Impulse

Tuesday it was when my internal conflict began.  It was warm outside 75 to 80-ish weather with the spring sun up high in the almost cloudless sky.  I hate the sun on my face.  I don't hate the sun itself, mind you, and I can deal with the heat.  But I hate the sun on my face.  It burns my face up like a dried leaf and fertilizes my face for new acne growth.  Acne which I should have gotten over with after puberty, but no.  It lingers on forever, a flaw I assume God Himself assured to make me human.  Without my imperfect skin, damn, I would be the perfect Homo Sapien specimen on the planet.  Oh yeah!

Well, anyway, at midday during lunchtime, I suddenly had a craving for ice cream.  Ice cream is one of the few sweets I love and I am craving for it now.  I wanted a Rocky Road or a Cookies and Cream right then and there.  That is when my internal strife began.  Part of me wanted to go to Walmart after work and grab myself an ice cream to satisfy my craving.  But then again, it was too hot outside and the sun will be on my face.  I hate the sun on my face.  And still I crave for ice cream and the only way to get rid of the craving to buy one from Walmart.  But it was too hot outside and the sun will be on my face.  I hate the sun on my face. And so goes my internal conflict about whether to get that ice cream or not.

It went on through the afternoon.  Me debating  with myself over the ice cream.  Not eating ice cream will not kill me and between want and hate, hate is a stronger emotion. And I hate the sun on my face.  So I decided, I will walk straight home after work.  No more trip to Walmart for a half-quart of ice cream which I probably will just leave inside the freezer for a long time before discovering I didn't really want ice cream after all.  So that was that, no ice cream, I am shading my face from the sun with my trusty stolen white folder going straight home. 

After my last patient, I logged my minutes out, locked the therapy room and headed out the door.  I had a cap on, my backpack, my Ipod playing James Blunt's I'll Be Your Man and my folder on one hand.  As I walked along the roadside, I realized how I no longer am the YesMan I used to be.  And that is a shame. When I was younger, I prided myself on the fact that I am one driven by my impulses and I follow them with much gusto I didn't really care what everyone else wanted.  I wasn't swayed by the crowd.  At times I even sway the crowd.  If I had the impulse to eat something from somewhere, by hook or by crook I will get that by the end of the day, no matter what it takes, by God, I will get that!  That was who I was.

I like to think that that is still who I am.  But, no, as I grew older impulses give way to rational thought.  There is nothing wrong with rational thought, of course.  In fact, it is a sign of wisdom.  But hell, it makes things predictable and boring.  Would I really give up my childish impulses which reminds me of my youth, to the convenience of rationalizing everything so I have an excuse to say no?  I don't think so.

So today my friends, I am young again.  I decided the ice cream was worth fighting for.  I still hate the sun but giving in to that one silly impulse, for a moment, gave my heart a sense of victory, something so remotely distant for people who are starting to forget how it is to be young.  For a moment there, I was young.  I was free.

Mother

It was a lazy afternoon when we spoke.  If I remember correctly, she was the last patient I saw for that day. For confidentiality's sake let us call her Ms S.  Ms. S is one of my favorites.  She is easy to be with, has a sarcastic sense of humor which is of course to my taste, and we often talk about silly things during therapy.  But what started out as a light conversation while she was on the exercise bike eventually led to something serious, sad even.  Here is Ms S' story:

Me: Ms S, you seem to have pretty eyes, what color were they before you got old and wrinkly?
                *we both laugh*
Ms S: Well there were blue, but now it's more of a blue-gray.  I also had rich blonde hair.
Me: You must've been beautiful back then.
Ms. S: I'm not sure about beautiful, but I think I was pretty.
Me: Wow talk about confidence huh?  *we both laugh* I'm sure many guys wanted to date you.
Ms. S: Well yes I did have many of them.  Until I met my husband.
Me: Is you husband handsome?
Ms S: Yes he was.  The girls were always chasing him.
Me: Even after he married you?
Ms S: More so even after he married me. Hihihi.
Me: Seriously? So you mean he had an affair?
Ms S: Oh yes he did.
Me: With different women?
Ms S: Not really.  He had this one woman for so long...

As Ms S shared her story with me, I can feel like she is holding back tears.  She opened up her heart for me, and out gushed her emotions.  Something she kept by herself for so long, to so few.  I must be one of the precious few she trusted enough to hear her story.

Ms S: I always knew he was unhappy with me.  We had three girls already and I can't seem to make him feel happy or proud of me.  There is a distance in his eyes and his arms that stops us from getting close.  And then I got pregnant again, and this time it was a boy.  I thought having a baby boy for him would make him happy, but I was wrong.  He grew more distant.  And though we lived under the same roof, I knew he didn't love me.  He loved his other woman....

