Mentoring

A new weekly activity since October has been spending at least an hour with my mentee. She's a delightful 1st grader who is full of energy. We spent most of the fall doing outside activities which she loves. We played in parks, went on a nature scavenger hunt and hiking, and we played at the beach. Her mother says she isn't very athletic but the child loves to run. The favorite game at the park is tag and the trails at the park were often taken at a run. It's a good thing I'm somewhat in shape so I can attempt to keep up. She can run faster but I can run longer. Activities have been more difficult since winter arrived. We went swimming at the Y and last night we joined some people from my church at the bowling alley. Even the kid bowling balls were a bit heavy but she managed a decent score thanks to the bumper pads being up. The bumper pads added a few points to my score and I broke 100 which was my goal. My mentee was excited to see a classmate there and she enjoyed interacting with the other kids who cheered her on.

A friend jokingly asked if the program was for at-risk kids or at risk adults. Probably a bit of both. It's hard to tell what impact I'm having on a 1st grader, other than I'm providing a listening ear and one-on-one time in which she has a hard time getting in trouble because there are no other kids around to egg her on. Even when there have been other kids around she's been obedient. For me, it is an opportunity to be around a kid, which means even more to me because I spend my work day primarily with the geriatric population. My creativity is also being challenged as I come up with ideas of things to do and places to go. She has ideas as well which helps.

Try a mentoring program in your area. There is especially a need for men to be a role model for the boys who are waiting for a mentor of their own.

Surgeries

I don't usually make New Year's resolutions, but it will take some resolve to get back to writing here on a regular basis. There is plenty to write about but after a month (and now months) of silence, there is too much to write about and I don't know where to start. I've decided the best way is to jump back in with the most significant change over the past several months.

In May of 2014 I noticed a nodule on my neck in the thyroid area. I was in St Cloud at the time and didn't know a doctor even if I had the time to go. Besides, I was preparing for a six-week bike trip and didn't want it derailed. A doctor friend told me it wasn't urgent since I wasn't feeling any differently. I let it go longer than I should have, but I did finally get to the doctor in September. That began more trips to doctor's offices than I've had in 20 years.

The results from a fine needle aspiration biopsy was suspicious enough that the right side of my thyroid was removed on November 16. The diagnosis came back as follicular carcinoma which meant the other side needed to come out too. The second surgery was on December 24. I was off work for a week both times but recovered fairly well with little pain. The first time I stayed overnight at the hospital with a drain. The second time my surgeon allowed me to go home that same day and without the drain I had more swelling. But overall it didn't make much difference in my recovery. Both times I ran 3 miles 4-5 days after surgery. I went slow but I had no problem doing them. I did have a lifting restriction for a week and I dealt with some lightheadedness which evidently was due to being dehydrated.

People have asked me if I'm feeling better now. I wasn't feeling bad to begin with. In fact, in some ways it's "worse" now as my body adjusts to the thyroid meds and we figure out the proper dosage. It's only been a couple of weeks but they made a change in the dosage following a blood test on Friday. I haven't quite figured out how it all works, but I was feeling rather amped up especially in the early morning hours when I would have just as soon been sleeping. This will be the biggest challenge in the weeks or maybe months to come. I've joked with nurses that I now have a medical history and yes, I do take some medication. In February I'll be swallowing some radioactive iodine which will destroy any remaining thyroid tissue in my body. No further treatment should be needed. If I have to have cancer, thyroid cancer is a good kind to have.

A Hard Day

In the early afternoon I sat in the lobby area finishing up a daily note after seeing a patient off for a doctor's appointment. As I finished I looked out the window and saw a family dressed in suits and ties and dresses. A couple of them were carrying flowers and one was pushing their mother in a wheelchair. They were bringing her back after attending their father's funeral. She had been one of my patients several months ago. Her dementia makes it difficult to have a conversation with her but she is always pleasant and has a smile for me. I can't help but wonder if she will remember why her husband no longer comes to visit.

I shut my computer and headed around the corner in time to see another family leaving the room where their mother's body now lay as an empty shell. There were tears streaming down their cheeks. It hurts, even though she was elderly and her body was worn out. She too had been one of my patients. The things she said cracked me up sometimes. Upon return from the hospital she commented several times, "I can't believe they kept me at the hospital all that time without feeding me except through my arm. And they just let me lay in bed and didn't get me up. Now I just don't have any energy." Every time a resident dies, part of the personality of the place dies as well.

Later in the afternoon I walked by the office as one of the administrators explained to another resident and his wife that we were going to have to stop therapy with him. I was glad I wasn't responsible to have that conversation. It is hard to see someone stop progressing and even regress, especially someone who works so hard in therapy. He never complained though he would sometimes express frustration when his legs didn't cooperate. He wanted to go home and, even though the doctor had told him it wasn't safe, he and his wife still held out hope that he'd get better. Having the therapists tell him we couldn't continue must have felt like the final blow. We want to help people get back home and it's hard when that doesn't happen.

