Monday, March 16, 2015

Finding peace

Tomorrow is kind of a big day.  Tomorrow will be my last with a particular patient.  The stress surrounding their care has ebbed and flowed for ten long months, and it will finally come to an end as all things do.  

It shouldn't have been that big of a deal, but after Grandma's stoke and my hiatus from work to help with her care, it all changed.  It was no longer just a patient and family who received preferential care because of their connections to our CEO and upper management.  It was no longer just trying to make important improvements in the most pinnacle of the patient's mobility needs (transfers with assistance) with the family repeatedly asking when he will walk on his own again (likely never).  It was no longer just a patient who had been under my care for six months (at that time) and whose insurance gave them twice as many visits as anyone else for no reason except nepotism.  

This patient became a continual reminder of just how much change is possible with rehab.  No one expected this much recovery due the great severity of their original stroke.  And I should note that the stress and aggravation a came solely from the family.  The patient was nothing but sweet, motivated, caring, and in many ways an ideal patient.  It was why I simultaneously loved working with them while also, because of the family and the context, dreaded it each week.

So last November while I was in Iowa and later Illinois, this patient was continually on my mind with every single decision I made to allow my grandmother a respectful and graceful death.  The fact that I did not push for rehab because I knew that was against my grandmother's wishes.  Once the plan was settled with palliative care I sat next to Grandma holding her hand, wondering how much she would recover if we were to try - how much we were giving up on her, even though that wasn't the case because it was per her written directive and previously verbalized wishes.  It was still on my mind the night I slept at her side in the nursing home, waking at every little breathing change, hoping she'd last long enough for Sam to get back from a work trip to Australia to say goodbye in person. 

Once back in Alamosa, I had to work to keep my composure when this patient came around. This patient became a reminder of my role in Grandma's death, the appropriateness of that role notwithstanding.  Patients were told I had a family emergency the week of my unexpected absence, but no more than that.  So the spouse - ever needy, ever overwhelmed and unable to remember, ever naively hopeful for the patient's full recovery - didn't know that they were nitpicking on little nothings at a time when they should just be grateful that their spouse survived, was able to speak (albeit with moderate aphasia), and was able to enjoy interactions with family.

Everyone's situation is different; their beliefs, their expectations, their former roles that have changed in ways small or large.  But at some point you HAVE to take a breath and realize what you still have in front of you.  I had bought Grandma a get-well-soon card for her cardiac episode the previous August, but for one reason or another it never got mailed.  I spoke with Grandma on the phone, emailed through my uncle for updates.  But something as small as that card turns into guilt for all those those things you took advantage of - and that you can no longer redo.  

At this point, tomorrow will be my last appointment with this patient, signaling the end of a very long ten months - the latest four with a little black nagging spot on my heart.  Every week I would physically wash my hands before their arrival so that I wouldn't place any of my own "things" onto them.  Every week the patient tried their best and the spouse repeated the same questions based off their state of denial.  

I didn't expect the end to hit me so hard.  And it didn't, or at least not until last week.

Luna, our sweet yet single-minded dog, got skunked and we had to leave her out overnight when temps dropped to zero at the most with negative wind chill.  Our neighbor's garage door got stuck half way down, so instead of staying inside she followed me home.  I felt guilty going inside, hoping she'd migrate back to the garage soon.  At 11:30pm I got up to use the bathroom, and she was still sitting on our stoop.  SO GUILTY.  The next morning I went on my pre-dawn run but never saw her. Turns out our neighbor got her settled with the door down, but I didn't know it.  I worried that if she died overnight that it would be my fault.  Nathan checked the garage on his way to work, and she came bounding out as wiggly as ever.  It still gave me a bit of a meltdown nonetheless.    

Then this weekend our rancher neighbors were branding most of their calves.  They were mostly done by the time I got home from my long run, but as I walked to get the mail I heard a bleating cry of higher pitch than most mama cows.  Immediately I was back in the hospital with Grandma, holding her arm in place while the nurse tried to get one last needle stick for an IV while still at UI hospital.  The sticks were her most hated part of medical care, and even with facial paralysis and aphasia from the stroke it was clear that she still hated them.  Had I helped with the branding I would not have lasted longer than two minutes. 

Grief is a very unique and highly personal process, and no two people can grieve the same.  I, for one, will be grateful when Grandma's memory rests simply as her own instead of series of "what ifs" in the face of another.  I can only hope that the patient's spouse may find their own peace with their situation and that they may enjoy the time they still have together.

Thursday, March 5, 2015

Skunked

IT WORKS!  IT REALLY REALLY WORKS!!  

Thank. Good. Ness.