And so it went on.  I learned that the other woman stayed remained until they got old and gray.  I asked Ms S., " So did you fight back? Did you fight for your husband?"

She said, "I wanted to but I didn't.  I didn't want any trouble. I was busy anyhow tending to the kids. But one day I almost did.  He took his woman with him to our home. Well she didn't come in but I saw her pickup truck outside.  I wanted to grab her and slap her.  But I was thinking of the kids. It would break them.  I'd rather they have an illusion of a happy home that shatter their lives by revealing to them that their dad is a cheat.  I'd rather keep the pain to myself than bear it on the children.  So I never told them.  Even until now, they don't know..."

"I kept thinking what made him unhappy with me.  It's maybe because I don't drink too much or party too much like he does.  I don't have his lifestyle.  So I can't make him happy.  But I took care of him when he got sick.  I took care of him until he passed. That woman never even came to see him"

"Do you love him that much?"

"I don't know.  I love my kids more. I was a mother first and a wife second. You can call it love, you can call it loyalty.  I did the best I could.  You know I never tell many people about this.  Not even some of my closest friends know."

"So I guess I'm special huh?," I smiled.  She gave a small laugh, "I guess, honey, I guess you are."

**********************************************************************************

Life is a matter of perspective.  You can call it unconditional love, unwavering loyalty or spineless martyrdom. Her story took a lifetime to realize.  She wanted to protect the unhappy marriage because she wanted to protect the kids.  Is this sacrifice a sullen form of idiocy, a sad and lonely state of passive aggression or is it because she wants to set him free?  Is it worth it in the end? Is your love worth fighting for after all?

Pikchoors

Just because I don't have an expensive camera and I  absolutely have zero know-how with photo editing doesn't mean I can't take good pictures.  And take note: I just took snapshots I didn't really focus too well on every detail. Enjoy! (as if you'll enjoy this hahaha)

Dusk Amidst A Perfect Sky

Light and Shade

Entrance of Colors

Arms Raised to the Heavens


And my favorite picture:

Cherry Blossoms

Shame

Today is the 9th of March, a couple of months has passed since I got here to find myself a more decent livelihood, perhaps a better life for me and my family.  In my two months, I've had a lot of fun learning experiences I want to share with you, if you still manage to read my blog.  Anyway, here we go.

Let me start by saying that I haven't cried yet since I got here.  Crying is supposed to be one of the stages I have to pass through being away from family and all.  But no, I haven't, although at one point I almost did.  I suppose I'm happy to distract myself by watching TV and playing computer games and drown the world out.  I am learning again how to work with patients, something I haven't done in a long time.  I am learning how to be relevant again in my chosen career and by the grace of the Heavenly Boss little by little I am regaining my confidence in patient care.

Today, the 9th of March, I felt so ashamed of myself.  I am a proud man most of the time.  But today I am ashamed of myself.

Amy is my boss at the workplace and Jenny is a PT assistant.  They were the first PTs ever when the facility I working in now opened more than a couple years ago.  I have great admiration for both of them.  I don't know if I can call them my friends, or what friendship entails in this part of the planet, but I admire both of them.  Not only do they have great ethic at work, they embody what a physical therapist should really be.  On the sides, while I'm working with my patients I steal glances and learn how they deal with their own.  I am amazed by the smoothness and grace of their patient handling, their efficiency and how well they manage their time with patients.  Most of all, my greatest admiration comes from their ardent desire to fight for every patient, to ensure that every patient gets the best care they need.  With Jenny especially, she has this tremendous passion to help her patients.  Now where does the shame on my part fit in here?  Lemme explain.

Several days ago I evaluated a patient with a bagful of complicated pathology including a viral encephalitis that he got from simple knee arthoscopy.  He looked like he was in terrible shape and that no amount of therapy would ever get him back to where he was before.  I told some people at the office that I didn't know why they even him to a skilled nursing facility when they should've sent him to hospice.  He clearly is gonna be a vegetable and it's pointless to even give him therapy.  It then surprised me during team meeting a couple days after when his name was mentioned and Jenny goes on a barrage of let's try this, let's try that on him.  And in my mind I was like Oh c'mon goodluck on your dream to have him get any better +2 max assist on everything zzzzzzz.  Jenny said, I am not ready to give up on him just yet.

I am not ready to give up on him just yet.  I am not ready to give up on him just yet....

