I knew a residency would take time, energy, and discipline, but I didn't realize what else I would have to ante up to be part of the O&P club. As my rotation in the fabrication lab at the University of Michigan Orthotics & Prosthetics Center (UMOPC), Ann Arbor, came to an end, most of the abrasions and small burns on my hands and fingers were healing well. The wounds would not leave any remarkable scarring, but their memory is a small reminder of the sacrifice involved in learning this trade. Transitioning into my clinical rotations, I could only hope I would escape with less bodily harm. I will spend the next six months rotating between various members of the University of Michigan clinical staff, working with them and their patients. In my current rotation, my attending orthotist treats mostly pediatric patients. After a short breaking-in period, we decided it was time for me to take the lead on a patient. In school, they had told us about the particular challenges involved when taking pediatric molds, but it didn't really sink in until I opened the exam room door and was greeted by a young boy, his lip quivering as he whimpered, "Please don't hurt me!" Patients crying at the mere sight of me is definitely not the reaction I was looking for. The only thing I really wanted to tell him was, "Hey buddy, I'm probably more nervous than you are!" I somehow dodged being kicked by his squirming feet and walked out of the room with a decent mold of his leg and foot. Now I just had to remember how to turn all of this information into a functioning orthosis. My attending clinician and I had modified plaster casts side-by-side a few times at the beginning of my rotation, so I thought it was time to try doing one by myself. However, after my first attempt, my proctor looked at my cast and pointed at some areas that needed to be reshaped and touched up. After my second attempt, I knew my cast still didn't look right. I began to worry. If I had spent more time in my youth playing video games with my brother, would my eye-hand coordination be better? I couldn't figure out why this was so difficult. I began to smooth the surface of the cast, and a drop of sweat that had formed on my brow fell onto the cast and mixed with the slurry of plaster that was rapidly forming. I loosened the vise to rotate the cast and continued to smooth the medial side when suddenly the mandrel slid out of the vise, and my cast tumbled to the floor. I took a deep breath, slowly retrieved my cast, and wondered what I did to anger the plaster gods. I needed some time to walk away and reevaluate. I had modified plaster before in school, but that was mostly for classmates and agreeable patient volunteers. This time, it was for real. I think I must have been suffering from plaster performance anxiety. I was making my patient a definitive orthosis that he was going to wear out of the office, and the fear of making a mistake was wreaking havoc on my confidence. What more could go wrong? Worst-case scenario, I'd have to mold his leg again. So, realizing that I didn't have anything to lose, I walked back into the plaster room and grabbed my Surform®. Somehow, knowing that I had nothing to lose made it easier to shed the fear of making a mistake, and I was able to salvage the mold and fabricate my patient's orthosis. I wish I could tell you that my first real AFO was a perfect fit, but it wasn't. However, with a few minor adjustments, it was a decent fit that I am proud of as my first attempt. I smiled as I watched my patient walk out of the office holding his mother's hand. That was the first orthosis that I had made by myself from mold to fit, and I had put a lot of myself into making it. I was a little sad to see him-and my AFO-leave. Sara Pschigoda is a graduate of the master of science in orthotics and prosthetics program at Eastern Michigan University (EMU), Ypsilanti. She is a resident at the University of Michigan Orthotics & Prosthetics Center (UMOPC), Ann Arbor, and will be sharing her experiences as she completes her residency.
