Thursday, May 29, 2008
I'm so excited because I also got little things that grommet on that are pictures or letters.
So if you see the dorky OT with one shoe with 2 dogs and 3 cats (my pets if you count my share of my mom's dogs) with appropriate pictures and the other shoe saying OT, that's me.
Also, did you know that if you take Crocs back when you are done they will give them to someone who needs shoes, or recyle them and I believe donate the materials? That's the main reason I didn't even try an off brand.
Tuesday, May 27, 2008
Unfortunately I'm also very, very tired. So I'm going to modify an email a bit and post it here. Please feel free to tell me whatever you think, even if you think I was totally out of line, which I'm pretty sure I wasn't.
When I eval someone I write their name under an assistant's name, along with the number of minutes I feel they need. For whatever reason that has evolved into something that is usually my call. There are guidelines; the sickest patients are to get the most time (happens only sometimes as ortho stuff also needs lots of time, some insurance patients get 60 minutes unless there are special circumstances, Medicaid generally get 30 minutes. Last Monday I picked up a dementia patient and assigned her to an assistant who balks at harder stuff. I've been forcing her to do more than she wants in these cases. She was very unhappy about both it and my picking up another patient with dementia who was not on her caseload. I explained my reasoning. Later that day I noticed that the minutes were changed to 40. That's a lot of time over a week, a lot of revenue and they should be spending time just coaxing this lady to cooperate. I was pretty mad, but it was late and I'd worked 24 hours in 2 days and was exhausted. I left the direct manager a note sealed and taped to her computer about did she change those minutes, because if she didn't I was angry but if she'd approved it I was ok with it because I did realize this lady would be tough to treat. At the bottom I wrote a PS saying that I was very grumpy and I didn't want to react until I had rested and also knew whether she'd made the change. I had a phone call from the higher manager, who reads everything on the first one's desk every day. I guess theoretically she has that right, but it is ridiculous that a copy of any memo I give my assistants is in my personel file, along with many other random things. She wanted to know what the last sentence about being grumpy meant. Feeling stupid, like this always does, I said "It was 1 am, I was tired, I hadn't had supper, I was exhausted, and I was grumpy. I didn't want to respond until I knew more facts, but I wanted it known that I didn't like this issue". I see no place in that where I deviated any from a normal person who had worked a ton of overtime, had dealt with several difficult situations, and was tired. I think it was actually quite responsible of me to not react until someone clarified. She said ok so I thought that was it.
Today in my fun probation meeting that came up AGAIN. This time HER boss was there. And her boss gave me a lecture on not making threatening statements or anything that could be misconstrued. I was told that if I felt I ever was a danger ot myself or others I needed to tell someone. Would that ever have come up if I weren't bipolar? I'm thinking not so much. And I'm pretty insulted, to tell the truth. I had no idea how to respond. I'm a bipolar patient, not a serial killer.
Saturday, May 24, 2008
This week is FINALLY over. I wound up with a total of 10 evaluations on new admissions, plus my patients, plus all the added crap that goes with a state survey. Thankfully although the building had a bunch of cites (like WAY too many) the therapy department had none. So we're all-clear. Until the next time. With 20 they may be back in a bit more. I don't know the severity.
Yesterday I decided to leave early and come in today after a haircut to do my 3 evals. I simply was exhausted, the people weren't all there yet, and it was a chance to mooch 2 meals off my mom. So today I did that. I only partly did one, she had a fairly high temp and just couldn't, but I am pretty happy that I made it through the week. I even went down to check on one of the 2 people who fell in the first 10 minutes I was there.
State week is always just a nightmare. You suddenly have to do everything on overdrive. Someone who we all knows yells and who normally is allowed to yell once or twice must immediately be attended to, and it's best if it is 5 or 6 employees. All these strict rules about what can touch what where and when must be followed. How many times gloves have to be changed during any procedure is monitored. Patients are asked about dissatisfaction and the surveyors don't always listen for how competent the patient is. Once they spoke with a man who had severe damage to the language centers in his brain from being beaten in the head. He couldn't really express himself, but he could get words out, they just weren't the ones that said what he meant. He also had limited understanding. We (the speech therapist and I) had tried to teach him to push buttons to communicate, but he couldn't even do "up" "down" after days of practice. Anyway, he told them we were keeping him from having a picture book to communicate and withholding his soft cushion for his wheelchair. In truth he hoarded things and we had to go to his room and pull out his TWO picture communicators and TWO cushions, plus documentation that we'd tried to convince him to use these things.
Bipolar-wise I'm actually doing fairly well. I'm really excited because I got sick, reacted immediately and am ok now. I'm just really tired. I have to work Monday, but probably only 1/2 day, and it's time and a half which is fine by me.
Heh, not the things I meant to say but I guess there's always tomorrow.
