The Proof is in the Pudding

For years I have heard the expression, “the proof is in the pudding”. I have often wondered what the true meaning of such an odd saying was meant to convey. The proof is in the pudding…..hmmm. What proof? What pudding?   Ok, admit it, you don’t know what it means either!  The good news is….I finally found the meaning ……so we can all relax and sleep well tonight, knowing the mystery has been solved! But first, allow me to ramble about why I am bothered by this old saying, “the proof is in the pudding”.

These past few weeks have been very challenging, both professionally and personally. Don’t get me wrong, I love what I do. My life’s calling is to serve dementia patients and support their families.  There is nothing more rewarding than seeing a dementia patient interacting with their loved one in a comfortable environment.   I thoroughly enjoy sitting with the residents, listening to their stories, knowing that many of their facts are not on point…………. I love my job.  The thing I dislike, no, not dislike; HATE….is the politics of governmental agencies dictating care through forms. Paper forms.  The governmental “gods” run through long term care facilities, spewing off mandates for care, when they nothing about the day to day care provided. They know FORMS. They even hand me forms to fill out with a tidy little sentence written in size 0 font that tells me how long it should take for me to fill out their form…..

Oh my goodness, I may have to go to church on Sunday and get saved all over again all because of these form- driven jackmules.  Let me share a few real life experiences from this week. If after reading my accounts and you think I am the one in the wrong, I will find Jesus all over again.

Resident Joe has a pacemaker. The pacemaker is now protruding from his chest, actually visible. We call the doctor. After days of phone tag, he refers to another doctor. That doctor refers to another doctor. Well that doctor says to contact a cardiologist. Cardio says he needs to see a pulmonary doctor……While this is all happening, resident Joe is appointed a guardian, (a lawyer paid to oversee his affairs). Guardian tells us to not do anything about the pacemaker because he is a DNR (do not resuscitate).  Guardian sends me a zillion forms, executing her power and authority in the matter. Right on. Let me get this straight, the pacemaker is going to physically fall out of the man’s chest, and we as health care professionals are to do what exactly? Stuff it in a desk drawer because guardian believes his DNR documents cover his need for NON-treatment?     Resident Joe is in pain. The site itches, burns and is infected.    Guess what? He is a DNR; therefore, we aren’t to treat.   SAYS WHOOOOO? The Guardian.  She faxes more forms, defining her role as decision maker.       Okay fine. I concede the point. She is in charge. She is a jackass. She is wrong. But, she has the forms to show she is large in charge.  I simply have Resident Joe who has an exposed pacemaker……..but her forms trump reality.  Again, she is a jackass.        If only the story ended there…..

I receive a LETTER in the mail from Guardian.   Oh boy, you will love this part.  Resident Joe has run low on funding. His monthly cost in my facility is 4 grand a month.  He has fallen one month behind in his payments.   This letter from Guardian says…..”Joe has $18.98 in his bank account. Therefore you will receive no payment until his house is sold. I will list it in summer 2015. Thank you.”     Ummmm…aren’t we in the fall right now? Am I wrong with the whole season thing, spring, summer, fall and winter? She really is NOT saying that she isn’t going to move on anything for 3 seasons???    I call Guardian. Guardian says,” You can plan discharge, but without funding, no place will accept him, and you cannot discharge unless you have found an appropriate place to accept him………see form G34B J Z. It clearly states you must”…blah blah blah blah blah………Pardon me while I snap my head BACK on.  Let me get this straight: Joe has a pacemaker that is coming right out of his chest, and you don’t care. Joe has no money, and you don’t care. Joe has a house that you can sell, but you aren’t going to be bothered until the summer of 2015.     At the rate of Joe’s decline, he will not be alive in the summer of 2015.  Right on.  Guardian is a form pushing jackass who lacks understanding, compassion, concern and consideration.

kindness

Next case in point.  Government agency does it annual monitoring of my facility. Agent sees what thing, writes down something entirely different. I appeal to his boss. His boss tells me to file Form 22A. I complete form 22A. I wait for a reply. I call Agency. They acknowledge that they are in receipt of Form 22 A. But I need to comply with Form 71BC and have it sent certified mail within 15 days of submitting form 22 A.    Well I sent Form 22 A in over 21 days ago. The Agency tells me that since I missed the appeal date, I can file Form 8922Gk and mail it registered mail.  I argue the point, that no one told me I had to file Form 71BC in conjunction with Form 22A. Agency explains to me that normally I would not have to file 71BC but since I missed the deadline for 22A, I would need to file 71BC and Form 8922Gk to be able to file Form 22A again………….What?  All I want to do is talk to a supervisor about a simple matter, set the record straight……I just want to talk to someone……Agency is a jackass.        I comply with the Form gods and file all of the alphabet forms alphabetically….I am set for the meeting.

Not so fast Jessi……Ten days pass, 14 days pass….no word from Agency about meeting date. I call Agency. I decide to use my itty-bitty knowledge base to my advantage. This is how the convo went:

Me: This is Jessi Steele, calling about my Form 22, Form 8922GK and Form 71BC Appeal. It has been over 14 days since I have filed, and the guidelines say you, the Agency, have 10 days to grant me a meeting. (Ha. I have them now!)

Agency: We understand your concern. We have received all of your documents. At this time, we have declined your request for a meeting.

Me: You can’t do that! The guidelines state on page 14, paragraph 4 A, that this is the process. How can you deny my request?

Agency: Ms. Steele, if you believe your rights to an appeal have been denied we suggest you file Form 11 B and Form 920 A and Form 872598. Please have all form notarized and sent to our office within five days. The forms can be found on the internet. Thank you for calling.”

