Archive for February, 2010

Cooking Patients on Virgin Atlantic

I discharged “Barry” the other day. He’s improved quite a bit and is probably doing about as well as could be expected at this point. In fact, thanks to his vision being restored, he’s even doing a little bit better than before his brain surgery. Granted, he’s not perfect…he still  needs varying degrees of help for some, if not most of his self-care needs. But not every patient becomes 100% independent and it’s part of my job to recognize when they’ve reached their potential. He never did consistently learn the answer to the riddle, by the way, but he made my day at the beginning of our final treatment session when he spontaneously asked, “So, when are you going to ask me the question about the alligator?”

I’m going to miss Barry. I promised him and his wife that I’d call next Friday, to see if he knows the answer to the riddle yet.

Otherwise, things are pretty quiet on the patient front. With Barry’s discharge, that only leaves me with two other people I’m treating. No really good stories about either of them (well, there really are, but this is a public blog and I wouldn’t want to take the chance that certain people would recognize themselves in the not-so-wonderful light in which I would portray them) but when/if it happens, I’ll let you know. I wouldn’t mind having a few more patients, either but that’s part of the up-and-down roller coaster known as Home Health.

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I made another “awesome dinner” the other day – salmon on the grill, with a horseradish marinade and sauce, with baked potato, steamed asparagus and corn on the side.

It still amazes me that I’ve turned into such a good cook. Granted, my mother was is was is was is was/is a good cook and I watched her cook throughout my childhood. But anytime I tried to cook something, she felt the need to “help” me with suggestions. Some of what she told me was, I’m sure, sound advice. But the recommendations that I remember more than anything were the the ones from the “control freak” part of her personality. My favorite was the one where I was mixing something counter-clockwise and she told me to mix it clockwise. WTF? And so, with very few exceptions, I got to the point somewhere in my mid-teens where I just rebelled gave up and simply would not cook in her home. So by the time I moved out from my mother’s house and in with Joe, I was proficient with cooking spaghetti, brownies, Nestles Tollhouse Cookies, stuff on the BBQ and that was about it. Despite this, Joe still loved me, took me under his wing and taught me some of his culinary skills, such as Hamburger Helper and baked chicken breasts. It’s taken some time…it took YEARS before I trusted myself to cook a whole chicken and to this day I still haven’t broiled or used a wok. But otherwise, if it’s written as a recipe I can cook it. But considering my meager beginnings, I’ve become a damn good cook, if I do say so myself!

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After a long delay, we finally got the details of our chorus’s trip to England this year. It will be the Royal Albert Hall revisited (members of Sing Live UK and USA will be the chorus for “The Night of 1000 Voices,” a fundraiser concert for Leukemia & Lymphoma research), plus some extra days visiting Leeds and London. Anyway, instead of flying on a domestic airline that wold force us to have a stopover, our director was able to grab some non-stop seats for us on Virgin Atlantic. Doesn’t really matter much to me…a plane’s a plane and I have a supply of good drugs to keep me asleep for most of the flight. But apparently VA’s policy is that carry-on luggage can only be 13 pound. WHAT? That’s all? Just 13 pounds? My PILLOW weighs more than that, for crissakes! And yes, I bring my pillow with me when I travel. Don’t judge. Anyway, I’ve gotten really good at making sure my big suitcase is less than 50 pounds (my record is 49.80) but that’s taking into account that whatever would tip it over into excess weight will go into my carry-on.

I’m so screwed.

Hey travelers…any words of advice?

It Was the Best of Times, It Was the Worst of Times…

As I mentioned in another post, I sometimes get some AWESOME patient stories.

Take “Barry” for example. I’ve had him for 5 different admissions over the past, oh I dunno, 3 years?, because of various major problems that unfortunately have come up with him over time. Both he and his wife are nice people, they’re realistic in his abilities, they do most of what I ask them to do (read: they’re compliant) and although they speak fluent English, their mother tongue is Hebrew so I get to hear accents, terms and phrases that I haven’t heard since I was a very little girl when my Russian-born paternal grandfather was alive. With all of that, every time Home Health Company #1 (of 2) has offered Barry to me, I’ve always said yes.

I have Barry right now because he recently had brain surgery to remove a benign brain tumor that he had had for several years but was now giving him more problems. The good part about the tumor being removed is that his vision, which had been nearly all, if not totally gone because of the tumor, had now partially returned. The bad part was that the surgery/anesthesia had left him very confused, disoriented and disorganized, as well as weak from having such a procedure and laying in bed for so long. So my goals were to get him stronger and more self-sufficient, re-teach him how to use his eyes again and work on his ability to, well, think.

Working on strength and self-care was easy…it’s what I do. Even working on his vision was simple enough because it really only involved reminding him to look at things to help him get the job done (after a few years of being blind, it’s no longer a habit to use your eyes). However the “brain stuff, that was more of a challenge. Not a big one though…I just went back to my days of working with my patients who had psychiatric disabilities, who many not be in tune with the “here and now,” and did a lot of reality orientation, number work, memory games, problem solving, following game rules, etc. And slowly but surely (this is his 4th week with me) he’s been getting better.

