23 October 2013

Wednesday

Seeking sanity in an insane situation

Maybe I can try to be like my dog

I had been told, in an off hand way, almost as if in casual discussion last evening by the second shift nurse that sometime in the near future – in the next week or so, another blood test was scheduled for me. That was it.

This morning I awoke before breakfast was brought forth. Cleared the tray table of some of its collected accumulation and put it beside me on the bed temporarily, as the CENAs bring the breakfast just appear holding a full tray. Without much in the way of discussion they stand there impassively waiting forme to make ready a landing zone for this tray. If I take too long or haven't had the place ready by the time they arrive, I get to hear all sorts of comments about how the tray is heavy, they still have a lot of trays to deliver or other comments designed to alleviate some of the discomfort they are feeling. These comments ring with some of the same thinly disguised cover used by many people who want you to know something they believe would make their job easier, but they don’t want to come out and directly tell you.

I had the area clear and still the breakfast was late in arriving. Usually the breakfasts arrive about quarter to eight, with regularity. Except once in a while they are delivered at nine fifteen. No idea why, it just seems that maybe the kitchen got behind or some thing.

This was one of those late days. Breakfast arrived about nine twenty, no comments made. I began to eat. I had just taken the last bite when a knock on the closed door announced that someone wished to enter. The door opens and I recognize the phlebotomist from the hospital, she has drawn blood from me before. She sees the tray in front of me and asks if I have finished eating. Thinking that she was asking as she didn’t want to do her work and bother me, I cheerfully said, “Just took the last bite, come in.” With great disappointment in her voice she indicated that this one is supposed to be a fasting blood draw.

I indicated that I was told last night that there would be another blood draw sometime, but fasting or when was never mentioned. She said that they schedule the fasting blood draws for Wednesdays at this facility's request.

No one ever told me.

She indicated that we will have to do this next Wednesday.

After she left, I asked every CENA who came in my room what about fasting blood draws on Wednesday. None of them had heard anything about it, the nurse came in with my morning medications, I asked her. She knew nothing about it. I mentioned my meeting with the phlebotomist, she didn't know that I was scheduled for a blood draw. Hmmm, it is becoming obvious that one of the big problems I have noticed around here is a big lack of communication. Then i started to wonder if the sometimes late delivery of breakfast didn't correlate to the Wednesday fasting blood draw. Maybe the kitchen knows but the CENAS and nurses are not in on the secret. Strange way to run a facility …

Later one of the physician assistants stops by to check on me and have a chat regarding last Fridays near shower event and being very light headed. He listens to my heart, tells me that the EKG showed no problems. We chat a while, I give him a lot of anecdotal details around the event, including the night before it was a little cool and I was just slightly chilled. I can't stay too warm as the MS makes my muscles very spastic if I am too warm. I was just at that barely not comfortable stage. My body wanted to do a light shiver, but the MS makes that not happen. Instead I get what seems like a start to a shiver but the muscles contract then don't release. But contract even more, like doing isometric exercises. After a thirty or forty second clench my muscles would relax. Maybe two minutes later in would occur again. Another contraction, then hard for another half minute. This happened several times before I went to sleep. I noticed that my muscles ached as if I had been working out too hard or there was lactic acid in them from working. When I mentioned that the CENAs approached me that morning before breakfast, instead of after as was usual. The physicians assistant put some clues together to arrive at a plausible cause/scenario.

Due to the use of my muscles the night before I had probably depleted the glycogen stored in my muscles for instant use. Normally breakfast would replenish blood sugar and provide fuel. The before breakfast start for a shower preempted that and I began to slide into not having had enough in my system to meet the demands placed on it. Seems to fit the clues better than anything else.

They keep looking at my blood sugar – at the right range and stable. Blood pressure – not deemed to be a problem. My heart rate – no problems seen there. Electrolytes are good. I just seem to be an enigma no mater where they look. The same seems to be true of trying to understand my thought process and behaviors, I am just too enigmatic from the staff who deal with me on a regular basis to figure out, for some strange reason I just don't take pleasure in the same things they think I should.

This evening the CENA assigned to me this evening told me that she needed to get my weight. Now, the only manner that I can be weighed is to use the one (of two) Easy Stands that has a built in scale and lift me out of bed. I told her we could make one lift job do double duty in that when she first got me up she could take the weight reading, then rather than reposition me right back in bed, she could park me on the commode, - leave me a while and maybe with time and gravity a bowel might drop. She agreed. When I was secured on the commode with the Easy Stand still strapped to me she asked if I could be alone for a few minutes as she had to finish passing out ice water to the residents. The call light was left where I could reach it if necessary. She left. A few minutes later another CENA poked her head in the door and asked if she could borrow that, nodding toward the machine. I indicated that I was somewhat attached to it right now. She said no, that she meant the battery. She detached the battery and left, saying she will be right back. Shortly after she left my CENA returned. She could not lift, clean me or put me to bed as the machine was now without any source of power. I told her the other CENA took the battery and said that she would bring it right back. My CENA went to look for her.

I'm sitting there, on the commode, strapped to a now useless lifting machine,with nowhere to go. I muse over the events of the day.

Is this anyway to run a facility? Lack of decent communication so that not everyone knows what is going on at the same time so that things can run smoothly. Are those kate breakfast starts by design or happenstance? To someone not of the system (like me)does this inspire confidence and instill a relaxed healthy rehabilitative atmosphere” does anyone have an idea why such a supportive condition might possibly be desired? Does anyone understand the significance of reducing stress and the resulting cortisol for everyone concerned? Does anyone care about such things? Do they know that they could, that it might make a lot of things better all the way around?

Why am I here?