Thursday, December 30, 2010

From the diary of an overwhelmed working mother...

I guess what I’m saying is, this is probably not the best time to test the theory of happy new life.  I’ve had to let drop so many things I enjoyed when I was an at-home mom.  My blog is moribund.  I haven’t read any of the other blogs I liked so well.  If a news segment caught my ear and I didn’t catch it at the time I could always go back to my computer later and read a transcript.  Now I’m helplessly hearing stuff that interests me and I want to know more about slide right on by.  I feel ignorant.  I feel really weighted down by this job.  I feel anchored to it like it’s a ball and chain.  I’m faster on the documentation, but the real slow-down is the phone calling.  Call a dr, call a patient back, call another staff member to coordinate something and try to remember everything I want to tell them so I don’t have to call them a second time.  I really do wish people used email, because I could communicate much more efficiently.  I’m burning through my phone minutes but there’s no way I can not use it on the job.  I have to call back assistants to tell them a plan of care for patients, and I then have to be thinking about that pt, remembering who they are, any special things about them.  Yesterday I saw 6 patients, drove 80 miles, and I’ve only worked my way down to the third one I saw in documenting, and I’m not yet done with that.  I went from downtown (where I had to scrounge for change for parking because I’d forgotten my wallet at home).  I guess I’m just trying to describe the pieces that add up to overwhelemed, and also me coming home from working, doing documentation, taking a break to fix dinner, or go to an appointment, or a teacher conference at Connor’s school, and that puts me behind the whole next day.  Even if I get up at 5.   Even if I go to bed at 11 and then get up at 5.  Which I’ve been doing for a while, and I suppose that’s another nail in the coffin of morose.  The dog has been particularly wearing, whining pitifully this sound that is like nails on a blackboard.  Take him outside and he doesn’t want to go because it’s cold.   I don’t want to take him out because I have to stand there while he sniffs aimlessly and I’m cold. It seems like all we’re doing is stopping our activities and taking him outside to poop or pee.  And that’s not counting the ‘accidents’ in the house.   The house is a mess, and this is really distressing for me.  When it’s in such disorder…counters unwiped, sticky on the floor, crumbs, food left out…I just start to feel like it’s one more Other demanding my attention.  The work demands seem implacable—patients need orders for service, and they deserve to have them done quickly and seamlessly.  However, this agency is not seamless.  All of this, and I don’t think I’m even meeting productivity.  And with the pressure to pass patients on to assistants, where I do an evaluation and then don’t see the patient again until I discharge, yet I have to keep track of what the goals are for that person, and the increments toward that goal, and is the assistant doing it.  And then have to really think about the ‘skill’ part of my visit (and assessments don’t count)—just dissect what I’m doing to present on a documentation template that tends to give a cookie-cutter ambiance to the session anyway.  My head is spinning, and I just don’t feel like I’m keeping track the way I should, and there’s always something more to do.  And there’s calling patients beforehand the night before to arrange visit schedules, as well as having to bring up the computer and look up each one and figure out a system  of sequence that makes sense, only to have it derailed if that doesn’t work for the patient.  So yesterday morning I also had to take the next door neighbors kids to school, and I hadn’t yet written down a schematic of a patient list and directions to each, and telephone numbers (because it’s hell to try to find that on the computer while driving—take off sunglasses, locate bifocals, open computer, turn to avoid glare—oh, the car ahead is moving now—and the stupid cursor is taking forever to appear, and I can’t see the list of patients to select the one I want and then I have to drive some more, select the ‘basic’ box to call up name/address/phone.  Squint because it’s difficult to find the number and read it because the font is so small.  Scott is like trying to push jello through a straw and the two boys begin fighting viciously with Scott yelling so loud it hurts my head and then Connor trying to yell over him to the point that I tell them I don’t want to risk this kind of behavior in a motel room, or a restaurant; I haven’t washed my hair and it doesn’t look like there’s going to be time to; there are dishes in the sink, then we have to wait for several minutes for the kids next door to come out of their house and I’m fretting because I need to be downtown before 9:00 to see this guy.  Which reminds me of another phone call I should make—to his orthotist to be sure that he’s following the stump changes.  Then  I’m getting calls from people asking me about other people.

