Sandwiched Support

Tag: healthcare

  • It’s fine, I’m fine, Everything is fine

    Sandwich Generation life took over over the holidays between all 8 of us getting the flu over our Christmas break and New Year’s, one after another after another. Thankfully we had our vaccinations but it was still yucky and ugly. I told myself I was going to be able to do this blog daily. Then I told myself I was going to be able to catch up all of the daily posts I missed starting in October and add photos and then starting with making the Trick or Treat magic for the neighborhood with an amazing fellow neighborhood mom and then getting everything ready for the holiday season this fell off the list. But isn’t that just the epitome of Sandwich Generation life. I am hoping to shift to once weekly consistently now in 2026 starting with today.

    Thrilled that Mom’s first knee replacement surgery is February 2nd but we still had to not only go to a surgery scheduling appointment with the surgeon’s PA to choose which knee to start with and discuss the surgery, but also had to have a Clear for Surgery appointment with the PCP, and another one with the Cardiologist. And as if that weren’t enough an NP at the surgeon’s office had to see Mom a month prior to surgery to clear her when we were just at the PCP three days before that and at the cardiologist 3 days before the PCP. Simply cannot help but think that there are too many cooks in the clearance kitchen and everyone wants a piece of the billing pie. She’s high risk in certain ways, but that last checkup with the NP when she had just seen her PCP took the overkill cake for me. I am the Sandwiched accompanying uber driver and appointment advocate and when I can’t schedule my own clients I don’t get paid. But yeah, let’s have an NP take up our time checking on Mom when a physician plus a specialist’s office just checked her within the past week.

    One of my awesome bosses gifted me some dumpster fire socks and I am still looking forward to finding a time to put my feet up so the sock bottoms can be read by others “It’s Fine, I’m Fine, Everything is Fine.”

  • October 9, 2025

    Tis the Season

    When Mom entered the hospital a year ago for emergent surgery (which led to nearly a year of complications at the little hospital before a seemingly successful surgery in September has provided significant relief and hopefully has solved the problem) I lost what little control I was getting of our already cluttered new-to-us home. When my parents sold their home and we sold ours 4 years ago and moved into one house I almost single-handedly cleared years of clutter (things Mom hoped to use again) out of my parents’ home. But then as we combined what we kept we realized we did not quite purge enough stuff along the way and 4 years later after a year of almost constant advocating for better care for Mom, there is a serious clutter explosion lining the sides of one basement room, piled in a basement storage room, covering the one side of our bedroom, choking our dining room, and don’t ask about the attic and one section of the garage. I use A Lot of the stuff but rarely have a minute to put it away rather than putting it down.

    So now we’ve entered the season of celebrating it all! We are counting our blessings and almost ALL of this holiday themed cheer from Halloween to Thanksgiving to Christmas to New Year’s, but honestly I am already exhausted from the trunk or treat I organized and moving through crowds at the Halloween Parade and there’s work and youth sports and plenty of ongoing outpatient appointments for both of my parents. So far I have two little Halloween signs set out around the mess and a Falk wreath on the door. I tend to go ALL OUT and love to, but these days it’s like I just don’t have the bandwidth.

    We just got our pumpkins out by the front door next to the doormat that says “Sunshine Vibes”. Maybe I’ll get the “Trick or Treat“ mat out by Friday, maybe not. But I do know that I have to clean up the dining room before the end of November (trust me there is very little margin to get this done and it will happen at the sacrifice of plenty of my sleep) and the Christmas shopping already began after Christmas last year because I’ll nearly single handedly be bringing all of the magic like I do every year. And I wouldn’t mind if that was all there was to do but, that’s the furthest thing from the case.

  • October 01, 2025

    I Blame Her a Little Bit and Also I Blame Myself

    Blame is not really the way to go I guess but late morning Monday after I saw the CRNP at my PCP’s office, one of my best friends who is a PA asked me to describe my symptoms to her and I explained the back pain and the pain up under my left side and she said right away that the CRNP should have gotten a urine, maybe it’s the kidneys. The CRNP ordered the Lyme’s test that I requested because of what’s been going on with our dog and my husband and weird symptoms and wanting to rule out Lyme’s and potentially other tick born illnesses. But she said if it was anything other than Lyme’s I would be too sick to be in her office. She didn’t order the infection/inflammation marker panels because I went on the steroid Friday from the urgent care provider.

    Having gone through everything I have gone through as my mom’s hospital advocate I should have remembered that the steroids mess up the bloodwork, sometimes falsely raising WBC count or raising it higher than it would be. And then the CRNP informed me that it would be a month before the steroids being in there wouldn’t affect the infection markers.