Me : Wait wait, I have five days from when?

Agency: Since you called today, we have documented your notification of denial as of now. The five days starts now. Should you miss the deadline, you may file an extension by using Form…..

I hung up the phone. I am going to have a nervous breakdown at any point.  Ok, I will play along and file the entire alphabet again, using the Chinese and Arabic calendars as guides……

It’s Tuesday morning. I am perched at my desk, filling out FORMS.  I have no time to talk to the residents, visit with their families or pet the Therapy dog. Listen people, I am on a roll doing very important things. I have FORMS to fill out.     I look up from my desk to see Agency person in my doorway.    This is a bad bad bad bad day.

I ask why he was here, since I have appealed his last findings and am awaiting the Agencies response. Without hesitation he spouts off, “I am here because you did not file form BJM Z; therefore you are in violation of the Code.   Wait, a form without numbers? How can it be?

Okay, I blew it. I became enraged. I lost my temper. The calm, collected cucumber that I normally am became a hot pepper in full bloom. I yelled words such as “ignorant, stupid and bull-dung”.  Ok, I didn’t say dung.  I was angry.  I brushed past Agency.    I left the room.    Agency gave me MORE citations while I stomped off.       I appeal again. I filed forms.  Guess what?  Nothing happened. I called agency. Agency told me file more forms. Forms filed. Forms denied. Appeal denied.   Agency drops my rating from a 5 star to a ½ a star……………in the end, Agency has won the battle. I concede their victory. I am formed out.

paperwork

Here is the thing. We give good care. We provide a service to one of the most difficult populations.  The five star rating what we should have….not a ½ star, but because I cannot seem to file the right form, at the right time, with the right signatures, to the right place……..our rating is in the dirt. Paper compliance dictates care? I don’t think so.   You see, the proof is in the pudding.

That brings me back to that old saying. The actual saying is ““the proof of the pudding is in the eating”.  See? The situation I am in is very bad, but you know what? I know I have done my best, and I know the care the residents exceed any expectation set by a goofy agency that has nothing better to do than worry about forms.     The Proof, my dear friends, does not lie in any form for any quest in life. The PROOF is in how we treat our fellow man; not regulated by paper pushing gods.  Compassion is not limited to a form. Kindness is not rendered by pen and a pencil. Caring is not ruled on by a stapler or Xerox machine………we are real people, caring for real people. Five stars, three stars,  or even no stars,the proof of the pudding is in the eating!

pudding

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3 thoughts on “The Proof is in the Pudding

  1. Pingback: The Proof is in the Pudding | Latest News

  2. I feel you, sister. Paperwork is the devil, I swear!

    I don’t know if this will make you feel any better, but at least the jack-mules that are causing your greif are not within your own house.

    Allow me to explain.

    One of the techs with whom I work has an outstanding work ethic when it comes to the things he for which is personally held accountable. Mostly, those things have his initials or signature on their associated paperwork. Yet, when it comes to doing the best quality care he can provide for te patients we see, he just doesn’t care. Case in point, yesterday, he was involved in a procedure to map out a patient’s veins which included a central angiogram from their axillary to their SVC. Turns out, the subtrated image was not very clear, but he convinced the physician he was with that the patient’s central veins were open.

    Then, we come to this morning. That patient came back to get a catheter for dialysis. He has a pacemaker on his opposite side, and my physician is going to place the catheter on the right, that being the side which had been filmed yesterday. After struggling, using ultrasound to access the external jugular since the internal is getting us nowhere, we take a pic from the neck and see that this vein is occluded and it has so many collateral veins that the doc has me check yesterday’s study.

    I look in the chart and see that the central shot is unclear. I cannot see contrast going past the subclavian and it is blurred because the patient’s breathing has moved the image from it’s masked image. So, I go to to other room where that study was done to try to clean it up. The end resulting film indeed CLEARLY shows not only occlusion but multiple collateral a coming from the patient’s axillary and bassilic veins.

    Here’s the thing, had the tech DONE HIS JOB TO THE BEST OF HIS ABILITY, he would have done exactly what I did today and given the physician all of the story. We would no have wasted ours or the patient’s time this morning. He had to go to the hospital and could have saved himself an extra trip to us for nothing. I was so upset, that I, too, bad mouthed that tech. The tech I worked with today was upset at me for pointing out the other’s lack of caring as though I was just picking on the guy. NO! I want every patient to receive the same care I would provide my mom and dad. Perhaps I’m just too concerned, or perhaps I have greater ethical frame of mind. Either way, I was pissed off that all my fellow tech cared about was getting through an assembly line of patients never giving any one of them true quality of care.

    So, be grateful that the people in your house are of the same mind as you concerning the people for whom you care. In my eyes, though I understand your anger and frustration, I think you are blessed and very possibly a great blessing at that facility. 🙂

    Like

    • Marcus, you warm my heart with your understanding. The medical field has become an electronic, robotic, heavily regulated and skimpy field. Just as the tech in your story took shortcuts…..the patient is the one who suffered. I so relate to employees not going above and beyond….heck, I would be happy if they even DID there job! Forget going above or beyond!
      I don’t know if we will ever change the field, but this one thing I do know. As long as you and I and the countless others who SERVE our patients, continue to provide them with compassionate care and understanding, WE will make a difference. Someone once told me this:
      If you don’t think one person can make a difference, light a cigar in a crowded room. Point made.

      God bless you Marcus. You always touch my heart and bless me with your words of wisdom and encouragement.

      Liked by 1 person

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