The Long and Winding Road
Despite rumors to the contrary, I don’t get paid to spread snark — and what I like to think is the occasional trenchant commentary — throughout the land. I wish! No. What I get paid to do, four days a week now, is to work as a physical therapist for a home healthcare agency.
It wasn’t my first career. When I started down this road, I was in my thirties. I had recently finished my bachelors degree in writing, going to school part-time while I worked full-time, and I was working as an editor for a small, non-profit feminist quarterly magazine (now defunct). Ronald Reagan had been reelected, so we had tons of stuff to write about. It was in many ways my dream job. But, like many of my previous jobs, it was a lot like herding cats and it involved endless meetings. One day, I woke up realizing I had developed a severe and what would turn out to be a life-long case of meetingitis. Somehow, my notions of changing the world and helping people seemed to be unfulfilled by spending hours hashing out the meaning of collectivism while editing atrociously-written and sometimes hand-scrawled submissions. I guess I got a little cynical. I wanted to do something more concrete, more hands-on, more tangibly helpful to someone. And so, I went back to school, took more science classes and eventually got accepted into grad school for physical therapy.
All this and health insurance.
A lot of you have had physical therapy somewhere along the line, either during your cancer adventure or for some other reason, like the odd sprained ankle or back strain, probably in an outpatient clinic. I did that kind of PT for several years myself, had a good time, met a lot of nice people, learned a lot.
But there was always something about home care that drew me. Occasionally, I suspect that I was just a glutton for punishment. Mostly, it’s because my mother had home care for the last five years of her life, so I got to see its strengths and pitfalls up close and personal.
Home care was my second PT job after grad school, after a stint in subacute, inpatient neuro rehab, the serious stuff, the post-brain injury, profound stroke kind of stuff, the teaching people how to move again from scratch kind of PT. And I loved that, too. And it was a good training ground for home care PT. So I did home care for about four years, then, not by choice, had to take a side trip to outpatient, orthopedic rehab, and then got to come back to work for my old home care agency. And here have I been ever since.
Working in home care is not like any other kind of PT. You’re not stuck in one place, for one thing. You get to drive around and you get really good at reading maps and following directions. After a while, your car starts to look like an office on wheels. You meet people’s dogs, cats, parrots, horses, and, around here, you may encounter flocks of unthreatening but wild turkeys and geese, several cows, and assorted bunnies and red foxes. You’re also meeting people who’ve just had something traumatic and life-changing happen to them, who’ve just come home from the hospital after surgery, heart attacks, falls, fractures and cancer. You don’t usually have any other colleagues in there with you, no staff of nurses, doctors, social workers or nurses aides to help you out. You’re on your own, so you have figure out what’s going on as best you can. You ask a lot of questions, listen as well as you can, and try to determine what you can possibly do to help this person, who is hardly at his or her best, to feel better. Later, you might decide you need to call in the troops, and contact their doctors to make sure that a home care nurse or social worker or nurses aide comes in to help sort things out.
You do a lot of things that aren’t strictly like standard physical therapy. You listen to heart rates, and lung sounds, and blood pressure. You try to figure out if your patients are taking all seventeen drugs they’ve been prescribed, and what all these drugs are for. There’s almost never just one thing wrong. You need to know if they have diabetes or hypothyroidism or a pacemaker. You need to know if they have anyone who can help them get to the bathroom or wash themselves or buy groceries or take them to their doctors’ appointments. You need to move furniture sometimes, so they don’t trip over something and hurt themselves again. You need to figure out if they’re with-it enough to be safe on their own. You need to persuade them to let you get their thirty-three scatter rugs off the floor. You need to figure out if their spouses or daughters or grandchildren are up to the task of being caregivers, temporarily or forever. You need to make sure their surgical incisions are not bleeding or infected. Most importantly, you need to determine whether they are capable of recovering. The old saying, ‘you can lead a horse to water, but you can’t make him drink’ is a very pertinent concept in home care.
Then you have to write all this up, in very specific and seemingly endless ways, so that insurance companies will pay for your services.
Sometimes, a lot of times, you meet people whose lives are a wreck, who have no family, who live in squalor, who are angry and distrustful, who are poor, who are delusional or have serious dementia, who are addicted to alcohol, who have saved every issue of National Geographic for the last forty years and have them stacked and piled over most of their available floor space. Sometimes, no matter what you do, you can’t help them, because they are incapable of helping themselves. But you still have to try. Sometimes, you go in and find them on the floor, and you have to call the EMT’s and send them to the emergency room.
Sometimes, your patients die.
Sometimes, you feel like you could write an angry treatise on what’s wrong with our healthcare system.
Sometimes, everything goes well and you help people get better.
When you’ve lived with post-cancer-treatment fatigue and brain fog for any length of time, sometimes you forget that you have legitimate reasons to feel exhausted at the end of the day. Sometimes you don’t give yourself enough credit for what you actually manage to accomplish before you crawl home and collapse into another stupor. Sometimes, you forget to be grateful you can work at all, and pay your bills with less than your former full-time wage, and the hell with the housework because at least you have a roof over your head and can walk upright without an assistive device.
Sometimes, you really need a vacation. Mine starts next Tuesday.
Do you give yourself credit for all you do? Are you too hard on yourself sometimes? Have you ever had home care?