Except for the riddle.

Q: “What do you call a sleeping bull?”
A: “A Bulldozer”

I frequently use this riddle for my patients who have memory impairments due to injury or illness (not due to Dementia)…their response, or lack thereof, helps me to determine “where they’re at” in their cognitive abilities. When I tell it to them, I look to see if they remember my telling it before, if they remember the answer (with or without help, and if so, how much help) and if they “get it” (which can be determined with a laugh or a groan). Barry started off with laughing at the joke (so he “got it”) but not remembering it from visit to visit (short term memory deficits), to eventually knowing that I had told him the joke but couldn’t remember the answer (improvement of the STM), to being able to remember the answer with a hint (i.e. “The answer is a ‘bull-something.’ A Bull what?” – to which Barry would usually first say, “Bullshit! A bullshitter!” with his cute little accent). He still can’t remember the correct answer from visit to visit (usually 48 hours apart but occasionally just 24 hours) but can usually remember it in the 45 minutes between the beginning of the visit and the end of it. He also tends to remember “Bullshit” and his other totally bizarre, no idea where it came from answer of “Alligator”. So he’s not there quite yet, but almost.

Other forms of reality orientation include working on the date, names of family members, etc. He’s starting to get there almost consistently (although he fluctuates back and forth between thinking it’s the year 2010, 2011 and, my favorite, 210) so we’re making it a little harder by seeing if he can differentiate between the various Home Health people who come to visit him.

Sharon: “Barry, what’s my name?”
Barry: “Your name is Sharon.”
Sharon: “That’s right! Good!”
Mrs. Barry: “And why does Sharon come here to see you, Barry?”
Barry: “To torture me!”

Yeah…he’s almost ready to be discharged, LOL!

I do my best to make my therapy sessions as fun and enjoyable as possible – it keeps the patient motivated, redirects them from the hard work I ask of them, etc. But sometimes there’s no way to get away from the tragedy of the moment.

I met “Jack” yesterday. He’s in his late 60’s and recently had a huge, massive stroke that was so bad they had to open his skull to allow for the swelling within his brain. He spent several weeks in the hospital, then several weeks in a Rehab place but still needed a lot of care. And I mean a LOT of care. The Rehab place strongly suggested that Jack’s family send him to a nursing home but they wanted to bring him home. It’s their right to choose that, so home he went.

Enter Home Health. The whole shebang, too…Nursing, Physical Therapy, Occupational Therapy, Speech Therapy, Home Health Attendant (to help him with bathing) AND a Social Worker.

Why?

Because this guy is out of his mind.

Usually a stroke causes weakness on one side of the body or the other. Sometimes there may be varying degrees of problems with eating or talking or how you see the world. Unless you were very weak to begin with, you can usually regain SOME part of your life, even if it’s not the way you used to do it, or if you always need some help to do it. But sometimes a stroke will occur in some areas of the brain where it’s not so much your movement that’s messed up, but something even more important.

How you think. Understand. Your entire personality.

And that’s Jack and his problems resulting from his stroke.

Physically, he’s fine. Oh, he has some issues with his balance but he can walk (rather, RUN) around the house, take his clothes off, etc. But:

— He can’t talk (well, he can but it’s just gibberish and half-sentences that have no realistic context)
— He doesn’t seem to understand what you’re saying (he will follow visual cues…so if you put your hand out to shake, he will shake it. But if you say, “Jack, shake my hand” without putting your own hand out, he does nothing)
— He often doesn’t know what certain items are for (it’s called agnosia. Put an everyday item into his hand and he has no idea of what to do with it)
— His attention span is *about* 1 minute
— All he wants to do is go outside. Outside is dangerous because there’s uneven surfaces and cars in the street but he doesn’t realize that – his judgement is horrible and he just wants to GO. RUN. And he knows how to go into the garage and press the button for the garage door to open.
— He doesn’t seem to recognize his family, except as people he vaguely knows (it’s hard to tell because he can’t tell us. But he was more affectionate with, but also more physically ready to hit his wife than me).

I hate to even say it, but the only way to explain Jack’s behavior in layman’s terms is that he acts like a belligerent drunk who is THIS CLOSE to passing out. I think you know what I mean.

The only way anyone has been able to control Jack since his stroke has been with medication. Heavy-duty sedatives that make him sleep his life away, because without them he’s running around the house, trying to leave and getting ready to hit his wife, the woman who he perceives as the one hindering his ability to leave.

So we have a guy who is sleeping most of the time and agitated when he’s not. And he doesn’t understand anything.

Not really a candidate for Occupational Therapy at this time.

