33) Cramping & Jack's Hallucinations

July 22, 2006
Saturday

Morning: Called and talked to Herman, who said they had an opening at 1:30 that I could use. Johnny was here for the last few days (compulsory time off from the stress and intensity of Camp C.A.M.P.*) so he went over my last blood work report and wondered how and why my protein count could be down. We also discussed his financial situation for the fall semester in Hawaii** and looked over his financial aid apps. Although he is unclear about the figures to use as his annual income, John appears confident that he will have enough money for the year in Hawaii, I hallucinate.

El Milagro: Diane cannulated me today and again did a good job. Rosie stopped by and said, “Hi stranger.”; I guess referring to my being in Dallas last week. As she was moving about the center working she kept glancing at me and giving me a little ‘knowing’ smile. But I have to admit, “I know nothing” so these little cutesy eye glances just confused me. I wondered if she had read the blog, or if she was just being friendly, or what it was all about. Rosie is always kind, attentive, and chummy so perhaps I am hallucinating the cutesy eyes thing (I am sure it is not flirtatious).

By “hallucination” I mean thoughts that I have that have no basis in objective empirical observation or verification from the person observed. In family counseling, we challenge students to identify ‘hallucinations’ they are making about their clients; such as thinking the ‘mother is acting this way because of her past abuse’, or ‘the child is angry at their parent and therefore acting out in school’. These are hallucinations because they are based on the counselor’s ideas of how the world works, not on exploration of the client’s thought processes or rationales for behavior. We ask students to listen to the client's story and ask about their ideas about how things got the way they are and their theory of how things might best be changed. Any time we think we know the answer without exploring the other person’s world view, we are hallucinating.

Today there is an older man in the corner chair who is moaning (“Auhhhhhaaaaahhuh” is close to the sound). The staff generally are ignoring him: I notice Herman glance at another staff as the man moans and arch his eyebrows slightly. I hallucinate that this means “just let him moan”. There are two of the man’s relatives (maybe they’re friends) with him and the female occasionally attends to him in his moaning. It may be that part of the moaning is in response to cramping in his legs (I hallucinate). It seems that the female relative is rubbing his legs at times. Staff does go over and attend to the man on their regular schedule of stopping by every 15 minutes or so to mark his chart with numbers from the machine. Later he moaned in a major way when staff picked him up out of the dialysis chair and placed his in a wheelchair to leave.

Today I watch a Hallmark movie about ranching in the hill country in Liberty Hill. The landscape doesn’t look like Liberty Hill to me; much more hilly than I remember LH to be. I hallucinate that it is really around Fredricksburg or Johnson City, drift off for a few naps, and think about the visit with Johnny. I look at the clock on the wall at 3:30 and imagine him driving to San Antonio with Helen, who came up to Austin from SA just to pick him up. He is ‘Hombre Importante’ at camp and can find folks to drive for an hour to get him. Also, he’s her boss. They are cruising down the freeway listening to modern rock music and driving too fast to get to the San Antonio all night party that will end when they all arrive back at camp on Sunday morning…… I hallucinate.

Muscle Cramping: “Muscle cramping of the hands, feet, and legs is fairly common on hemodialysis. The cause of muscle cramping is unknown. However, three conditions that seem to increase cramping are: 1) hypotension (low blood pressure); 2) the patient being below dry weight; and 3) use of low sodium dialysis solution.

“Muscle cramps are more commonly associated with low blood pressure. However, some cramping continues even after a normal blood pressure is obtained. In fact, muscle cramping can occur even without a fall in blood pressure. Muscle cramps also can occur when you are below your dry weight. (As the dialysis machine filters fluids out of the system, the patient can fall below their ‘dry weight’ and then muscle cramping can begin). The severe muscle cramping experienced near the end of the dialysis treatment and persisting for a time after dialysis often is due to dehydration."***

Notes: In at 73.5 Kg, and out at 72.7 Kg.
* Children’s Association for Maximum Potential: C.A.M.P. (2006): retrieved May 15 online at
http://www.serve.com/campcamp/
** University of Hawaii at Manoa: retrieved July 22 online at http://www.hawaii.edu/marine_biology/default.htm
*** Problems associated with dialysis (nd) Kidney Patient News: retrieved July 23 online at http://www.kidneypatientnews.org/kpt7.html