Category: Anecdotes
Posted by Dr. El - June 6, 2011 - Anecdotes, Communication, Customer service
I went for my annual mammogram last week, leaving work early to do so and throwing my schedule into chaos. When I arrived at the diagnostic center, the woman at the desk told me someone else would be out to talk to me. Never a good sign.
The second lady took an apologetic tone. “The doctor’s out today. I’m sorry. I thought I called everyone who was scheduled, but I must have missed you.”
“But I phoned this morning to confirm!” I replied with irritation.
After some negotiation and discussion with other people in the back room, they allowed me to have the procedure, with the understanding I’d have to come back again if more “views” were needed. It was a crapshoot, but better than wasting the whole trip.
I think of how often residents have told me, “They didn’t have the paperwork they needed, so we had to reschedule” or, “The ambulette driver couldn’t find the hospital and by the time we got there, the doctor had left for the day,” The residents were wrung out from the journey and from trying not to act irritated. Their anxiety about their next appointment would include the worry about whether or not it would transpire successfully.
Personal reminders like this increase my compassion for those living with illness, and my appreciation for the nurses, secretaries, and transport aides who check and double check that everything is in place so that residents only have to worry about their medical conditions and not whether or not they’ll make it to their appointments.
Posted by Dr. El - May 23, 2011 - Anecdotes, Role of psychologists
“I’m sorry, Rita, I can’t breathe,” I said when she paused for a moment in recounting her story. “I have to go blow my nose.”
“Yes, I can hear that. It’s okay,” she said, reassuringly. In the many months I’d been seeing her, this type of interruption had never before occurred. Her movements painfully crippled by osteoarthritis, Rita couldn’t clear her own nose.
I went into her bathroom and pulled off wads of toilet tissue, blowing until the air flow returned. I could see her patient reflection in the mirror as I did this, but I was grateful she wasn’t watching me.
Sitting down, I apologized for the disruption to our session.
“That’s okay. It’s natural. We’re all human.” She paused. “When I first got here, I was so embarrassed by people having to take care of me. It was terrible.” She closed her eyes and shook her head slightly. “One time, the doctor had to look at my behind. I was turned on my side and completely exposed. When the doctor saw me closing my eyes, he said, ‘Rita, it’s okay, I’m the doctor. You can open your eyes.'”
“You were trying to hide, to protect yourself.”
“I wanted to disappear. But the doctor, he was very kind.”
“They see these things all the time. It’s hard to get used to the lack of privacy, though.”
“Yes. But what choice do you have?”
Posted by Dr. El - April 26, 2011 - Anecdotes, Communication, Resident care
It was around Easter time one year when the following exchange took place:
“Hand me my peeps,” Isabelle commanded from her geri-recliner. She pointed to something behind me.
I turned and saw a package of yellow baby-chick-shaped marshmallows on her tray table. The word “Peeps” was written on the front of the box. I handed them to her and watched as she stuffed one, and then another into her mouth. As she picked up the third, I pointed to her red wristband. “I guess you’re careful about the sugar with the diabetes.”
“I don’t have diabetes,” she stated flatly, munching the third peep.
This was only the second time I’d seen Isabelle, and I’d had to convince her to meet with me today. I didn’t know if she had diabetes and had forgotten, or was in denial about it. It was unlikely that her wristband was the wrong color, but she sounded so certain I had to consider the possibility. “Red wristbands are for people with diabetes.”
“Everyone’s been saying that since I got here two months ago, but I don’t have diabetes. Check my chart,” she directed me. “Check it now.”
I went to the nursing station and pulled out the thick binder, reading through the diagnoses on the Physician’s Order Sheet. No diabetes. I went to the nurse, who thumbed through her records. “No,” she said, “she’s right. She doesn’t have diabetes. I’ll change her wristband after I finish what I’m doing.”
I went back to Isabelle, who’d been referred for anxiety, and told her what happened.
“I wonder what other mistakes they’re making,” she said.
I had my work cut out for me, but, for now at least, Isabelle was letting me on her team.
Posted by Dr. El - April 11, 2011 - Anecdotes, Money Issues
Stella had been in the nursing home several years before anyone had thought to refer her to the psychologist. She sat in her room reading her bible all day, emerging only for showers.
