Paperwork

  My friend Joy was an indomitable trauma nurse. She never minded taking on the most challenging patients. She and I worked together in the ER for six years, and no amount of blood or guts could scare her off. When EMTs brought in a gory-looking accident victim, Joy was always the first one in the room, cutting off the patient’s clothes, taking vital signs, starting IV fluids, connecting monitors, noting injuries… The only thing Joy hated was paperwork.

  I retired last October. After forty years in a cardiovascular ICU, I left the profession I loved. I left, in part, because of the paperwork.

There are three kinds of paperwork in my office. The first kind of paperwork, the one the phrase evokes, is really mostly computer work. Although my shifts often run late, I don’t mind the time actually spent in the exam room with patients. The exhaustion hits as I finish a four-hour sprint only to realize that I have another one to two hours of documentation work. Then add on answering messages, dealing with lab results and filling out forms (some of which are on actual paper), and I can feel the joy of my job leaking away into mute surrender.

In March 2017, my son died of a heroin overdose. He was twenty-five years old. It began with his use of recreational drugs in his early teens. Before long, he was addicted to prescription opioids. And, finally, heroin. Watching my beloved child slowly destroy himself was a heart-wrenching experience, almost as devastating as facing the finality of his death.

There’s an old binder still sitting on the bottom shelf of one of my bookcases. The cheerful primary colors of the label stand out amidst the other books, especially because it takes up nearly twice the width of the next largest spine. It proclaims itself to be the “New Family Handbook” from the local NICU, and it has been sitting on that shelf for nearly six years now. That binder became the dumping ground for all the paper associated with my son’s premature birth, his month-long hospital stay, the small hernia he needed surgically repaired.

On December 13, 2017, I had major surgery. That operation involved hours of paperwork, both before and after the procedure. Once my surgeon and I agreed upon the surgery, I had to fill out health forms in his office—forms about past procedures, about my current medications, about my physical and mental state of being. The forms even asked about my marital status. Does being divorced really affect how I will handle the surgery? Completing the forms exhausted me, causing my pain to exacerbate.

  We take a man home on hospice from the hospital: end stage cancer, metastatic. His Power of Attorney requested one last pain shot of Dilaudid. We cinch belongings into bags, gather discharge papers and old flowers in vases. He groans being moved from cot to gurney, and again over the bumpy roads. It’s his final ride; we are his transporters.

  Paperwork helped me find my voice as an occupational therapist. Many occupational therapists struggle to describe the profession to patients, other health-care providers, and health insurance companies. Oftentimes, occupational therapy (OT) is incorrectly billed as physical therapy (PT), and some insurance companies do not even cover occupational therapy, reasoning that physical therapists can do everything necessary to address patients’ rehabilitation needs.