Joyce's KP Adventure mikepasini.com headlines
Two Puzzles
23 June 2025
Technically, three. But two kinds. Sounds more like a riddle than a puzzle, put that way. Which is, after all, puzzling.
Last Friday I wheeled Joyce into the gym but not to exercise on the SciFit. She had given her customary refusal the day before to a simple jigsaw puzzle Cassie had offered her.
None of the physical therapists (Liane, Jayce, Kevin, Cassie) have been assigned to her. She's been exercised twice a week by two RNAs (Daisy, Neil, Wendy), walking on Monday and climbing stairs on Thursday. Every other day I take her for walks or a run up and down the stairs, plus some gym time.
So on Friday, I took her back to try the puzzle. It was pretty simple. Not a lot of pieces. Maybe 20. And the scene was a busy drawing of green car in the country. So lots of clues on each piece.
I didn't ask her if she wanted to try it. I just asked Cassie where it was. She got it out and put it on a tray and rolled the tray over. And Joyce went to work.
There is a printout to guide you but it was still difficult. She found the edge pieces and worked inward and eventually put it together with a few encouraging tips from Coach Mike. Several times she wanted to give up, but I gave her a clue and she persisted.
Cassie was delighted. "Monday I'll give you a hard one!"she enthused.
So today, after Neil and Wendy took her around for a walk (and weighed her at 109 lbs. 4 oz. without the wheelchair or trekking pole), we went to the gym. With the SciFit occupied, Wendy went to get her a puzzle but Cassie jumped in to put the difficult one with more pieces on the rolling tray.
It was an underwater scene with a dolphin. Quite a few more pieces, maybe 50.
Again, it was a struggle. The number of pieces made it hard to find anything but because it was an underwater scene, it helped to group them by predominant color. Then you could look for a clue like a small fish or a bubble or some plant life.
She found a corner right away but had trouble pressing subsequent pieces together. She was always using just her right hand so I suggested using two hands. She's becoming one-handed lately.
I asked Cassie were they got the puzzles, which were knew but had not brand name on the back of the printout.
"Amazon," she said, generically.
I told her I looked there without finding the car. Today I looked for the dolphin but didn't find that either. I did find puzzles for dementia patients, though.
It's a good visual problem solving exercise. I almost had the feeling I could see her brain working.
℘
OK, puzzle number two (or three, depending how you're counting) was the podiatry issue. If you recall, Mike the Administrator had promised to get her on the list if there was one and with priority.
It's been a month. No podiatrist.
As a form of passive resistance I haven't paid Joyce's share-of-cost for the month either.
But as she was waiting for lunch in the hallway, who should walk by but the state ombudsman. He didn't recognize her but he had a vague recollection of me because we had both witnessed a patient's advance directive a while ago.
I mentioned I did have a problem. And filled him in on the podiatry I'd requested in November with no response other than Mike's promise.
He zipped off to talk to the social worker (not Lauren) who told him that one had come in two weeks ago but Joyce wasn't seen.
Quite a puzzle.
But that's pretty much how these things go. There's a lot of promises and much less action.
So I made a promise myself.
I promised to get her to her old podiatrist, the amusing Dr. Sendak, and deduct his fee from her share-of-cost.
The Golden Heights podiatrist charges $65. Dr. Sendak last charged $90 in 2024. I suspect it is more this year.
He thought that was a plan. He also thought Sendak's office would know how to bill Medi-Cal and Joyce's share-of-cost would show a discount for that amount.
Uh, that's not what I promised. I'm not going to front the payment for Golden Heights. I'm going to subtract it from the share-of-cost. Golden Heights can chase the payment from Medi-Cal.
And, it turns out, Dr. Sendak's office doesn't bill Medi-Cal anyway. Most insurance, yes, but not Medi-Cal. Probably because they are only reimbursed $65 for a $90 service.
So that's not really another puzzle.
I made the podiatry appointment for July 10. Then I wondered if she'll still be at Golden Heights then. I should pay for June at Golden Heights as billed and deduct the podiatry charge from July if she's still there (likely she will because I'm not improving enough to take care of someone else yet).
That's the plan, anyway.