Hold on Tight

Alternate title: Why Social Work Will Take You on the Ride of Your Life...Every Day

I mentioned that Friday was a crazy day, right?  There are many reasons why a day in the life of a hospital social worker can be crazy.  But Friday was a particularly special kind of crazy. 

Not only did I have multiple discharges to arrange (which means making referrals, finding an accepting facility, getting insurance authorization, setting up transportation, and communicating all of the above to the patient and family), but I also had a patient who refused to do anything without my "permission" (more on that in a minute), and a psych placement.  With out-of-area insurance.  Who was refusing to go to inpatient treatment, despite the fact that she was under involuntary committment and therefore legally couldn't refuse.  It's unnerving to have to tell someone, "I'm sorry, but, um, tough shit, you're going to get on that ambulance stretcher and go to treatment."  Legal committment or not, it's not pleasant to force someone into treatment.  We actually had to call security at one point because she threatened to walk out.  I had to stand there and have a discussion with her about the fact that she was being committed against her will and she had absolutely no choice in the matter.  Not. Fun.

But that's not the part that made my day so roller-coaster-y.  (Yep that's totally a word).  I had another patient who, when he first came into the hospital, you could not have a rational conversation with him.  He was delusional and paranoid.  I know, it sounds like I work on a psych floor, doesn't it?  I promise, I don't.  He was delusional due to a medication toxicity - he'd accidentally/unknowingly overdosed on one of his home medications, and it caused him to go a little wacky for a bit.  Once his toxicity level came down, he calmed down and was able to have a real, meaningful, purposeful conversation. 

This patient had been (through his perception) abused by the system his entire life.  He was distrusting of everyone in the hospital.  He threw several doctors and nurses out of his room.  The first time I met with him, I had to walk away because he was so abusive.  But somehow, I got through to him and he grew to trust me.  He felt like, for his whole life, he'd been promised things that were never delivered.  I did what I told him I'd do, and I think he felt like he finally had someone on his side.  He needed help at home but refused to sign the paperwork necessary to get the help at home because a) he is illiterate and b) he was afraid they'd take his house (a very common misconception, unfortunately).  Once I explained everything to him, he agreed to have the caseworker come back and to sign the paperwork...only if I was present for the meeting and explained anything he wasn't sure about. 

So I was and he signed everything.  It was kind of a proud moment for me.  As a social worker, it is incredibly fulfilling to know that you gained the trust of a man that so few others could not.  He signed the paperwork.  He agreed to go a nursing facility for rehab ("for one week!"), even though the facility that accepted him was outside the city.  I had everything arranged for him to go on Saturday.  I left work exhausted but feeling like I had done some real social work. 

I came in this morning and received a voicemail from his insurnace company saying that he'd never arrived at the nursing facility.  I called the facility and they told me that they'd received word that he'd left the hospital AMA, meaning Against Medical Advice, before his discharge.  I checked the chart and, indeed, he had signed out AMA. 

I have to admit, I'm a little heartsick over this.  I thought I had done some real work.  I thought I had made progress and made a difference in this man's life.  I thought we had a deal.  The nurse practitioner who was on service the day of his discharge is not here today, nor is the nurse who discharged him, so I can't find out what exactly went down until later in the week.  I ended last week on such a high, and this is a pretty major blow.

In my heart of hearts, I know that I do good in my job.  But things like this make it hard to see the forest for the trees.

Man-Candy Monday

Happy Monday, lovers!  Hope you all had a great weekend.  We had a blast at the circus on Sunday, even though it was chilly.  And Saturday, well, I guess we all survived the end of days.  Or whatever that was supposed to be.  Which is kind of nice.  I kind of like my life.

But you're not here to hear about my weekend, are you?  Ok, well, ready for some yummm?

 

 

Mm-mm-mmh.  Bradley Cooper.  He randomly appeared on Saturday Night Live tonight, and despite the fact that Matt was sitting right next to me, I couldn't help myself - I squealed.  Like a 10 year old girl.  "EEE!  Oh my God, it's actually him," she said, breathlessly.  You'd have thought he walked into our living room.

