Dear Medicaid

You suck.

Why? Let me count the myriad ways...

One, you are the payor of last resort,  but alas, when you have a loved one who goes to the emergency room because someone else caused their injury as they were going down the street, you are checked first.

It's especially nice when the injury occurs on the same day as the spend down deduction and you freak out said relative by saying, "Your Medicaid rejected you".

Two, you assume so much.

Three, when in doubt, you cut people off. It's way simpler than finding out what the actual problem is (i.e. a little timely communications re: the changing of spend down payments by $4 also helps) I guess.

That's okay. In the spirit of Christmas, besides assisting said relative in hiring an attorney, I'm just going to hang on the phone lines at your place and remind you of what the state laws really are when you've collected your $150 spend down.

And I'll make sure the nice people in Saint Elsewhere ER and the attorney do, too.

Sincerely not,

RehabRN

Loud noises at inopportune times

Yes, folks, these are the things that drive me crazy or keep me awake at night. Last night, it was the latter.
Nothing like crazy driver swerving to avoid a mailbox, then hitting the neighbor's car and stopping at the tree.

Just very thankful that the driver didn't continue on and end up in our yard.

The perils of living near a crazy, county road.

Stay tuned for more traffic reports.

Spring break diversions

Yes, to keep the vacation atmosphere around here for one little boy: let's go out to eat more than usual. At least that part seemed like a vacation, even when you're staying home, and the parents are working.

I decided if I ever want to be a nursing instructor when I grow up, I ought to take some more education classes before I run out and get a terminal degree. I've been checking out MOOCs (Massive Open Online Courses) from all over the world here. It seems like a better option than handing over my checkbook for every class.

I actually found a nice course by Curtis Bonk (yes, it's his real name) about using technology in teaching on one of the sites. I knew of a few, but the MOOC list has many I had never even heard of at all.

Professor Bonk has some interesting viewpoints.

1. You need critical friends, web buddies, e-mail pals in online classes.

2. Your blog will be there 100 years later. What you post today might be usable tomorrow. Your digital history may be available for centuries. (Wow was my first thought). The professor mentioned a friend who published the Come and see Africa blog. The author's died in 2010 in a car accident. Her blog remains.

This tidbit of that course provided a lot of food for thought today.I can only imagine what rehab nursing will be like in 100 years, and what would they think of this blog?

Today, I read an article that people are still trying to keep rehab hospitals relevant, when the pointy haired policy wonks want to send everyone to a skilled (nursing home) care facility for rehab.

Only time will tell...enjoy your night wherever you are.

Pain at a distance

I talk to a lot of people I don't normally get to see through Facebook. Yes, I know Facebook is now for old people, but in terms of socializing, with the crazy life I sometimes have, it's the only way to be a part of someone's life.

Most of my friendships are cemented by life events. Kindergarten. High school. College. Nursing school. Rexie and I met in nursing school. The knockdown drag out year that was accelerated nursing.
We decided to sit near each other. Being creatures of habit, we gravitated to the same spot with our friends, D and J. We anchored our section in the lecture hall, and we bonded. We collected papers for each other. We called each other if anyone got sick. We commiserated after exams at the local coffee shop.

Rexie has been teaching since we got out of nursing school. She had another interesting life before nursing school which helped her land that job. It also helped that the professor wanted to train someone before she retires.

But today, Rexie is back in the town she grew up in, and I can't help her. I can't make anything better, because Rexie's son died in a terrible accident. It was supposed to be fun: the men out for the weekend. It wasn't supposed to end like this.

As her friend, I can only see her pain from a distance; an uncomfortable space I have only travelled reluctantly in my life. I watch from afar. And pray. Pray she makes it through everything in the coming days.

More later...

Queen of BBS

Yes, I am old enough to remember this BBS, but I never had a computer to use it while it was in its heyday.

The BBS I'm talking about it is the crux of what we do as rehab nurses. My preceptor G. told me as a young rehab nurse that most of what we do is about "bowel, bladder and skin." Yes, it surely is, and I had a lot of time to discuss these issues with a couple of patients recently.

Eddie is a guy who's had a lot of bad luck. His Hummer was attacked in Iraq and he lost three buddies. He made it out of there with a mild TBI and his life. He recuperated and things were going along nicely, when he was minding his own business driving home one night and ran off the road dodging wildlife in the rural area he lives in. As a result, he became a paraplegic.

He's still young enough to see the bowel routine as a boring routine. And since it becomes a synchronized routine for many patients, you can expect results at about the same time every day or every other day, depending on how you do it. Yes, he had results at his usual time, while he was doing something else he wanted to do. Lots of cleanup followed--to him, the wheelchair and his clothes. He was upset, but I managed everything so in the end, he was laughing. There are worse things...

Happily, while it's been crazy at the Hotel, we've been  able to get things done. It's required a lot of teamwork. People feeding other people, people transferring people, people helping vendors bring in new mattresses. I may have only sat down once or twice, but we got things done.

Let's hope it stays that way! Stay tuned...

If you want driving tips...

And search Google for them, most of them will be from lawyers like this one.

My shopping list was ready, and as I'm getting ready to head on out the door to our country lane, I hear a loud pop.

Turns out someone took a left into someone else at the intersection. Nice.

More excitement to come...

Life's comings and goings

Lots and lots of stuff happening this week...so today on my day off, I'm doing the usual errands including taking our dog to the groomer. He hates getting a bath, but he needs it. He's been shedding like mad and really needs the haircut.

The story of the last few days has involved that famous (or infamous) condom catheter.

They are a real issue getting them on and staying on for men who have what we facetiously call a "hider", or a penis that really, really retracts. One patient got wet, not once, but twice Monday because no matter how I put his catheter on (with SkinPrep or without), it came loose when he urinated. This meant clothes changes, equipment changes and a few transfers for me and for him.

Luckily, my other patient who used these catheters was not spontaneously voiding, so there was no leakage issue with him. If I only had a cath with a removable tip, it would make his intermittent caths a cinch, since I'd only have to put a condom catheter on once a day. (Now I have to put one on after every four hour catheterization.)

We also have a patient who's on our unit while he's completing SATP. He's a relatively quiet fellow, but something yesterday's program spooked him because he came back all breathless and he has an electric wheelchair. His heart rate was way over 100, so I called the doc. She checked him out and declared he could rest for the afternoon (He has several other health issues, too.) He took a nap, ate his lunch at 1400 and vegged the rest of the day in the room. When I read the notes I noticed the topic of the AM session--Grief and loss while giving up drugs. My guess is that he's still on the fence about staying clean. It's going to be a rough road, but hopefully, we can help him get there.

More goodies later....gotta take the dog to his groomer.