Journal Entries
NaJoPoMo 2013 The Art of Death 19
Posted Nov 19, 2013
Rehabilitation
How it works is, the hospital, whichever hospital, makes a determination that the patient is fit to be discharged to a unit that specializes in rehabilitative therapy, a halfway house between surgery for that broken hip or that tumor, and the sanctuary of your own home. They call around the area, find a "slot" (bed) in one of the places like this, and in comes the stretcher, bearing a patient who may or may not be aware of what is happening.
Doctors, physician's assistants and CNAs attend to your continued improvement -- knitting of bones, healing of wounds and so forth -- but another layer of staff are tasked with making you fit and ensuring your functionality on your return to your home. These are the therapists. There are three kinds of therapists: occupational, physical and restorative, but the third sort (counter-intuitively) only work with residents. And I'm not sure I've got that right. It took me a long time to figure therapy out.
The patient in the skilled hall will be tag-teamed by a physical therapist and an occupational therapist. Work begins with an evaluative interview. On the basis of this, a plan is developed for the patient to meet x number of intermediate goals over a period of y weeks (which number of weeks is likely determined by the insurer). And off you go, meeting with your physical and occupational therapists five days a week until they sign you off, tag you, and release you back into the wild.
Or not. Some of us almost make it but something comes up and we find ourselves instead moved to long term. My very first room mate here, Della (87 years old), is several doors down the hall from me. She was just recovering from a stroke and broken collarbone (from falling down when she stroked) when I arrived, and her mentation was badly affected. She has since recovered those mental faculties and when we meet up we talk about books she's reading on her e-device. She has a good spirit about her retention by Ladera, helped by the near constant attendance of her two sons.
Therapists need first to make you strong. Have you been lying down for six weeks? Sitting up may be more of a challenge than you anticipate. It was for me. I had lain on one side or another from February through to the beginning of May, and had initial difficulties that surprised no-one but me. So at first the big feat was to sit on the edge of my bed, wearing no-skid socks and resting my feet on tacky plastic, under the watchful eye of my occupational therapist, Dan (who forgave me for my churlish manners on that first day). I kept losing my balance and falling sideways.
So he guided me through a series of exercises designed to strengthen my core and overcome a huge psychological problem I had without even realizing it -- a fear of the floor. Lean forward? Not on your life! Which is where my physical therapist came in, with the Evil Green Ball.
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Latest reply: Nov 19, 2013
NaJoPoMo 2013 The Art of Death 18
Posted Nov 18, 2013
I've enjoyed Icy's quizzes so much that I've decided to do one of my own, on the theme of death. You have to identify the entities referenced below. Most of them are from the past 50 years. Dates are given in yyyy-mm-dd format to prevent confusion between British and American conventions. During my research, I realized that "This Is Spinal Tap" had it right -- this quiz could have been composed of nothing but drummers!
1. Born: 1998-1-1 - Died 2010-12-1.
Cause of death: infirmity.
Clue: inherited $12 million.
2. Born: 1920-06-29 - Died: 2013-05-07.
Cause of death: old age
Clue: Clash of the Titans.
3. Born: 1987-05-10 - Died: 2009-01-10.
Cause of death: avalanche.
Clue: youngest Briton to climb Mt. Everest
4. Born: 1947-07-31 - Died: 2013-03-28.
Cause of death: heart surgery complications.
Clue: appeared in HHGG, the movie.
5. Born: 1937-05-12 - Died: 2008-06-22.
Cause of death: heart failure.
Clue: seven words you can't say on television.
6. Born: 1940-11-27 - Died: 1973-07-20.
Cause of Death: cerebral edema.
Clue: Jeet Kune Do.
7. Born: 1935-02-16 - Died: 1998-01-05
Cause of Death: skiied into a tree
clue: I got you, babe.
8. Born: 1560-08-07 - Died: 1614-08-21
Cause of Death: Starvation.
Clue: Convicted of 80 murders.
9. Born: 1990-08-06 - Died: 1996-12-26
Cause of Death: Murder.
Clue: pageants.
10. Born: 1962-02-22 - Died: 2006-09-04
Cause of Death: Stingray attack.
Clue: Crocs.
11. Born: 1948-05-31 - Died: 1980-09-25
Cause of Death: Asphyxiation.
Clue: Zep.
12.Born: 1906-04-28 - Died: 1978-01-14
Cause of Death: starvation
Clue: 
If the system is consistent, it cannot be complete.The consistency of the axioms cannot be proven within the system.
13. Born: 1932-04-12 - Died: 1996-11-30
Cause of Death: Heart Attack on stage.
