Well, here we are, back in work mode, my personal life having stabilized to some extent, the grieving process for my canine soul-mate continuing. My back pain is still with me, although somewhat diminished after a spinal injection three weeks ago, and now my step-father seems to have an apparently malignant mass in his pancreas, necessitating major surgery and other treatment. If only I could take a leave of absence to simply live my life, but no such luck.
At the office, we have the usual goings-on:
A patient dying of advanced cancer and AIDS took it upon himself (with help from his brother) to destroy a $3000 IV home infusion pump which they said "broke" on its own. They were apparently attempting to figure out how to extract the morphine from the pump to inject it all at once intravenously for a major dose of relaxation. Probably a good thing they failed----it most likely would have killed them both.
Patients struggle with psychiatric illness and the lack of services in our area. So many psychiatric outpatient facilities work on a "fee-for-service" basis, hence our patients---who tend to not show for appointments alot---get taken off lists and moved to the bottom, often losing all hope of treatment in town. That leaves us with dozens of the most fragile patients without proper psychiatric treatment. This fee-for-service idea has got to go. That's one of the things our program has going for it---we are paid an annual amount to care for our hundreds of patients and then we figure out how to care for them best. We don't bill for each contact, thus we are not desperate for visits, nor do we avoid visits which might take a number of hours to accomplish. We are relatively free from that economic disincentive to provide quality care.
That said, I struggle under a caseload of 83. How to keep that many people in my consciousness? How to remember what I need to follow up on each day? How to not lose the threads that need to be connected again in the fabric of care? I hobble along, sometimes stumbling, sometimes sprinting, sometimes collapsing from exhaustion.
A number of my patients have broken bones this year. One was hit by a car while crossing the street. Another patient with Multiple Sclerosis fell against the kitchen table and fractured her humerus. Someone else tripped on a wet floor and broke her ankle. I don't usually have this effect on people, but my patients break their bones at an alarming rate. Do they need pedestrian airbags?
Still others seem to develop multiple chronic injuries from out of the blue (sort of like I manifested a spinal cyst). This one has several meniscal tears in her knee. Another has herniated discs. Still another has a torn rotator cuff. These bodies sure take a beating.
My mind is spinning with scenarios, issues to deal with, patients to follow up on, people to call, referrals to make, treatments to assess. It seems that when you take 83 chronically ill people, put them all together in a big box, add poverty and stir generously, you get a recipe for multiple comorbidities needing a comprehensive and global approach to care managment. That's where I come in, and it is, I must confess, not an easy row to hoe.
But tomorrow's another day. And I'll be there.
4 comments:
83 people to care for? Your resilience is extraordinary. I don't know how you can track so many comorbidities and the potential for ADR in their regimes etc.
No funding model will ever be wholly satisfactory and will always be a source of frustration.
Best - Tony
Glad to see you back and hopefully it was somewhat restful and regenerating.
Yep, you'll go back. Lots of patients will be glad of that fact too whether or not they take the opportunity to tell you so.
To the nurse juggler-extraordinaire,
How ever do you do it, my friend? Necessity is the mother of ...stress due to overload, me thinks. Yet, still you return with a full heart and clear mind, if aching back.
I am impressed with your ability to find some humor in all of this and share it with us here. It is a great coping mechanism. God knows you need to keep your feet on solid ground or you could pulled into the undertow of so many unmet needs.
Your presence in each of those 83 lives is truly a golden, if thin, thread weaving them into a healing space in the midst of their own stressful worlds. You are an living, breathing, walking, loving, caring oasis in so many lives. Lives that have been deserted or stranded by allied support services, like the fee-for-service mental health system that you mentioned.
Please continue to replenish your life-giving waters in ways that you so richly deserve. I, like you, only wish that your caring service wasn't spread so thin.
Good Luck on your return and best of luck in navigating your work world while caring for your back, and offering support to your step-father.
Amiga de Malone
I know what it is like to have a Psychiatric Illness and not be able to get treatment for it. I have been diagnsoed with Bipolar Disorder type one for well over 6 years now. The county mental health services for the indigent and uninsured are pratcially useless because there are such long waiting lists for services and they will only allow two psychiatrist visits a year. I had Carpal Tunnel Syndrmone back in 2002 and trying to get a surgery that is not life threatening, but I would lose permanent function of my hands with out the surgery.
I was unmedicaded at the time and felt even worse being told this by an Orthopedic Surgeon that took an oath to heal people. I was so depressed, I told my grandmother and my mother not to worry about coming up with money for my surgery because I wasn't going to be alive for much longer.
My mother and grandmother decided inpatient treatment would be the best option. I was taken to the ER and admitted. I felt this would be my only change to get a surgery that would essentially cripple me if I did not have it done. The psychiatrist referred me to an orthopedic surgeon,ironically the same one that dx'd me with it. I did recieve the treatment, but ignored when I told the nurses I was allergic to latex. They did not believe me until I broke into a rash and had slight trouble breathing
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