I spoke to my supervisors – we agree there’s nothing I can do for the guy right now. So after some teaching to the family about safety (get new locks on the door that he can’t open, get alarms on the door in case he still figures out how to open the door anyway, buy a Medical Alert bracelet for him in case he gets lost, talk to the doctor about continuing to play with his meds to get him on more of an even keel, call 911 if he’s agitated enough to try to hit you, etc.), I got ready to leave. The family was still at wit’s end though, and were practically begging me for more help. I had mentioned to look for things to keep him busy…they had already figured out he could fold laundry so he was folding towels, on and off, for short periods of time. I had also suggested rolling a ball of wool or yarn – again, a simple, repetitive task (repetition helps to soothe and relax – that’s why people are told to “count sheep” when they can’t fall asleep). Perhaps using a broom to sweep the house. Maybe the exercise bike, if the Physical Therapist said it was OK. I asked what he liked to do when he was healthy…they said he played soccer and enjoyed music. I suggested that perhaps they could involve him in music. At that point his wife pulled out his ukulele and gave it to him, I guess to see what he would do with it. And Jack, whose mind was one big mess of global confusion, settled down for 3 whole minutes and played that ukulele. It was incredible. As screwed up as he was, that part of his brain still worked. He sat on the couch and plunked a tune while his wife sat at his feet, crying. He was so close, yet so far away.

He didn’t play for long…his need to “go to work” overtook him and he was running around the house again. But for those few moments, when I could see a glimpse into the man who was lost, most likely forever, I felt totally helpless. He was a relatively young guy who had been healthy and strong, had a wife and family who loved him to pieces and he was totally lost because of his sick brain.

And I could do nothing.

I’m a health care professional. My work, my entire career, is based on helping people. When I can’t, I worry about my adequacy in my job…do I just not know enough? Surely there must be SOMETHING I can do to help turn some of this sad tragedy into hope, be it ever so small, for the future? But for him, I had nothing.

And it sucked.

I called the nurse to let her know I had seen Jack (both asleep and awake – I even went home and came back later to be able to see him in both states, in case he was more reachable in one than the other) and that there was nothing I could do. I also let her know about my concerns for his and his wife’s safety when he was in his agitated state. And in talking to her, I discovered I was not alone…apparently both the nurse and the Physical Therapist were in the same boat as me and really had little to nothing to offer this guy right now, when he was so unteachable. Speech Therapy hadn’t seen him yet so perhaps there’s hope for that but all of the rest of us were done.

There are still some unanswered questions for Jack – as I said earlier, nursing home placement was recommended and they refused, apparently still in denial, despite being told about the slim chances of his recovery (statistically speaking, people with brain injuries due to massive strokes like these don’t do very well). Seeing how much work he is, I have a feeling that may come up as a viable option for them in the not-too-distant future.

Still though, it’s a shame. Such a loss.

I love my job. I really do. Except for the times, here and there, that I hate it. Not because of what has been done, but because of what can’t be done.

I’m sorry, Jack.

Dobby the Devil Dog

I started begging asking for a dog when I was 3 years old and my control freak of a mother parents finally relented when I was 24. Pippi was a joy for the vast majority of her 18 years on earth; sure, she started to show her age when she was about 16 but it was really only her last 9 months or so, when she was riddled with arthritis, totally deaf, blind in one eye, visually impaired in the other and  senile to the point of barely functioning that

Pippi, age 15 or 16

we knew we would soon have to put her down. But she still ate and she still kissed us, which made us agreeing to do it that much harder. Pippi finally made the decision for us on a morning in December 2008, when she suddenly couldn’t stand up anymore – she kept falling to one side and it looked like she had a stroke. Our favorite vet in the world gently helped her go to sleep and that was that. It was very sad but not at all unexpected and probably the best thing that could have happened to her by that point.
There was never a question that Joe and I would be getting another dog but we wanted to wait a while to have our Master Bathroom done. We purposely had waited until Pippi was gone so the workers wouldn’t interfere with the life of an old, fragile dog who walked in near-continuous counterclockwise circles and got lost in corners, and the last thing we needed was the noise, dust, open doors and confusion rocking the world of a brand-new puppy. So we waited. Granted, I took the time to look for “puppy stuff” and to find a reputable breeder, but we still waited.

The bathroom was done on June 24th. We brought 3-month-old Dobby home on the 27th because after 6 months of being dogless, god forbid we want to wait even another second.

What a cutie she was!
Dobby on the day we got her. She looked kind of like a gorilla.
It had been a long, LONG time since I had a puppy. And I had specifically looked for a dog who was not the skittish little wallflower that Pippi had been. I wanted a brave dog. An active dog. One with personality.

I got exactly what I was looking for.

WHAT was I thinking?