    She had a student there and kept repeating the phrase “common things happen commonly” as I expressed that I have no idea what’s going on with me and wondered about Mono or Meningitis which I learned does not have the potential to be airborne from the college students in my office. She told me to finish the steroid and to get the limited bloodwork she sent to the lab and she did not add a urine.

    I did message her and ask her for one and she added the urine, but I had already been to the lab Monday and didn’t message her until late Monday or early Tuesday and didn’t go get it until this morning with my other lab orders after I saw the third provider last evening.

    More on that tomorrow. It really is tough to know which place to seek medical attention on our community first when it comes to certain symptoms. On one hand I am thankful we have an Urgent Care so when it’s bad but it’s not feeling emergent and the PCP has no appointments available there’s a place to go, but they seem to not want to order bloodwork or scans because they don’t want to be following up with you. And then your PCP has helper providers that don’t always know you and honestly you don’t see your PCP enough for them to know you either. And they don’t seem to want to jump to getting bloodwork or tests to find things out either.

    Very thankful for provider number 3 who I sought out at our local orthopedic urgent care and she was very attentive and ordered many things that have brought the diagnostic process along a bit. More tomorrow.

  • September 30, 2025

    Going Through the Process

    Couldn’t tell you exactly what the rules are for managed care payments and I’m sure there are good reasons for providers to take things slow but after feeling some symptoms that I haven’t felt before that I now think might be related to Lyme’s (my husband is going through similar symptoms and trying to get a diagnosis as well right now) for about a week and a half and trying to fend them off with ibuprofen. I went to my regular urgent care asking for diagnostic measures.

    The provider told me it sounded like just an issue with my back. She stopped short of saying the word “injury,” and as I told her I haven’t injured myself, but she told me flat out I don’t have enough symptoms for her to order bloodwork and that I will have to go to my PCP. She also said that they are urgent care don’t order bloodwork because they aren’t going to be following up with the patient.

    Can we truly not assign a trained medical assistant plus the urgent care’s online portal to alert the patient of the bloodwork results and then connect the patient with the right specialist or the primary care provider from there depending on the results?

    So in my limited experience around here, I spent time waiting for an urgent care’s provider to examine me (she barely touched me) and was sent on my way with a 5-day steroid pack after a shot of Toridol (a non-narcotic anti-inflammatory).

    It was not a bad start for a sensation of pressure and numbness in my back and pain in my side. But she would not order any tests. Not a urine, not a basic panel of infection and inflammatory markers. No blood work and no scans of any kind including an xray.

    The pain was in no way unmanageable and I told her right away I was not seeking pain medication, but rather a diagnosis to seek relief from the pressure and numbness I was experiencing.

    More tomorrow about how my symptoms continued and the next step I took.

  • September 29, 2025

    This morning I rushed from my early client session to log my mom onto this call that the rehab she was just in for post-surgery PT and OT (associated with the big hospital) wanted to have with her. It was short, involved a bunch of cover-their-butt questions and what I heard of it involved things Mom definitely already knew.

    I’m sure they have all kinds of different patients they follow up with and I’m also sure not everyone has the same support at home as Mom does so maybe these calls are more helpful for others.

    But the call was scheduled for 9 AM and this call center representative in another state was calling me several minutes ahead of time insisting that we log on and then the nurse was right there several minutes beforehand and rushing as though we were behind…seeming to want to get through it quickly….appearing a little annoyed when Mom was still finishing up in the bathroom and we weren’t 100 percent ready to have her on camera Ahead of the appointment time.

    So maybe this is better than the endless waiting we have experienced, especially on telemedicine calls, because the provider is overbooked and late. But this didn’t feel awesome either. I barely got down the stairs to Mom’s room and the call center lady was telling me to just click the link while I was getting down the stairs. There’s impatience there

    There must be quotas and overbooking and an understaffed, overworked situation. Not great.

    Better than not having it at all? It’s a toss up for us because it didn’t really help and it was an extra annoyance, but also we have learned that if the patient declines anything for any reason it goes down in the chart (almost always without a reason specified) as a refusal and refusals in your past count against you as you are trying to get into rehab in the future.

    And we hope Mom can get her knees replaced in the not too distant future. And we want to get into our favorite rehabs.

    So we better hustle down the stairs and out of the bathroom and onto that follow up video call so the rehab can check their boxes, document that they checked on us (in this case almost completely without added value for the patient, not gonna lie), and make sure they get and stay paid.

