Whenever the rainbow appears in the clouds, I will see it and remember the everlasting covenant between God and all living creatures of every kind on the earth." Genesis 9:13

Friday, September 04, 2009

I can do it.....just not here. And the potty dance.

I'm really tired tonight. I've had a physically demanding few days with more full-body lifting required than usually happens in a week. I have no idea why everyone has been challenging, but it makes for quite a week.

Then today was nuts. I had to have a minor repair done to my car. I specifically scheduled it so that it wouldn't disrupt my life much. The plan was: drop the car off at 8:20 this morning. The rental agency was to pick me up at 8:30 and take me to get the rental. Then I'd go to work, arriving around 9 or a few minutes after. This would get me done well in time to return the rental and pick up my car before closing. I was to be off early today so that was even better.

So, I did my part. I woke up with my sinus infection back, which caused annoyance because I was to finish the strong antibiotic I was on today. The car was at the dealer at 8:20. I was waiting at 8:25 for the pick-up. At 8:35 I called in. They said someone would be right there. The dealer is 4 minutes away if traffic is heavy and you get the main light. At 8:51 they showed up. I was livid. He asked how I was and I told him I was fine until I was made late for work. Then I was very terse with him as he tried small talk. I would have relaxed had he apologized but he kept trying to ignore the fact that I was furious. Then he tried to excuse it as "we ignore the things that say pickup because the internet orders all say that." Which I might have understood had I not specifically called them to confirm all of this yesterday. So I got to work around 9:45. Then I had to rush and both my evals were difficult and my discharge visit involved trying to explain why someone can't safely go home. It included one of my least favorite and yet very common conversations:

Patient: I want to go home. I can be home. I did fine before.
Just Me: Well, I know that's true. But things were different before. You hadn't be so very sick. And you've worked extremely hard and you've come a huge distance. When you were first here you couldn't do this that or the other. And now you can do this, this, and this with some help.
Patient: I can do it without help.
Just Me: Ok, but there are things you aren't able to do at all right now. You've not even wanted to try to put on pants. Which is fine, that's your choice but to go home you'd need to be able to do that.
Patient: I can't put on pants. I get too tired and out of breath. But I can do it at home.
Just Me: But how? If it's tiring here it would be tiring there. And I don't think you want to go without pants.
Patient: Oh shoot. (Experiences loud bodily function which makes him laugh and distracts him, THANK GOD.)

I have this discussion several times/month. It never is less painful. There are several conversations I have so often I know what all possible responses to my statements might be. The one that nobody has ever completed to my satisfaction though is the one surrounding toilet safety.

Just Me: Ok, I want you to lock your brakes on your wheelchair. I'm going to put this safety belt on and tighten it. This helps me keep you from falling. Now, put your hands on your armrests and push up to stand. On the count of 3. One...two...three. (Just Me helps the patient stand with varying degrees of physical effort. ) Now, I want you to hold the walker/my elbows and turn so you are facing me and in position to sit.

(Inevitably at this point the patient does what the aides tell them and tries to pull up with the grab bar. Inevitably I explain the entire above sequence again. Sometimes I have to explain why doing it my way is important and that I need them to do it themselves to be able to go home.)

Patient: (nearly always) Now pull my pants down.

Just Me: Well, first you have to get turned all the way around. Then YOU can pull your pants down. I'm here to help you do it for yourself as much as possible. But FIRST YOU HAVE TO TURN. (that's emphasized because about 90% of patients, especially female patients, want to turn with their pants down).

I cannot figure out this turning with pants at half-mast thing. It truly drives me nuts trying to figure it out. I even tried it and all that happened was I nearly fell. It does not make any part of going to the bathroom easier.

Anyway, getting back to the real story, glimpses of my inner life aside....

I also discovered this new therapetic strategy today and I used it shamelessly. I don't know what it never occurred to me before. Probably because it is slightly evil. This woman wouldn't move her arms because it made her hip hurt. My standard explanation that hips and arms aren't connected and do not pull on one another just by simple anatomy (and yes, this is a converation I also have routinely) failed. The woman refused to do anything because...here it comes....she could do it if she wanted. Never mind her broken hip. If she chose she could do anything. Although even my touching her leg made her hurt terribly, much less moving it. She kept refusing to do anything and getting mad if I asked her. She had a dab of peanut butter on her shirt. I made a fuss about it and made it seem worse than it was (I could have wiped it off easily), got her to change shirts and then shamelessly told her she had peanut butter on her face and needed to wash it. She didn't, but she did do as I asked. Evil therapist.....but it got the job done.

I then flew through work, got no lunch break because I didn't have time, and scurried through patients. I suddenly realized while finishing paperwork that I had to get my car NOW and that I hadn't gotten out as early as I'd hoped thanks to getting in later. So I called and paid the dealer over the phone. I then made sure to pocket the paperwork from the rental agency because I had every intention of calling customer service tonight.

When I got to the rental office there were several people waiting in chairs. The guy asked me how it went. I said "well, after you all made me late for work and caused me to have to give up my lunch it wasn't a great day". I was nice and clear so everyone heard. They asked what happened and I told them. I pointed out that I had trusted them to keep their part in my plan for a tightly squeezed day and they violated that trust. Ultimately they gave me 50% off, which is why the name of the agency is not being plastered all over this blog. That was fair and I appreciated this guy who was nice about it.

In the meantime I'd given the wrong street for the pharmacy I wanted (wrong cross street). So my new antibiotic was called in to a pharmacy I used to use which isn't really convenient down here. I had to get that, plus a $15 OTC medicine and since I still hadn't eaten I nearly starved. I also was totally puzzled as I had a message from the doctor to take a small dose of something that as far as I know it TOTALLY forbidden for bipolar patients. (Sudafed. Makes calm people hyper. Last time I took it I wasn't diagnosed but sure was manic. I know why this was suggested, although I suspect it was either by a med student or nurse rather than my doctor specifically, it's because my infection doesn't clear easily because I can't dry things up. But unless Dr. Brain says it is ok, I'm ignoring that suggestion because nobody who has not been in a mixed state for months on end is allowed to tell that there is an acceptable amount of mania, or an acceptable risk. For someone who avoids caffeine totally (it's now been over 2 years since I had a cup of real coffee or a real Coke or iced tea in a restaurant) taking a stimulant in any way is a little bit more than it would be for someone used to this. My reaction to just about anything that causes a bit of adrenaline release proves this. Anyone who has been around my dental office when I've had numbing knows; I have to take 1 mg of ativan before any procedure, not because I need the sedation but because the epinephrine in the shots causes me to shake head to toe for quite a while. When this first happened the dentist himself had to get my ativan out for me because I couldn't work my purse or pill container. Now we know, and prepare. Even with all that ativan though (and that's a good bit for me since I'm pretty sensitive to it) I still always have to wait for probably 20-30 minutes after the shot before they can do anything in my mouth safely. By now we just have a routine: I get the shots. The dentist sees about 5 other patients. (Not really, although he does sometimes do a filling or two). He pops in and out and checks my vitals a bunch of times. Someone usually stays with me most of the time to keep my company and I think to keep me calm since it's a rather frightening sensation. And then when I'm not shaking we drill.

Regardless I'm tired and I think it's about bedtime. I don't even know what my point was tonight. Welcome to the ramblings of a very tired, somewhat stressed woman who at lunch at 9 pm.

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