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talking to myself

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Choosing my battles


markdohle

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Choosing my battles

In taking care of the sick, there are two things that I have learned. The first is to choose my battles, to know what can be dealt with for the benefit of my patient, and what needs to be let go off, since to pursue it would only cause more harm than good. I suppose diet is one of the hardest things to deal with. For many of us our eating habits can be a bit compulsive and our choices bad for us. I have a man I am taking care of at this time, who is rapidly gaining weight, has diabetes, which is worrisome, and his kidney’s are starting to go, and he may soon have to start taking dialysis. It is obvious his eating is compulsive and we have talked several times about the danger he is putting himself into. He listens and then ignores us. After a meeting we decided to continue to encourage him, but not to push it, since it something we can’t constantly monitor, and in the long run leads nowhere.

He also has some emotional problems, with serious issues in dealing with his anger. In the past he went to therapy about this specific problem, and since this is an issue that has to be dealt with, I was told that I needed to deal with it, and talk to him. One of the reasons for this is that this particular man trusts me, and he will listen to what I have to say, and hopefully understand how serious his situation with his anger is becoming.

We talked on Monday, it went well after I explained the reason why we wanted to call in a therapist for him to talk to, and we would start off doing it once a month and then go from there if more time was needed. When the therapist came, I was at the first meeting. I explained to him that his outburst of anger, that sometimes lead to violent behavior, needed to be addressed, and here I have a few examples. The first one I brought up was his tendency to push patients in wheelchairs away from him violently, if they got in his way, his verbal outburst that many find intimidating; even some of the nurses working here can’t handle this. He does a good job in presenting a very intimating façade, that many can’t see as that and are therefore afraid of him when he is in that condition.

Since this seemed to be accelerating, it was time to do something about it before something extreme needed to be done. Changing his meds only helped a little, what we felt he needed was for someone to come in so that he could not only vent his frustrations, but to also hopefully get some insight into what he is doing (like I said he did well in the past), so that it could be deflated, if that is the right term. He was also notified that this was a form of family therapy, since while in the home he was part of an extended family, so from time to time I could be called in to be part of the process.

So in this instance more assertion was needed because his behavior was having a detrimental effect on the home, and also the possible harm it would do him if he was asked to leave, or worse if he had to be placed in a home that dealt with this kind of problem. We also did not want to use medications that would lower his quality of life either, so we felt that this may be the best course of action. He did listen, and wants to work with us on this issue, much to my relief.

At times a certain kind of bluntness, done with compassion is needed. Francis for instance just got over a serious illness and would not eat. I encouraged him, but he would not listen to me. So I asked him if he wanted to die, he thought for a moment and then said “no, I want to live”. So I continued that if he did not eat, and perhaps force himself, he would surely die. He would get weaker, and become bed ridden, and with his heart condition it could lead to complications. He thought about it again, and now he is eating better, we are trying to serve him foods that he likes, good for him, and will hopefully keep him on his present plateau for a while longer.

When to become assertive and when to let it be, is not always simple, but people have rights, and if it does not interfere directly with their care we give them their freedom; our most precious possession, in other words, we strive to treat them as we would want to be treated if in their position.

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Diabetes, as I personally know, is a vicious battle of feedback loops and complications that must be fought on many fronts. A bad side affect is impairment in mental clarity and patience which also hurts ones ability to deal with it. And so many of us have complicated issues with food!

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