Chemistry is FRIGGIN AWESOME. 

Luna got skunked yesterday.  Really bad.  And really gross.

We didn't realize it was on her because a square mile of the ranch, including the homestead, was covered with a tear wrenching, nose hair splitting, Pigpen emanating, noxious burning rubber or diesel fuel gone wrong stench so thick it was nearly a fog.  As Luna paced the house and stirred the air in lieu of her normal evening nap I finally realized it was on her, not from a camp out of skunks under the house. 

We didn't figure it out until past nine o'clock when the two possible stores selling peroxide within twenty miles were already closed.  Neighbors had only isopropyl alcohol.  So Luna spend the sub-zero night in our neighbors' garage, which is unattached from their house and already smelled like skunk, so they readily offered it up like saints. 

This morning at work I got a text from a rancher neighbor: "Wow, Luna smells intense!"  During lunch a coworker entered my office: "What's going on here, teriyaki or something?"  At least none of my patients noticed it on me.  (Or does that mean I'm always stinky and I didn't know it already....)

Luna did grandly once I was home for bath time. One quart of hydrogen peroxide, 1/4 cup baking soda, and 1-2 teaspoons of liquid soap (thank you sosososo much, interwebs.)  I used her leash for the first time (yes, first time since we've ever known her, let alone since taking her in), and had a 12 quart bucket of tolerably hot water ready to follow the 5-10 minutes of shivering peroxide bath in the tail end of a sunset at 20 degrees.  She didn't like it, but she was magnificent.  


Within twelve minutes she was back in the house and stink free.  I may have missed a bit on her tail, but you have to get up close and personal to smell it.  

Chemistry is.  It just is.

And thank goodness for that. 



Sunday, March 1, 2015

Track meets and Superman slides

Saturday I drove to Gunnison to watch a couple kiddos from Adams State compete at the Rocky Mountain Athletic Conference indoor track and field championships.  The main kiddo of interest had only one event thanks to a recent injury.  He pointed out it was "a long drive for eight seconds" of watching the 60m hurdles go down.  But it was my first time getting to watch a collegiate athlete perform after I've helped them return to sport.  Totally worth it.  

It was also the first track meet I have attended since the state finals of my senior year in high school.  The memories flooded back.  The D2 athletes all had much more codified preparation and routines, but they are just as apt to go too hard too fast and then get reeled in and passed by the pack.  The no-long juvenile and yet still immature nerves!  It was also impressive to see those who truly have a good head on their shoulders along with the physical capacity to back it up. 

I wondered how many were there for the love of the sport versus as a way to fund their education. Sometimes a particular school has gaps in their training which are apparent, but the body language of runners can speak loudly.  They all end up wanting the win or wanting to PR on the right day when in the moment.  It's the daily/hourly commitment when off the track that speaks so greatly. 

I always wonder how my track trajectory would have differed if my high school is a true distance program.  The more I watch and learn, the more I wonder if I wasn't more suited for the mile.  The irony is that I hated the mile in high school.  I'm not sure if it was the distance itself or the fact that it was multiple laps and thus required many many multiple laps during practice. I didn't even really like the 800m, one of my main events, but my competitiveness made it meaningful anyways. There were hardly any others running the mile (particularly females aside from the occasional freshman who didn't stay the whole season) so that contributed to the lack of fun. That was what made the 4x400 so passionate for me - the team, the interactions, the strategy, knowing how you know your teammates, and the gut wrenching effort involved.  But I was burned out by the end of senior year.  I never once considered running for college as a remote possibility even though I likely could have.

Even so, my heart nearly pounded a hole through my sternum during those eight seconds and the minute beforehand thanks to someone's false start.  And while the 10,000m on an outdoor track is probably THE most beautiful of running events, it was sole soothing to watch the 3000m.  (I missed the 5000m, as it was Friday while I was at work.)  

The track meet certainly took the sting out my my morning run, where at 14.87 into a 15 mile run I slipped on an unseen flake of ice beneath the snow while turning into the ranch.  I belly-slid a la Superman but with a snow-filled face plant, hit both knees, and my right knee got cut up as the ice slashed my winter tights.  Then as I looked up for dogdog sympathy I saw Luna dashing off into a field a quarter mile away, chasing what she thought was a fox or coyote but probably was her imagination.  Bleeding, ego deflated, and with a dog that didn't care less.  Just the day before I laughed when a colleague said they fell in the parking lot when their three-inch heels hit ice.  My response: "Of course you did, idiot!"  She fell gracefully into a large and poofy pile of snow and had coworkers to help her get up.  I ended up with this:


Ain't karma a bitch.