Random Thoughts For Late June 2011

After not having an entry for a couple of months, finally another edition of random thoughts.

I wanted to open a bottle of wine last week so I went to get my corkscrew from where I usually get it from – a drawer in the kitchen. Well, it wasn’t there and I searched high and low, even in unlikely places, but I couldn’t find it. I must be getting forgetful, having more senior moments, or worse, developing dementia or Alzheimer’s disease. I finally had to use a very old rudimentary cork screw, the one with a piece of steel attached to a piece of wood. I didn’t have to resort to my imitation Swiss Army knife with a corkscrew after all. The next day, I bought a new one at the 99 cent store but it wasn’t the same as the one I lost. I’ll probably find it one of these days when I’m looking for something else. Either I lost a corkscrew or lost my mind. You pick.

While at the 99 cent store I noticed a product called Sunny Acres Flavored syrup for coffee. Hmm ,no calories. Sounds like a retirement or nursing home doesn’t it? ! I have a couple of bottles at home now: French Vanilla and Hazelnut. Goes very well with my instant coffee.

Our condo association is making it more unaffordable to own and live here. They have been increasing our monthly dues 10% each year for the past three years. I can barely afford to pay the mortgage anymore. They work the same way as the government: tax and overspend.

Observations on store bought salads: Reser’s potato and macaroni salad taste like what my mom used to make while Kroger brand tastes like what grandma used to make. The first one is more tangy while the other sweeter.

This from a news item I read on the web: alcoholics in Australia confined in hospitals are drinking the alcohol based hand sanitizers which are available all over the building.

I finally retired the Sorbothane cycling gloves I’ve had since the early 80’s which I’ve been using to lift weights in recent years. The Sorbothane gel had disintegrated and was staining my palms.

Ever noticed in grocery ads that when they have a sale on hot dogs, there is usually no corresponding sale on hot dog buns? Goes the same for hamburger patties and buns. Unless of course it’s the Fourth of July, then all of those are on sale.

Noticed at the 99 Cent Store: 4 port USB hubs for what else? 99 cents. You can find Iphone and Blackberry skins there too.

I can’t decide whether to immobilize my left ankle or keep on doing flexibility exercises on it in an effort to promote the healing process.

The other night a patient came up to me asking for an extra pillow because her roommate was snoring. I asked her if she was planning on putting the pillow on her roommate’s face. (Similar to gallows humor, but in a psych unit.) Thankfully she said that she was just going to use the pillow to cover her own ears.

Last week, a psychiatrist was looking for a patient. The patient was taking a shower but since the doctor was in a hurry to leave, he conducted what I would call “shower therapy”. No, he didn’t join the patient in the shower. Rather, they talked through the shower door for a few minutes.

I just realized that when I turn 55 next year, I would qualify to be admitted to the geriatric psych unit if ever it came to that. I should bring my own earplugs so I don’t have to smother a snoring roommate. Don’t even think about doing shower therapy with me!

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NOC Shift BHW Duties and Responsibilities for South Campus (Revised 6/23/11)

Since I don't have anything else to write about, this is what I'm going to post. Ever since my job switched to electronic medical records a couple of months ago, some of my duties and responsibilities have changed and/or have been rearranged. In 2006 I independently made an orientation checklist for new Behavioral Health Workers (or mental health workers) and also as a reminder for old ones in case they have forgotten what they have to do. The checklist below shows the current responsibilities shared by all BHW's.

*Get report from day shift.

*Q-15 minute checks on all assigned patients.

*Pass out snacks at 8:00 p.m.

*Monitor free phone calls at 8:00 p.m.

*Vital Signs – all patients need orthostatic vital signs taken at start of shift. Make 4 copies afterwards and give one to Team 1, 2, and 3 RN’s and Med Room.

*Chart vital signs, nutrition, and ADL’s in Cerner Powerchart.

*Put stickers on Close Observation (Q15 minute checks) Sheets

*Check stickers binder first to see if it is up to date: contains all the patients names in them and in the correct rooms. If any are missing, check the charts if there are some in them. If not, ask the charge nurse to print some out.

*Mark precautions (everybody is automatically on Fall Precautions), write in date and room number of both sides of the Close Observation (Q15 minute checks) Sheets.

