Wednesday, October 08, 2008
I looked under the hood a bit more today on a second visit with one of my "clients" and I'm in way over my head here. And the other two "clients" aren't exactly filling me with confidence in my ability to do much to make any improvements in anyone's health this quarter.
The first time I visited "Client A" she was chatty and friendly. She had an I'm-taking-gooooood-care of myself aura and I thought, phew, this ought to be easy. Sure, there's the issue of the pain that has her screaming in rooms alone and, ok, it's a problem that she's not leaving her home, but once those are addressed (I thought last week) we can talk yearly mammograms and What Are You Reading. Today, I took a look at the kitchen after "A" let me in, grumbling in her shiny pj's. There was rotting food on the table and flies buzzing around. I noticed the boxes stacked in the hallway, the bunched up area rugs,
[And, for goodness sake! (my seven-year-old has been exclaiming that a lot lately), what is it with frail, homebound elderly folk and bunched up area rugs? Is it just my "clients"? If I was in charge of that statistic it would be 75% of frail, homebound elderly folks have a bunched up area rug waiting around to be tripped upon (and, yeah, head injury..broken hip...unable to reach a phone: Yes! I was thinking the SAME thing!). I'm not kidding, 3 of my 4 people have this affliction. Nursing diagnosis: Knowledge Deficit; Area Rugs.]
clothes in stacks on many surfaces. "A" was agitated and going through her meds I realized she's not always taking 'em and the blood sugar was too high and the blood pressure was too high and I'm jabbing the bottom of her foot with my pointer finger -hard - and she finally says, "Yes. I can feel that." Let me say, too, if I haven't already, she was not really into working with me today. So... exhausted, I'm on to my next "client".
And I thought "A" had clutter. I had to get a map from the front desk, just about, to find "B's" apt in the Senior Apartment Complex. And, once there, there was a walker-wide swath cut through the clutter and things teetered on every surface. Random things: a clay mask, a balancing act of books stacked here oh and, also, there, leaking pens, plates. This was an area about this big and now multiply it by 20 and you get the whole 9 by 12 foot apartment. "Oh, and I'm moving." Ah, I said. "Will it be an, um, bigger place?" Turns out, no. No it will not. It will be a smaller place. The great news, though, no area rugs! After this visit I was on the phone with a fellow Nursing Student and she was trying to remember the name of the edema that's so bad it leaks ("weeping?" "seeping?" <----- that was my suggestion!) after having talked about "B's" legs.
And then Stinky Dog Guy. His closing salvo: "Ah, great, next week we can talk about some other ways my doctors have tried to kill me!" Sounds fun! The area rugs might beat his doctor to it.
So, we need to keep track of all the hours we're putting into Community Health: drive time, client visits, prep, conference. My other Community Health People and I are joking about how we can "double bill" our time when we're chatting about the class whilst writing progress notes. I am considering counting this blog posting towards my hours. But the sad, sad truth is that I don't need to throw it in. We're all going to have way, WAY more hours than we need.
Have you ever seen a million ladybugs in one palce at one time? It's...neat. Maybe a little creepy (all that writhing and all), but mostly neat.