July 4 at the Lakes

I grew up 30 miles from Okoboji but we didn't make the trip east very often during the summer except to go to the Conference. We definitely did NOT make the trip on July 4. Staying up to watch the fireworks was already a big enough stretch for my family without adding on the drive home complicated by "all that traffic". This year I got to see the craziness of the 4th at the Lakes in person and here's a few reasons it wasn't that bad.

• I had already learned on Memorial Day weekend to go down to the light when I want to turn left.  
• On a few Friday afternoons as I headed home from work I've been caught behind enough cars at a light that I had to wait for it to cycle through 2 or 3 times before I could be on my way. But on July 2nd and 3rd I worked in Spirit Lake so I didn't get to see what traffic was like then.
• I spent most of the 4th celebrating with my cousin Nick, and his bride, Dondi, at their wedding. which began with a 2.5 mile run at 8:00, a wedding at 1:00, followed by a reception with grilled hamburger and pork patties, potato salad, chips, ice cream, and a dunking tank which the kids throughly enjoyed. The traffic didn't affect me, but Dad said the line at the 4-way stop at Vick's corner was 1/4 mile long. In normal circumstances, 3 cars would be considered a traffic jam.
• As I got home, my next-door neighbor was headed out for a bike ride. We talked of going to see the fireworks on our bikes and I told him that one of my patients had said the best place to see them was at Des Moines beach. He went to scout it out and found a house under construction with a small dock directly across the lake from the Park. It was a perfect spot for two introverts who aren't night owls. From our vantage point we could hear the music and the announcer without having to deal with the hordes of people. (Later someone told me there had been so many people in the area of the Park that she couldn't even hear the music.) We also had a great view of the fireworks when they began. At the end, Matt thought it was one of the best firework displays he'd ever seen. I decided not to mention those at the top of my list including the show for the G-7 in Lyon, or the competitions I saw in Germany and in Clear Lake, IA. For NW Iowa, it was good. And the best part was I was home and in bed by 11:00.

What's your plan?

This week I received an email from an aunt saying, "People rarely want to leave their homes, though I have known a few people to make the decision to move from home to assisted living of their own volition." She went on to mention two people who had decided to move. I work in a nursing home so most often my patients are facing the question of whether or not they can or should return home. There are more that want to go home when they really shouldn't than those who willingly stay.

No one wants to be in a nursing home even if it is called a care center. One woman I've worked with wants to go home. "I don't want to spend the rest of my life here!" Never mind that she needs two people to help her move from her recliner to her wheelchair. I think she would be happier if she accepted the reality of her physical limitations and was content where she is. Stir in a little dementia and it is hard to reach that state of acceptance. Another friend cared for her mother for a time in her home but there came a point when it was no longer safe to leave her alone for very long. Even after a year in a nursing home her mother still doesn't understand why she can't live at home even though she appears to be quite content where she is.

This week I had a conversation with one of my patients that went something like this. 

Me: What do you do during the day when you are at home?

Pt: I sleep a lot.

Me: Do you help your husband with the cooking?

Pt: Yes, we do that together.

Me: How about the laundry?

Pt: No, that's in the basement and I can't get down there any more.

Me: What did you do for fun?

Pt: (pause) I can't think of anything.

Me: What do you like doing here?

Pt: I like the exercise class, bingo. I've been going to all the activities and I like them.

As a therapist it has been wonderful to see the change in this woman. The first time I worked with her she couldn't hold her eyes open and it took two people to get her to the bathroom. Now her eyes are bright, she greets us with a smile and she just needs some supervision for safety when moving around. The marked improvement has come, in large part, because she has things to do. Sure, she still takes a nap or two during the day, but she isn't sleeping for hours at a time. And now she is talking about going home where it seems she will end up back in the same situation as before without the extra stimulation.

Last week another patient decided that she was going to stay in the nursing home. Could she have made it at home? Yes, she likely would have done fine. Her health has improved and she has family in the area who are helpful. But as she thought of being in that house all by herself, she decided that she would rather stay. Her family and the staff applauded her decision.

When I was a teenager, a woman in my church commented, "It is always better to make a move before you have to." I couldn't agree more. Making the decision to move to a higher level of care is easier when you feel like you are in control of that decision. Of course, life throws some curve balls at us that we don't expect and the move has to be made before we had intended.  But thinking through the different scenarios and talking with your family about different options before you ever expect to need them will likely make the move a whole lot easier -- even when dementia makes it harder to understand why you can't be at home.

A Silent Retreat

Since January I've been going through the book Sacred Rhythms which talks about spiritual disciplines beginning with silence and solitude. At first glance, more solitude isn't something I need as I already spend a lot of time alone. However, that time is usually not silent and I rarely think about the solitude as purposeful time with God. I found it difficult to be silent and listen in God's presence for even a few minutes, much less a whole weekend. Yet, I do long for deeper intimacy with him so when I came across a silent retreat sponsored by Christos Center I decided to sign up. I had little idea what to expect but as I packed, I resisted the urge to bring a novel along. My bible, journal, and some other paper should be good enough -- right?