I didn’t think two dogs could be such polar opposites. Pippi was afraid of her own shadow…Dobby is afraid of nothing and no one (except, as she’s gotten older, loud noises). Pippi turned her nose up at dog food for the first half of her life…Dobby literally LIVES for that 1/4 cup of Purina Pro Plan kibble twice a day. Pippi was obedient and responded to the word “No”…although she follows through with “Leave It”, “Drop It” and “Off” Dobby LOVES her papercommands 90% of the time, Dobby completely ignores “No” in every tone we’ve ever tried – but responds beautifully to redirection (usually food). Pippi didn’t take things that didn’t belong to her and would leave things alone if we told her to…Dobby is a master at stealing socks, paper, ball point pens, twisty ties and anything else on the floor (to the point where we’ve become much more aware of, and retrieving things that have fallen on the floor). Pippi was a voracious kisser and would even kiss us on command…Dobby only kisses us on her terms, usually when she’s sleepy (although I think the “kiss command” is starting to work on a more consistent basis). Pippi was the epitome of submissiveness…Dobby is the leader of the pack (not our pack – she’s learned her place – but she sure does like to beat up on other dogs, regardless of size). However although they came from two entirely different dog families and are so very different, I still see little “Pippi-isms” in Dobby’s personality…how they both stare at the doorknob when they think we’re going to open the door, their mutual love for the “warm spot”, how they “jump/hop” to “help” us pick them up when they’re in a sitting position, stuff like that. I’m sure it’s more “dog-isms” than anything – any small dog will do it (OK, large ones too but I can’t see trying out the “jump to help pick them up” with, let’s say, a Mastiff) but I prefer to think that the contents of the box of Pippi Ashes in the barrister bookcase in the living room are occasionally talking to Dobby from the Great Doggy Beyond.

It probably will gross some people out but Joe and I allow our dog to sleep with us. The one rule we have is that the bedroom is for “sleepy time” so, save for one particular brand of bone that she loves more than any other (and it’s the only time we let her chew that particular brand, to ensure it keeps her occupied), we don’t allow doggy play in that room – she can chew quietly or she can sleep, period. That’s it. Dobby’s still learning that rule though and doesn’t always care to follow it.  We have a baby gate in the bedroom doorway, which keeps her either in or out, depending on our needs (note that doesn’t always exactly jive with HER needs desires). So when she starts romping all over the bed, trying to chew on our hands, the blankets, the pillow, etc., in her doggy attempts to play in the bedroom, she gets locked out for a minute, to both calm her down and help her realize that sort of behavior isn’t allowed in there. Usually it works. Two nights ago it didn’t.

It was partially our own fault. We had been out for hours and were tired when we got home. So on top of being all worked up because she was worried and thought she would never see us again she finally woke up from a 5-hour nap we were finally home, we also didn’t take her out on her usual “long” walk to get rid of the last of her energy…we took her out, walked the length of 3 houses, she pooped and we went back home. So while Joe and I were really tired and ready to go to sleep, Dobby was all about playing. In the bedroom. Not a good thing.

True, she started off OK, chewing her “bedroom bone” like a good girl. She even gave us “goodnight kisses” like she usually does (unprompted, mind you…it’s the cutest thing!) and we figured she was going to settle down and go to sleep. But she had other ideas. Like chewing and pulling on the blankets. And playfully nipping at our hands when we went to pull the blankets away from her. So I did what one of us always do and picked her up and locked her out. She whined a little because she was separated from us (apparently a fate worse than death for a dog) and a minute later I opened the gate, picked her back up and brought her back in. I put her down on the bed and she immediately started pulling on the blankets again.

Shit.

Planning to lock her out again to teach her that “that” behavior means isolation from the rest of “her pack”, I went to pick her up and she suddenly Devil Dogbecame what our original Obedience Trainer calls Zoom Zoom Dog but what we in the Heg House fondly call “Apeshit Puppy.” Apeshit Puppy is when she gathers ALL of her energy and uses it to RUN. FAST. Usually just back and forth in a room, sometimes in large circles, but sometimes it’s just a haphazard running here, there and everywhere. Think of a running back’s path and that’s what Dobby would be doing, but with sharper angles and at something like 500mph.

The latter one was what she was doing now. Zig-zagging all over the bed. And when she is Apeshit Puppy, she is out of control. She’s in that 10% of the time where verbal commands don’t work and there is NO way to stop her unless you catch her…which I think could be compared to trying to catch a greased pig. Joe must have had some history of greased pig chasing though, because he somehow caught her in mid-zig.

And she was escorted out of the bedroom once again.

After a minute or two, I decided to change tactics and instead of just letting her back into the bedroom (obviously she wasn’t ready to go to sleep yet), I’d come out (because god knows *I* certainly wasn’t sleepy anymore by this time) and dig into my “bag of tricks” to help make her sleepy. We joke that our La-Z-Boy chair has magical sleeping powers for both man and beast so I brought her into the computer room and we laid on that for a good 10 minutes. I did some soothing massage, scratched her belly a while, used neutral warmth from my body, talked to her quietly and did whatever else I could think of to calm her down and make her sleepy. She did eventually calm down and even yawned a few times so I figured it would be a good time to bring her back into the bedroom.

And the second I set her down on the bed, she became Apeshit Puppy again.

Son. Of. A. BITCH!

