It never gets better

Every job change I have had has had worse health insurance. And within each job, every time there has been a change in the insurance plan, it has been for the worse. The new plans came out for next year- we now have our choice of two options- but neither includes out of network coverage. They took that away. Neither my psychiatrist or therapist take insurance.

50% of psychiatrists do not take insurance, it is the highest percentage of all disciplines. And in my state the number of doctors-of all kinds-who do not accept insurance is very high. There are hardly any psychiatrists around who take insurance, and the waiting list for those who do is many months. But at $150 every 2-3 months, I think I will stick with my doctor. My therapist is another matter. And I am sure that there are good therapists who take insurance, but I can never seem to find them. I found one- but then she left for maternity leave. Most have been, at best useless, at worst really bad. So I think that as of December 31st, I will be done with therapy for a while. I guess they got what they wanted- they cut costs.

The high deductible option will still be there- with $500 added to the deductible and no more out of network coverage. The other option is an HMO which is no bargain either. There is still a high deductible- but is doesn't apply to doctor visits or prescriptions- there are co pays for these, and these copays are high. $60 to see a specialist (like a physical or occupational therapist, for example- imagine 2 times a week). And for the HMO I would need a referral for all care- which would annoy me, but I don't think would be too hard to get. I have a good doctor.

I think the HMO would save me money- and I wouldn't have access to any more doctors with the high deductible plan. The downside is that there is no health savings account attached to it. So when I try to figure out what is in my financial best interest, my head starts to spin. Shouldn't they teach this in schools? And I really don't like the idea of an HMO. And I feel very sorry for all of the PCP's who have to write referrals. They must have something better to do with their time.

Not a great day for medical news

America has its first Ebola case- that was contracted in the US. And it was a healthcare worker who knew the patient had Ebola and was using protective gear. This is not good. Too many healthcare workers are getting Ebola- here and abroad.

When I do inpatient I sometimes have to wear a gown and gloves. Once, when I was a student, I had to wear a mask as well because I was doing an eval on someone with TB. I was terrified. But really, if you think about it- gowns may not be enough. If someone has sneezed and there are droplets on the floor- you could get your shoes contaminated, etc. Any part of your body that is not covered with protective covering is at risk. So many ways that this could all go wrong. And apparently it has, at least for one nurse.

On a more personal level, I am wondering why the end of life has to be so hard. My grandmother broke one of her vertebrae- and things have been really bad ever since. Her pain is not under control- except when it is, and then she forgets she was in pain. The pain is making her more confused and agitated and more difficult. I don't know if they are going to be able to continue to keep her at home- but my mom has finally agreed to have someone come to the house- but they can't start until later next week.

Part of the problem is lack of continuity of care- my grandmother sees a gerontologist at a major university clinic- but the doctors keep leaving and the clinic keeps moving and reorganizing- so that there was no one they could call this weekend about pain medication because she is seeing a new doctor next week. And I'm not sure that there is anything that they could have called in, anyway, as they are all controlled substances.

I wonder if an antipsychotic would help her. I could send her some of my Zyprexa! Or maybe she will be better if her pain is managed better. Or maybe she just can't stay at home anymore. My mother really wants to take care of her mother at home- but it might be the behavioral aspect of things, rather than her declining health, that makes this not possible.

Another day of struggle

The depression was there today again. I got up late, didn't take a shower or even eat breakfast- hoping that my morning cup of coffee with a lot of milk could tide me over until lunch. I did make it to work just on time. And work did go pretty well- except that by 11am I thought that I would pass out from hunger.

Today is mental health day or week or something like that. I think I have compassion fatigue when it comes to these illness-awareness days. I was supposed to wear pink last week I think- but I didn't. Does mental illness have its own color? It ought to be black- but then everyone would just think you are from New York City.

Do we need more awareness of mental illness? Do these days really reduce stigma? I don't think they do. Not for serious and persistent mental illness. I think this manifests in two ways. Of course there is potential discrimination on the job, from dates, friends, etc. And then there are the other people who will tell you that you are not really mentally ill because you are working and living on your own.  I guess we are not supposed to get better.

What has my interest right now is the Ebola news. I don't think- for the near term- that the US is at risk of a significant outbreak. I think the biggest worry is that it will not be stopped in West Africa and will become endemic in this area, with a huge loss of life and a constant threat of infection spilling out to other areas. Because the economy will go so bad that people will migrate for work, as well as medical care. And it will become just awful in this area.

I have also been reading that India may be next in line to get Ebola, due to crowding and lack of medical infrastructure in places. I hope this doesn't happen. I really hope we get a vaccine. Before the economy crashes.

I have to admit- I have a patient who is recently back from west Africa. And I mental calculated that he had been here over 21 days before I saw him. Safe!

