Just A Day

Mar. 24th, 2017 06:50 pm
ladysprite: (new)
[personal profile] ladysprite
At this point, I've transitioned to doing hospice pretty much full-time. I still do relief work maybe one day a week, but I may be dropping that after this summer - I'm keeping busy enough that it's possible that relief time is cutting into my time to care for hospice patients, rather than giving me something to do when I don't have any hospice work.

Anyway, I realized that I haven't ever taken the time to write down what a regular hospice day looks like for me. So, just for the sake of anyone curious, and for my own posterity.....

My first appointment, at 9am today, was a follow-up on one of my palliative care/geriatric patients. It was also, luckily, my only semi-distant one, and I managed to schedule it so I'd be driving in the opposite direction of the rest of morning rush hour.

Pet and family are doing pretty well - she's a lucky pooch who's responded well to minimal interventions, and the only real challenge is encouraging her people to keep up with the long-term meds and supportive care. Today's visit was mostly to track one or two of her chronic low-grade problems, as well as make sure that her pain was still well-managed; we got some lab samples and made a plan, if everything is good, to follow up in another 8 weeks.

Home, then, to package up the samples and call FedEx for a pickup - I hate their phone maze, but I've at least gotten the process down to a routine now - and back out to my next visit.

This one was a post-intake follow up for a hospice patient with a more serious diagnosis; today's visit was mostly to make sure the pet is stable and that the people are getting the support they need. They're facing a rough diagnosis, so they need a lot of education, reassurance, and emotional support. I also put together an emergency med kit for them, and trained them on how and under what circumstances to use it.

Break time after that; just long enough to run home, make a sandwich, and write up my charts from the first two cases. Lunch is one of the hardest things to manage; there are days when I stuff a PB&J in my purse on the way out the door in the morning, but today I timed things right.

Then out the door to my next visit, an end-of-life call. This is the first time I'm meeting these clients; they're not existing hospice patients, so there's a bit of getting to know them and talking through how they want it to play out (pet in their lap, wrapped in a favorite blanket, blanket to go with the pet afterwards); luckily everything is smooth other than a pinch of discomfort from the pet when I give it the first sedative. I check my GPS after; I have just enough time to run home before my next visit. Thank goodness; I always feel bad if I have to keep a pet in the car with me.

So back home - a lot of back and forth today; luckily everything is close to home - to take care of the pet from the last visit. Pawprint made, labels labeled, crematory called, and back out the door again.

This visit is more fun; it's another one of my palliative/geriatric pets. He's usually cranky as anything, but he seems to be getting used to me. Much to his caregiver's surprise, he takes a treat from my hand, stands still for his nail trim, and tolerates his exam with a minimum of stress. We still use a muzzle just in case, but he lets me pet him after, which is a victory. Unfortunately, his arthritis is progressing, but we make a plan to add a new pain medicine into his protocol; I write the script and the caregiver promises to follow up with me in a week to let me know how he's doing. If everything is good we'll schedule another visit in a month so I can put hands on him and see how he's responding.

At this point my schedule says I'm supposed to go to circus class; unfortunately, while DayQuil is keeping my bronchitis down to a nuisance level, I've noticed that walking up a flight of stairs is still enough to wind me and leave me coughing like crazy - an hour-plus of hard exercise is likely a bad idea. I decide that skipping class is more wise than lazy, and call my 8pm client - would they like me to come earlier?

They would. This is the saddest case of the day, another end-of-life call. They're not existing hospice patients, but I've been talking to the caregivers for most of the week, planning and preparing for this visit. They initially weren't certain that it was time, so this was originally planned as a possible hospice intake, but things have progressed and they're certain that it's time to say goodbye.

I head straight to their house from my last visit, and once I'm there go over the plan that we had put together by email. I'm lucky today; this one goes smoothly too. Thew caregivers have their own plan for caring for the pet afterwords, so I help them wrap and prepare her, and let them know to call me if there's anything more they need.

And then, finally, home for good. Time to lock up my meds, log the controlled substances I used, write up the last three charts, get the day's payments into quickbooks and the paperwork scanned into records, and write cards for the patients who passed today.

....it's a long, long way from where I was two years ago, or even one. I'm not sure I ever actually imagined being this busy and full. But it's pretty amazing...
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