*Update Roster (South Campus Combined Precautions Diet Meal & Shower Log) with patient names, precautions, and diet then print out to put on clipboard for day shift.

*Update Goals and Reflections sheet then print out to put on clipboard for day shift.

*Update South Campus NEW Orthostatic Vital Signs sheet for NOC shift.

*Update VITALS-Sherrie Version for A.M. shift then print out to put on clipboard for day shift.

*Monitor smoke breaks at 9:15 p.m. and 6:45 a.m.

*Turn off phones and close dayroom for housekeepers to clean at 10 p.m.

*Insert forms from chart packs in empty chart binders in preparation for new admissions.

*Assemble new chart packs

*When the chart packs in folders run low in the basket, put in new packs in folders and refill the basket.

*Admissions: Check vital signs, height, and weight. Have patient sign forms then witness them. Inventory property and call Security for valuables to be placed in the safe. Orient patient to unit.

*Check showers for items left behind by patients like: soiled towels, gowns, pajamas, empty plastic bottles.

*Assist patients with ADL’s as needed

*Assist with laundry as needed.

*End of the month: Denial of Rights sheets – make new ones for each patient by filling in Month, Year, Medical Records Number and Legal Status. File each under Graphics divider in chart. Tear off white copy from the previous month and place in case manager’s filing tray.

So there you go. This is my job and that is what I do. Oh, and talk to the patients of course.

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A Fortnight of No Walking and Blogging

Oh well, I haven’t posted anything in more than a week which is my longest drought since I started this blog. Just lazy I suppose or nothing to talk about, more likely. Ideas must be running dry. Notice how I managed to add “running” to that sentence?

First, a freak injury which sidelined me for more than a week in which I had to hold off from walking. It was more about overstretching an already injured or weak tendon, that being the left posterior tibialis. I was trying to keep awake or warm one night at work and was doing squats. The first few sets were okay but when I tried to do faster repetitions, that’s when disaster struck. I guess I didn’t control my legs too well and I overstretched to tendon mid squat. I was hurting the whole night and even though I avoid taking analgesics other than a daily aspirin for heart health, I had to take Motrin for pain relief. After that I had to limit myself to stationary cycling for exercise for about a week and a half.

Second, I missed participating in the Wrigley River Run this year (I ran it the past couple of years) because I had to attend a mandatory Management of Assaultive Behavior class on the day of the race. Renewing it annually is a requirement for my job and my certification was supposed to expire the day after the class. Even if I didn’t have to attend the class, I would have missed the race anyway due to the aforementioned injury. There were physical movements involved in the class and I tried to limit myself as much as possible due to the ankle pain.

I tried walking again on the treadmill when the pain subsided last Thursday morning. Normally I would have gone to 10% incline within the first five minutes of the workout and at least 3.5 mph and gradually increasing it up to 4 mph. That may sound slow, but remember it’s an uphill walk all the way. Well, on my first day back to a walking workout, the best I could do was 7.5% incline (which I didn’t even reach until about half an hour into the workout) and 3.5 mph. It was good enough for that day and besides, I have to save something for Saturday’s AREC workout.

And that brings us to Saturday. My alarm woke me up mid-dream at 5:00 a.m. and my first thought was - do I really have to do this?. After all, it’s too soon to try a six or eight mile walk after not having done so for almost two weeks. I banished the thought and got up, prepared myself for the task ahead, then headed to our meeting area. That day, instead of starting with the group I left about 15 minutes early to get a head start before they caught up with me. Normally I would do a mile warm up, then start with the others. I incorporated the warm up with the whole workout this day and instead of doing six miles (for the half marathoners) or eight miles (for the full marathoners), I did an in between seven miles. I tried a few steps of jogging while I was at it, but the left ankle felt very tight, as if it was about to tear. So I went back to walking and didn’t try to push the pace even at that. It was brisk but not as brisk as the 13:30 to 13:45 pace per mile I did in previous weeks. I managed a few short jogs in the last three miles which was probably not a good idea, but the ankle felt okay when I finished. I’ve mentioned this before in my posts: once the endorphins kick in, the analgesic effect lasts for hours and the pain feels diminished. It wasn’t until the next day that I felt it really badly. Rest, Ice, Compression, and Elevation were of little help. Fortunately, when I left for work the pain had subsided probably because of the increased circulation in that area. Now, it’s a wait and see to figure out when I can do a walking workout again. Stay tuned.