In other words, there’s an avalanche of details that each need attention, and triaging them and figuring out which are most important while not losing any of them is really taxing for me.  I’m trying to keep a notebook but that system has its limitations with my scrawled cryptic messages and phone numbers.  And I let a big detail drop through cracks, where a patient that was on my schedule for Mon had not come home from the hosp Sunday and I’m on the phone with his wife Sunday night and she’s wanting a schedule for when I’m coming and we agree on Tues in the afternoon.  Then he was moved to a different day on my schedule, and I honest-to-god don’t know if I did it myself because I’d gotten the impression he wasn’t going home from the hospital til Tuesday—but I also remember feeling surprised to see him on my schedule Wed.  I don’t know if I did it, in an effort to see which configuration of visits would work, and then forgot to switch it back, or if a scheduler may have done it—because sometimes they do move things on my schedule:  I’d forgotten he was a Dr. T  pt with a fairly strict protocol:  nurse and PT go out on the same day.  It was team meeting morning and I’m trying to get out the door because my first patient is in Newberg and my next in West Linn, and I’m seeing the schedule I’d constructed the night before slipping away and I may have to be making more phone calls and if I have to be I want to be doing it from the office because my cell phone bill was over $120 due to phone overages, but then that keeps me from leaving too because I have to look up the pt’s phone numbers and write them down, then take them to another phone in another part of the office because the phone that’s usually in the conference room where my computer is set up is not there, and I don’t really like to take my laptop with me because then I’m unplugging it from its power source and wearing down the battery.  Then I’m called to talk to—whatever the hell position it is that Carol has, warrenting her own (shared) office—because I’d bypassed an important step in a patient’s hospitalization which I hadn’t known about until the wife called me after he was already home, and I’d just gotten orders to continue PT without realizing he was in the hosp, and the wife requests no therapy the rest of that week (it’s Wed night), and I talk to the dr. on Fri, who says she thinks we should wait to continue until pt’s wife feels able, so I call the wife and she asks to take the next week off too, which means more phone calls to keep track of because then I’ll need to call her on the Sunday just prior to that week to see if they are ready for more, and I have to call  the dr’s office  for orders and in the meantime I inadvertantly bypassed this whole other official channel where there is this whole transfer and resume process, re-referral and getting new orders to resume and I’ve skipped all that because I’d been working with the doctor’s office and they’d said to go ahead and that’s what they’re calling me into Carol’s office for.  Further squeezing down the time to get to my first boonies patient and feeling myself getting later and later, and at least, thank god there is a person who offerred to pick up my son at school and take him to her house, so I have longer at the end of the day before having to pick him up—because that’s usually the firm deadline that I have to get everything else to conform to and usually that really compresses and squeezes a day.  So I leave the office to go see my patient and get lost, meaning I’m having to stop and pull out the computer for the map that I'd kept the window of, but it’s not resolving to the detail I need so I have no choice but to completely retrace my steps, and now I’m having to call people and tell them to expect me about an hour later than the times I’d originally scheduled and hoping I won’t have to call and revise again.  So it’s while I’m on my way to my final patient’s that the cell phone sounds as I’m driving so I don’t pick up until I pull over (watching the time drain) and listen to the voice mail and it’s a very clipped voice of the patient’s wife whose agreement with I’d forgotten about seeing them this day—because he’d been moved on my schedule (by me?  By a scheduler?) and so I’ve got to call her and get a really frosty reception when I apologize.  So I’m feeling just unsettled and yucky as I head to my last patient.

And that’s just one day.  I spent a great deal of Wednesday trying to hold together a schedule that kept threatening to collapse—so it was phone call after phone call.  One Adult Foster Home would only render a fax tone so I called the pt’s dtr who gave me the number of the home’s manager, who I called and got the visit scheduled.  One lady is way out in the boonies, and this was to be a final visit and she was one whose daughter had never gotten back to me to schedule a Monday visit and so I drove out blind and stood knocking at a locked door after having gotten lost and wandered in ever-increasing traffic for a while and it’s probably partly my fault because I hadn’t persisted in calling after I didn't get an answer when I called over the weekend but I have so many phone calls to make and I’d thought the number that was hers might be an office number and so I’d have less of a chance of speaking with her than the home number, and I’ve sensed a certain passivity of the daughter in advocating for her mother anyway—have offerred to meet her at the house (at least before turning her over to an assistant, but I’d asked the assistant to see if she could arrange a visit when the daughter would be home, and I guess I never verified that the assistant did this or not), but not been taken up on it—no return call after I left a note on the door that Monday—just a peculiar kind of disconnect when it comes to bridging concern about her mother’s condition with action to address it. 