Clue: falsetto
14. Born: 1889-04-20 - Died: 1945-04-30
Cause of Death: suicide.
Clue: Started World War II.
15. Born: 1946-09-05 - Died: 1991-11-24
Cause of Death: AIDS
Clue: galileo galileo
16. Born: 1946-12-02 - Died: 1997-07-15
Cause of Death: Murder by gunshot
Clue: Personal friend of Princess Diana
17. Born: 1877-05-27 - Died: 1927-09-14
Cause of Death: strangled by a car
Clue: Dancer
18. Born: 1929-03-01 - Died: 1978-09-11
Cause of Death: assassination by umbrella
Clue: cold war.
19. Born: 1948-05-31 - Died: 2010-09-03
Cause of Death: car struck by round bale of hay
Clue: evil woman
20a. (Brit) Born: 1943-03-22 - Died: 1976-05-14
Cause of death: electrocuted while playing guitar
Clue: was actually a lead singer in his band
20b. (Yank) Born: 1936-09-07 - Died: 1959-02-03
Cause of death: plane crash
Clue: a hey, a hey hey
Discuss this Journal entry [14]
Latest reply: Nov 18, 2013
NaJoPoMo 2013 The Art of Death 17
Posted Nov 17, 2013
Lil Arrives at Ladera
If you've never spent an extensive period of time in a hospital, I would like to try and give you some insights into the experience.
The most important thing is that your life and well-being are in other people's hands, not your own; you have no control over the great issues, so many patients will attempt to seize control of the little things. Some do it with diplomacy and some do it by becoming royalty in their own minds. Some are entirely passive and others have to be watched because they are looking for the opportunity to grab their clothes and go AMA. Some people cooperate with their care givers and others treat the aides like dirt.
I like to think I'm a diplomat. Once I was ensconced at Specialty, I was curious about the people around me. I learned their names, joked with them, learned and remembered things about them. I didn't get on with all of them, but I was civil. Later on at Ladera I would hear and witness some stupendous displays of rage and rudeness. I imagine the staff are trained to recognize that a lot of people are lashing out at their circumstances and that tantrums should not be taken personally, but, boy howdy, you have to wonder what well of nastiness some patients are drawing from. And of course some of them are on drugs, literally not themselves. I'll not soon forget hearing Linda walking up the hall, laughing, "Well, now I've been called a nincompoop!"
Older folks tend to be very disoriented the first night or so. It's common for them to disrobe, even more common for them to leave their bed and wander into the hall, looking for their own kitchen or bathroom. One of my elderly room mates became so angry with me that she left the room and never came back. Her bitter complaint was that I had not turned the lights off and gone to sleep at 7 p.m. Like I ought to. As it happened that evening, my netbook was shanghai'd by a very large system update, so it was sitting near me on my bed while I read from my kindle. She saw the square-ish screen of the netbook, presumed I was watching tv, and stomped off to complain to the nurse about my selfish ways.
She was found lying on one of the settees in the front reception area -- hardly a dark or quiet venue -- and flat out refused to return to our room. A patient had been sent out [to hospital] that afternoon, so that bed was hastily made ready for her, and her things were taken to her the next morning. She was quite venomous about me and my evident sense of privilege. Well, we were never meant to be. If she couldn't tolerate my having the light on at 8:30 p.m., she would have come undone when the aide repositioned me (chattily) at 9:30, again at midnight and yet again at 4 a.m.!
This is all an exculpatory preface for how I behaved when I first got to Ladera. I didn't know Albuquerque at all. I didn't know where I was, mapwise, at Specialty. I got the notice to move with just 24 hours notice. I was wheeled in, placed in a bed with little natural illumination, and now knew even less about where I was. All my new acquaintances were history and I had to start again. Same with my daily routine and the same with my diet. When was dinner?
The rest of the afternoon was alternately stressful and tedious. A woman came from administration with a thick sheaf of papers requiring lots and lots of signatures, and detailed explanations aimed well below my level of intelligence. Dinner came. So did another administrator, with more papers to be explained and signed. I was hot. My medications hadn't arrived from the pharmacy by the time I slept.
The next morning I was regarding a pile of unsalted scrambled eggs when I became aware of movement at the door. There stood three people, all with clipboards and/or bundles of papers. I became very cross. "Oh, take a number!" I exclaimed, "I'm eating." "Shall we come back later?" asked a woman sweetly. "Sure," I retorted, "But why not try and space yourselves out a little?" They backed off with blank faces and I grumbled to my room mate's son (loud enough for them to hear), "Don't these people talk to each other??" He shook his head no.
