What follows are stories collected/gleaned from my site pages that I have written during this current odyssey I am on... who knows if it will ever end [during my lifetime]? Although I started my site 9/01, I did not start including stories about clients/people until 12/01- the stories start with this first one.
12/5/01: Today at work a friend and co-worker, Carol, came to share with me some trauma she had just encountered. Seems she has an older client who has been struggling with brain cancer for two years. Carol had been working to set up the client's daughter, who is in her mid 40s, as the client's paid care giver so the client could stay at home. The daughter was recently remarried and in the thick of life. Then Carol spoke with the client and was told that the daughter was just diagnosed with the same brain cancer. Today Carol was told that they had just turned off life support for the daughter.
Our work brings us in contact with some of the harsher realities of life, and on those especially illuminating days we vibrantly come in contact with the concept of time. On those days we remember how fleeting it all is, and then we move on, back to the mundane tasks of life. I think it was Winston Churchill who said that sometimes we stumble over the truth, but most of the time we just get up, brush ourself off and go on.
Witnessing peoples' lives is a gift; retaining the meaning of gifts is a challenge.
December 2001: Sometimes it takes courage to peak out at this world. Friday I met with a new client, a nice looking young man with paranoid schizophrenia. He asked me what his different meds were for, one I told him was for depression, the other I thought was for high blood pressure, and the third for schizophrenia. "So that's what I got" he said, although he really didn't sound surprised. "Schizophrenia goes away after a while, right?" he asked me. No, I told him, it is like diabetes, you have to take medicine for the rest of your life. He waited a bit and asked me the same thing again, and I looked at his chart, saw he was 23 and said, you are young, just a kid (he looked at the gray in my hair and took the comment well) and I looked at him square in the eyes and said, no, I won't lie to you, it will not go away, it is a disease just like other diseases and what you can do is take your medication for the rest of your life and it can help to keep your disease under control- that is the good news. He heard what I said and looked chagrined, so I smiled at him and said, I know it's the same thing you've heard a million times before- but it's the truth. He told me how he was going to finish his high school diploma, go to technical school, get a band together and play his drums. I encouraged him to play his music, and to myself I wished I hadn't met him a hundred times before, wished I didn't know how slim his chances for happiness are.
January 2002: I went to an adult family home to see 2 clients last September, one was in her 40s and talked A LOT and was not really very interesting at that, the other one was an elderly woman, very short, very wrinkled face, wore a jacket and woolen hat inside. She reportedly has a foul mouth, gets agitated, spits on the floor, etc., but not because she is psychotic per se- she had a big stroke which has left her with receptive and expressive aphasia, but she jabbers nonsensically. I asked her if she would show me her room and between the nonsense I heard her tell me that I was stupid to want to see it, then she grabbed my hand and had me feel her cheek, then had me feel her scalp, then had me feel her face again. I asked her if she had a headache, she said yes. I asked her if she wanted some tylenol, she said no, and then between the nonsense told me basically that tomorrow would be a different day, that she would lie down and then it would be a new day, and her head would not hurt. I like interacting with clients that other people say make no sense. Anyhow, this little munchkin lady smiled at me, then she said goodbye by hugging me and saying "I love you too". Sometimes love is easy to find.
January 2002: Working with the elderly is interesting. However, we get referrals to see those people needing help, who have dementia or are physically frail; the energetic, healthy elder rarely crosses our path. Recently I met with a woman who was turning 98 next month. She had become increasingly unable to get around, was taking meals only in her room, had difficulty getting up and down so spent much of her day in her living room chair. Her eyesight had gotten worse but she could still read large print and she could still enlarge the font size on her compluter but, alas, the cursor had become invisible to her eyes. She spoke of losing her husband many, many years ago, then losing one of her sons a couple of years ago to cancer, and how her brother comes to see her but it has become challenging for him because he is ill also and her surviving son has his own problems. She says she is ready for God to take her. How many times have I heard that? Sometimes the person is not really ready, it is just that they are depressed and isolated. But other times, as in this case, they are right- it is time. The body is fading fast, the loved ones are already waiting on the other side, and the purpose for being here is a more elusive concept than ever. Sometimes the party is over, but our ride has not yet arrived.
In some ways death gives structure and meaning to life, yet in other ways it makes you wonder what the point is. Some days we have made peace with this matter and on others it is astonishing still to think that we someday will die. Carol sent me a joke today and one line says that not one shred of evidence supports the notion that life is serious. It is a big ole goofy world indeed, just as John Prine says.