I somehow managed to catch the little bastard her in “mid-zag” this time and once again she was isolated from the rest of the pack.

For an hour and a half.

And do you know why we knew it was an hour and a half? Because we had had enough and were not going to let her in and she spent the next 90 minutes keeping us awake, with whining and crying and pawing at the baby gate, trying to get back in. She may have gone on even longer than that but I finally fell asleep, exhausted, around 2:30am.

I woke up at 9am the next morning, with a quiet, well-behaved puppy between Joe and I. Joe said he finally let her back in at whatever time and she had worked herself up for so long that she was exhausted by that time and fell right to sleep.

It’s a damn good thing she’s cute.

Looking like Angel Puppy. It's all an act...

Help For Anissa

This blog entry starts out about me but eventually discusses a total stranger. Whatever the case, it’s amazing how one thing can lead to another.

Over 7 years ago, Joe and I lived in Tampa. We were big fans of an Orlando-based a cappella group called Toxic Audio and hearing their CDs and shows inspired me to follow a dream I had been holding on to for years…to join a female Barbershop singing group. I quickly learned that the female version of Barbershop is actually called Sweet Adelines and besides the opportunity to sing in quartets (NOT for me), SAs are larger groups of women singing as a chorus. After some research, I discovered that my local chapter of SAs was called Toast of Tampa.

I really enjoyed singing with TOT, but there were a lot of things involved in it that made me second-guess my participation in the group…I couldn’t (still can’t) sight-read sheet music and, because I was coming in to an established group, always felt like I was behind the 8-ball when it came to knowing my music. To their credit, they had a “Big Sister/Little Sister” program in place for newbies but I never felt my Big Sister was a good match for me…she was at least 30 years older than I was and instead of holding my hand like I really needed, she was more of a “ask me any questions you have” sort of person. As a virtual newbie, I had NO idea of ANYTHING so I didn’t have even any sort of “base” to ask questions from. My entire participation was one big “question”, LOL! On top of that, I soon found out that the Sweet Adelines’ main goal is that of Competition…Regional, National and International. Part of the Competition meant I had to have the same shoes, costume, makeup and hair style as everyone else, to say nothing of learning a LOT of choreography for each song we did i the Competition. Well, I didn’t want to look like everyone else, I certainly didn’t want to learn choreography and I really didn’t want to compete, either…I just wanted to sing! On top of all of this, I had (rather unwisely) joined TOT a whopping month and a half before Joe and I got married. So my mind was, understandably, on other things.

I did the best that I could under all of those circumstances but eventually wound up quitting Toast of Tampa about two months after the wedding. However I somehow remained on their email newsletter list. I didn’t mind because I had made some acquaintances there so it was fun to see what they were up to.

One day though, I read some very sad news in the newsletter…the young daughter of one of the singers I remembered and liked had been diagnosed with a brain tumor and was being treated at St. Jude’s in TN. They had included a web address for a blog so people could read updates on how she was doing, which I visited and bookmarked. I’d check her blog periodically, happy and hopeful when she was doing well and saddened when it was discovered the tumor had spread. The blog also included links to other kids who were St. Jude’s patients and, ever the health care professional who liked to read Case Histories, I’d occasionally check out their blogs, too.

The years went on, I’d read links of links and eventually I found the blog of Anissa, a woman whose daughter had Leukemia. The daughter, fortunately, made it through her chemotherapy well and has been off treatment for over a year now. Without having to report on medical stuff, Anissa changed the focus of the blog from mainly her youngest daughter’s health to the happenings of her entire family, with funny stories and her view of the world. And let me tell you, Anissa is one kickass writer! Funny as anything and the kind of person you think you could really like in person, if you ever were to meet (don’t worry…I no have plans on being anyone’s stalker, LOL!). http://freeanissa.com/ became “just another awesome blog” that I read, like Pioneer Woman or GaijinSmash, and I looked forward to every new entry.

Until late this past November.

That’s when her husband posted something on her site: Thank-you for all of the kind words of encouragement. Going forward, all further updates on my wife’s progress will be at www.hope4peyton.org.

As it turned out, Anissa, a healthy 30-something-year-old woman, a wife and mother of 3 kids under the age of 12, had suffered a massive stroke in the area of her brain stem. A few days later she had yet another brain bleed. She was non-responsive for several days and it was touch and go for a while; no one was sure she would make it. Fortunately she did and the “long road back to her former life” began. Based on her husband’s writings (and my own professional knowledge as someone who has worked with hundreds of stroke victims), she’s progressed well and is doing very, very well for someone who had such a significant event happen inside her head.

After 3 months of hospitalizations and inpatient rehabilitation, Anissa finally came home to her husband and kids yesterday.

She’s not done though. She’s still got a ways to go in her rehabilitation, trying to get her right side to work, learning how to speak more clearly, and everything else that goes along with recovering from a massive stroke. Her health insurance is allowing her 40 Outpatient Rehab visits, but there’s a $100 co-pay per visit (I hate insurance companies). I’m not sure what her husband does for a living but whatever it is, it doesn’t pay enough to cover $4000 in co-payments. So they’ve set up a Paypal site, with requests for donations.

