. I gathered myself and entered the auditorium, and it hadn't started yet, which was good, although some heads turned as I walked up to find a seat. People may have been thinking she is a little too young to be here, but maybe not, or they may have been wondering why I was out of breath. Either way grand rounds are open and I attended the one this morning on Polycystic Kidney Disease (PKD). PKD is an autosomal dominant genetic disorder that is hereditary. Although there is both a dominant form and recessive form of PKD. PKD occurs by mutations in the PKD 1 or PKD 2 genes within the genome. These mutations cause cysts to form within the kidney, as sacs that come off the nephrons (the tube system that filters the blood and then concentrates the urine within the kidneys). This condition also causes the kidneys to increase in size and can be diagnosed over a variety of ages beginning as a fetus and continuing into adulthood. Research is currently occurring to try and manufacture a drug to reverse the effects of PKD on the kidneys. These studies are trying to focus on limiting cell proliferation and apoptosis in the kidneys to decrease the enlargement of the kidneys. In addition, abnormalities result in cell signaling of the epithelial (lining) cells within the kidneys, with pathways including cAMP contributing to cystogenesis. To limit the formation of cysts in the kidneys research is trying to focus on targeting the cAMP within the epithelial cells in the cilia of the kidney. That is a brief recap of grand rounds this morning, and I will attend these seminars every Thursday morning during my project, so stay tuned for more.

Rounds also occur on every floor of the hospital. Rounds are when the staff gets together and debriefs the patients on the ward. On the acute care floor the Hospital School teachers also attend the rounds to understand the students conditions. I will begin attending rounds next week and I'm excited to be apart of that, I think I will learn a lot about both the medical and overall approach of maintaining the patients well being while they are in the hospital. 

My level of contact with chronically ill patients has greatly increased in the last two days. I have been working with one student I wrote about in my last blog since Tuesday. The student suffers from renal failure and has been in the hospital for a few weeks. Having a chronic illness like renal failure and having to endure the treatment of kidney transplants has made it so the student has holes in their understanding because they have missed so much school during their childhood. The student I have been working with the most, remains highly taciturn, although since I have been able to work with the student consistently we have developed a reciprocal relationship and communicate with greater ease. Today I helped the student complete four worksheets, where as in the past the student would only do two worksheets. In addition, we made a bag and T - shirt today. Then once everything else was done we played a game on the computer and printed out the animals the student designed and wrote a story to go along, which the student gradually got in the rhythm of writing. Developing a closer relationship with one student has made my first week amazingly enjoyable as well as challenging. At times I feel the student can do the work well, although the work provided from their school is so routine and repetitive it is hard for me to know if the student truly understands the concepts, and it is hard for the student to vocalize what they are thinking at times. Overall, working with this student has taught me a lot about how to approach interactions with different people and the value of a supportive environment.

Another student I worked with has Rett syndrome. Rett syndrome is a disorder that affects the nervous system and causes developmental reversals. Some students are in their late teens and are functioning cognitively at a first grade level. Although the patients with Rett syndrome loose function of their hands and language it has been understood that the individual can still understand. I read to a patient with Rett syndrome the other day and it was an overwhelming time, as I was getting used to the severity of the disease and how to approach reading aloud. I began by reading, tried to show them the pictures although their eyes would open and close gradually, and once the student didn't open their eyes when I showed them the picture and was speaking, and it was feared by the staff the patient was suffering from a seizure, but then after further observation the patient didn't have a seizure while I was in the room. So as I was reading the patient could only engage with subtle eye movements, although through the research I have done on the disease it seems the patient probably understood what I was saying. The severity of the illnesses is staggering and every case has such drastically different challenges, which is challenging my cognitive abilities to react and my emotions. 

The last case I will talk about in this blog was today with a Spanish speaking family. The patient is developmentally delayed and the family couldn't converse well in English. I attended the room with my mentor and she attempted to try and provide the patient with reading materials from the classroom. Then my mentor tried to understand what educational level the patient was at and this is when I became shocked, and the variety of family and social situations lining the halls of the hospital became glaringly evident. The father didn't know what grade or school his child attended. The myriad of cases I have experienced doesn't even touch on the the number of experiences I will have by the end of my time at Dornbecher. 

Overall, I'm having a great time, I'm challenged and I'm constantly learning about different illnesses, coping strategies, teaching and many other facets of the Hospital School Program, as well as a hospital setting at large.