Things noticed during the above mentioned walk: swim trunks are similarly cut and just as comfortable as running shorts for workouts and much cheaper too. I never knew there was a lifeguard museum in Long Beach. It was housed in what was not more than the size of a snack shack. That’s what happens when one has a meandering pace. You observe more things than when you are running breathlessly. When I took off my shoe when I got home, I found a piece of jacaranda flower in my shoe. The search for a runner’s high even when it pain is not such a good idea, but runners (or in my case: ex runner) do it anyway. Nuts, I say!
And as an addendum: In the last mile of my walk, one of the long time runners from the AREC club passed me and said "I couldn't do 21 years of running every day like you did". Thanks for making me laugh and smile Bernard! I responded - I couldn't even do 5 minutes non stop nowadays! With that, we continued on our way to the finish. Since that running streak has been long gone, sometimes I forget nowadays that it even happened.

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The Soreness of an Infrequent Runner

You’ve heard of The Loneliness of the Long Distance Runner which was one of the books that started the first running boom in the 70’s. I have not read it and neither can I identify with it since in my case, it has become the soreness of an infrequent runner. Please allow me to explain. If you have been reading my blog recently, you would know that I do power walking now when I train with my running club - A Running Experience. Last Saturday morning, I was feeling a little frisky after doing a three hour walk two days prior so I thought I’d try to do a little jogging. I did my usual one mile brisk walk warm up then set my GPS watch interval timer. The plan was to jog for two minutes then do a one minute recovery walk. With a bit of delusional thinking, I thought I could keep up with some people whom I’ve run with before, at least during the first two minute interval at the start. I was woefully mistaken when reality struck me in the face after I saw that those people had gotten much faster since I last ran with them. That, plus the combination of me having gotten so slow. No matter. I kept plugging away and didn’t do the walk break after two minutes and numerous more times thereafter. I mentioned in my previous post that I didn’t sweat very much during the three hour walk. Well, within the first five minutes of slow jogging, perspiration was dripping down my brow. I kept shuffling along not knowing how far I could take it before my ankles start to protest. When my stride became heavier at about 3 ½ miles, I decided it was time to do the walk breaks, but not until I reached 4 miles. A couple of people passed me at that point which was a surprise because I thought I was again the last runner. The one minute walk break ended and I started jogging again but this time I opened up my stride a little bit until the two minute alarm told me to do another one minute walk break. During the two minute run, I would catch up with one or two runners and they in turn would pass me on my walking breaks. This pattern kept on for the last 3 miles of the 7 mile route.

                Let me tell you how it felt to open up my stride for those two minutes of running: it was two minutes of pure bliss at a time which made me feel like a runner again. Look at the picture below with the forward lean while I neared the finish. Do I look like a runner? LOL! And of course look at the picture above with the more upright posture near the two mile mark when I was just shuffling. Oh by the way, those runners going the other way were from another training group. (Thanks to our intrepid and speedy club VP - Dave K., who runs all over the course to take these pictures.)

                So how does the title of this post fit in? Well, as can be expected, when you don’t do a certain activity often enough, you feel soreness in your muscles and joints afterwards. What surprised me was that I didn’t feel as sore as I expected even though I had to work the next couple of nights. But oh, boy was I tired Saturday night and it took every ounce of energy to keep myself awake while on the job. As far as my muscles and joints? I lucked out this time because the soreness was minimal.

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A Slow Blur of a Birthday Walk