He's so hot.

Link up and join in the fun!

*all images from google

Fun Fact Fri(Satur)day

Yesterday was an absolutely insane day at work, and by the time I got home (2 hour late), I was so wiped, all I could do was collapse on the couch and have a glass of Bailey's on the rocks.  So I didn't get around to Fun Fact Friday, even though I totally knew what I wanted to write.

Matt and I are going to circus tomorrow!  Assuming, of course, that we survive the whole end-of-the-world-as-we-know-it hoopla.  It's the annual LuLu Shrine Circus.  I've wnated to go for several years, but just never got a chance to.  This year, I had a 1/2-off offer and we actually had a (semi)free weekend!  So we're going.  

(source)

The LuLu Shrine Circus is near and dear to my heart not only because it's a circus (and who doesn't love a circus) but also because it's put on by the LuLu Shrine Temple.  What does that mean, exactly?  It's run by Shriners.  Ok, aaaannnd?  Well, I used to work for Shriners Hospitals for Children, and since then Shriners Hospitals has been my pet charity.  I donate money every paycheck through a direct deposit to Shriners Hospitals.  I donate all our soda can tabs to Shriners Hospitals because they recycle them and use the money to buy equipment for the hospitals.  Shriners is very very important to me. Read more about Shriners Hospitals for Children here.  It seriously is totally free care - regardless of income and insurance - and it's amazing care.  The things I saw when I worked there were so inspiring.

Anyway, every year, many Shrine temples around the country put on circuses or other such things to raise money for the hospitals.  The LuLu Shrine is the Philadelphia-area Shrine temple.  In Hershey, it was the Zembo Shrine, and I grew up going to the Zembo Shrine Circus before I even know what the Shriners were.

So, for this week's Fun Fact Friday, here are some fun circus facts!

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~ A basic balancing act = a base to lift/catch the flyer + a flyer to perform skills in mid-air + a spotter who assists the flyer.  We used the exact same terminology in cheering.  I was one of the lucky ones who did all 3.  (c:

~ Cary Grant started his career as an acrobat in a circus

~ It is statistically harder to get into Ringling Brothers School of Clowning than into Harvard Law School.

~ Sousa's march, "Stars and Stripes Forever," was usually played to quickly alert all circus personnel to an emergency in the tent (sound familiar, Water for Elephants readers?)

~ Human cannonballs travel at 60-70 miles per hour.  So the next time you're driving down the highway, imagine not being in a car.  Yikes.

~ The first circus in America was put on in Philadelphia (woohoo!) in 1793.  George Washington was in attendance.

~ The hamburger was born out of necessity at a circus in 1892 when a food concessions manager ran out of link sausages and instructed his assistants to grind the meat into patties.


~ July 4, 1944 - the tent at the Big Show catches fire.  Dozens are injured and killed.  It's the first big tragedy to happen at a circus.  Six officials were sent to prison.

~ Ringling Brothers Clown College started accepting female applicants in 1970.

*fun facts from here and here

Freebie List

I'm jumping the bandwagon with Jessica and Steph.  Seems a little blog party is making the rounds based on the Friends episode where everyone discusses their Celebrity Freebie List - the top 5 celebrities they're "allowed" to cheat on their significant others with.  Matt and I have had this discussion before.  Or, well, basically, I've told him, "Honey, if he ever shows up at our front door, you'll just have to forgive me."  So who did I say that about?  Here's my Freebie List (I haven't laminated it....yet):

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Bradley Cooper.  That smile.  The messy hair.  Those abs.  He's just delicious.  He was filming in Philadelphia a few months ago, and - I'm not gonna lie - I seriously considered calling out of work so I could go find him. 

(source)

Adam Brody.  AKA, Seth Cohen (on The O.C.).  His devotion to Summer, loyalty to Ryan, and relationship with his parents were just adorable.  And the wit and charm?  I die.  I loved Seth Cohen and said many times that I'd marry him if he were real.  Apparently, Adam Brody pretty much is Seth Cohen.