    Nothing wrong with it per se, but there are some different things going on these days that are not entirely without a sense of weird “over-the-top-ness” in my opinion. Wish I could get clear reasoning from those in power regarding them.

    Another example is that when we call with a medical question the bill looks a lot like they are saying it was a session. A little borderline questionable at times with the wording on the bill. I’m sure the codes are legit and show that it was a phone call in but some of those calls were QUITE brief and yielded very limited results but the language on the bill seems to describe them as though they are an in-depth service of significant value. Maybe sometimes? But sometimes I was the family member on the other end of that call in to the provider’s office and certainly didn’t speak to the provider. Someone got a message back to the provider and got back to us but we didn’t really have a telephone session. Just saying.

  • September 23, 2025

    Outside Texting In

    You would think I would simply be grateful and I am grateful, but it’s complicated! Mom is home doing well on small amounts of soft foods right now and so far it’s been a good day with me wrapping up at work outside of the home today and Dad holding down the fort at home. He grocery shopped and has helped Mom care for our family dog who hasn’t been feeling the greatest lately (she does show improvements though).

    But late morning today at work I missed a call from our church prayer chain where a recorded message is sent out on a call line and plays repeatedly until you hang up so that you can get all of the information. It’s a great resource so that those who want to pray know how they can do that for someone who is in need (frequent prayer requests are for medical needs and concerns and losses of loved ones and anyone at church can ask for prayer for anyone in the community, sometimes using last names, sometimes not). Very soon after I saw that I had missed the prayer chain call and didn’t get to the voicemail before my mom-in-law texted me that a close extended family member on my husband’s side of the family had a major medical event happen to him earlier today.

    Certainly others have had things happen medically other than Mom recently, but not a lot of family has had something this major that needed immediate surgery at least not that my worried brain is remembering at the moment, since Mom’s initial emergent surgery about a year ago. We do know of medical conditions and treatments that are ongoing for several family members, many of them due to serious medical conditions, but to my knowledge all of those individuals are currently stable at home.

    So lately I have been the medical advocate, the closest family member of the patient, the one hurrying into the hospital on repeat and texting everyone else urgent questions and regular updates. Today I am the friend who also happens to be a relative as two of this man’s daughter-in-laws are my very close friends who I have done a lot of life with. They have been neighbors at one time, part of the church we regularly attend, part of moms’ groups I was part of when my kids were little, part of my baby showers (one was at my wedding shower and played violin at our wedding). We have been friends for decades. One of them was at college with my husband and I, another had me in her wedding. And I am texting them today trying not to intrude, but communicating love, support, and encouragement fully from a small distance.

    I’ve assured them as they assured me when I was going through something similar (but not exactly because I cannot know what this specific situation is like for them) that I will come pick up their kids when they need me, that I have no specific expectations of when they will contact me back if at all, and that I am praying for their family member and am here for them.

    This extended family member is wonderful and truly loved as is his caring and compassionate wife. They lost their youngest son in a terrible accident years ago when we were in college and have been through so very much already and never lost their beautiful faith. They are a true example of loving parents and grandparents and loving people who serve those they care about and the community so selflessly.

    Lately I have been the one sitting by the patient’s bedside texting away to receive support and answers from knowledgeable others. The daughter-in-laws are both nurses and have often been two of my go-to medical people I know who I can go to with questions about Mom.

    Now I sit at my desk in my office with everything caught up waiting to see if I’ll have a walk-in appointment pop up before I leave for the day. And really all I can think about is that the man who married us 20 years ago, the man who we asked to provide baptism for all four of our children, and the man who has a very distinct voice and personality and who can talk to everyone with a focus and a sense of encouragement showing that that person really matters to him is having major surgery and I am waiting away from the hospital. I am not in this waiting room this time.

    I am on the outside of this one, texting in. And I can barely contain my prayers and my questions. And I can hardly remain in my seat. And I know that no matter what happens that it has been and continues to be nothing but the utmost blessing and privilege to know this family member and both the family he comes from and the family he and his wife have built together.

  • September 16, 2025

    This is not a cutting matter.

    If a surgeon is being asked to do anything beyond determining if surgery is needed, if post-surgical healing looks to be on track, or of course surgery itself they seem to unequivocally prefer not to.

    I get it, they are the highly trained specialists and the only ones who can perform the surgeries (along with other types of providers and specialists on their team and similar teams). So they seem to want the hospital to pass the patient, with post-surgical complications, onto another department of providers (in Mom’s case it’s been internal medicine or GI) to monitor and treat them if there is nothing that warrants emergent or scheduled upcoming surgery.