Mid-January 2002: In my work I mostly see elderly people, many of whom have dementia- I am fond of those clients- the essence of the person is sometimes the only thing that is left, other times the essence is among the first things to go. Some of my clients are memorable because they saw good things in me and made me feel good. One such client was in her 90s, sat with her doll she dealt with as if it were her baby and she would call out in a billy goat, braying voice. When I talked with her I held her hand and got down to her facial level- she listened to me speak, not really knowing what I was saying. Then she said, braying, yoouuu arrre niiiccce. Another lady was also in her 90s, lying in bed during nap time, thrashing her legs about in the bed mostly. She vascilated between english and her native Italian tongue, and she also listened and looked, not comprehending the words but seeming to understand something, and then said "she is wise" several times. It is interesting work at times.
February 2002: Another client that has stuck in my mind was a young woman about 30 years old I had seen who had cancer- can't remember what kind. She was having pain control problems but would not take pain meds because she had 2 kids, both pre-schoolers, and wanted to be able to interact with them and not be gorked, so she would take the pain as long as she could and then had to come into the hospital to get some relief. She had come back in again and I went in to see her, she was sitting in a chair with her hospital gown on and I was standing with my briefcase and clipboard talking as best I could with her. She was kind of shuffling her legs a little and then looked up and asked me to help her cross her legs (I hadn't realized that was what she was trying to do)- I scrambled and sat my stuff down, went over and lifted a leg up and crossed it over her other one for her. She thanked me as if I had done something wonderful for her. That was the last time I saw her, she died a couple of days later. So, that's about all I know about dying, it just happens and people don't get to be ready most of the time. I have gradually given up the little dream that somehow I won't have to face that task. I think that is where the Christian wish for the second coming comes from, that place of thinking that somehow the last task of life will be avoided. There are really no tasks of life we can avoid.
March 2002: A simple story about a community visit: when I picked up this caseload I groaned at the 2 mental health/substance abuser/homeless facilities I got assigned to, having worked with those difficult populations so much and it is more pleasant to just see elderly people that need help.
Going to the biggest facility the first time brought back memories of working at the state hospital, with a lot of very chronically mentally ill folks, mostly men, with not good hygiene, not good dental care, smoking until their fingers are brown, etc.
As time has gone on I have also remembered what I like about working with the mentally ill and interacting with them. Recently I went there to update the assessments of a couple of clients, and have seen most of my clients there now except for a handful. There is always a group of men on the porch smoking, who enjoy me coming and going, enjoy a person who looks them in the eye and smiles and greets, rather than the ususal response to their presence in the general public- one of averted eyes and silence, if not negative verbalizations.
As I left there were a couple of guys I had not met yet sitting out on the porch, smoking, and I smiled and said good-bye, and one said "have a nice afternoon" just as I was noticing the sun breaking out after a day of wind and rain. I said "well, at least the sun has come out and that is good", or something like that, and he looked at me and smiled broadly with gaping holes in his mouth where the teeth were missing, and said "I think it came out just for you".
Sometimes I don't know which of us is having the therapeutic interaction.
March 2002: Last fall I did an assessment for a 90 year old Romanian gentleman who had been in this country 3 years, using an interpreter. He is 5'10" but appears taller because of the way he holds himself. As we talked he took off on the subject of his life, he cried at times, telling how he had been a pilot in the army and was decorated twice with the golden cross. He had a small pile of very old documents that included the golden cross awards. He had been in the army when the Romanians were allied with Germany and then, later, Russia. He told how he had spoke out against the Russians and refused to join the communist party, so was expelled from the army- punishment was to work for years in a metal foundry despite being a well-educated man. He had to fight to try to get schooling for his daughter.
He spoke of distress at having come to this point in his life, and "for what?" having nothing... The interpreter said she had a hard time translating at times because the wording he was using was very old and some of the concepts had no equivalent in our language- ideas of lack of freedom. He talked about their saying that if a nail sticks up the Russians will pound it down, referring to people who stood out as leaders or intellectuals being targeted to eliminate their influence, keeping only the mundane people that they could keep control of. It was fascinating; I told him that it was a wonderful story, would be a great movie-- Anthony Quinn as him (which the interpreter thought was perfect), and he responded that he had started writing it down when he came to the US but now he loses his train of thought and simply cannot tackle the tasks, he cried some more... As this occurred I thought that all any of us have in the end is our story, and I almost reached across to hold his hand and tell him that, but my gut told me that he could not bear this information, so I did not.
