What a day

I am so tired.  Every so often days make my head spin and today was one.  One of my families is inexplicably angry that we didn't produce a piece of equipment in 30 seconds when they didn't even really WANT it when I initiated the process.  They've called and yelled a few times and refused to let me come treat their mom today.  Tine, 60 miles of driving avoided.  Then all these other people weren't available for various reasons.  I wound up with a totally different day than I planned.  I drove a long, long way to have someone I couldn't treat because of complications and then when I called the dr's office the nurse was using that "I've very patient, you are very stupid" voice telling me how to call for a back-up doctor.  Finally I explained (again) that I'm a therapist and don't usually get referrals and she said "oh, I thought you were from the nursing home."  I never said a word about a nursing home.....So finally she realized she had to take care of things there.  My next pt. is agreeing to her treatment but thinks it is stupid and forgets all the reasons she needs it between sessions.  This is slowing things drastically.  And then the next one had a caregiver who got very mad that I wouldn't take over care-giving while I was there.  I'm not allowed.  I can't be responsible for making medical decisions for a patient deemed to require 24 hour care.  If you do not have dementia and are sick and can't tell me not to call an ambulance that's different but when you can't ever make that decision someone else has to.  So I heard a lot of vulgarities.  My last patient was sweet but lots of sad stuff there.

And I have thrush.  It goes with inhaled steroids and I am prone to yeast everywhere so I should have asked for a preemptory script but I have followed the instructions to rinse after each use.  Guess not well enough.  I see Dr. Body in a few days so hopefully can squirrel away some diflucan.

Did I tell you about the crazy psychiatrist?  Dr. Brain is having surgery and will be out for a month.  One of my big fears is that I will have a bad asthma attack while working and be unable to express my preferences prior to treatment, then within minutes I'll likely be very manic/psychotic.  At that point nobody cares what I want.  I'm working on legal documents to help with this; I'll talk about them later as they may help others sometime.  But what I do not want is to be put on the psych unit at the hospital that partially employs me.  My co-workers would find out easily and accidentally where I was just using the computer system that is in place for finding people who go to the hospital making them hard to reach at home.  Plus although I do not want to ever be hospitalized again the chances of that weren't great before and are about none now unless we get awesome control of the asthma with the next drug.  It feels like we are working against a clock as one cold or exposure to the wrong chemical for too long and I'm in the ER.  If I must be hospitalized and it is likely that I will be at some point (although we have made it for 4 months now.  Not pleasant months, but out of the hospital), then I want to be where I was before.  I hated it there but at the same time there are distinct benefits:  anonymity; it's tiny; the psych unit is the only place that I will feel like I can relax and not have to 'behave" (that was the biggest relief in 09; I could cry for hours and that was ok.) and I am known there.  So anyway, we decided it made sense to have a local psychiatrist aware of my situation and able to help.  Dr. Brain knew someone or knew of her, and so I called there.  I explained everything and was told that I couldn't see the dr. without 2-3 diagnostic therapy sessions with psychologits.  I explained that I have a diagnosis, I have a psychologist, I even have a psychiatrist and that all I need is someone who has met me and can say that they have heard me express my concerns while well and able to make decisions and that they support getting me (via family or ambulance if I'm unsafe) to Cleveland Clinic.  They positively refused.  And so I ultimately wound up having to call Dr. Brain and she agreed this was a waste of time and money and so we cancelled and a different plan is in place.  But really, I thought that was the dumbest process ever.  I understand if you've never been treated for a psych issue, but when I'm able to give you a list of diagnoses, 45 meds that have been trialed, a specific reason for wanting nothing but a consult, you are NOT treating me beyond giving me a shot of haldol or whatever if I am out of control in the ER, I think we could skip that.  I honestly think this is how she avoids the severely mentally ill.  I've seen other such schemes before, including the family doctor allegedly 'the best" in this county who refused to see me based on my med list which included an antipsychotic.  I understand that some doctors specialize in this stuff and that those are the best for me, but it makes me so angry when someone refuses to see me for who I am or even meet me to find out who I am and how I manage my illness but instead rejects me because of a few words.  Actually it's usually only 2:  "bipolar" and "[whatever antipsychotic]" I'm taking.  Without the antipsychotics I got that less but I need that med a lot more than I need jerks in my life.

I'm falling asleep sitting up and haven't even had meds.  More tomorrow.