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

Tuesday, December 03, 2013

Big thoughts

One day recently it suddenly occurred to me that part of what I'm fighting with still regarding having to stop working and how limited my life is in many ways is that I wonder if I had stopped sooner if I would have not lost quite as much.  From very early on in my career there were warnings that I was not in a specialty that worked extremely well for me (but in other ways (flex time) it let me survive).  I knew that I was struggling to survive working but I didn't know what else to do.  I kept thinking that if I was to change career paths that an obvious path would become apparent.  There was once a chance to do something with wheelchairs that I would have taken but it fell through because Medicaid didn't approve of the innovation of the position I would have had.  There were hints about wheelchair jobs another few times but never clear ones.  And so I kept going until I no longer could.

I asked Dr. Mind if I would have wound up where I am now if I had stopped sooner.  He thought a bit and said that emotionally I hadn't been ready to stop sooner and that I would have had a harder time getting approved for disability before the drastically sick time when I was.  He also told me that he had become concerned about my ability to keep working over the course of the last year that I did it.  He said he wasn't ready to say anything but was afraid he would need to because he was concerned that I could become so tired I wasn't safe for my patients.

At first I was really surprised about this.  The last 2 years I worked were my best career years.  But he's right.  The last year things were showing signs of falling apart.  I was not getting enough sleep and was spending a lot of my free time doing notes because I wasn't able to do complete notes while doing therapy and the notes had to be quite detailed so I needed at least an hour and often considerably more depending how many evals I had done to work at home.  Then I had a long commute and drove all day so that cut into my free time as well.  Physically I was so sick for a lot of that last year because my lungs could not heal from pertussis while assaulted by being in homes with smoke, mold, general filth, and an area with excessive air pollution.  While I still am on an oral med for asthma and am never without an inhaler I no longer have asthma attacks every day or even every month.  I no longer am triggered by a whiff of a chemical as long as I'm careful what chemicals I'm around.  On top of that when I am honest I can say that April 1, 2011 was a dividing line.  Medicare began a new rule that required much more extensive evaluation visits be done with patients repeatedly throughout treatment but in the first few weeks they were done 3 or 4 times.  Each one was more paperwork and less free time.  I felt myself being unable to adjust to  this and unable to feel that I was keeping up.  It was so much more stress because I just couldn't manage to do the same job I'd been doing for a year and I was too proud to admit that.  Plus I was waiting for an assistant to be hired and was training another therapist to help me as needed so I think that I was telling myself I'd be fine as soon as those things happened.  But the truth is that I wouldn't have been fine.  I had reached the line of "too much" and no matter how much I hated that it was the way it was.

Obviously God knew the story before it played out and as it was I think that leaving because surgery had screwed up my cognition was a lot easier for me to face than leaving because my bipolar was spontaneously progressing.  It never will be easy that I went into surgery one way and came out another because in a way I signed the things that happened into being.  But I'm ready to admit now that I was already experiencing changes, just not as drastic as what the combination of Reglan and the Mirena IUD caused.  I suspect that another year and I would have had a very difficult situation develop anyway, if it took that long.

The other reality is that while the things that happened to my brain have been challenging to handle (and I am aware that I have improved with that, I am just leaving it as things changed because they did and some did not improve and some got worse and it's too hard to define well) the sequence of events was the best thing that could have happened in terms of getting me on disability.  I can't say that any of that time was good, it was scary and awful and so sad, but I was saved from waiting years for disability.  I'm sure that my Christmas 2011 hospitalization alone contained the word suicidal enough times to show that it was a huge problem and many other forms went in saying that my psychiatric and cognitive statuses were severely impaired.  That also helped me get my students loans forgiven and we'll just say that if they weren't I have no idea how I would have paid a massive amount of my income to them because even bankruptcy doesn't discharge student loans. 

I don't know.  It's just a lot to think about.  I guess I'm finally ready to see it but it still is sad to think about.


Jean Grey said...

The paperwork is the part that is the hardest for me as well. It is the reason that I keep thinking that maybe I should be working part time. Because while I can work 40 hours a week, I don't know that I can work the 45-50 hours a week that this really means. And then I wonder why I have no life.

Just Me said...

Jean Grey-When I worked 32 or 36 hours it still was an issue. However neither of those jobs was at all supportive about letting me do the paperwork more slowly and on my own time. When I did 32 hours they expected me to do everything the 40 hours PT was doing and I was not allowed to even be in the building one minute past the end of the day. Of course I wasn't smart enough to see that they were expecting way too much and so I didn't quit when I should have. When I went back to 40 I was able to document while treating in nursing homes with paper charts but I couldn't manage a computer, the extremely detailed notes and the activities I was doing in home health. Most therapists had trouble; the nurses were better off since they weren't using both hands through their treatments with most patients. But when they added that extra evaluation (it was awful. I had to do a standardized ADL assessment, complete ROM and strength testing all extremities, review progress toward all goals in detail as well as describe the treatment plan implementation to date, assess each goal individually and document that, and then revise goals or treatment plan to reflect progress. That had to be done even if I wasn't working with a patient on strength; in fact I had to do ADL assessments on my swallowing patients each time. It was so hard.

I think without paperwork and the need to be so detailed I would still be able to work. But I don't see a job where you don't have to document coming along.

Michal Ann said...

Your "Big Thoughts" about the clouds and the rain have given you a glimpse of the rainbow...and even the pot of gold. I know it's been stormy but you've come through to a new place.

What a great thing that your bad tooth situation is on the mend. Sounds like your dentist was pretty wonderful. Prayerfully the migraines will abate.

Your charting burden was HUGE! Just HUGE!

I hate to hear you saying that something you "did" led to the post-surgery problems. Please reconsider your statement "I signed the things that happened into being." Jen, you don't have that kind of power!! It happened.

Many warm thoughts to you Jen!