(source)

Josh Holloway.  Seriously?  How hot was Sawyer?  With the accent and the abs and the hair... oh boy.  And remember when he wore the glasses that he made?  Love.

(source)

Ryan Kwanten.  Oh. Em. Gee.  True Blood is not lacking in pretty things to look at, but boy oh boy, Ryan Kwanten is certainly a highlight!

(source)

Jared Leto.  Be still my 14-year-old heart.  In 1993, if you were a girl and didn't love Jordan Catalano, you may not have been alive.  He's still gorgeous today (even with his eye makeup). 

So?  Who's on your list?

Rant

Do you ever have one of those days/weeks where everything and everyone just seems to be out to piss you off?  Maybe this is one of those weeks for me.  Or maybe I'm just feeling extra-sensitive - it's a full moon and I have my period.  The two most wacktastic times of the month are in full alignment for me this month, and it ain't pretty.  I feel cranky, tired, annoyed, and fat. 

The way things are set up in my hospital is that the social workers are in the department of Clinical Resource Management.  This means that we are in the same department as the nurse case managers, who do the insurance reviews to make sure the hospital gets paid.  When I first started here, over 4 years ago, the social workers did all the discharge planning - set up home care, ordered equipment, arranged placements, setting up transportation, ordering medications...it was a lot, and things fell through the cracks.  We were totally overwhelmed.  About 3 years ago, the set up changed a little bit in that the home needs fell to the nurse case managers, so now they do the insurance reviews plus arrange home care and order equipment.  The theory behind this was that it would provide the social workers more time to do what we're trained for - to provide supportive counseling for patients and families.  It hasn't done that, but it was a nice thought.

Anyway.  Where I'm really going with this is that it can be very difficult to be paired with someone whose job is basically about the bottom line.  The case manager's job is to make sure we - the hospital - is getting paid.  Which means they have to find reasons to prove to the insurance companies that the patient needs to be in the hospital.  If the patient no longer meets "hospital level of care," it's time for him/her to go.  They also have to make sure that the patient's discharge plan is "safe," which sounds very altruistic and lovely, but really, it just means they need to make sure we're doing everything we can to keep the patient from getting readmitted, because if a patient comes back to the hospital within 30 days for the same reason, we (the hospital) don't get paid. 

While I understand that making sure the hospital is getting paid is important (I'd like to keep getting a steady paycheck, too), my first priority is to see that the patient's rights are being respected and upheld.  And this is where the social workers and the nurse case managers fall off the same page.  And me and my nurse case manager?  We may as well be in different books.  Social workers operate based on a core code of ethics and values.  The biggest one of those is to support the patient/client's right to self-determination.  And I take that value very seriously.  I feel like it is my job to advocate for the patient's right to make her own decision (so long as the patient has the mental capacity to do so).  If the doctors recommend placement for a patient, I am happy to discuss it with her.  But if she tells me that he wants to go home, that's her choice.  My job is to provide patients with the knowledge and choices to make an informed decision.  After that, it's up to the patient.  And we have to respect that, whether or not we agree with it.  Everyone has the right to fail.  But at least they failed with their dignity in tact. 

My case manager and I butt heads on this a lot.  And I get very frustrated with her very quickly.  She is constantly trying to get involved in cases that I am working on.  If I have established a relationship with a patient or family and am working with them to help them make a decision about home care services or rehab placement or (and this is my pet peeve!) hospice services, but the family is not deciding fast enough, she gets involved and puts pressure on me and on the family.  It's completely inappropriate and it makes me really angry.  I have discussed it with her and with our boss, but it never corrects.  It's her personality and unfortunately, my personality is the complete opposite.  We do not work well together and it's very difficult.  I am currently in discussions with my boss, who has just hired someone new, to change up the assignments a bit and put a new nurse case manager on my floor.  It's not a healthy work environment for either of us, and I fear that we do a disservice to our patients because we're so frustrated with each other.  But I worry that because she's so busy undermining me and then I'm trying to clean up the mess she inevitably causes, we're just confusing and frustrating the patients.  And as far as I'm concerned, it's ok to piss me off, but when you start affecting my patients, then it's not cool anymore.  I am here, as a social worker, to fight for my patients and to support their wants and needs.  If someone is interfering with that, it offends me. 

