Quality Vs. Quantity

This case has been weighing on my mind for the last couple weeks.

“G” is a newly widowed male in his 80′s who was recently admitted for long term care.  His primary diagnosis is end-stage renal disease and he is new to community dialysis treatments.  Up until about 6 weeks ago, he was a vital, active, independent man, who still drove his car and took care of his ailing spouse.  Unfortunately, G became ill himself and was hospitalized.  It was during this time, his wife passed away.

He received dialysis in the hospital, but the prognosis was poor.  He will need to maintain the treatment otherwise, he will die.  He only has one kidney to boot.  Like many elderly dialysis patients, G is experiencing  increasingly unpleasant side effects which are interfering with the quality of life he still has.  He returns from his treatments with low blood pressure, respiratory distress, general malaise and nagging low back pain.  He is exhausted.  He wants to stop the treatments and he is fully aware and with the capacity to understand the outcome of ending dialysis.

His family is still grappling with the death of G’s spouse. G is still in a state of shock and numbness over losing his wife of 60+ years.  He has only been at my facility for less than two weeks, but he has shown some impressive resilience and improvements in his physical functional levels.   I met with him again today to talk about his wishes and he struck me as someone who is still overwhelmed with all the losses he has just encountered.  “I know if I stop going to dialysis, I’ll die. But I don’t care…I’m ready”, he tells me.

I fear that G’s grief is underlying his decision making process right now.  I also believe he has the absolute right to determine how far he wants to go with extraordinary measures to maintain his life.  Does he mainly want to stop his treatments so he can join his wife?  Probably.  Would he feel this way about dialysis if his wife were still alive? Probably not.  The thing is, I question the true benefit of elderly patients undergoing dialysis.  It just seems to reduce overall quality of life in most circumstances…weakening already weakened individuals with a host of chronic medical problems.  They get to buy more time, but what about that “extra” time is worth it?  Only they know for sure.

Dorothy & Sophia: Together Again

It totally sucks that the entertainment world has lost legendary actor Bea Arthur.

I think I’ve seen every episode of “The Golden Girls” at least twice.  My friends and I would wonder which Golden Girl we would most likely be like when we got older, and I always felt that Ms. Arthur’s portrayal of the intellectual, sometimes sarcastic, spot-on-dry-witted Dorothy Zbornack was the character I related most to.

Several years ago, Estelle Getty, the actor who played Dorothy’s spunky mother Sophia passed away.  Maybe the two women have reunited  somewhere and are now creating new golden moments together.

Don’t Ask, Don’t Report

This is a good example of  how health care policy itself often gets buried in the news media and how in the dark the public is typically kept.  Coverage of health related issues and diseases (particularly cancer) do get a fair share of coverage, but the issues of health care policy and the crumbling system itself lag behind.  We have a health insurance problem in this country-big time.  Policy awareness and public participation in forming policy are key in resolving the crisis.  But if no one talks about it or reports on it consistently in the media, does it really exist? Kind of like the age old question about whether a tree makes a sound when it falls if no one is around to hear it….

See also the Kaiser Family Foundation report on the study of health news coverage in the media.

Lexapro Nation: Psych-Uptopia

I’d always been told the main difference between psychologists and psychiatrists was that the latter could actually write prescriptions.  An oversimplification, perhaps.  Or perhaps not so much.

The quick-fix prescription?

Seems like more people visit psychiatrists to maintain refills on their anti-depressant/anti-anxiety/anti-psychotic medications rather than receive actual psychotherapy.  It’s easy, fast and you don’t have to re-hash long-standing psychological issues on the proverbial therapist’s couch.

Plus, it’s cheaper.

I wonder what this might mean for the “helping” professions.  If people really feel uncomfortable talking to a therapist or just don’t have the time or money to spend on sessions, what does this imply for clinical practice?

Worse yet, what will happen to the Dr. Laura’s and Dr. Phil’s? (ok, bad attempt at sarcasm).  But you get my point.

Crazy Canucks Talk About Rewarding The Social Workers

In the social work and/or human services industry, this tends not to be such a common phenomenon:

Paying workers what they’re worth.

Bless those Canadians.  Maybe they can pass along the word here in the States…if you want to keep the front line workers happy and in your organization or agency for a respectable period of time, you might try giving them a raise once in a while.

I’m just sayin’.

Booksmart

I went to Barnes and Noble today. It’s been quite some time since I’ve wandered around in a bookstore, which is kind of bizarre for a person who could once spend half a day and a week’s pay in a bibliothecal house of worship without flinching. I bought a couple fictional novels that were on the clearance table; it’s been an even longer while since I’ve actually sat down and read something for sheer escapist pleasure.

