Day Job

The Long and Winding Road

Despite rumors to the contrary, I don’t get paid to spread snark — and what I like to think is the occasional trenchant commentary — throughout the land. I wish! No. What I get paid to do, four days a week now, is to work as a physical therapist for a home healthcare agency.

It wasn’t my first career. When I started down this road, I was in my thirties. I had recently finished my bachelors degree in writing, going to school part-time while I worked full-time, and I was working as an editor for a small, non-profit feminist quarterly magazine (now defunct). Ronald Reagan had been reelected, so we had tons of stuff to write about. It was in many ways my dream job. But, like many of my previous jobs, it was a lot like herding cats and it involved endless meetings. One day, I woke up realizing I had developed a severe and what would turn out to be a life-long case of meetingitis. Somehow, my notions of changing the world and helping people seemed to be unfulfilled by spending hours hashing out the meaning of collectivism while editing atrociously-written and sometimes hand-scrawled submissions. I guess I got a little cynical. I wanted to do something more concrete, more hands-on, more tangibly helpful to someone. And so, I went back to school, took more science classes and eventually got accepted into grad school for physical therapy.

All this and health insurance.

A lot of you have had physical therapy somewhere along the line, either during your cancer adventure or for some other reason, like the odd sprained ankle or back strain, probably in an outpatient clinic. I did that kind of PT for several years myself, had a good time, met a lot of nice people, learned a lot.

But there was always something about home care that drew me. Occasionally, I suspect that I was just a glutton for punishment. Mostly, it’s because my mother had home care for the last five years of her life, so I got to see its strengths and pitfalls up close and personal.

Home care was my second PT job after grad school, after a stint in subacute, inpatient neuro rehab, the serious stuff, the post-brain injury, profound stroke kind of stuff, the teaching people how to move again from scratch kind of PT. And I loved that, too. And it was a good training ground for home care PT. So I did home care for about four years, then, not by choice, had to take a side trip to outpatient, orthopedic rehab, and then got to come back to work for my old home care agency. And here have I been ever since.

Working in home care is not like any other kind of PT. You’re not stuck in one place, for one thing. You get to drive around and you get really good at reading maps and following directions. After a while, your car starts to look like an office on wheels. You meet people’s dogs, cats, parrots, horses, and, around here, you may encounter flocks of unthreatening but wild turkeys and geese, several cows, and assorted bunnies and red foxes. You’re also meeting people who’ve just had something traumatic and life-changing happen to them, who’ve just come home from the hospital after surgery, heart attacks, falls, fractures and cancer. You don’t usually have any other colleagues in there with you, no staff of nurses, doctors, social workers or nurses aides to help you out. You’re on your own, so you have figure out what’s going on as best you can. You ask a lot of questions, listen as well as you can, and try to determine what you can possibly do to help this person, who is hardly at his or her best, to feel better. Later, you might decide you need to call in the troops, and contact their doctors to make sure that a home care nurse or social worker or nurses aide comes in to help sort things out.

You do a lot of things that aren’t strictly like standard physical therapy. You listen to heart rates, and lung sounds, and blood pressure. You try to figure out if your patients are taking all seventeen drugs they’ve been prescribed, and what all these drugs are for. There’s almost never just one thing wrong. You need to know if they have diabetes or hypothyroidism or a pacemaker. You need to know if they have anyone who can help them get to the bathroom or wash themselves or buy groceries or take them to their doctors’ appointments. You need to move furniture sometimes, so they don’t trip over something and hurt themselves again. You need to figure out if they’re with-it enough to be safe on their own. You need to persuade them to let you get their thirty-three scatter rugs off the floor. You need to figure out if their spouses or daughters or grandchildren are up to the task of being caregivers, temporarily or forever. You need to make sure their surgical incisions are not bleeding or infected. Most importantly, you need to determine whether they are capable of recovering. The old saying, ‘you can lead a horse to water, but you can’t make him drink’ is a very pertinent concept in home care.

Then you have to write all this up, in very specific and seemingly endless ways, so that insurance companies will pay for your services.

