Yep. My personal spiel on my first visit goes something like this: “My passion is education and empowerment. I want to teach you the things I went to school to learn so that YOU can take control of your health. I’m only here an hour a week. That’s more time than your doctor gets, but it’s still only an hour a week. You’ve got 6 days and 23 hours that are up to you. And at the end of the day, it’s your body and your choices. I know what’s likely to happen if you keep on the path you’re on now, and I can teach you about that. I also know a couple of other paths that I can shine my flashlight down for ya. Your doctor has a flashlight, I have a flashlight, 'cause we paid a lot of money to get our flashlights at school. But you’re the one who’s going to pick which path. I’m going to go home and hug my kids whether you keep your foot or not. No judgement, just reality. The only one who can fix this is you. And hey, I’m not perfect*. I like food more than I like exercise, and I know which path that’s leading me down. I’m working on it. And you can work on your path, too, if you want to. But I’m just the tour guide; you’re the boss.” (And by “you,” I’m addressing the family, as well. The whole family is my patient, most of the time.)
A few people find that threatening, and we don’t get on so well. That’s fine. We have other good nurses with other strategies, and I have no ego around asking my boss to reassign a case to a nurse who is better for that patient.
But most people start out looking guarded and are then beaming by the time I get to the end. Most people WANT to take control of their health, and they WANT to learn how their body works and what exactly their medications are doing. They’re just not sure how to do it.
And, y’know…sometimes people love doughnuts more than they love their feet. I can’t form a judgement around it or make it my problem. As long as they are mentally competent adults, that’s their choice. I just want to make sure it’s an *informed *choice.
That’s home nursing. Hospital nursing…whew. That’s a whole 'nother ball of wax. They really, honestly, don’t have the time. I don’t know how they get done all that they get done in a day. I can’t blame them for not taking another hour with each patient to carefully explain the difference between the mechanism of action of metformin and insulin. That’s complicated, and it takes time. If they’ve got just 6 patients, that’s half a shift just for medication teaching on two drugs. It’s just not possible given their environment and job duties. They need that time just to make sure people aren’t dying.
*I am, in fact, morbidly obese. It’s clear to see me that I don’t always make the best choices. People appreciate it when I admit that, too.
She also liked that Gila Monster spit, and with Obamacare maybe we can afford it. When she was working we were in that No Man’s Land between not being able to afford insurance (our companies didn’t offer it) and too rich for Medicaid. So, I see you are in Chicagoland. Do you work out by Lombard? Maybe we and BCBS could work something out.
While I concur with pretty much everyone here that your wife is her own worst enemy, I’ll admit that I’ve never understood osteopaths myself. They take that route to becoming doctors, then go on and on about how they are real doctors, just like MDs. If that’s true, then why didn’t they just go to medical school? There must be a difference, or why not just send everyone to med school? Osteopathic manual therapies have never been shown to be effective in double-blind studies, so in the US anyway, nothing an osteopath can do that is evidence based isn’t something a medical doctor can’t do as well. So why bother to be an osteopath, other than, I can’t help suspecting, to embrace some kind of woo.
I’ve occasionally seen these for sale at Aldi’s of all places. They show up in surprising places. Heck, check out good will, local flea markets, and yard sales.
But yeah, check out the “nurse’s closet” type places, too.
Not offended! Hope you weren’t either - honestly, sometimes when you write about your wife I get pissed off at her and I don’t even know her.
I look at someone like my husband who was born with spina bifida, probably had a stroke that went undetected at the time in his 40’s, suffers chronic pain every day of his life, and has battled diabetes for nearly 10 years now but is trying once again to start a business (part time, this time around, and with help from me) and gets his ass out of bed, walks as much as he can, and really makes the effort to take care of himself, including losing 40 pounds shortly after his diabetes diagnosis and keeping it off despite disabilities that make exercising problematic. I have friends who are actuaries who throw up their hands, laugh, and say according to their tables and data he can’t exist. Yet he is still trundling along
Then there are folks like your wife, and my late mother in law, who were given normal bodies at birth and treat them like crap. All my MIL had to do was check her blood sugar and take her medications. She didn’t. It was the cardiovascular complications that got her in the end, but she was on her way to foot and leg problems. I just wanted to shake her and get her to take care of herself but she simply wouldn’t. The only consolation was that I didn’t live with her daily and have to watch it daily.