One of the days that I was struggling I had an issue with an assistant overstepping boundaries. I didn't know if it was her or the manager, so I left a note for the manager. For whatever reason the other manager picked this up and talked to me about it, agreeing with me but not doing anything. That was Wednesday.
Today I had a call from her about clarifying something from that note. At the bottom I had written that I didn't want to say anything until I checked with her because I was very tired and grumpy. She wanted to know what I meant. Well, I meant I had worked 24 hours in 2 days. I had not gotten much sleep. I was frustrated.
We're going to have to talk about how if I'm feeling bipolarish I'll say "I'm having a bipolar moment and can't handle this". I am not sure why this isn't obvious; I've said I'll be honest and I'd think anyone would be in a bad mood given the circumstances I was operating under.
And did she actually DO anything? No way. Figures.
Wednesday, May 21, 2008
Equals 24 hours worked in 2 days. Going to sleep at 3 these days.
Very, very tired.
Saturday, May 17, 2008
I monitor what I'm eating both by fiber and fat content. I have a chart that I can refer to to see how many grams different things have, and with experience I know what foods I can count on to be more helpful than others (when things are at their worst I eat a can of spinach, for example). My doctor and I decided together than if I can succeed with my diet, even with some unorthodox methods like eating fast food french fries a few times/week, that this is good because the only med I can try hasn't been out long and I'm just too much at risk for side effects/interactions with my other 10-12 medications. Dried fruits are a great source of fiber and I have a stock of them, but I get bored with them pretty quickly. Today though I discovered something I'd never had before: dried red raspberries. One-fourth cup is 26% of your daily fiber. And they are yummy. Somewhat expensive but I'm willing to put money into this project so worth it. Combined with my other recent find, FiberOne bars with another 28% that is 2 sweet treats for 56% of the needed fiber.
Friday, May 16, 2008
So I switched to the mail-order. I've had that as an option before but have never been able to use it because my doses changed so often that I was unable to rely on having any dose be effective for 3 full months. Now though my doses are pretty much maxed out, so any changes will pretty much have to be new meds.
A couple weeks ago I sent in the paperwork and scripts for all my meds. I ordered supplies of everything except for 4 meds either had plenty of or needed a new script. My doctor had warned me that 3 months of Depakote was a lot of Depakote. I also knew I'd be getting a lot of Seroquel. Well, Tuesday I had a package slip at the post office, and when I picked it up it was 10 lbs of medication.
I brought it home and gradually sorted it out. I am going to have to buy markers and color the tops or something because there are so many bottles that look identical. I had to find a whole extra drawer for meds. And there were 6 bottles of Depakote. 540 pills. Plus there were 3 bottles of Seroquel.
The savings was huge. And the process couldn't have been easier. Even Provigil came without me having to lift a finger to fight. My doctor may have had to fill out a form to talk to someone, but generally the Provigil annual review involves me having to do something. This time it just appeared, no questions and no huge penalty.
So, besides storage, what ever could be wrong? I don't like having so many drugs in my house. Right now and for a long time I have no been suicidal. Right now and for a long time I haven't had to worry about my ability to control this. But I've also lived with this illness for many years, and I know that I will be suicidal again.
I don't know how suicidal will present next. Usually I want to take pills, but my lithium toxicity adventure also taught me why I might not want to consider that way. I realized the very hard way that overdosing makes you so sick that it's entirely possible to have no result except to make you really sick and in the hospital. I know that it is better to be not sick and in the hospital if I must be there. So last spring I got rid of all of the pills I had hoarded over the years.
I've been careful since then to get rid of pills if I have to stop taking them. The only things I save are things like thyroid medication that my dose often changes on and which are pretty safe.
So now I have sort of an anti-hoarding problem. I have access to a huge amount of medication. More than I am comfortable with, but I need to get my meds this way to avoid paying penalties. I'm in no danger now, but if I have a serious episode I do not want such temptation.
I think I'm going to get a lock-box for it, just as a way to have to slow down before I could access anything. Slow probably would really take care of my situation, given that I have so much trouble taking pills that actually swallowing the tons and tons of medication it would take to hurt me without vomiting.
Anyone have any other ideas? I'd love to turn the whole heap of mess over to my therapist or someone else, but I am afraid of running out and not having access easily. Those pills must stay in this house.
Thursday, May 15, 2008
However, the day itself hasn't been the cure-all I had hoped for. I wanted to nap. I hoped for at least a 3 hour nap. Instead I slept maybe 45 restless minutes. Dr. Mind said several times I was agitated, but I didn't feel like I really got the agitation out in a lasting manner. I remember thinking that I was calmer at the end because of letting go of some of it, but I was agitated again within 45 minutes. If I don't get sleepy in the next hour I'm going to really drug myself into it. I need some good sleep. Tomorrow I have booked a hotel near my doctor's office so that I can drive up in the evening, spend the night, sleep in on Saturday and still make it to my appointment. Then I'll return home with a brief stop at Target and then spend the rest of the weekend resting.