Today, I saw the patient sitting on a good new wheelchair fitted for him by Amy and Jenny.  He was sitting with good trunk control.  He does look better.  I wouldn't really know how much progress he will make but yes he does look better.  He didn't seem as useless as I expected him to be.  I felt ashamed of myself.  Here I am calling someone useless, never gonna get better without even giving it a try.  I judged him based on that first assessment and condemned him to being an infirm, an invalid for the rest of his life.  I haven't given it my all.  I had given up too quickly.

I am not a religious person but I consider myself somewhat spiritual.  I will not say God-stuff just to impress people or what ever bullcrap you do with it.  But I know one thing.  Me seeing Amy and Jenny work their asses off to help that patient was no accident.  It was part of my Heavenly Boss' masterplan for me.  He showed me why I am a physical therapist, why He pushed me towards service for others.  Through Amy and Jenny, He showed me my purpose in life.  With that, the shame starts ebbing away and a new sense of determination slowly sets in. I may not be the best therapist there is clinically, but hell I will try.  I will not take the easiest way out each time I encounter a difficult case.

This is my mission.  God hasn't given up on me just yet and so will I to the patients I serve.

White

This is a voyage I took

Two hundred years ago

              to a land 

      barren of passion.

My last vision is you

In tears waving a white glove

        waving goodbye

Yes, goodbye

And the shade of your parasol

Hides the silvery drop of

Salty tears on your face.

This journey,

This journey is empty

 Without you in it.

Without your smile

         your mood

             Your white glove

It is empty.

Now is when life ended

And existence 

                    begins.

A life 

A life without you in it

Is a voyage I took

Two hundred years ago

   to a land barren

       of passion

To a land where there is no life.

No life

There is no life without you.

And so I stay on

       to merely exist.

11:40pm 2/20/12

A Long Friday

For the first time ever, I went home and the first thing I did was open a bottle of beer and smoke a cigarette.  I have never drank a bottle of beer alone, nor smoked a cigarette straight from work here.  This day is more unique than others I think.

I told you the last couple posts that I work with the elderly.  Some are nice, some are funny, some are hopeless and some are downright nasty.  You have to deal with different people everyday, it is given, but add to that the effects of multiple medications, time of day, weather, and whatever extra credit you can think of and it makes dealing with people less than appealing to the physically, socially and emotionally unprepared.  

Today I dealt with a patient who gives me a hard time.  He is in his 90's, with multiple pathology, multiple attachments, easily angered and basically deaf due to presbycusis.  This is a patient I have to talk to through sign language and a communication board or paper.  You can imagine how hard it is to educate, instruct or simply do small talk with that man.  And since he is very impatient, he just screams when you do something that does not please him or whatever. He is also dysphagic so speaking is difficult for him which makes it worse. It's a guessing game what he wants and you just have to grin and bear the sh*t you do to make him go to or/and do therapy.  

Today, I asked a certified nursing assistant (CNA), a euphemism for a caregiver, to get him up, dressed and ready for therapy by 11.  She complied.  By 11 I came to pick him up and the nurse told me he has to get back into bed so the wound physician can see his sores on the buttocks.  I asked the CNA to get him back into bed and she told me why do you need my help? And I said well I need help to get him back into bed.  She said I don't know why I can get him in and out of bed on my own, and I'm a woman and why you would need help doing so.  In my mind, errrr cause that's your job? Well anyway to make the long story somewhat shorter she did it herself and stomped out the door making me feel stupid and worthless.  I had to take it though it did pinch my ego.  Anyway, I scribbled on the board that I gotta leave and see some other patient while the he waits for his doctor.  Frantically, the patient scribbled back: Please don't go.  I wrote back: Well I can't stay here I have a schedule to keep.  He replied: Please stay. I want you to be here when the doctor comes.  I need you to interpret for me. U understand me.

It broke my heart.  This man, this man from hell, made me feel special, needed.  He didn't ask for his nurse, or his nursing assistant.  He wanted me to be there cause he trusts me I guess.  Cause maybe I did something that others who are involved in his care plan didn't.  It did make me proud despite the fact that afterwhich he screamed again at me when I didn't get his foot orthosis back on in the exact way he wanted it to.  Oh well, you can't win em all.