We met at Villa Maria where several retreats were happening at the same time -- and they weren't silent. We began with getting to know each other over supper where I talked primarily with Julie, who had spent a year in France 30 years ago. After the meal we met together to go over the plan for the weekend. We went around the room and briefly introduced ourselves and what our expectations were. As we left the room at about 8:00 Friday evening we entered into silence. There were smiles of greetings in the hallways and at meals but for the most part we gave each other plenty of space. I had thought that meal time would be awkward, but that didn't turn out to be the case at all. We got our food in the main cafeteria which was full of chatter from the other groups. I had a sense of relief when I got into the smaller room reserved for us where relaxing music was playing "so you don't have to listen to each other chew." It was quiet and peaceful and everyone was lost in their own thoughts. I had no desire to break that for them or to have anyone speak to me. I was content to mull over whatever it was I had been thinking about before I came in.

There were regularly scheduled times of meditation where the leader of the weekend spoke briefly but none of it was mandatory. I only attended one of those which lasted about 10 minutes. I just wanted to stay where God was directing my thoughts as I spent most of the day outdoors. I talked for about an hour with one of the spiritual directors which was helpful. I went on an hour walk in the woods and the meadow which was part of a state park. There was a few times I was bored and was wishing for a novel, but in the end I was glad I could just sit. With my nose in a book I would have missed the soaring eagle in the morning and a soaring hawk later in the afternoon. It was also part of slowing down that I needed so I would stop thinking and listen for God's voice. I'm always doing something even if that is simply reading or listening to the radio as I fix supper. By the time it was over, I felt much more settled and peaceful. I was glad to talk again but I didn't mind silence on the drive home and my mind wasn't flitting from one thing to another.

Sunday morning we met for the Lord's Supper together and we broke the silence by giving a brief report on how God had met each of us. It was different for everyone. God wanted me to experience again that he loves me and he is with me. The passages that God brought to mind were:

He rescued me because he delighted in me (Ps 18:19)  and 

The Lord your God is in your midst, a might one who will save; 

he will rejoice over you with gladness; he will quiet you by his love; 

he will exult over you with loud singing. (Zeph 3:17)

On the way home I realized that God tells us that he loves us over and over again in Scripture because we need to hear it over and over and over again. The context of each of these verses show that God is with us and to what extent he will go to rescue us, to rescue me.

A silent retreat may seem like an oxymoron but for me, it was a precious time. I highly recommend it.

Efficiency

Every job has its own way of measuring success and every business has key benchmarks that ensure they actually make some money. After years of working for a non-profit where my monthly salary was "discovered" I'm still working on reaching the major benchmark in the therapy world: efficiency. Medicare, or some other health insurance, pays for all the therapy my patients receive and they reimburse the company I work for according to the amount of time I spend with patients within a certain target range that varies from patient to patient. Ideally all of the therapists end the week at 70-80% efficiency. In other words, we spend 80% of our working time with patients and 20% doing other things: documentation, talking with staff or family, or just getting from one room to the next. In March I was pretty consistently in the 70-80% range so I was feeling good about myself. But then...

Three weeks ago I was moved to the nursing home in Spencer. In many ways it has been a good move. It takes me longer to get there (but gives me the opportunity to catch up on my favorite podcasts), but I'm working with a lot more people who intend to go home and will actually get there. That means there are more things to work on besides making sure they can get dressed and to the bathroom on their own. I've enjoyed the change and the challenge. However, my efficiency has taken a major hit. Instead of having one new patient every couple of weeks, I have 3-5. Today I saw one new person and spent 29 minutes with her. (I bought a watch with a timer on it so it is easy to keep track -- when I remember to push the start button upon entering the room.) It took me at least that long to write up the Plan of Care which includes the goals of what the person needs/wants to be able to do to go home. So about the best I can do with a first visit is 50%. Add in two discharge summaries which can take about as long, an updated plan of care, and finishing two Plans of Care from last week that I had only done the bare minimum on before leaving on Friday, and I was once again below 60% for the day. It will get better since I am getting lots of practice in filling out the paperwork. And maybe I'll get better at tuning out the distractions of the cartoons the resident down the hall likes to watch, co-workers talking to residents or each other, or other staff coming in with the latest update. And for the time being, my supervisor has my back with those higher up in the company. But soon, I will no longer be able to say that I'm doing discharge summaries on people that I only saw once or twice so I have to read all the notes before I can say anything coherent about how far they have come. Until then, I'll keep plugging away even as I take the time to poke my head into a room to see what the resident needs. Today all the woman wanted was for her table to be pulled over close enough to her bed so she could reach her water.