There are many other things about our working relationship that frustrate me.  She sends me emails throughout the day, telling me things about my patients that I already know because I've already established a relationship with them!  She makes inappropriate remarks about our patients.  She tries to drag me into situations where I do not need to be.  She tries to pawn work off on me.  She tries to make me feel guilty when she stays late and I leave (relatively) on time [somehow the fact that she sits around and gossips with other staff rather than getting her work done means I should be helping her out].  Luckily, my frustration (and let's face it, disdain) with her does not outwardly show, thank goodness (I asked a friend of mine who used to be a floor nurse on our unit). 

What do you think?  How do you deal with coworkers who you just cannot seem to mesh with?

Me-Time

I had a great weekend, you guys. I hope you all did, too.  Matt was away, visiting a friend of his in Maryland, so I had a girls' weekend.  On Friday night, I stayed in and had a night to myself.  It was the first time in a really long time, and it was quite lovely.  I love my husband, but every now and then, a girl needs to have a couple glasses of white wine and watch some chick flicks.  First I caught up on 2 weeks' worth of Nurse Jackie and The United States of Tara.  Do you watch those shows?  They're absolutely fantastic.  Toni Collette, as Tara, is phenomenal.  Seriously.  You should watch it.  Then I watched Easy A.  Emma Stone was cute enough, but for me, Stanley Tucci stole the show.  He played the father and he was hysterical.  After that, I watched Once.  What a beautiful film.  If you like music, especially organic, raw, beautiful, acoustic guitar music, you must watch this movie.  It actually made me cry.

Anyway, on Saturday, my friend Nicole came down.  We had a lovely day.  We spent a few hours at my house, just catching up and gossipping.  We also went to get our nails done.  I had hoped we'd have time for mani-pedis, but we chitchatted at home for too long, and only had the time to get manicures.  I chose a color that was way out of the ordinary for me:

Purple with a Purpose

Yeah, it's bright.  But I kind of love it.  I went in wanting a dark grey, but I'm glad I went with this.

After our manicures, we went to see Bridesmaids.  Really funny.  You guys should go see it.  At one point, I laughed so hard I was in tears.  Kristin Wiig is adorable and I just love Maya Rudolph,  And what's not to love about a movie about a bridal party gone horribly, hysterically awry?  I really enjoyed this and give it "two very enthusiastic thumbs up, fine holiday fun!"  [name that movie]



Wanna know something funny?  Half of this stuff wasn't in the actual movie.  Anyway, the movie was over and we were starving.  Initially I'd planned for us to go into Center City for some dinner and drinks, but it was raining and neither one of us felt like walking around the city in the rain.  So we opted to stick around where I live and ended up at the Melting Pot.  YUM-O.  Did you know that even if you don't have a reservation, you can eat right at the bar?  Yup, they have fondue pots right at the bar.  Awesome!!!

Sunday rolled around and I ran a few errands and then got dinner going in the crock pot while waiting for Matt to get home.  Sunday night we watched The King's Speech, which totally lived up to the hype, in my opinion.  If you haven't seen it, see it. 

Yeah, this was a movie-fest weekend for me, but I really needed it.  Work has been crazy, and I feel like I've been going at 180% for weeks.  My body was really craving this down-time, so it came at a perfect time.  What do you do with your "me-time?"

Man-Candy Monday

Selma, over at Crazy Little World of Mine, has been doing this for the psat couple of weeks and I've been thoroughly enjoying it.  I mean, what's not to like about spending a few minutes of your Monday morning gazing at cute boys?  Right?  So, I'm linking up and joining the fun.  My first Man-Candy?  Brandon Boyd.  The lead singer of Incubus.  He is just. so. pretty.  Take a few moments and soak in the yummyness.

Mmm.  Isn't he delicious?!  (all images from google)

It's a blog hop, so link on over at Join the Gossip to start your day off with something pretty to look at!