That afternoon, around 3 o'clock, I was scrambling to get more patients.  I still had three patients to see, the clouds outside didn't look friendly and talk of snow during the weekends abounded.  I had to get the three of them done so I can go home by 530 which around here is dusk.  On my way to my new patient's room (let's call the patient "A", patient "B" called me from across his room.  B is a Parkinson's patient who almost made me cry on my first day on the job.  I worked with him a couple more times and now we are somewhat good friends.  He called me in, and although my precious time is being consumed, I obliged.  He wanted to change cause he 'wet' himself.  I told him I will tell the nurse to get the assistance he needs.  The nurse pointed me to a CNA incharge of B.  I told her he needs help and she just told me: Oh I'm sorry but I'm just about to go home. Just wait until the next shift comes and she'll help him out.  Wow! I was mortified! I just couldn't understand why you couldn't help the man while you're still at it.  Anyhow, I saw the man, standing, trying to get his pants off to change himself.  He is a PD patient my God he could fall anytime! So i did what I think I had to do.  I told my patient on the opposite end of the room that I'll come back for her and went on to help B who wasn't my patient at all! I helped him change, wiped him clean, threw out the soiled clothes, etc.  I know I didn't do everything right and sanitized everything perfect, damn I din't even have gloves on.  But I did what I have to do eventhough it wasn't my job at all.  I mean, I am far from patting myself of the back and calling me hero, but at that time, it was the right thing to do.  As a consequence though, I lost 30 mins of precious time.  I had to cramp the schedule of the other three patients so I can go home by 530.  I did get their complete minutes but some minutes were overlapped which shouldn't happen cause it should be a 1:1 patient-therapist ratio.

I texted my boss about the incident and she told me I did the right thing and she will report the said CNA to whoever she called them.  I told her I don't want any trouble with anybody and I just want to do my work as peacefully as possible without any strife with anybody.  I'm sure if she finds out I complained on it, the CNAs will gossip amongst themselves how horrible, inefficient and stupid a PT I am, which I do not contest entirely. Bur argh the drama of this day makes it so unbearable.  And so...

For the first time ever, I went home and the first thing I did was open a bottle of beer and smoke a cigarette.  I have never drank a bottle of beer alone, nor smoked a cigarette straight from work here. Damn this was a looooooong day.

Old

In wine there's truth. In veno veritas. While this holds true, as we, the tanggeros, have witnessed time and time again, working here in the Land of the Free reveals a new truth to people.  Old age reveals how you lived your life.

I work in a skilled nursing facility.  This is like a halfway house between hospital and home or assisted living or hospice whichever is determined best for the patient by the family and careplan team.  In simpler terms, for example you have been hospitalized by a stroke.  You undergo treatment and acute rehab at the hospital.  When you are somewhat better they will send you to a SNF for further treatment and restoration.  It is then that it will be determined if you are capable and able to return to your home or not.  Well anyhow,  I am mostly dealing with the elderly and the first month that I am staying here so far, I am thinking that I could make this longterm.

Working with the elderly is a roller coaster ride.  It is not as easy as you imagine it to be.   Some come in as a ray of light amidst the gloomy winter sky, some come in as a blackhole of depression and hopelessness.  Overall, though, working with the ancestors of the modern world is highly fulfilling and it gives a lot of self-satsfaction.  What I want to talk about now though is that I have observed that old age unmasks the different life stories of people without them having to relate each and every experience they have.

I had a patient before who hated her husband (who takes care of her in the facility) so much she used to sob and sniffle during therapy.  She claimed she was married for 37 years, he was her second husband, and that 'that was 37 years of my life wasted'.  Sad ain't it, I later found out through chismis that during her hospitalization for multiple diseases significant of which is C-Diff, a highly infectious condition with contact precautions for all who handle the patient, as the nurses attempted to teach the husband how to take care of the wife, the husband reportedly said "No, there ain't no way I'm gonna take care of that shit".  What loving relationship that does make don't you think?

I had a patient who claims to be 102 sometimes 202, demented, slowly physically and mentally deteriorating who always laughs and make unique childish jokes during treatment.  She told me she was a nurse and worked as one for 63 years.  I didn't know if her 63 yrs was accurate, but she often told me she loved her job though it really didn't make that much.  You see, it shows.  When you love the life you had and you go on living with love and promise, it shows.  The light of your eyes reveals it all.

Old age may take away your strength, independence and state of mind.  It can never take away hope.  I resolve to myself, when I get old enough to develop Alzheimer's dementia, I won't be the brooding, angry old man who thinks the world is out to get him.  I will be the incoherent, playful and joyful demented client who has lived a life of joy and acceptance.  After all, when you're old and gray, there is no room to recount frustrations, dreams that will never happen and you will just take to the grave, or hatred for the world.  What matters is you have lived life to the fullest and believe me, when the day comes, without fail, it will show in the light in my eyes.