I’ve sent them some money because I felt it was the right thing to do. Anissa has given me hours of enjoyment with her writing…sure, she’s essentially a total stranger but since it’s something I can do, it’s the least I can do. Take a look at her blogs and if you get sucked in, or laugh out loud, maybe you’ll feel moved to help her out too.

— Anissa’s original blog, written to keep people abreast of her daughter’s fight with Leukemia, now being used to keep people abreast of Anissa’s recovery from the stroke: http://www.hope4peyton.org

— Most recent entry, with Paypal link, written by Anissa’s husband: http://www.hope4peyton.org/2010/ahem/

— Anissa’s “non-medical” blog: http://freeanissa.com/

Thanks, y’all!!!

And How Was YOUR Day?

I work in health care as an Occupational Therapist. Before you ask, no I don’t get people jobs, I’m not the same as a Physical Therapist and I am not a Bath Aide – SO many people think I’m one of those, LOL! As an OT, I re-teach self-care skills after someone (in my case, usually a senior citizen) has been sick or injured. I have a BS in OT (because if anyone should have a BS degree, it’s me), am nationally certified (which means I pay the national organization a buttload of money every few years) and am licensed to practice in the state of Florida (which means I pay the state of Florida a buttload of money every 2 years after paying a buttload of money for continuing education units through each 2-year period). I currently work in Home Health, which means that I go to see my patients in their respective homes, usually after they’ve been discharged from the hospital or Rehab facility. These are the people who are considered to be “home bound,” which means it would be a hardship for them to go to an Outpatient facility for therapy (because they’re too weak to tolerate the ride, they’re in too much pain, etc.). My services are paid for by their medical insurance (in my case, usually Medicare but sometimes private insurance).

I didn’t always work in Home Health. I’ve been an OT for over 20 years and although I’ve been doing the Home Health thingy for nearly 12 of those years, I also worked on a Psychiatry unit for 11 years (weak or physically sick people have to be strong enough to safely take a shower with or without adaptations and compensatory techniques…mentally ill people have to know it’s important to take a shower daily so you don’t smell and you have to have the organization skills to do it), worked in a handful of nursing homes on and off, and had a Rehab. Manager position with an Outpatient facility for 2 years (and yep, I know it all adds up to more than 20 years – I worked part-time a Home Health company in NY at the same time I worked full-time on the Psych unit for about 5 of those years). So I’ve certainly been around the block a few times when it comes to having patients.

I don’t work full-time anymore…instead I work “PRN” or “as needed”, which means the schedulers of the companies I work for offer me patients and I have the option to say yes or no (possible reasons why I say no: if they live far away from all of my other patients (if they’re 45 minutes from everyone else, it’s just not worth it), if I already have a lot of patients on my caseload, etc.). Once I see the patient, I decide if he or she needs me, for how long and what we will do to help them to be able to do as much as they can for themselves the best they can be. That can vary from person to person but on average I usually see people 2-3 times a week for 3-4 weeks. Give or take. I can ask for more time if it’s justifiable (read: it looks as if he/she can continue to improve with therapy) and I can discharge them early if they’re doing better than originally anticipated. I like it better than working in a facility because I don’t have to worry about anal retentive, cost effective accounting for my time and I have a little more control in calling the shots when it comes to what I do with my patients. Plus I think working with the patients in their own homes is especially rewarding…teaching them how to do things in their “real life”, instead of the sterile, not always realistic environment of a hospital or rehab place…I like that. It’s also given me the chance to see and work in all kinds of neighborhoods and homes, from RV’s to mansions and everything in between.

Having had lots of patients over the years has led to having lots of patient stories. The best ones, in my opinion, were the stories from the Psych unit…when the lady with Schizophrenia ran up to me one morning to tell me that she had choked on dinner the night before and they had to give her the Heineken. Or, during our Religion Group, how one lady was thanking her god for her family, for the staff, for Cigarette Time and for the books on the bookshelf. And the lady who would only talk to yell out Bingo numbers. And the one who had $15,000 hidden in her rat’s nest of hair. Or the agitated, hallucinating guy who almost killed me. And the endless confused, disorganized people who walked down the halls naked.

Home Health has its own share of stories though. Keeping to the “naked” topic, there was the guy with the brain tumor who I was visiting for the very first time – I had never met him before and was there to do an initial evaluation. His wife opened the door, I introduced myself and she said, “You’re the OT? Oh wonderful! He’s stuck in the shower and we can’t get him out…maybe you can help!” So within 15 seconds of walking into the house, I met “Larry”, naked as  jaybird. That’s my world record for seeing a patient naked, by the way.

