A whole career in 11 years

(This was begn on the 21st).

It's just after 3 AM.  I  have not been able to settle into sleep tonight.  I'm supposed to go sleep on the couch when I struggle but I was so anxious about specific things that I didn't think it was going to help.  And my mind kept working and I realized that the end of my career means also the end of stories.  Not all stories, of course, but I had some great work stories.  Tonight so many people are visiting me.  I'll tell some stories but know I am changing details to protect confidentiality.

Who is haunting me tonight?

• The last patient I ever treated was always very receptive to ideas and was learning about overdoing.  This person had a transplant soon after I stopped working.  I don't know what happened next.
• One of the men I enjoyed most had been in a place of authority requiring both skill with the job and political savvy.  I learned about some of what I find hard now from this person, that giving a job everything that you can, when it involves people, means you're going to be hurt sometimes.
• Many years ago I went to evaluate a woman on a dementia unit.  We got through the small talk and I explained simply why I was there.  Then I asked her to do some things for me.  Her response?  "You are 12 and you may NOT tell me what to do".
• There was a patient when I worked in psych who mystified us because he'd do anything for the speech therapist, even when she was working with him at the same time, and nothing for me.  Once day I hung out in the background and he did everything needed for my session.  We were also puzzled as he called me "the gorilla".  Turns out that was a racial slur and that because of my curly hair he thought I was not Caucasian and therefore not acceptable.  If you could only see me; I have the fairest complexion there is.
• Once before we figured this all out the physical therapy assistant and I tried to get him from bed to wheelchair.  This took 2 people but wasn't usually hard.  Because he was protesting me he lifted both feet off the floor, leaving us holding his whole weight for a long time.  We laughed so hard we barely could fix it.
• One of my favorite married couples were both in their 90s.  She had advanced Alzheimer's and was nearing the end of her life.  He had a little forgetfulness but was fine.  His love for her was so touching.  Every day he walked from the senior apartments to her room.  It was connected but a long hike.  I wound up involved with a need for fabrication of something weird that she needed and spent a lot of time with her.  Every day he was there, and every day he'd ask my name, tell me names were hard for him so he'd write it down, and then the next day he'd repeat.
• I may have saved someone's life about a year ago.  This happens from time to time in home health but this time it was more something I did than something than just being in the right place at the right time.  The woman had a heart attack, done some inpatient rehab, and was just about finished working with me on some safety stuff.  I saw her on a Saturday and knew she'd be home on Monday.  Monday I called about 20 times because I was worried.  I called her family and they couldn't reach her.  I decided to stop by.  It took seconds to determine she was having a stroke and had passed out and did not hear the phone.  She was aware of feeling funny but not of danger.  She was in the ER 20 minutes after I found her.
• Sometimes it was the staff that made you realize why medical professionals can have such bad reputations.  Examples:
• Once a patient had fallen and was complaining of pain in a place where the most common fracture in the elderly occurs, in the wrist.  It's generally one of those automatics, pain in that area, xray needs done.  So I told the nurse that the patient was having "significant radial head region pain with swelling and erythema (redness)".  I was trying to not scare the patient.  The nurse yelled at me to use English.  um, ok?  "I think she needs a wrist xray".  "WHY" "Um, these are common symptoms of the radial head being fractured." "Well, YOU can't order and xray".  "yeah, that's kinda why I'm asking yu to ask the dr.  Protocol and all"  (half these thoughts were unsaid)
• Another time a family had asked me to help their loved one feel comfortable with new hearing aides that cost $10,000.  Since learning they were expensive the patient wouldn't touch them.  So I draped a sheet around the patient to catch anything that fell and we worked at managing them.  We were just about independent with this when a doctor I truly dislike came to check on her, looked at what we were doing and said "oh, wow, those are those new $10000 hearing aides!".  Patient turned pale and put them down and it took 3 days to retry it.
• One doctor from another culture refused to ever tell his patients they were dying.  Some guessed or had family tell them.  Others just never knew.  Yet the doctor inevitably ordered therapy to be followed by hospice.  Essentially make them stronger so death takes longer.  I remember have a fit over this because I just refused to push this poor woman who hadn't been told of her stage 4 cancer and I didn't care what it messed up.
• One I accidentally found lung cancer.  That was weird.  The patient had a shoulder injury that healed badly and was very painful; nothing I'd tried helped.  He fell, landing on that shoulder.  Because of the pain pattern I requested an xray of his ribs to be sure one of them wasn't cracked.  The ribs were fine.  The lungs were pretty much solid tumor.  He was gone in a few weeks and had it not been for that xrays nobody would have known.  I never figured whether that was bad or good.
• One of my favorite patients called me "VIIRRGIN MARY" consistently from the day we met until his death about a year later.  He taught me massive amounts about gaining trust and doing what is necessary to maintain that.  Near the end he thought I WAS the Virgin Mary and I think he died feeling he'd confessed and was forgiven.  I hope so.
• Sometimes people who were used to doing everything a certain way really struggled with short term rehab.  Once one of my neighbors was my patient and was very concerned about getting in that last mowing to grind up leaves.  We kept talking about it being fine to wait.   Within days of his return home I drove past and he was mowing.  In December.
• If you have a prominent birthmark you become very accustomed to comments and questions.  One day I was talking to a relative of my patient about some issues the patient was having and how I wanted to fix them.  The relative noticed my birthmark and told me that a mouse must have touched my mouth in that area when she was pregnant with me.  I thought they were joking and laughed.  Unfortunately they were dead serious.  Oopsie.
• One patient started being very resistive to treatment and making comments to me and others about how she felt I wasn't aggressive enough.  I explained the treatment plan,my supervisor explained the treatment plan, and she continued to not follow instructions resulting in additional injuries.  Finally I figured out, and then confirmed, that she truly believed that if she did not get 100% recovery that it was my fault.  Pressure anyone?

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