Sometimes, a lot of times, you meet people whose lives are a wreck, who have no family, who live in squalor, who are angry and distrustful, who are poor, who are delusional or have serious dementia, who are addicted to alcohol, who have saved every issue of National Geographic for the last forty years and have them stacked and piled over most of their available floor space. Sometimes, no matter what you do, you can’t help them, because they are incapable of helping themselves. But you still have to try. Sometimes, you go in and find them on the floor, and you have to call the EMT’s and send them to the emergency room.

Sometimes, your patients die.

Sometimes, you feel like you could write an angry treatise on what’s wrong with our healthcare system.

Sometimes, everything goes well and you help people get better.

When you’ve lived with post-cancer-treatment fatigue and brain fog for any length of time, sometimes you forget that you have legitimate reasons to feel exhausted at the end of the day. Sometimes you don’t give yourself enough credit for what you actually manage to accomplish before you crawl home and collapse into another stupor. Sometimes, you forget to be grateful you can work at all, and pay your bills with less than your former full-time wage, and the hell with the housework because at least you have a roof over your head and can walk upright without an assistive device.

Sometimes, you really need a vacation. Mine starts next Tuesday.

Do you give yourself credit for all you do? Are you too hard on yourself sometimes? Have you ever had home care?

This entry was written by Kathi, posted on Saturday, April 21, 2012 at 10:04 am, filed under Cognitive Dysfunction & Depression, Fatigue, Health & Healthcare, Making A Difference, My Work Life and tagged , , , . Bookmark the permalink . Post a comment below or leave a trackback: Trackback URL.

12 Responses to “Day Job”

  1. Have a terrific holiday, Kathi!

    Funnily enough, next week – just as you head off – I’m meeting with my employers in Darwin to talk about starting back at work again (they were kind enough to employ a locum in my unanticipated and extremely long absence, which started only shortly after they’d employed me)…and his employer is a home/community care agency! In Sydney prior to moving here I was a social worker in a hospital – largely in aged care-related areas – but got a job after moving here with a not-for-profit that mostly does home care. They also have the funding to run a Commonwealth government program aimed at assisting older people who are homeless or at risk of homelessness to obtain appropriate accommodation and services – coordinating this program is (was – and soon will be again) my role. Prior to my life falling in a heap I was enjoying it, while also missing the camaraderie of hospital work. Early days in terms of deciding which I prefer.

    Anyway, am rambling now. I hope you feel refreshed after your break. Enjoy!

  2. Thanks, Liz! So, you know exactly what I’m talking about here!! Good luck & congrats about going back to work. A big milestone…

    I’m whipped, needless to say. I’ll probably spend the first day of my vacation sleeping.


  3. Hi Kathi,
    I never had home health care nor PT. I could have used PT after breaking my back (50% burst of L1 with fusion of T11-L3 and parallel Harrington Rods spanning the 5 fused vertebra). But my situation at that time in my life didn’t cover any home PT or any PT after leaving Presby Hospital in Pittsburgh.
    I wanted to say that my experience as a paperboy for 3 years in my early high school days (years ago) doing my ‘Saturday collecting’ for paper route money brought me in contact with many older people that lived solitary lives. I spent many hours in conversations about a wide range of subjects that were beautiful and important to so many lonely and lovely people. That experience left a lasting affect on my life that I have re-discovered as I age. Just wanted to share that with you.
    Thank you for what you are doing. I just wanted to share that also.
    Have a wonderful vacation and make some good memories that will bring you smiles to enjoy and to share with others.

  4. Tom, it’s nice to hear from you here. I’m not surprised to hear that you were the kind of kid who would sit and listen to some of the lonesome people you met on your paper route. Early on in my own childhood, for lots of reasons, I learned to be one of those people who felt moved to stick up for the underdog. Explains a lot about us both, doesn’t it?

    I have met lots of lovely people in my job, most of whom are incredibly grateful that there is such a thing as home care. In a funny way, meeting so many older folks has made me less afraid of growing old myself.