         So I turned 54 a few days ago and like last year I got greetings for two days because my friends in the Philippines and similar hemispheres are about 14 hours ahead of U.S. time. Since I was off from work those two days, I managed to individually thank all those who greeted me. Click the “Like” button and say thank you. But enough about that. For some reason I woke up very early on June 2nd and since I didn’t have anything better to do, I thought I’d go out for a long walk, perhaps in the two hour range. It didn’t turn out quite that way even though I turned around after going out for an hour. I did some meanderings into some neighborhoods instead of heading directly back home and that added another hour to the whole jaunt.
This was not one of those arm swinging, hip swiveling, face paced walks which I had been doing on Saturdays with AREC. It was more leisurely. In fact the first couple of miles were in the 17 minutes and 20 seconds per mile range. The pace picked up ever so slightly in the miles that followed but it was never forced. I hardly broke a sweat, certainly not on my brow, and just a little bit on my back. Maybe because it was a cool morning and I started early. I can’t really describe the sights and sounds of this experience because it was mostly a blur to me. My mind doesn’t quite work very well that early.
I used to do these long jaunts years ago during special occasions like New Year’s day, my birthday, 4th of July, etc., but I did it running and not more than two hours. I don’t know what came over me that I extended it to 3 hours this time. Maybe to prove that I can do it or to see what distance I can cover on an easily paced walk. I ended up with 11.35 miles at an overall pace of 15:52. If I went another half hour, I would have done a half marathon!
The aftermath of that long walk? From the shins up, everything felt ok. Below that, my ankles hurt, but not so badly. So maybe if I can keep my ankle tendons as they are come October, I just might be able to finish the Long Beach half marathon. The only question now is: walk more briskly so I can get to the finish line faster but with more pain on the ankles, or walk like I did on my birthday and get to the finish line longer but with less pain?

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Back To Basics - A Uniform and Group Therapy Mandate

          Starting June 1st, our hospital has mandated the mental health unit staff to start wearing nursing garb, i.e. scrubs. We’ve always had to option to wear those instead of the civvies that has been standard wear for psych units for decades. One of the reasons why out administration decided to do this was because they wanted to eliminate the wearing of hoodie sweatshirts. I guess they finally got a clue that people wear hoodies so that the cameras that surround the hospital hallways cannot identify them. As I post this, I would have been wearing my uniform the previous night.
Another thing our bosses wanted us to do was group therapy on the night shift. That would be difficult to squeeze in between the time we report to work at 7 p.m. and 10 p.m. when the patients go to bed. I commented facetiously during a staff meeting that maybe I could conduct group therapy while passing snacks at 8 p.m. Pass the patient a snack and ask him/her how the day went and if he/she met her goals for the day. If not, what he/she could have done better to achieve those goals. In the meantime, the rest of the hungry masses (and they are always hungry) wait in line for their turn. Then a group riot ensues… Just stating the worst case scenario.
In reality, this is how the night shift schedule works out: at 7 p.m. we report for duty and until 7:30, we listen to report from the day shift. At 7:30, we do our rounds, check on how our assigned patients are doing (first we have to make sure that they haven’t run away, and are still alive). The mental health workers do this while the RN’s talk to their patients. It is also in this span of time that patients get visits from family and friends until 8 p.m. The LVN’s on the other hand are getting the medications ready for the evening. At 8 p.m. we serve snacks to all the patients. They line up in the dining room and we pass out whatever the dietary department left for snacks: sandwiches, or fruit cups, or yogurt, plus juice and milk. This can be quite chaotic since everyone wants their share plus more. Some patients want a second helping even when the others haven’t had their first helping yet. Also at 8 o’clock, we offer free phone calls on the hospital phone and there is another queue in the hallway for that. Some patients do their phone calls first, then come to the dining room to get their snack or vice versa. Did I mention that we also check the patient’s vital signs at that time? There is another line in the hallway for that and we have to do orthostatic blood pressures and pulses which take time especially that we almost always have 30 to 36 patients. This takes about an hour and a half to finish.
So there is a constant flow between the hallway and the dining room. How are you supposed to conduct group therapy that way? By 8:30, the medication nurses are ready to pass medications and that requires a separate line in the dayroom area where the medication room window is. So there are actually 4 activities going on at the span of time between 8 to 9 p.m. After that, at 9:15, we conduct the last smoke break of the day, which lasts till 9:30, and finish off the remaining vital signs. Most of the patients go to bed after that and a lingering few watch TV until 10 p.m. after which we close the TV room so that the housekeepers can clean it up before they leave for the night. As you can see by now, the schedule is tightly packed between 7 and 10 p.m. and squeezing a group therapy session in there would be an exercise in futility. Of course the bosses who told us we should do group therapy has never worked the night shift or even observed what goes on in the evenings. Go figure.

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