Hard day but a good OT moment

The depression was definitely worse today, and I couldn't be so philosophical about it. But I did have one moment at work that broke through it- getting out a golf club and balls and having a patient with a very painful arm do some putting. A good occupational therapy moment. Purposeful activity. I wonder if I can get my hands on a tennis racket.

I think I might have a UTI. Maybe that is the source of my recent fevers. I felt feverish towards the end of the day- but then I took some naproxen and I felt better- my mood felt better too. But I just couldn't get myself to the support group- I just wanted to go home. To no food- I had milk and m&m's for dinner- it was a very yummy dinner actually.

I did three eval's today and I didn't finish writing up any of them. All of the eval's had complications. The mallet finger patient with a lag- so we will try more splinting. The tendon repair patient who came in with no splint. The patient who comes in and it seems totally like something rheumatological- but the MD wants to try therapy before doing bloodwork. Sometimes I don't understand doctors.

This weekend I am going to a Bat Mitzvah for my step niece. I am kind of dreading it. But I really should go. I don't even know what I am going to wear. But I guess I have something.

I think today was a little better- but I am still down

I think my mood has taken a dive- and I am trying to ride it out. I know that if I am depressed, I need to be gentle with myself. But there is a fine line between taking it easy on myself and turning into a blob! For today, though, I let myself use dry shampoo and skip the shower. I tried to be present at work and focused on mindfulness. I just did what I could do. And I think that it helped. Or maybe it was just the truly delightful fall weather that we have outside right now.

Focus on little things. The radial nerve palsy splint I made today that came out well. The new shoes I bought- all black running shoes to wear at work- which are the most comfortable shoes I have ever worn. And try to forget that I thought about quitting when they told us that we have to fill out more checklists to make sure we have done certain things- just another step and all of these steps add up.

Tomorrow I am going to walk before work. Just a mile, but something. Because I really need that. It is my late day tomorrow to go in, so I have to do it. And for my sanity- it is going to be a really busy day. I have to make a splint, do 2 evals, and I am double booked quite a bit. My schedule has gotten really hectic because Mondays I am at inpatient, so I have to see all of my patients in 4 days.

I want to try to get myself to the support group after work tomorrow. It is a little hectic- I have to leave exactly on time and I still get there a couple minutes late (I hate being late). But I want to try it again and see if it is useful. I could use the socialization.

More than Monday morning blues

I woke up really depressed and had the hardest time getting out the door. I figured it was just Monday morning blues- some Mondays I am depressed. Not that I don't like my job, I am just bad with transitions I think. But usually I feel better as the day progresses. Today I didn't.

By lunch I realized that it wasn't going away. The darkness accompanied me the rest of the day until I could finally clock out and run home. I needed to do some grocery shopping- instead I just stopped for milk and some cookies- I needed comfort food. I'll have some lentils later. At least I had vegetables at lunch.

I know I should go for a walk or something. I just feel so tired. Maybe in the morning before work.

I have to get through this.

Sweet Friday

Friday's are always good. It is my shortest day of the week, and I know I have the weekend coming up- and I always feel so light and free at work. It was also a good day because I had a student job shadowing me to get observation hours so that she could apply to OT school- I have that a lot- but this one was really enthusiastic about what she saw, and I think she might want to go into hand therapy.

Otherwise it has been a week with a lot of discharges and a couple of really interesting patients- but if you are a patient, you don't want to be interesting. You want to be boring. These people are really involved or have unusual things that don't have clear treatment that works.

Today I have finally felt pretty much over my cold, although my throat still feels a little funny. Otherwise I am okay. Physically. I am a little anxious and my thoughts are a little loud at times- I think this is a consequence of going back down on the Zyprexa after taking too much for a week. Or maybe of starting light therapy.

My thoughts aren't exactly racing- but I just feel the weight of all of the knowledge in my head. Like I don't want to think anything, because I know that anything I think is connected to all of these other pieces of knowledge/memories, etc. which are just going to follow and it just all feels so heavy and I think I can't bear it. So this evening I took a quarter milligram of klonopin. The past couple of days I have been taking benadryl, because I have hoped it would also help with the cold symptoms. Oh, and I have been a little talkative too. For me. Probably for someone else, it would not be! But I am usually quiet.

But it hasn't been bad, I'm not too off. I think it will quiet down pretty soon.

I am supposed to go on a nature hike tomorrow, but it is also supposed to rain, so I don't know if I am going. And the last few days my left ankle is really bothering me- and I don't know why. That is not the bad ankle. I kept blaming my shoes- but it doesn't matter what I wear. I think the only thing that would help is my hiking boots. So for tonight I put on my Jimmy Copper ankle compression sleeve- that I bought for the other ankle. It seems to be helping a little bit.