Andres Brito

7/25/16

Clinical Instructors: Kevin Schell, Lauren Detmer

Clinical Narrative:
My name is Andres Brito I am a Kinesiology Exercise Science major, minoring in
Leadership and Psychology at the University of Rhode Island. I am currently completing my
undergraduate Internship at Massachusetts General Hospital in The Surgical Intensive Care Unit
(SICU) with Physical Therapist Kevin Schell and the Medical Intensive Care Unit (MICU) with
Physical Therapist Lauren Detmer. The patients that I see on the SICU are patients whos
primary teams are followed primarily by surgical teams and are recovering. The patients in the
MICU are patients with variable diagnoses and complications including multi organ failure
including the kidneys, liver, and lungs, along with other various reasons.
The patient I am discussing is a 77 year old male on the SICU who will be going by the
initials BM. He was admitted into the hospital for Gastroparesis (the stomachs inability to empty
itself of food), and abdominal pain with a history of the cancer (Pancreatic adenocarcinoma).
Following an initial surgery for the treatment of gastroparesis, he has a complicated post
operative course forcing BM to be readmitted into the hospital leading to surgery and being back
in the SICU. These complications lead to gross weakness causing BM to become deconditioned.
Limiting factors for BM were the weaknesses in his hip, knee extensors, as well as
respiratory failure for which he required mechanical ventilation and a tracheotomy. This limited
BMs activity tolerance required us to modify our care including the incorporation of different
machines for physical activity. We were able to use the arm and leg pedal of the motomed for
extremity exercise, the moveo for leg movement and to stimulate standing in an upright position,
as well as the quick move to get BM active in standing upright. Although his weakness stopped
him from engaging in physical therapy for extended periods, he made steps towards getting
better throughout sessions. What made BM an interesting patient were the complexities of his
care with the many setbacks and improvements. One day hed be cycling on his bed with the
motomed and the next day he would have to cancel his session due to weakness or respiratory
failure.
A difficult part of the treatments with BM was communication; he had a tracheotomy
making conversations hard to understand because he was unable to speak. The setbacks BM
faced were frustrating him at many points and could be seen with his body language and loss of
motivation. During these low points I found myself reflecting on his complicated course. While
reflecting I felt as though I would have been equally as frustrated if not worse if I were in his
position. A big challenge that Ive realized while working with physical therapy and patients like
BM is the idea of progression with baby steps. As a physical therapist, progression is seen
through a series of small areas like strength and sitting on the edge of the bed. A patient sees
progression as getting healthy and going home. Although a patient may have been making small
improvements, nothing seems to be a good enough unless it means they are leaving the hospital
and getting back to their regular life.
BMs main goal was to get home and be with his wife who was a strong support system
for him. A turning point for BM came a few days after finally being able to speak a trial of a
speaking valve. He was in a pretty down mood and had seemed to be in plateau in regards to
physical activity and overall energy. Kevin was reevaluating BM once again when we discussed

Andres Brito
7/25/16

Clinical Instructors: Kevin Schell, Lauren Detmer

what his goals were. Kevin explained to BM what it was going to take to get to the point of
getting home. From there we engaged in physical therapy and BMs progression increased
dramatically, he was squatting with little assistance from Kevin and I on the moveo. This was an
encouraging sight for me because I was witnessing BM work towards his goal through this
session. A big part of this progression came from the Physical Therapists goals matching the
patient goals, allowing both sides to work towards a common goal.
Being in both intensive care units along with this patient in particular has validated my
perspective on physical therapy as a whole. It has opened my eyes to see how difficult the roll of
a physical therapist is especially with patients who may be heavily sedated or that have no
motivation to be active. I have also been able to see the variety of rolls a physical therapist takes
on while ultimately trying to achieve the ultimate goal of getting stronger. With this patient I
gained valuable experience in adaptability as well as using mechanical tools to get the best out of
the patient. Throughout the sessions, our plans would rapidly change with BM depending on the
days leading to Kevin and I modifying our care to maximize activity using mechanical devices to
get BM maximized PT outcomes. This internship has pushed me in many ways to break the
levels of discomfort and forcing me to adapt to the fast paced environment in order to experience
everything that comes with being a physical therapist in an inpatient hospital setting.