The end of the line: expectations collide with reality

And so I’ve come to the end of the line…the end of my 30 year career as an occupational therapist. I’ve been put on long term disability and terminated from my job. After 30 years of lifting kids at work and at home, the pain from my degenerative disc disease and spinal stenosis is unbearable, and the doctors say I shouldn’t be putting any more stress on my spine. Barring some medical miracle, I doubt that I’ll ever be able to return to this kind of work.

I have to say that, at the end of the line, my expectations had a head-on collision with reality. This certainly wasn’t the way I saw my career ending. It’s not that I ever imagined myself as a supervisor or department head. That’s just not my cup of tea. I hate telling other people what to do…I’d rather do it myself. I am the first to admit that I lack the organizational skills to manage or supervise, and that I have an aversion to paperwork that borders on a phobia. What I always loved about my job was working directly with the kids and seeing the progress they made.

But what I did expect was that all those years of experience would count for something in the eyes of my bosses and colleagues. I was wrong. I didn’t see Gen X and Gen Y coming. I guess I had always assumed that I would be supervised by people who were my seniors or at least my contemporaries, people who had respect for the knowledge and experience I had gained over 30 years. But, no, Gen Y disdains experience, you see. In their eyes, it only makes you out of touch and outdated: a dinosaur. In their opinion, it is irrelevant that I was practicing OT before they were born. So what if I had treated kids with disorders that they had never even heard of? So what if I had personally raised 10 kids with disabilities? (They felt quite qualified to give patients’ parents directions on managing behavior, even though they didn’t have even one normal child of their own.) I must have appeared to have no ambition and did not constantly promote myself, and to them those are signs of inferiority.

And, so, in the final 5 years of my career, when I felt that I had earned a measure of respect, I came up empty handed. When I signed on with the company, I was offered a respectable hourly compensation, based on my extensive experience. It was downhill from there. I first realized which way the wind was blowing when I attended my first Christmas party, when they announced the winners of Therapist of the Year. I’m embarrassed to admit it now, but I actually thought I had a chance that first year. But as I saw all of the 20- and 30-somethings step up to receive their awards, I realized that my time had passed. In meeting after meeting, I heard therapists praised for the astronomical numbers of visits they made each week, and realized that, given my declining endurance and energy, I could never compete. While the parents of my patients were often complimentary of my work, as their children made impressive progress, those positive words were never repeated by the bosses.

And then the downward spiral began in earnest. Those of us who had been offered a higher rate due to our years of experience saw our pay cut by 11%. This was a tremendous blow to me, as it signified a lack of respect for my accomplishments. With the onset of my son’s schizophrenia and then my dad’s death, I struggled with profound depression, but tried to keep plugging away. I was floundering financially because I was never given an adequate number of patients, and then I found out another therapist (one of the self-promoters) who worked in the same area was making 50 visits a week, compared to my 12 or 14. Last June I was given a mediocre job performance evaluation, and I was devastated, as I felt it was an evaluation that would have been given to someone right out of school. I have no doubt that the stress of that evaluation contributed to my heart attack the next month. I got an inkling that my decision to discharge a patient was being second-guessed between another therapist and the manager behind my back. I was quite disappointed that the milestone of my 30 year anniversary of practicing OT passed without mention. And then, the coup de grace: I recommended discharging a patient and his mother called the office to question that decision. Did the case manager and district manager express confidence in my professional opinion? Did they stand up for me and tell the mother that I had more experience than any therapist on staff? Nope…they arranged for another therapist to provide a second opinion, as if I were a rookie therapist.

And so my life’s work comes to an unceremonious end. No retirement party, no testimonials, no gold watch, no nothing. Just an envelope of COBRA forms in the mail and a last trip to the office to turn in my electronic equipment. The words of T.S. Eliot keep going through my head:

This is the way the world ends
This is the way the world ends
This is the way the world ends
Not with a bang but a whimper.