“Why don’t you try some of the activities?” I asked her. “They have lots of good stuff here — even church services,” I added hopefully.
“It ain’t my denomination,” she replied. “I don’t want to go.” She ran her hand absently across the worn cover of her bible, the pages dog-earred and frayed.
I scanned the room for other signs of interest and spied a small photo tacked to her bulletin board. “Would you mind if I take a look?” I asked her.
“No, go ahead. That was me with my girlfriends from church. Ooh-ey, we did like to travel. I went everywhere with them ladies.”
“And where were you in this photo?” I took the picture to her.
“We was at a convention in Baltimore.” She laughed. “That was some fun. This here’s Mayella. She been gone eight years now. And that one’s Ray Ann. She went down South to be with her family. And there in the middle — that’s me!”
I put on my glasses to get a better look at the tiny image of a buxom woman in a lavender gown and dramatic wig. “Wow! Look at you!”
Stella giggled. “I liked to dress up in them days. All my money went to clothes and travel. Arthur, God bless his soul, took care of everything else.”
I noted her dingy housedress and hair plaited into two simple braids. “If you enjoyed it so much, how come you don’t dress up more now?”
“Ain’t got no money,” she said simply. “I been wearing this dress ever since I got here.”
“What do you spend your personal needs allowance on?”
“My what?”
“Your personal needs allowance — the $50 you get each month after the rest of your stay is paid for.”
“Nobody told me about no money.”
I frowned. “Well, you should be getting it. Let me make some phone calls. Hold on a minute.” I left the room and returned triumphant. “You’ve got $1,850 in your account downstairs!”
“What!” Stella’s face lit up. “Why I got so much money?”
“If you’ve been here for three years getting $50/month you never spent, that adds up.”
“What I got to do to get it?”
“They said I could bring you down now if you want.”
“Let’s go.” She placed her bible on her tray table. “I want to buy me and my roommate some egg rolls tonight. Her people been treating me ever since I been here.” She started rolling herself toward the door and I jumped up to push her chair.
Stella never became a regular at activities, but she did enjoy the attention she received when she came down to the lobby to pick up her take-out food in her new wig and colorful dresses.
Posted by Dr. El - April 4, 2011 - Anecdotes, Money Issues
“I wish my boys weren’t so busy,” Greta commented. “I’d really like to get some new dresses and I have no one to take me.”
Greta’s boys were always “busy.” There were two names listed on the face sheet of her chart, but I’d never seen them or met anyone at the nursing home who had. When I asked Lynne, her social worker, about them, Lynne’s normally pleasant tone became one of controlled anger.
“Do you know how many messages I’ve left for them? They never respond! They just left her here! I feel so sorry for her.” We agreed it was a bad situation, made worse because Greta wasn’t a United States citizen and therefore had no personal needs allowance. She was flat broke.
Greta lamented, “I came to this country because of them, and now they don’t have time for me.” She glanced at a photo of her well-dressed youthful self. “I just want to get some new clothes.”
I went back to Lynne. “Do you think we can get her citizenship?” A few weeks back the nursing home had held a touching celebration for two residents who had recently become U.S. citizens.
Lynne shook her head. “I tried. Her family won’t bring in the paperwork and they can’t grant citizenship without it.”
“That really stinks. The poor lady just wants some clothes, and she’s got nothing to buy them with. I actually brought in a couple of things for her,” I admitted. “I try not to do things for one resident I wouldn’t do for any other, but I can’t help myself.”
Lynne smiled. “I’ve been bringing her things too.”
“Out of your social work salary, huh? Remember in school when we learned that the basic needs of human beings were food, clothing, and shelter? I wonder why nursing homes don’t provide clothing.”
“They can get leftover things from the laundry,” Lynne pointed out. “And sometimes people make donations.”
This accounted for the fact that Jewish residents sometimes had Christmas sweatshirts, non-drinkers wore beer t-shirts, and men occasionally sported tops proclaiming they were the “World’s Greatest Grandma.”
I sighed, and went home to search through my closet for good-looking items I wasn’t really wearing.