I know this is nothing so far. Sleep, my most reliable signal, is not bad enough to show that things are very bad. I'm not falling asleep until 1, and I'm restless, but that is manageable. The episodes that land me in trouble are the ones where I go from sleeping fine to being up until 4 or 5 am overnight.
One of the signals that I'm having an episode is always food cravings and a lack of appetite for anything else. I'd been very interested in pineapple lately and should have paid attention to that. Now it is Lipton Noodle soup. I'm about to go make the 7th packet I've eaten of it, plus 2 cans of regular chicken soup when I was desperate, since Sunday.
I am proud of myself for changing the kitty litter today. Tomorrow I need to do some dishes. I can do this. This is not the end of the world as i know it......
Wednesday, May 14, 2008
Yesterday was the end of my orientation period at work. I knew I wasn't always super-effecient, and once I was told I had to get paperwork done more completely before leaving but then seemingly understanding was voiced of the reason the paperwork wasn't correct. I had no idea that these things were big deals.
Apparently they were. These things, combined with something that I can't go into, are placing my status into "extended orientation". I am told that this isn't because I'm in trouble, but since I had to sign the same kind of thing you get for a written warning I find that hard to believe. And, essentially, they were telling me they don't want to commit to employing me for more than 30 days.
They did listen to what I said about some of the issues I have with keeping up with certain things and how delegating these things might be better. They are willing to work with me. And they did have good things they are aware of, most specifically that I'm made a HUGE amount of money over budget for them last month, huge enough to get us expensive, fantastic equipment and possibly another assistant for me (which would really make the PT mad, but that's another story).
I think that there was some degree that the issue I can't talk about needed a scapegoat and I was in the right place at the right time. But of course I'm going to feel defensive like that. I also feel that some of my non-productive time is because 2 of my 4 assistants, 75% of the progress notes I read, are not done well at all. I've become more and more aware of this and am trying to address it. This takes time, but it is important. I want good work and nothing else.
I'm trying to remember that at some point in this job there will be a time that I will know my nursing home career is over. This is my last nursing home job and I won't change that. I don't know what comes next, but that part is God's job. So if I am let go in 4 weeks, well, then it will be time to figure it out.
But at the same time I feel like my whole world is crumbling......
Saturday, May 10, 2008
I've changed my mind. I think I am a bit down. No clue why. I honestly think that the trauma of the choking patient set off some reaction in me. And then I've been busy and not resting enough. As of Monday I'm allowed time off; I am going to schedule a Friday off, which gives me a 4 day weekend. I'm actually off this coming Friday, but will be working tomorrow instead.
I haven't really felt this much mood swing for a long time. I'm a bit afraid of it. It's nothing major yet, but it could turn into it. Everything has that potential and I have no clue what the sign that any given moment is it.
So now I'll have to email my doctor if this isn't better pretty soon. Which will mean resuming my prior dose of Seroquel, which doesn't help because I don't need more tired. However, we know that at this time of year increasing my antidepressant will generally only make me manicky. I also have to get bloodwork done because Dr. Body thinks my thyroid meds need upped, again. Thyroid issues feel very much like depression to me so hopefully that's it.
I hope the cycle will break itself.....
Tuesday, May 06, 2008
But overall I'm pretty open here about what's happening in my life, right down to the ugly details. Over time this has become the place that it is easiest to go to when I need to tell someone that I managed to throw up my pills into my shirt and strip without making any mess anywhere. Or that I can share frustration when I finally respond to meds only to develop severe constipation.
I'm entering new areas in therapy. I'm trying to work on fixing the parts of me that have been hurt so badly over the years that I don't trust people enough to have friends. I want friends. I'm tired of being sad and lonely. But the things that happened are so, so hard to talk about. It feels sometimes like every word is being yanked out of me with tweezers, even as they are words I need to say.
I can't write about it here. I'm in the midst of dealing with something that caused a lot of problems but which I can't go into much detail about without crossing that "this is the internet" line.
Consequently, I'm around but may not be posting a lot for a little bit. I may be totally wrong too. It's happened before. But the main thing right now is that I hvae to make myself focus firmly on this stuff and not let myself be diverted by stupid things from work, like the rehab aide (no training) telling me how to do my job. I could go on and on, and that is stupid.
I'll try to keep checking your blogs, although lately I've had no chances as I've been working horrible hours.
Thursday, May 01, 2008
The therapist also pointed out that we do so much to tone down my response and exposure to adrenaline (even caffeine; 9 months now without a drop) that this may be an extra shock. That makes sense. So he said I may react for a while.
I can't wait to see her and believe it myself. I now have to start turning my thoughts into "we saved her life" and rid myself of "people who are that color, that floppy, and unconscious die". (Not that people who are unconscious have good posture, but it all is blurry).
I wish I knew how long it all took. In my mind it's so weird, it was both forever and only a few minutes. That adds to the unreality of it all.
I'm just so tired tonight.