  5. You are an amazing person, Kathi. I don’t know how you do it, snark and all! Venting is part of the healing process. As for myself, I don’t usually take credit for all I do. I feel like I haven’t done enough, even though I’m exhausted at the end of the day. I am definitely too hard on myself. But having just watched “Eat, Pray, Love”, I feel so much better, so much less guilt.

    I haven’t had home care, but know many who have. You are an angel to so many and I hope they appreciate you as much as we appreciate your writing. Have a wonderful vacation. You more than deserve it. xxx

  6. Good morning,

    What an awesome post. Physical therapists and home health healers, as I think of them, are like manna from heaven. I was terribly ill at one point from a post op infection and after a week in the hospital had a home health nurse for a month. And she WAS a healer, the bridge from which I returned from the crushing isolation of an encounter with death back into the world of sunlight.

    What’s even more amazing, Kathi, is that I only realized this now, reading and reflecting on your post.

    Thank you so, so much for writing this and all you do.



    PS. As far as I’m concerned – the snark is plain gravy:)

  7. Thanks, Jan. Most of the time, I feel privileged to get paid to do this. It certainly helps me keep things in perspective, and it’s nice to feel like I’ve done something useful for someone at the end of the day.

    But it is exhausting. The mental exhaustion is possibly more profound than the physical. I feel like a detective sometimes, trying to sort out why someone is not responding to treatment, trying to figure out what is getting in the way. Fortunately, we all succeed at figuring things out more than we fail. But we can’t fix everthing. And that’s hard. Makes me wish my magic wand would work…

    Jode, you hit on one of the things that I really like about home care, that makes it so compelling — it’s the bridge you’re trying to build for someone to help them get back to living their lives, from being a patient to being a person.

    After having cancer, that bridge is even more meaningful to me now.


  8. Kathi,

    I admire you for all you do. You really are a blessing to many people, and what you do is so very difficult. I had physical therapy three times — all cancer surgery/lymphedema-related, and it would’ve been a lot nicer to have the services at home.

    By the way, I was also an English major (close enough to Writing major) in college and worked at a magazine. We are kindred spirits!

  9. Kathi,
    Honestly, I don’t know how you manage it all. I’m exhausted just reading about what you do.

    Home care workers like you are such a blessing to people when they are often at their most vulnerable. I remember we had a home care person when my mom was really ill and she was wonderful. I’m in awe of all you are expected to do, not the least being a savvy detective.

    I’ve had some physical therapy, too, post-cancer and I immediately bonded with my therapist. I felt such gratitude for her help and compassion. Your patients surely feel the same way about you. That must be so rewarding. Anyway, thank you for all you do to make people’s lives better. And that includes creating snarky stuff too! Enjoy your vacation!!

  10. Kathi I hope you are having a fabulous break wherever you are. My mom has had a couple of occasions to have home PT (my dad too, now that I think about it) and the PT people were the nicest, most caring and helpful folks! I greatly admire the work you do. You are seeing people at their worst, at some of the most vulnerable times in their lives. I am thankful for insurance that pays for this benefit for people who need it the most!! ๐Ÿ˜‰ Thanks for giving us a peek into the window of the PT world.

  11. Thanks, Beth. I’ve always thought we were kindred spirits. I think somewhere there’s an old post that mentions this magazine I worked on. Should write about it again. xoxo

    Nancy & Renn, even though sometimes I feel pretty useless in the face of someone’s insurmountable problems, most of the time it’s quite a wonderful thing to do this and get paid for it.

    You can all imagine, though, what it’s been like to do it, what with fatigue and brain fog, which were really fierce the first few years. Slowly getting better, but I do need my time off more than ever. I think I have much more empathy now. And most people are really pretty amazing the way they face what they’re going through with good grace. And most of them appreciate a good laugh, which of course I’m very happy to supply. ๐Ÿ˜‰

  12. Hi, Kathi.

    This is a really thought provoking post. I’m sure you’re equally good at physical therapy and spreading snark. ๐Ÿ™‚

    Because of your awe-inspiring nature, I’ve given you a blog award:

    Best wishes, and enjoy your break.


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