Posted by Dr. El - March 28, 2011 - Anecdotes, Money Issues
“It’s not right,” Carlos complained. “That son of mine isn’t telling me what’s going on with my money.”
“You’re worried about your finances?” Carlos had been anxious and irritable for most of the three months since his admission to the nursing home.
“Yes!” He pounded one fist into another. “I know how to take care of my bills! I’ve been doing it all my life! Who is he to take over?”
I’d heard similar concerns many times over the years. “It’s hard when the kids start acting like the parents,” I empathized, “but there really aren’t bills to worry about now.”
“How can there be no bills? Who’s paying for me to be here?” he asked angrily.
“Well, Medicare and private insurance when you first got here, but now that you’re long-term, your stay will be covered by Medicare and Medicaid.”
“But what about my rent? And my doctor’s bills?” His tone softened only slightly.
“All that’s covered, ” I explained gently. “You’re basically living in a money-free world now.”
He looked puzzled.
“Your food, medication, doctor’s bills — that’s all paid for,” I told him. “You don’t have to worry about it. You’ll get $50/month here in New York for things like your telephone, clothes, take-out, or a special trip. Otherwise you can pretty much live without money.”
“Humph!” Carlos replied, staring out the window for a moment before turning back to me. “Well, I want to see my phone bills. My son better bring those to me!”
Posted by Dr. El - March 21, 2011 - Anecdotes, Money Issues
James Hawkins, III liked to sit in the lobby drinking tea and watching the passersby. At 93, he spoke about his well-traveled childhood, his Ivy League education, and a lost love and penchant for liquor that had led to the life of a bachelor. He confessed his virginity, and then later on, another confession:
“I’m not worried about dying itself. When you’re done, you’re done. That’s it.” He scratched his head. “But all that family money is gone and I’ve got nothing to bury myself with.” He threw up his empty hands.
I marveled silently at this. The man had been a banker. “What about your cousin? Can he help you out?” I’d met him once during his monthly visits, which had declined in frequency since his car broke down. I realized as soon as I asked it the futility of the question.
“He’s from my mother’s side of the family and he’s broke. I’ve got a few cousins on my father’s side, but I don’t feel comfortable asking them.”
We sat in silence for a moment.
“It’s not that I care so much for me if I go to Potter’s Field, but it’s not the way we Hawkins’ are buried.”
“No?”
“No. There’s a certain decorum. It wouldn’t look right.”
“I see.”
He hesitated. “I’m thinking of donating my body to science.”
I stared at him, surprised. “Really? That’s brilliant!”
“That’s what I thought,” he replied, pleased at my reaction. “I’d be doing some good, and then I wouldn’t have to worry about burial expenses. I hear they cremate you and give the ashes to your family.”
“That’s a great idea. I can’t believe nobody’s talked to me about this before.”
He smiled. “Can you look it up for me on your thingy?”
“My iphone? Sure.” I Googled it, and registered him to get an information packet from a site I found online.
——————————-
“Well, I got the papers we sent away for,” James informed me a couple of weeks later.
“Yes?” I prompted, eager to hear the details.
“I’m too old.” He gave an ironic laugh. “The cut-off is 90.”
“What! I can’t believe that — too old to donate your body,” I grumbled. “You want me to try another one? There have got to be more places.”
“No, not right now.” He waved away the notion. “Maybe later.”
I dropped the subject. James hadn’t been feeling well lately and I guessed the issue was too close for comfort.
——————————-
A month after that, James had a visit from his cousin. “We had a good talk and worked things out. I’m going to be cremated. It costs $1700 and he said he’d help me out. I don’t know what they’re going to do about the service, but at least that part’s taken care of.” His voice had lost the tension it had held during our previous conversations.
“That’s great, James.”
“I feel a lot better. I’m going to start saving up my Personal Needs Allowance to put toward the expenses. It won’t be much, though, after I get my monthly haircut.”
Nursing home residents in New York State get $50/month for their personal needs. Haircuts at the home cost $10.
He laughed. “I figured it out. If I don’t buy anything but haircuts for the rest of my life, I can pay for the cremation myself — I just have to live to 97!”