But wait, I do have a testimonial. A few years ago I ran into a former student of mine, a young man with cerebral palsy. He was in first grade when I started working with him my second year of practicing OT, so he was in his mid-30s when I ran into him. When I told him who I was and that I was his OT in elementary school, he grinned and said, "I remember you. You taught me how to write and how to dress myself. You wanted me to be independent. My mother wanted me to be dependent, but you wanted me to be independent!" And that was better than any Therapist of the Year award.

The flood

Well, it finally happened. I had a major meltdown this week. I suppose it was bound to happen, sooner or later. I mean, the stress has pretty much been unending all year: Marcus’ two surgeries and his slow recovery, the bad evaluation I got at work in June, my heart attack in July, my angioplasty in August, Gabriel’s deteriorating condition since September, my mother’s stroke in October, the financial hit of missing so much work and paying medical bills. Through it all, I’ve been quite depressed, but have shed very few tears…until this week. Once the dam was breeched, the trickle of tears became a flood that lasted well over 12 hours.

So what was the straw that broke the camel’s back? (I know I’m mixing metaphors, but I guess my brain is still drying out.) Since it involves work, I can’t go into too many details, but the bottom line was this: I was disrespected. My professional opinion to discharge a patient was questioned and the company is sending another therapist in to re-evaluate the patient and give a second opinion. Never mind my 30 years of experience in the field…I have someone second guessing my professional judgment. I wish I could quit, but the reality of needing to stay with this company so I qualify for health insurance and FMLA (and maybe long term disability) overrides my self-respect.

Catching up

I’ve been absent from Blogger for a while, so thought I’d write a wrap up of the last few weeks.
After Gabriel’s trip to the ER, he did start taking his meds again, but it has taken a long time for him to reorganize after this major episode. Even now, he still has not regained his previous level of function. I fear that this is how it will be…that each episode will result in some degree of permanent deterioration. If I wake up in the middle of the night, I still hear him laughing for no reason. His short term memory is terrible; he forgets things after a day or, sometimes, after only a few hours. But at least he’s socializing with us again and joking a bit.

I often go online to research which states offer the best mental health services, with the hope of moving someday. But I had not really considered the possibility that there might be non-governmental programs that might meet his needs. I have now discovered the “Clubhouse” movement for folks with mental illness, which provides a center for vocational and social programs, structured around the “work ordered day.” There are such programs throughout the US and around the world, but the one that most interests me is the one in St Louis, which is one of four US training sites for the movement. I am really excited about the program and, if all goes well, I’d like to relocate to St Louis at some point so Gabriel would be able to participate.

After Gabriel stabilized, I returned to work. I’ve been working my butt off, catching up and evaluating new patients. It was pretty hard to get back into the work routine after such a long time off (I miss those long afternoon naps!), but I’m doing OK now that the evaluations are complete and I’m caught up on paperwork. My previous bitter feelings about work have receded…getting a nice profit sharing check and a raise did wonders for my attitude! Given the current economic crisis that grips us, I feel quite fortunate to have a career that is not really impacted by the economic downturn.

A situation this week has set me thinking about some of the values we hold. I’m thinking about those values that are relatively easy or clear cut in a general sense, but which are challenged when a personal situation throws them up in our face. For example, one might be opposed to the death penalty, until the murder of a family member challenges that long held position. One might be theoretically opposed to abortion…until a loved one becomes pregnant after a rape. And so this week my firm belief in the rights of the disabled met a challenge. I discovered that my daughter who is severely disabled is pregnant. This young woman cannot take care of any of her own personal needs. She is totally dependent on others to feed her, dress her, take her to the bathroom, get her in and out of bed, etc. As a parent and as a therapist, I have long advocated that people with disabilities be allowed and enabled to lead normal lives. But this situation has definitely challenged that ideal.

On a lighter note, we now have a porch kitty. I’ve never been much of a cat lover, but this pretty stray kitten had been wandering the neighborhood for a few weeks, digging in the garbage for food. So I put some food out for him, and that was that. His name is Mufasa. He’s what I call a “dog kitty,” ie, a cat that acts more like a dog than a cat.