One recent change I noticed, as the relative of several people with chronic health problems, is that the medical folks don’t always include the family as much as they should, all too often citing HIPAA. Not such a problem with my spouse, as he insists on me being the loop since his memory isn’t perfect, particularly when ill or under a lot of stress, but it would be very easy for him to leave me out of the conversation. Really, though, a patient is not an island (and when they are, it’s very sad) and the circle of family and friends is going to be part of the recovery/adaption process.
Anyhow - my sympathies for what you’re going through. I haven’t experienced your exact situation but similar enough ones I understand your frustration and anger.
It’s too far west to be in my personal territory, although if she had Medicare, I’d make an exception 'cause I like ya. (But I’m glad she’s not disabled enough to qualify for Medicare!) My company does service out there, but we only take Medicare patients at the moment; we’re not a BCBS provider.
You should definitely talk to her doctor and your insurance company to see if she is qualified for a home nurse for a short time. Private insurance carries varied requirements to declare someone “homebound”. Medicare requirements are that they have a medical condition which creates a “considerable and taxing effort” to leave the home and that their absences from the home are infrequent and of short duration. It doesn’t mean they never leave home, but that it takes a lot of effort. Private insurance may be more or less strict than Medicare.
If not, or in addition, see if you can get her a referral for a Certified Diabetes Educator or a Registered Dietician. They know even more than I do, and they’re fantastic. I know AD Medical does excellent home education related to diabetes and they serve your area; I do not know if they work with private insurance. Worth a phone call.
Definitely! Walgreens carries them, as well. Pay attention to weight tolerance and, er, width, however. Some of the cheaper ones are also fairly narrow, and won’t work for People of Girth.
Actually, you’d like her a lot. Most people do. She and I just have…issues sometimes, and because I overshare here you just see what I’m pissed about at the moment. None of it is inaccurate–if I quote somebody I work damn hard to quote directly–but it’s only part of the picture. The OP was a bit more rant than request for information, but the info and help I’ve received was needed and gratefully accepted.
Anyway, I have something new to make me angry! We went to Walmart for her first wheelchair outing, which went splendidly. She hates the chair we got from the Masons (On the one hand the awkward Illuminati thing but on the other hand they let us borrow a wheelchair.) because it’s so big and heavy (leaving aside that she’s recently become bigger and heavier than she will accept), but I’m having trouble finding a place out here where we can rent something sportier. Anyway, it went well, but then I couldn’t get the car started. By the sounds of it it’ll need a new starter. (“What’s wrong with the car?” “Listen,” and I turned the key. She said, “Needs a new starter.”) When it rains it pours.
Coincidentally, my spouse went off on a tirade about wheelchairs just this week. He used them extensively until he was about 9, so he knows something of the topic as a user. What it comes down to is that the people designing them are seldom if ever end-users themselves, commercial manufacturers tend to be restricted by a variety of rules imposed by the people who pay the bills - that’s Medicaid/Medicare/the VA/various insurance companies - and those people in turn tend to slant towards worst-case patients and CYA.
Nothing new - this is why FDR made his own wheelchair by sawing the legs off a kitchen chair and slapping wheels on it.
Most wheelchairs, but especially loaners, are heavy and awkward. They also require some upper body strength to operate, which can be a problem for debilitated people, especially women.
That’s true, and if an engineer can’t close her eyes and visualize using the product so completely that she doesn’t sometimes (often) say, “Oops! That needs to be changed,” then she should ask the users. Which includes both the person in the chair and the person pushing it. ETA: But ask the users, anyway. And try the prototypes yourself. And so on with the Basic Rules of Engineering.
Shopping to buy, rather than rent, I found this. Base price just twice the deposit on the tank she has now; with the options I understand she wants it’s just $171. Even if she stops using the chair soon, she’ll need it again when she gets the skin graft. This is fun, like car shopping.
