Wow! I just can't how Rebecca's vocabulary grows exponentially! I love being able to have whole conversations with her now. Last night, I asked her what she did that day. She replied, "I eat apples and meat and cheese. Nanny Becca play with the ball. We go for walk. I hiding. I watch Elmo. Mama come home, we snuggle." Apparently it was a fairly accurate representation of her day! I asked her what she wanted to eat for dinner and she said, "Ummmm, how 'bout pasta?" So I made her some ravioli. As it was boiling, she wandered into the kitchen and said, "I vewy [very] hungwy, Mama!" I told her it would take a few minutes for it to cook. She heaved a sigh and said, "Alright." Then she wanted to watch it boil, so I picked her up and let her look into the pasta pot. She peered into the pot for several seconds to look at the boiling water and pasta and then exclaimed, "Almost there!" When we were finally ready to eat, she looked over at me as I was about to take a bite and said, "Be careful, Mama. It hot!" Very cautiously, she stabbed her own ravioli with her fork and blew on it, all the while, looking sideways at me, as though she wanted to be sure I understood how to cool off my pasta. After dinner, we were playing with a ball, rolling it back and forth and throwing it (kind of). I bounced it to her and she bent over to get it; the ball bounced against the top of her head. She giggled and said, "Ball hit Becca's noggin!" I had no idea she had ever heard the word noggin, much less could apply it appropriately. Paddington was a little less interested in being part of our ball game and wasn't too receptive to Rebecca rolling the ball at him. Apparently he was in kind of a grouchy mood, because he barked at Rebecca a bit harshly, which crushed Rebecca's feelings. We had several minutes of tears and she told me "Paddy mad!" Luckily, it was soon afterward that Daddy came home, and all was well again with the world!
It's been a busy week since my mom left. On Tuesday, I had to do feedbacks with three patients I've tested in the last few weeks, plus another eval. Fortunately, my eval was a pretty short, straightforward case of a gentleman who was diagnosed with Alzheimer's about two years ago and needed a re-eval to determine progression. Luckily for him, he's been on Aricept and Namenda, which is really working well and he was actually doing no worse on anything and his memory was actually better than two years ago. Unfortunately, my feedbacks didn't go as well. I had to tell one patient she has Alzheimer's (probably actually AD and vascular dementia) and not only can she not drive, she needs 24-hour supervision. (She got lost coming back from lunch on the day I tested her and was found wandering in the inpatient unit with no clue where she was going or why she was there). Another patient was unhappy that she doesn't have Alzheimers (she really wanted that diagnosis, for some reason) and told us where we could go. She went completely ballistic when we told her that because of her severe visuoperceptual deficits, she can't get the electric mobility scooter her assisted living facility has ordered for her. The best part was that when she was storming out of the office in anger, she told me that she could drive better than I could because she had glasses and I didn't (?). As she turned to tell me this, she completely ran into the door with her walker - a good example of why she would be unsafe with any motorized vehicle!
The best part of the week was that my new DSLR camera (my birthday present) came on Tuesday night! I just have to get a super huge memory card for it, figure out how to use the non-automatic functions, and I'll be a picture-snapping fool!
I'm finally all finished with all the paperwork before I start at county on July 1. I have my NPI number now, so they can bill for my services. The department is going to be hit really hard by the State of California's financial crisis. Mental health services under Medi-Cal are going to take a beating. One of the smartest ideas they have for saving money is to institute a mandatory state review before any Medi-Cal patient can get antipsychotic medications. What an AWESOME idea!!! I wonder if Gov. Swarzenegger would like my schizophrenic patients having a psychotic break and hearing voices telling them to do violent things to come hang out with him and Maria and their kids while they wait for the state to decide if they're crazy enough for some Geodon.
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