I met a new lady today, her name is “Dolly”. She had had a prolapsed uterus for 30-something years and it got worse and worse until something really gross happened and she had to have surgery to get it fixed. The daughter-in-law was telling me stories about how it was hanging out and how it squished when she would sit down. Yeah, I know…ewww (and that wasn’t even the gross part I was talking about!). Anyway, Dolly wound up with a lot of blood loss, was in the hospital for a week and change and, as a result, is very weak now.  So anyway, I go to do my initial evaluation today and when I get there, sonofagun, Dolly’s stuck on the toilet and the daughter-in-law asks if I can come in and help her up. I’ve learned a lot since treating Larry and it’s not really very safe to help someone do major physical stuff when you don’t know them from a hole in the wall…you don’t know how steady they are on their feet, how much help they need (so you can give too much or too little help and can hurt yourself or the patient in the process), etc…so I told her I couldn’t do much until I had a better idea of what Dolly’s problems were and to do whatever it was that they’ve been doing. Well, they tried. They really did. But Dolly, who apparently has been a mean, nasty bitch her entire life, had suddenly become a whiny pile of jello. Being sick can do that to a person. And she started crying on the pot. Well I couldn’t take that so I went into the bathroom to see what I could do about Dolly. I did eventually get her up (thanking god she wasn’t very big – helping people transfer from one surface to another, like the bed to the wheelchair or the toilet to standing, is the one thing I can’t always do because I’m so small – if they don’t need much help or if they’re little I’m OK. But once their center of gravity is above my head, or I have to do most of the work, or they have 50# on me, all bets are off) but it was touch and go for a few minutes. Meanwhile, the daughter-in-law told me that they had fixed the prolapsed uterus through the anus – not that I needed to know this but really, I had NO IDEA that’s how they fix that problem. And to help in healing, they had a bidet installed on the toilet. Well, that was an issue because the lady obviously needed a commode over the toilet so the seat would be higher and she’d have “chair arms” to push off of. So I needed to see the bidet to make sure the commode wouldn’t block it. The daughter-in-law took that to mean that I needed to see how the bidet worked, so she got it all set up and showed me. The problem is, the thing was retrofitted into the toilet and there’s not a whole lot of room so she had to lean over the toilet (the button was on the far/wall end). And in showing me, she squirted bidet water

all

over

her

face.

Fortunately, she had a good sense of humor about it, because as professional as I usually am to NOT laugh at awkward patient-related situations, I just couldn’t help myself. BWAAAAAhahahaha! When I got my composure, I reminded her that the water was from the tank and so was relatively clean, but I’d still recommend washing her face if for no other reason than psychological.

She smiled and agreed. And then we both giggled again.

I love my job.

How Much Do I Love Thee?

Joe and I were never much for Valentine’s Day. True, he did buy me flowers for our first few VD’s together but I eventually told him to stop – a nice bouquet is pretty but is too expensive for what it is and a cheaper-but-jacked-up-price-because-it’s-VD bouquet from Publix or the guy on the street lasted only a day before they’d start to wilt. Save the flowers for when I’ve sung in concerts, TYVM. I’ve never been one for jewelry. Chocolate was nice for a while but then I developed pre-diabetes (gee ,thanks a lot, heredity and being low birth weight!) and a box of caramels and buttercreams, although appreciated, wasn’t doing me any good, either. So we started going out for dinner for VD. Not on the actual day, of course – if we wanted to go anywhere that was nicer than McDonald’s, we’d have to deal with mondo crowds. But a day or two before or after would suffice.

This year we haven’t even do that. Oh, we’ve talked about it but with our wedding anniversary just 9 days after Valentine’s Day, it’d be like 2 “nice” dinners almost in a row. Plus we just went to Bern’s with Dar and John, “just because,” not long ago. AND my birthday is in a month so there would be yet another nice dinner. Plus there’s the whole “trying to eat healthier” thing, which, unless we go to Seasons 52, is not so easy to do when we’re out  (although I’m seriously considering Pizzeria Uno for my birthday…screw the carbs and calories, I want a LOT of pizza and their wonderful peanut butter cup dessert!). So at this point I think going out for VD dinner is on the back burner for now.

Joe was working 9a-5p on Valentine’s Day and since it was a Sunday, I had an excuse to make something “special” (I try to save Sunday dinners for new or special stuff…if he’s working, it’s only until a decent hour and I just have more time to plan and cook and we’re not in a hurry to enjoy it) and followed through with linguini and clam sauce (I LOVE Dreamfields pasta!), with baked zucchini with parmesan on the side. It looked good and tasted even better!

Linguini & Clam Sauce

Linguini & Clam Sauce

Dessert however, was another story. I wanted to keep to both the “Valentine’s Day” and “healthy eating” gendres, which led to pretty slim pickings to begin with. But I had some sugar free Jello and some containers of NF/SF yogurt so I figured I would be creative and do something with that.

I really should know better. I can follow any menu with ease but Littlebit + Cullinary Creativity = Bad Move.

