An emotional drain of a day

Ooh, I just love it when Blogger won't cooperate with uploading photos. Love it, love it, love it.

I've had a crazy day today where everything went wrong with my patients I've actually currently got, plus two patients who had already gone home. "M" was badly handled by a nurse yesterday morning apparently, and now fears retribution from the nurses if he complains-- I heard about it from his wife, and I am now obligated to speak to the matron (essentially Head Nurse)-- unfortunately what happens on the ward with nursing staff has a huge impact on progress in therapy. "F" is scheduled to go home tomorrow, and though I specifically said to the nurse at our multi-discliplinary meeting last week that she would be going home that day and an ambulance needed to be arranged to take her home, today we were told that the nursing staff had no idea "F" was going home, and no ambulance had been booked. "G" is a story of his own, which I will get into when I have the energy for it-- in a nutshell, he's a 52 (or 62, we're not sure which, he's got two different birth dates, I'll explain another time) year old man who's had a stroke, past medical history of heavy smoking and drinking for 30 years (read alcoholic), who still thinks after 12 weeks of rehab that he can go home and be fine on his own. Meanwhile he can't walk, but tries to get up every day and falls, is incontinent, and has absolutely no problem-solving skills, no safety awareness or judgement, and no insight as to capabilities and limitations. But he's very good at covering things up, so the psych has assessed him to have the capacity to make informed decisions. Wheeee. It's a long story, I'll tell it another day. Meanwhile, the son of a patient who was recently discharged was calling me up on the phone, telling me his father is impulsive, aggressive, shouts at everybody, and does things he knows he is not safe to do, now that he is at home. And he wanted me to tell him that eventually his father will be back to normal, and told me he thinks the sleeping pills his father is on are causing the aggressiveness and impulsiveness. The son apparently wasn't listening while his father was a patient, when we talked about the behavioral side effects of having had a stroke, and I don't think he really took it on board when I explained this to him again today. In addition, though our discharge plan specifically called for this patient to be set up for living on the ground floor, and the family agreed, the son told me on the phone today that his father has gotten up at least three times during the night and tried to go downstairs. What?!!! I said to the son, we agreed that your father would be living downstairs, he is not safe on the stairs, we had everything delivered that you needed to have him downstairs. And the son said yes, but we're currently having a toilet and walk-in shower installed downstairs, it's too messy for his bed. And all I could say was please, please, clear a space for him to sleep and for his commode, he cannot be upstairs, his behavior is not going to change, he will do things he knows he is not supposed to do, and all we can do is keep him as safe as possible bykeeping him on the ground floor! For the icing on the cake, though the family insisted on having this man back home, and stated that as long as there were carers to help with personal care, his spouse would always be home with him, and everything would be fine, the son was now saying today he wanted 24-hour supervision for his father. And I had to say I'm sorry, but you either have to pay for that yourself, or if you want social services (i.e. the government) to pay for it, he will have to go to a residential home.

Geez, it was like the hits just kept coming today. That's not everything, but that's enough for now.