It occurred to me that a major reason why I don’t read books like I used to has to do with the disproportionate amount of time I spend reading online nowadays. I read blogs, newsletters, online newspapers and forums ad nauseaum. There virtually is no time left over at the end of the day to curl up with a book. Virtual reading has taken the place of *actual* reading. I remember somewhere in the late eighties or early nineties, predictions of reading books, literature, essays, etc. on computers would take the place of reading good old-fashioned, regular books and papers. Libraries would eventually become obsolete. That felt pretty scary to me at the time. I couldn’t imagine curling up around a computer, giving up that delightful sensation of pages turning between my fingers. Or that adrenaline rush that overpowered me when I open a brand new book for the first time.

Of course, this was before the advent of the laptop.

Times are a-changin’.

The simulacrum is never that which conceals the truth–it is the truth which conceals that there is none. The simulacrum is true. ~ Jean Baudrillard

What I Learned Today

• My feet might be shrinking.  A pair of black loafers I’ve had for a couple of years are suddenly a little too big for me.
• Sarah Palin has a son named Track.  Track?  Are her other children’s names Nike, Adidas and Vans?
• Cross-stitching. It’s not just for Grandmothers anymore.

• Corn-on-the-cob shucked a day in advance affects it’s taste.  In that, it has no taste.
• When you’re covering for a co-worker on vacation, the event she said that is “possibly going to happen while I’m away” (i.e. the time-suck, chaotic, last-minute-pain-in-the-ass-task) will happen.
• There really is such a thing as sex addiction.
• I kinda think David Duchovny is even hotter now that he’s admitted he has a sex addiction.
• I have an odd way of reaching out to people.
• My cousin is pregnant.
• I drew the Hermit card twice today in a tarot reading.  Apparently, my self-inflicted attempt at solace is what I’m supposed to be doing right now

In The Hermit, we see how new life arises from what might seem like a bleak and solitary journey beneath the earth. Only by carrying the light of spirit into the deep places of body, memory, and unconsciousness can return to the surface realities of life and make them fruitful and vivid…

The Hermit is solitary not just because solitary study suits him, but because his mission of discovery and transformation can only be achieved in the interior landscape of contemplation.

He knows the way in.

(Interpretation courtesy of Starweaver)

P.S. I cannot for the life of me figure out how to make these extra quotation marks go the fuck away!

5 Things To Do Today

1. Step away from the coffee pot.  Seriously.  I started out today feeling rather lethargic and now I’m still yawning but my mouth is doing this strange tic-like thing.
2. Decide whether or not I’m going to get sucked into watching the new “90210″ tv series.
3. Figure out what I’m going to wear to work tomorrow/this week and launder accordingly.
4. Find something to make with all the tomatoes I’ve been gifted with from my dad, neighbors, and co-workers.  Salsa? Roast them? Check out canning options?  (Ehh…it’s 86 degrees today.  Fuck that, maybe next year.)
5. Be grateful that I have a job to labor at.  And a job I actually like, to top it off.  I feel blessed.

Today’s Mini Illumination: 8-26-08

An authentic life is the most personal form of worship. Everyday life has become my prayer. ~ Sarah Ban Breathnach

The way things are

My weekend consisted of the following: drinking lots of Chai tea, sneezing, weeping, coughing up some yellowish (but mostly clear) phlegm,  listening to an unusual amount of Natalie Merchant songs, reading books by Elisabeth Kubler-Ross that I happened to already own, watching tear-jerker movies like “What Dreams May Come”, “City of Angels”, and “Elizabethtown”, reminiscing, longing, weeping, moving in slow motion, ordering take out that had no taste to me,  noticing my bottom lip is chapped and realizing the tube of chapstick I have in my purse is the one I’d been using on my mother right up until the day before she died, weeping, sighing, dozing, cuddling my cats, listening to the non-stop rain, weeping…

I talked to my brother today.  He told me he’d had a dream about mom the night before the funeral.  She was lying in her casket in the funeral parlor, but she was alive and talking to both he and I.  She asked us both if it was ok for her to go.  We said it was.  She smiled and closed her eyes.

My dad has been hearing her voice in the middle of the night.  The sound of her crying or calling his name wakes him up.  He tells me he gets up and goes searching in different rooms of their house for her, but she’s not there.

The day after mom passed, I dreamt I was talking to her on the phone and I think she was calling me from the hospital.  Her voice was all raspy and high pitched like it had been when her respirations were poor.  I don’t remember what she said exactly.  Then I was in my parent’s house and she was there.  I was packing up my things and telling her I’d be going away for a long time.

I wish I could have the kind of dream where I’d get the sense she is ok, wherever she is.  I need some reassurance right about now.

The overly analytical part of me is trying to figure out what “stage of grieving” I’m currently in.  I think I vacillate between denial and sadness.  Then I start to think stages of grieving are a probably bunch of crap.

It’s interesting that I ended up getting sick right at the end of this week, immediately following the funeral.  It’s almost as if my body is purposely serving to keep me focused on my own physical ailment at the moment thus keeping me from having to really look at all that has happened other than in short intervals.  I’m too crapped out to really “go there” and acknowledge the various losses I soon will have to face.

I don’t look forward to any of it, but it is necessary to move through nonetheless.  It looms and hovers and waits for me.