And this doesn’t touch the times I open the computer and attempt to change a scheduled visit to someone else’s schedule, or schedule someone else’s to mine, only to get an error message saying that will exceed authorized visits and a lot of times it’s because the computer has duplicated the schedule; this doesn’t count the times of calling the office with either a question of my own or to answer a question they had for me, only to get put through to a voice mail.  Calling a dr’s office and wading through all the menu options (with the tantalizing feeling that maybe this is the office that I can bypass all of this by pressing 2, and wondering if I should take a chance and press 2, or wait it out in case pressing 2 will delay me further and the voice message comes to the end and tells me that in the future I can bypass this message by pressing 2, and then the receptionist asks me to hold.)

One more hour, and I really didn’t mean to put this time into work woes, but it actually did help to capture a slice of my day.  It helps me to get a sense that maybe anyone would feel overwhelmed too.  And I forget that Gary’s been gone in Asia which double-duties me as far as kid and animal care, I have phone calls hanging out there that I haven’t returned—personal friend phone calls—or family—and we just moved stuff into a place we’ve barely used.  I just didn’t have it in me to do the scramble required to find some sort of child care for Scott and a ride to the school for Connor on Wednesday night—which was on the day I’d see Sharon.  I wracked my brain for options and eventually gave up and missed the session with Sharon.  Didn’t know if this would be a productive one anyway, given the others I’ve had.  I guess it could be said that there is some sort of ‘message’ in my having forgotten her check the week before, and then missing this session.  This is the first time I’ve missed a session, other than when we’ve been travelling, ever.  The truth is, I think, that I am  in a slack, slack period.  Haven’t moved in to the apartment yet, that is,  gotten serious about establishing the rotation with Gary.  It’s Christmas, which is usually a pretty overwhelming time, but I don’t have to be doing any of it this year, so I’m not that overwhelmed, except with some remorse that I’ve been looking at all these Christmas trees in people’s homes with gifts piled high beneath them and nary a one under ours (in part because I can’t quite trust that Scott will be able to overcome his inquisitiveness and inability to handle the suspense—as well as the possibility that he may shake some packages and possibly damage what’s inside.  So this is the first year in a long time that I’ve not been dogged by Christmas busywork shit, but the slack is all taken up by my job.  So I’m as busy, but just haven’t had the additional Christmas busy on top of it.  For which I’m glad.  But, I wonder if the bare underneath of the tree is a metaphor for the bareness of Christmas enthusiasm within me to share with them.  I know that part of the fun of Christmas is having adults share their enthusiasm, to kind of reflect it and amplify.  So I’m totally lacking in that regard.  And if I was any kind of measuring up to the standard of a good mother, I wouldn’t be here writing, but out buying some gifts to have under the tree for them when they get home.

But this is really the first moment I’ve had to myself since last Friday.  Literally.  If I haven’t been up at 5 I’ve been up at 1 (once, when I woke and couldn’t get back to sleep and decided I may as well work—and did so for about 3 hours)

And in choosing this I’ve also chosen to not go and look at some material that’s been up in tabs on my browser forever, which probably isn’t good for the computer; probably uses up tons of memory.  Some of the stuff I’ve had to ‘cut’ (funny, guess it’s metaphoric for what’s going on everywhere, states cutting their budgets, all these demands that the US cut theirs, other nations cutting back severly) has been pretty hard.  Losing my sense of being informed, that’s a hard one to let go.

I wonder if I can call it a lack of intelligence on my part, that I can’t just absorb the important parts of the news as they’re being presented on the radio.  I zone out without realizing, and then 'come back’ just as something is said that I have a question about and realize they’d answered it ‘just’ before I ‘came back’.  Just trying to get a weather forecast does this.  I listen consciously for it, then when the broadcaster starts talking about program sponsors I zone out only to find that without a break they’ve gone into a forecast and I only get to hear the Eastern Oregon forecast because they did the Portland one first before I ‘woke up.’

My brain is scrambled eggs.