To the ER...and back

I finally took Gabriel to the psychiatric ER yesterday. After 48 hours of constant hysterical laughing, I figured it was time. After four hours in the waiting room, we got to see the doctor. As I expected, he said they couldn’t keep Gabriel there, because he wasn’t a danger to himself or others. Gabriel did agree to take his medication, which we now have to build up gradually again, along with weekly blood work.

And once again, I have the worry of missing work. I was just released by the cardiologist to return to work this week, but I’ve stayed home because I don’t think it’s safe to leave Gabriel unsupervised in his current state. I’m taking it as unpaid FMLA. But, in spite of the HR director’s assurance to me a few months ago that time missed due to FMLA doesn’t count against me, when I talked with the owner of the company last week, he brought up the visit quota required to maintain eligibility for benefits. Oh, great! Now I have the additional stress of worrying about whether I’ll lose my health insurance!

STD

Thank God for STD! Oops, lest you get the wrong idea, that’s Short Term Disability insurance. I finally decided that I should stop working and apply for it. Now if I’d gone to the ER the night I had the heart attack, there probably wouldn’t have been any question about it…I would have been advised not to work and that would have been that.

But, not knowing that I had, in fact, had a heart attack, I stayed home one day and then went back to work. It seems foolish now, but keep in mind that I had that performance review back in June and got low scores on Productivity and Absenteeism, so I was panicked that I had already taken two whole days off and missed all those visits. So I’ve been working ever since, but last week I only made 5 visits and it just about did me in. I’d go see a patient, then come home and sleep for 2 hours before going to see the next. But after the angiogram last week confirmed that I definitely had a “myocardial infarction,” I decided I should take some time to recover from the event and my upcoming procedure. Hopefully there won’t be any problem getting the doctor to sign the form stating that I have no business lifting 50 pounds on a daily basis.

This whole episode has given me lots of food for thought about ageism, disability, and the precarious grip many of us have on our health insurance. A recent poll conducted by NPR, the Kaiser Family Foundation and the Harvard School of Public Health found that over half of the people surveyed reported that they have gone to work when they were sick even though they felt they should stay home because of the financial issues that are involved. Robert Blendon, of the Harvard School of Public Health, says the poll suggests there are two main reasons people go to work sick: There is no paid sick leave, or they feel pressure from their employer to be on the job, regardless of whether they are ill.

As I have written before, my company offers Paid Time Off, but if you use it, you’re still expected to complete all your visits, so what’s the point? As long as you can plan ahead to use your PTO for a vacation and work in all those visits ahead of time, no one blinks an eye. But if you have to use that PTO for an unexpected illness or emergency and can’t make up all the visits you missed, it counts against you. Or you can take maternity leave for 6 weeks, no problem. I guess I should have planned this heart attack 9 months ago…

Over the last year, I have often worried about what I’ll do if I can’t handle the physical demands of my job any more. I was a bit reassured when I read the details of our Long Term Disability plan and found that, if I’m no longer able to do THIS job but still capable of working at some other job, the plan pays at least part of the difference in wages if the new job doesn’t pay as well. I may have been reading too much into a comment one of the office staff made yesterday when I called to say that I was taking short term disability. I told her I wasn’t yet sure how long I would be out, and she responded, “If you’re able to come back at all.” It seemed an odd thing for an office person to say and made me think that the district manager (the one who gave me the bad review) had said something. But what these folks don’t realize is that for most people, taking disability or early retirement isn’t an option for one simple reason: the need for health insurance until Medicare kicks in at 65. Like it or not, by the time I’m able to retire, I may be needing therapy more than my patients!

I think I’m beginning to understand how John McCain must feel. This month marks my 30th anniversary of doing occupational therapy. You’d think that experience would count for something. I was working in this field before many of the therapists at our company were born and when my supervisor was learning to read. But I find that I am less valuable to the company than someone right out of college because they are able to make 30-40 visits a week without breaking a sweat.

