Tuesday, January 4, 2011

Discharge Day. Will Rehabilitation Be Accepted?

Well as the doctor had indicated, Shane was discharged on Friday the 30th April 2007 from Waikato hospital.   This day my rehabilitation plans were going to be revealed.   My husband and I travelled the nearly 2 hour trip to Hamilton tp pick Shane up from hospital in complete silence.   It wasn't that we didn't have anything to say, we were both just in deep contemplation of what may lay ahead of us.   I think, I was more anxious about Shane's reaction and attitude to forced rehabilitation, than fearful of taking the task on.   Shane had good virtue's though, so I'd concentrate on those and, with tact, understanding and, above all, patience, maybe we would both reach a successful conclusion.

Walking into the hospital ward and hearing all the chatter and laughter amongst the four men made me realize Shane was going to miss this sort of company once he was home.   I almost felt like taking them all with me just to keep his spirits up.   However, Shane was eager and 'ready to roll' as he put it, so I quickly located the charge nurse for discharge paperwork, prescriptions and advice regarding his convalescence.   The nurse stated that even on the Wednesday, the swelling had made Shane's ankle and leg wound surgery difficult.   So for this reason, it was imperative, the leg was kept elevated until the swelling had decreased, and also why Shane still had a high level of pain and discomfort.   The doctor had prescribed a weeks supply of the pain medication Tramadol and a sleeping sedative, thereafter the prescription was to be renewed by Shane's own general practitioner.

Shane was 'chirpy' enough and didn't seem to mind me dealing with the discharge paperwork, even asking if I'd got all his prescriptions as we departed the hospital ward.   Which should've eased my anxiety, but it didn't.   His compliance only indicated that he understood the discussion about me being responsible for his Methadone and prescriptions, not so much that he was accepting of it.   And I wouldn't dare presume otherwise knowing Shane hadn't been told as yet just what that responsibility entailed.   This dreaded task of explaining all to him, re: my rehabilitation plans and authorities were proposed for the trip home.   I couldn't delay either as my first Methadone pick up from the pharmacy was scheduled for the following morning.   I felt sure, even if reluctantly, he would accept my authority over medications but probably not so for his Methadone.   But that's just the way it had to be now.   My husband and I had decided we couldn't continue living with Shane's drug addiction the way it was before the accident, and yet we didn't want to kick him out of our home either, so this was our only other option.   Shane on the other hand, had two options, to agree and accept what I was doing to stay with us, or disagree and leave our home, it was his choice.   We were both desperately hoping of course, that he would realize we'd taken this action out of love and concern for him, not out of bitterness for what he was, therefore, would choose to stay with us.

Helping Shane into the back seat of the car and noticing how swollen and black looking his toes were reinforced my discussion with the charge nurse, and why elevation of the leg was important.   But it was how well he'd handle the pain and discomfort of his leg on the long trip home that concerned me most, knowing what had to be conversed.   I was praying the pain relief Shane had at miday would suffice, well at least until the dreaded task was accomplished anyway.   I'd planned how and what I was going to say in my head, many, many times over, when to say it all though was my problem.   I knew choosing the right moment for my conversation was imperative, if not, all 'hell' could break loose.   The trip started with a reasonably cheerful, 'chatty' Shane, even humorous telling us all about his week in hospital and I kept prolonging the task, wanting to savour the mood and humour for as long as possible.   However, Shane commenting about having to travel back into Thames the next morning for his Methadone and then again the following Monday morning prompted me to finally pursue the subject.   I braced myself, and lovingly and tactfully told Shane how his dad and I felt and conveyed how much we loved him, so he would understand our reasons why.   Then I went on to explain, as brief as I could, about the measures I'd taken and how they were going to be carried out.

Understandably, there was complete silence for some minutes from the back seat of the car.   Finally Shane spoke and, in a curt manner, he asked if I was going to escort him into the pharmacy to pick up his Methadone, because that would make him feel like and idiot.   I reaffirmed I had the authority to uplift the Methadone myself, therfore it wasn't necessary for us to attend the pharmacy together, and reassured him that he wouldn't be demeaned in anyway because of it.   His next worry was what the pharmacist and staff's attitude would be towards him now.   "With this authority you've got", he said, "they'll all know I've been a naughty boy".   The tone of his voice and the way he spat the comment out did portray how 'pissed off' he was, but I understood why.

There is somewhat of a stigma attached to being on The Methadone programme.   Having to consume your dose of Methadone in front of other customers in the pharmacy is demeaning in itself, so being respected and liked by the pharmacist and staff is the only pride you can hope to retain about being on the programme.   And it was obvious Shane had achieved this, going by the concern all in the pharmacy had shown about his accident, and general well being.   I conveyed this and told him their genuine concern was an indication of just how much they thought of him, so he didn't need to worry or be embarrassed.

Shane's final, but probably most important question, well to him anyway, was the length of time my authority for the Methadone went for.   This was the sensitive, dreaded part of the conversation, and the part that was definitely going to test all those good virtue's Shane had.   So, once again, I braced myself, and conveyed my authority was for as long as it took to withdraw and rehabilitate him off the Methadone.   I quickly turned and looked at him and said, "Im not going to be a 'bitch', Shane, about being in charge of your Methadone and all, you'll see."   Although the look, and the way his jaw was set certainly depicted his anger, it wasn't actually expressed.   Shane just went quiet.   But I think he handled it all very well, considering how miserable he must have felt with his leg, and I believe this was testament to his true strength of character.

Shane's next challenge upon arrival in Te Mata was getting into our home.   With the heavy, cumbersome cast and leg being so painful he was fearful of knocking it, so we all sat in the car and pondered which entrance Shane should attempt.   To access the front door he had ten steep steps to negotiate, and to the back door there was a steep concrete path up the side of the house to negotiate.   After much contemplation the front entrance was chosen, and accomplished with his dad's help.   It wasn't long though before Shane found an easier and less stressful way of entering and exiting the house by going up and down the steps on his botom, slowly one step at a time.

Up until the accident, Shane had been on twice weekly pick-ups for his Methadone.   I believe, more for my convenience and authority, Shane's Manukau City CADS doctor and caseworker had renewed the Methadone prescription for weekly pick ups for the following two months.   After this time the Methadone prescription would have to be renewed by CADS Thames.   I was so thankful we only had to attend the pharmacy once a week for Shane's Methadone, especially in those first intial 2 -3 weeks of his injury recovery.

Shane, as explained, still had to consume his dose of Methadone in the pharmacy on my pick up days, which happened to be the day after he'd come home from hospital.   The deal was that Shane would attend and consume his Methadone first, and then I'd go in and uplift his take home doses.   Understandably, it was an awkward, embarrassing first visit to the pharmacy for him that day, so he entered rather hesitantly, but exited absolutely 'chuffed' that the staff had made a fuss of him.   As demeaned as Shane may have felt about my authority for his Methadone, at least his pride remained intact, thanks to the kind, understanding approach by pharmacy staff.

Shane's doctors appointment to renew his medication prescription was a week after discharge, and I attended this visit.   With Shane's approval it was recorded that I was to be responsible for all his prescriptions.   For Shane to retain the privacy of these visits though, it was arranged with the doctor that all prescriptions were to be left at reception, for me to collect.

Shane hadn't verbally agreed or disagreed with my plans and changes, but he appeared settled and content to stay living with us, so acceptance was assumed.   Although everything so far indicated that, I did realize that Shane was a bit incapacitated with the leg injury and would be until the plaster cast was removed at about six weeks.   Only then would I really know how acceptable my rehabilitation plans were.

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