I had some 3″ heart-shaped silicon molds that my in-laws had given me so I put some of the liquified Jello in there. I also had picked up some never-previously-used 1″ heart-shaped candy molds so I filled those too. Plus I had some Mickey Mouse and Minnie Mouse ice trays (again, silicon) so I filled them up too. Put all of those in the fridge to jell. So far, so good.

Meanwhile I took 2 containers of sugar-free, non-fat yogurt (one strawberry and one vanilla) and “blobbed” them onto a maroon-colored plate, followed by using a knife to “swirl” the 2 together. It looked OK but the strawberry yogurt was a relatively light pink so the swirling effect wasn’t very noticeable…especially after I put the whole shebang in the freezer to harden and it came out with ice crystals all over it so it all looked kind of whitish-pink. But I figured even if that part didn’t come out as I expected, it’d be OK because I still had all of the pretty Jello hearts to add to it.

Um, yeahright.

So first I had the three 3″ silicon hearts. Why didn’t I remember that I detested silicon for cooking, baking or anywhere in the kitchen? Because as carefully as I tried to push the Jello out by turning the silicon inside out, the fragile gelatin hearts started ripping . Torn hearts, how Valentiney! I figured I would be smart for the candy mold Jello hearts and dunk them in some warm water first, so they would loosen and it’d be easier to pop them out. And so, of course, I wound up either dunking them for too long or maybe the water was too hot but I now had re-liquified 1″ hearts. Well, shit. All that was left was the Mickey & Minnie heads and for those I just let them come out however the hell they wanted and in as many tiny pieces as they wanted because, let’s face it, I was totally defeated by then. So I had 3 broken hearts and a dozen mouse head pieces on top of the not-really-noticably-swirled yogurt, with another 15 melted 1″ Jello hearts down the sink. Nice.

I figured I had to salvage this somehow, so I grabbed a can of Reddi-Wip and squirted around the yogurt so it had a white border (more color contrast and to hide the uneven edges of the yogurt blobs). It helped. So I took a picture and then we had our special dinner…which rocked, BTW. The linguini and clam sauce was a hit and Joe had also managed to chill and hide a bottle of Moët & Chandon Rosé Impérial (my favorite!), which helped bring the dinner that one step closer to perfection.

And then we had dessert.

Creative Dessert

Creative Valentine's Day Dessert

It really didn’t look that bad, although it was not what was originally in my mind’s eye (contrasting colors of swirled yogurt, intact hearts, a Mickey or Minnie here and there for whimsy). But then we ate it. And discovered that the Jello pieces, from being on top of the frozen yogurt, had frozen…so we had crunchy, broken Jello. And the ReddiWip, after being squirted 45 minutes previously, had essentially melted (I’m sorry…I grew up in a Cool-Whip family and am not familiar with the Rules of ReddiWip). And neither of us really appreciated “regular ol’ yogurt” being frozen. So although it wasn’t BAD, it certainly wasn’t something I plan to make again in the near future. Or the distant future. Or even, I daresay, ever.

Happy Valentine’s Day, Joe. Next time I’ll make a package of instant, sugar free chocolate pudding in custard cups instead. Because I love you that much.

Should I or shouldn’t I?

There was a time where I posted blogs near-daily, or at least several times a week, over on my MySpace.  It was fun for a long time and there were several purposes for the entries, so I kept it up. But then times changed, as did my priorities and my long-winded stories eventually dwindled away in favor of one-and-two liners on Facebook.  Sure, I still voyeuristically read the entries of some of my favorite blog writers and anally obsessively kept up with blogs of my travels but the everyday stuff? Not so much.

But in preparing for getting an iPad (Will it sell? Who knows. But it will be ideal for me and my current needs) I needed something to take the place of what I could and wanted do with my laptop when on vacation – email, surf, dump pictures and blog. I’ve most recently been using MobileMe for the travel blogs and their setup is wonderful but do they have an iPhone/iPad app? Nope. So although I have no idea of what may come down the software/app pike between now and whenever I get the iPad (I’m holding out for a 3G version, so perhaps April? If so, I’m hoping it’s before I go to England, please!), I decided to start playing around with blogs and software that are already iPhone-friendly on top of being computer-friendly and, yes, techno-software-idiot friendly. That’s what brought me to WordPress.

To “practice” and start to get used to the WordPress Way, I decided to transfer all of my old travel entries to one place – they were previously spread around 3 other blogs (LiveJournal, MySpace and MobileMe – now you know why this blog is called “The Adventures of Littlebit 4.0“) and, with concern that the former two might go belly up and we may not always want to pay for the privilege of having the space for the latter, it made the most sense.

However something funny happened while I was scrounging my long-abandoned MySpace for travel-specific entries: I started reading everything else I had written. Stories of patients and friends and places I went and people I saw. The everyday stuff I did. The things that had made me laugh, cry, seethe and everything else in between. And I started to realize that I missed blogging. I missed the creative writing. I missed having a way to remember what I had done in my life. So I started thinking about starting it up again.

I’m still thinking about it. So watch this space…you never know what might start to pop up.