Posted by Dr. El - February 22, 2011 - Anecdotes, Transitions in care
Viola’s face was beet red, and she was hoarse from shouting. “How can they do this to me? I’ve been in this room for months and now they want me to move?!”
“I know, you’ve gotten used to it here,” I tried to explain. “But this is the short-term floor and you’re not short-term anymore.”
“I can’t live with anyone else! I need my own space!”
“You can put your name on the list for a private room as soon as you get there. In the meantime, I know the lady you’ll be sharing with — she’s very nice.”
Viola settled back on her bed, throwing up her hands. Her voice was resigned. “I guess I don’t have much choice.”
———————————-
The following week, I was surprised to see Viola leaning on her walker by the nursing station on the long-term unit, chatting with an aide. She’d always been resting when I’d visited her on the short-term floor. I followed her to her new room for our session.
“Lydia,” she called to her roommate, “don’t mind me, I’m just going to close the curtain for a moment while I talk with my doctor.”
Lydia smiled, waved, and continued watching the Spanish station on her TV.
“She doesn’t understand much English,” Viola reassured me, “so it’s okay to talk in here. What do you want to talk about?”
I gestured toward the privacy curtain. “So, how’s it going?”
“It’s good. We look out for each other. She watches TV all the time, though.” She wrinkled her nose. “I try to spend most of my time out of the room.”
“Have you been getting to activities?” She’d previously resisted my recommendation to try out some of the events offered by the recreation department.
“Oh yes,” she laughed. “I just got back from hearing that group, The Wrigley Brothers. They really know how to put on a show! And tonight I’m going down for bingo. I’m going to try my luck.”
Posted by Dr. El - February 16, 2011 - Anecdotes, Personal Reflections
I’ve been sick almost a week. Nothing major, but I’ve had to stay home from work. Completing everyday tasks has felt like swimming through jello, and once I’ve finished them I’ve had to lie down to rest. My lack of productivity has been incredibly frustrating. It would be easy to fall into a depression. And this is from a week of sub-par health.
I think about my residents, dealing day after day and year after year with poor health and the losses associated with it. I’m always impressed by the effort they, along with their aides, put into getting up and ready for the day, maybe heading to an activity. But this week, my admiration has been renewed. This post is for you. I swam through jello to get it up here.
Posted by Dr. El - January 31, 2011 - Anecdotes, Communication, Role of psychologists, Younger residents
“My aide treats me like I’m an idiot,” Katrina typed to me on her talking computer.
“What do you mean?”
“She thinks I don’t know what’s going on!” Her eyes radiated her emotional pain. “She’s a bitch!”
A series of strokes had stolen Katrina’s ability to speak, leaving her a silent observer of her surroundings and interactions. A former schoolteacher, she carefully typed her perspective on the world to me, hunt and peck with one good finger on each hand, then pushed a button that released them in a mechanical female voice. The computer saved her, but it was a slow process and the only way to prepare a sentence in advance was to store it in a memory key. We’d set it up so that Control-H was “Hello.”
“Does she know you can type on the computer?”
“That bitch won’t give me time to type!” Her brows were furrowed and she appeared ready to explode with anger. Her enforced silence was a frequent topic in our sessions.
“Let’s use psychology with her. We’ve got to show her how smart you are. And we need to make a personal connection to shift the dynamics. Is there anything you know about her we can use?”
Katrina thought a moment. “She used to work nights.”
“Perfect! What if we set up a macro that said, ‘How do you like the day shift?’ That way she’d know you knew her well enough to be aware of her schedule, and it would set up a friendly tone.”
Her eyes lit up and she nodded.
“What memory key do you want me to program? Hey, what about B for bitch?”
Katrina laughed.
I set up the macro and she pressed Control-B for practice. “How do you like the day shift,” the mechanical lady said. We discussed her plan: Control-H, Control-B the minute the aide came to her bedside.
———————-
The next week Katrina was beaming when I entered the room.
“Did it work?”
“Everything is different,” she typed. “She talked to me like I knew what was going on!”
“You pressed the key?”
“I didn’t have to! She just knew!” Katrina was smiling from ear to ear.
“Well, isn’t that interesting?” I said. “All we had to do was put it out into the world, and God took care of the rest!”