Dan came back later to do an evaluation. He eventually took my case as occupational therapist and has become a good and esteemed friend, but that morning, I thought him rather dour. I was still in a sort of narcissistic frenzy of stress, and it never occurred to me that moi had behaved poorly. Then someone arrived to interview me to see how I might fit into Activities, so I was asked about hobbies and did I like bingo and how sociable was I, questions that I answered with some incredulity. I had quite lost track of my Inner Diplomat.
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Latest reply: Nov 17, 2013
NaJoPoMo 2013 The Art of Death 16
Posted Nov 16, 2013
[content removed at user request]
Discuss this Journal entry [12]
Latest reply: Nov 16, 2013
NaJoPoMo 2013 The Art of Death 15
Posted Nov 15, 2013
Maggot Therapy! Yeah!
Well, there is more to say about me, after all. Call it backstory.
A couple of years ago I wrote a diary at dailyKos.com about what it was like to come down with the disease, which you can read here:
http://www.dailykos.com/story/2010/12/01/922351/-Kosability-How-I-Developed-a-Congenital-Condition
The last thing I remember about my home was how all my cats bounded for cover when the EMS crew wheeled the stretcher noisily through my front door. I was being taken to the local hospital in Ruidoso because my Medicare insurance provider would not pay for more than one week of consecutive daily visits by a home health nurse, but, yes, they would pay for the more expensive alternative. Hospital via ambulance. I had a running-away kit all packed for over a year because of the wildfire risk in Lincoln County, so I added a couple extra tee shirts, my netbook and kindle, and off I was borne. I expected to be back in Lincoln after no more than a few weeks. This was February 8, 2012.
After three days I was gurneyed into another ambulance and transferred to Specialty Hospital in Albuquerque, a 25-bed facility specializing in wound treatment. A pair of pressure sores near my coccyx had become infected and got to stage IV, complete with exposed bone. At Specialty I was isolated for 3 days until I was guaranteed free of MRSA, and to let all the other antibiotics settle out of my system, after which I was given a picc line* and moved to a semi-private room occupied by an extremely ill woman and her extended family. I slept a lot, collecting sleep that had been increasingly hard to come by at home. I was subjected to Spanish television and can now converse at length on the quality of acting and makeup in Mexican and Brazilian soap operas. Let's just say that, if it were up to Central and South American studios, Avon would be a major world power.
I begged for and got maggot therapy after Alvin, the lead tech, told me about how he uses them to clean the dead stuff out of wounds (debridement). The therapy was aborted after the first night when an over-vigorous repositioning of my torso by the aides tore the dressing and the maggots got loose. I had already named most of them (only a couple dozen are applied to a wound, to debride it -- Alvin showed me the container -- and then they are removed and destroyed after four days). There was Millicent Maggot, and Maurice Maggot, and Morton and Magdalena and Maria and Mike and so forth and so on. And now they were making a break for it, like some outtake episode of Toy Story. "Come on, Manny, you can't stop now! If we don't make it across this floor we only got four days to live and you'll never wear those wings!"
I was fed well (double protein intake for healing), treated attentively, paid my sleep debt in most part, typed one-handed into the netbook, monitored my home and cats via friend/neighbors, and tried to handle the whole experience as an adventure.
They took me to an outpatient mammogram clinic, an huge and ugly shopfront place with a warren of little rooms behind, all exposed pipes and ducting high overhead. It was a mammogram factory. They did not love me, lying there on my stretcher. This so-called medical facility had no place to maneuver a stretcher and no-one with the strength or knowledge to get me off the ambulance stretcher and into a wheelchair. They so regretfully denied me a mammogram. I bet they held stock in Avon.
They took me to a Temple of Imaging. Associated with University of New Mexico Hospital, it's a separate building with cathedral-like ceilings, wooden beams that suspend enormous planters, and a number of MRI machines, a PET scan unit, and cat-footed technicians administering to the whole.
They took me to UNM Hospital for a biopsy, having noticed anomalous bright patches in the MRI and also to check for evidence of osteomyelitis (bone infection, a big deal). There was a fear of cancer, unfounded as it turned out. It was a strenuous day that I hardly remember because I was on ativan for the first part, and under general anesthesia for the rest. And then the next day I was told that I was being moved to a rehab facility. Good news! I was no longer sick enough to remain at Specialty.
It was March 15, 2012, and I was now being taken to Ladera Nursing/Rehab Facility, Albuquerque.
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*peripherally inserted central catheter: see http://en.wikipedia.org/wiki/Peripherally_inserted_central_catheter unless you're squeamish
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Latest reply: Nov 15, 2013
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