Recently our employee newsletter had an article encouraging us to purchase clothing, hats, and backpacks with the company logo on them, as a way of promoting the company. There were photos of the owner and some other employees sporting their gear in various locations, such as at the Golden Gate Bridge, on the beach at Cancun, etc. We were encouraged to send pictures of ourselves in our company gear. I’m sure we’ll get lots of great photos of therapists at the Grand Canyon, on Broadway, on cruises, in Hawaii. Gee, I can hardly wait to submit mine…waving from my bed in the cardiac cath lab.

Getting it

I’m always frustrated when I’m in a situation where someone doesn’t “get it.” On a political level, we saw a prime example this week when John McCain’s chief economic advisor, Phil Gramm, informed us that, in this time of financial hardship for many folks, we are simply in a “mental recession” and that we have become a “nation of whiners.” While McCain was quick to distance himself from Gramm’s remarks, the fact remains that McCain himself has been slow to acknowledge, or even recognize, the seriousness of the current economic situation. Time after time, he has pronounced that the “fundamentals of the economy are strong,” seeming to believe that if he says it enough, it will be so. Are we surprised? Only 4 short months ago, our president was dumbfounded when a reported asked him about the prospect of $4 a gallon gas, responding, “Four dollars a gallon? That’s interesting. I hadn’t heard that.” These rich politicians who have very limited contact with us regular folks can’t imagine how we live. When Cindi McCain charges $750,000 in one month on her American Express cards, when she has a closet full of $3000 designer suits, when the McCains own eight expensive residences, I can see why it might be difficult to empathize with someone who lives from paycheck to paycheck, who can’t afford the health care they need, who has lost their home to foreclosure. It’s not just a failure of empathy. It’s a failure of what I like to call “empathic imagination.” These people, living in an insulated world with others like themselves, find it almost impossible to imagine what life is like for those who live in a much different world.

But this failure of empathic imagination isn’t only a fact of political life. I see it in my everyday life as well and I find it equally frustrating there. One recent experience at work immediately comes to mind because I was so upset about it at the time. Last month I had my annual performance review and received low scores on “Productivity” and “Absenteeism.” The supervisor assured me that the numbers were only based on the time period from October on, after my caseload picked up. Great. In that period of time, I have missed work for minor surgery on my feet, an emergency stress test, two MRIs, my sons’ two visits to the ER, my mother’s two trips to the ER by ambulance, Marcus’ two surgeries and follow-up care, my mother’s regularly scheduled doctor’s visits. I also had to take Gabriel to MHMR every two weeks, but usually managed to drop him off and see a patient or two while he waited. I reminded her that my absences were due to these circumstances and she sort of brushed my protest aside. (Later I checked with the head of HR and found out that I could have been using intermittent Family and Medical Leave Act time for these absences and they wouldn’t have counted against me…it would have been nice if someone had told me that!) Anyway, the supervisor was obviously trying not to seem uncaring and asked a bit about my mother, but what I find at work is that supervisors ask about things like that, but they don’t really want to listen to the answers. I explained that my mother is 89 and legally blind. A few minutes later the supervisor asks me, “Does she still drive?” Say what? Hello? I just said she was blind, plus if she could drive, WHY would I be taking her to her appointments? I also mentioned that one evening recently I tried to call my mother and didn’t get an answer over the course of an hour. My mother almost never leaves her apartment after supper, so I was in a panic. The supervisor laughed and said something like, “I guess you were wondering where she went off to!” I couldn’t believe she didn’t get it, that I was panicked because my first thought was that my mother was lying helpless on the floor after a stroke or heart attack. Naturally that would be my first thought, given her age and the fact that I lost my dad not so long ago. I see this as a failure of empathic imagination, something that I seem to encounter a lot as I am surrounded at work by 20- and 30-somethings, many of whom have responsibility for no one but themselves and have unlimited youthful energy and good health. They literally cannot imagine how life is for me. Maybe 20 or 30 years from now, they’ll understand how things change when you have to manage work while dealing with personal health problems, caring for elderly parents, etc.

Most people, I think, would agree that empathy is an important facet of emotional intelligence, but I would say that the first step of developing empathy is to develop the ability to imagine what another person might be experiencing. One has to be able, mentally, to walk a mile in someone else’s shoes.