    But yet the hospital wants them to show up each time to follow through with making sure the patients they operated on are taken care of. Seems reasonable and understandable until you factor in how busy they are and how few of them there are and you start to notice them getting short with abs frustrated with the patients who return with pain, with “inflammation,” with complications.

    From being unsettled and taking a longer time to heal and recovery than the average patient of the same age and condition (this seems to be Mom’s situation right now) up to the need for emergent follow-up surgery and everything in between I’m sure they see so many patients that it may be difficult to keep up with it all.

    So what are the hospital systems doing about this? Can there be more PA’s and NP’s who are trained by the surgical team and work for them and with them to provide excellent follow-up care not just in the office post-op, but also with the more complicated situations where patients are readmitted post-surgery with a variety of problems? Certainly the surgeon who operated on the patient and the team should be closely involved at looking at all scans, ordering tests, and weighing in on the treatment plan after considering all relevant information, but surely other educated medical providers who are not operating can provide supportive care as the patient is under observation.

    Can we come up with a better system where someone who has time truly listens to the patient and the patient’s family/advocates/support people to get the full picture while tests are being run? Can those individuals be trained to diagnose and treat post-surgical complications that do not appear to involve the need for further surgery to free-up the surgeons without leaving the patient and patient’s family feeling dismissed?

    How can the hospital teams communicate and work better together?

    And who can we assign to communicate with the family and other members of the support system on a regular basis to receive and answer their questions with empathy and compassion and to provide reasonable medical updates?

  • September 15, 2025

    Admit for Observation

    Mom has ongoing abdominal pain and is in the ED of the big hospital and they are going to admit her for observation for 1-3 days. Surgeon said earlier that the inflammation in the CT scan looked mild and Mom could go back to the rehab. Plain is not ongoing and they say admit 1-3 days. I wonder how we can know how long it will take, how long she will need.

    It’s tough to plan the week and when she might be discharged. It’s hard to know what to expect and to imagine next steps. There are worries that this could be last Fall all over again and everything that came with it. Dad says not to worry ahead of knowing what will happen and as a mental health professional I too know better, but in the sandwiches season it is a challenge not to fear the unknown.

  • September 11, 2025

    3 Day Rule

    I saw an article by CBS News on my phone today talking about how a patient on Medicare has to have been in the hospital (not counting the ED) for 3 days which is 3 midnights in order for the patient to be eligible to enter rehab following the hospital stay. Something new to me again. Mom always has been hospitalized for more than 3 days when we have sought out rehab for her so I did not give thought to how long she had to be hospitalized qualify to go. I just thought it was based on medical need to be in rehab for PR and OT.

    Always something more. I wonder if I will ever find the time to read through every document full of fine print.

  • September 10, 2025

    Always Something More to Explore

    Today I found the time between clients to answer the call from Mom’s caseworker at the rehab without having to return the call. She shared Mom’s EDD and stated that Mom has a certain number of authorized days in their facility this time around. It seemed like she might be new because when I questioned her about this, stating that Mom has been in the Acute Rehab Level of Care multiple times in two different facilities and no one ever talked about a time limit that Medicare had authorized. Thankfully this time it seems, in the improved condition she appears to be in, that it will be enough time for her to be ready to come home.

    But I asked to speak with someone who could explain the authorization and billing information a bit better and the caseworker said she would have to find someone to ask to call me. She also did not know how to transfer me to the nurse’s station and I waited while she asked someone. Totally understandable if she is new, but she did not explain to me that she is new and I truly would prefer to know what she does not yet know so that I can seek out someone there who does know the information I am looking for.

    And once transferred to the nurse’s station I asked about the xray that Mom had today and Mom had already texted me that they had just completed the xray. The nurse told me the xray technicians were still on the floor so it might be later this evening until I receive a call back with the results. I was as kind as possible, made sure she had my number and clearly requested a call back. It’s a good thing that as I drove home at 4:30 PM I called Mom on her cell phone and she was able to tell me what they found on the xray (which this time thankfully sounded like it was nothing of significance), but what if my loved one couldn’t keep me updated by cell phone.

    The nurses never called me back. Nor did anyone from the medical team. And no one was going to tell me about the xray she had just had because I brought it up to the caseworker and she admitted that she knew about it. When was anyone going to calk and tell me?

    The grass is not necessarily greener at the big hospital’s rehab and this new insurance benefits info regarding a limited authorization is definitely something new for this sandwiched advocate to find out more about. Always best to know more before, heaven forbid, next time.