Later I reflected, wondered at my resistance to my impulse, something newer for me. Is that all we really have in the end, our story? The story is important but the feelings are the most important to me- but am I just mixing in the ego again? The feelings the story evokes to me are the essence of the story, the feelings are in us for a reason, the reason is to feel, to feel the stories... An interesting afternoon to reflect upon.
There is a large Russian population here, one of my co-workers is Russian and does many of those referrals. Margaret was talking the next day about a play she had gone to the night before, how different it is here, that in Russia the arts were a means of expressing some ideas you could not otherwise express, thereby squeezing out a little bit of freedom from life- how going to plays there had underlying meaning for them, that certain lines would evoke all kinds of emotions...
April 2002:Earlier in the year I went to see a new client in an adult family home. She had been a single mom, supported herself and children, and now in her 80s had become quite ill and frail. She talked at length about her life, her children and her religion, and at one point commented that when I walked into her room there was a glow about me and she "knew" that I was kind. She was very chatty and we "ended" the conversation several times, although it was fun to listen to her stories and life. Then, as I was getting ready to leave she said "I am so glad you were the one who came to see me". I said thank you and was going to say it was nice to meet her too, when she stopped me and looked in my eyes and said "there are lots of other social workers in your office aren't there?", to which I replied that there are, and she said "See! God blessed me by sending you!". I liked her a lot...
May 2002: There is a poem called "Minnie Remembers" that I ran across many years ago. It remains one of my favorites and it guides me in my interactions with my elderly clients.
CLICK ME, to Read the Poem
Yes, I am rude, I call elderly people by their first name, and do not ask their permission to do so. I touch their shoulder, let my hand linger and hold theirs if they do not immediately let it go when I offer it on greeting, on leaving, and in the course of visiting.
I have never had a client complain when I have called them by their real name, but I have a couple of times had families question that- I tell them it is up to their mom/dad, that I just really want to talk to Minnie, not to mom/dad, grandma/pa. They look at me blankly, and watch their mom/dad talk to me, watch her/his face get more animated, watch them smile, watch me hold their mom/dad's hand, and, later, thank me for coming. Sometimes as I leave they put their arm around their mom/dad, and their parent keeps smiling.
Back in January I wrote of a client I had seen who was turning 98. She was used to being vibrantly alive and active, but her body now had other ideas, and she spoke of her readiness for God to take her, ready to see her loved ones already waiting on the other side. When I got to the facility the staff informed me that this woman was "crotchety", had thrown out the last social worker who visited her and told me to come back down for their help if I had trouble getting in. I went up to her room, called her by her first name, held her hand a little after we shook, sat and listened to her story that no one else had time to listen to, and had to pry myself away from her- it was getting late. As I prepared to leave she thanked me for coming and I explained to her that we try to see our clients every six months. She looked at me and said simply "I hope it is you that comes next time". She didn't seem to mind me calling her by her first name.
May 2002:One of my co-workers was off and had a referral for an emergency nursing home placement from home for an elderly (mid 80s) woman who was dying of cancer. My supervisor asked me if I could call them and tell them the worker was off but could get to them as early as Monday (this was a Thursday), and I told her to never mind, that I would call them and take care of everything. I called and then went out to her condo the next morning, scheduling it all with her adult son.
As I met with the client and her son and daughter-in-law, I told them that the referring hospital social worker had not gotten me her medical information yet and asked them to explain to me all of her medical problems, and so the son and daughter-in-law mostly filled me in, the client adding a few things now and then. Later in the interview I wanted to clarify the client's current condition, because the family had really just danced around the issue, so I looked at the client and called her by her first name, she glanced up quickly, unaccustomed to being addressed by her real name. I asked her what the doctor had told her about her prognosis and as I did I could see her son sitting to my left out of the corner of my eye, his eyes getting red around the edges and looking anxiously at his mom. The client looked calmly, easily at me and said that they had told her that she had less than 6 months to live, that she was getting worse just in the last couple of days and that she herself wasn't sure exactly how long she actually had, and at the end of that excrutiating exercise the son looked relieved, the question had not hurt his mom, the question showed him that his mom understood her prognosis and was not falling apart with the knowledge, and it showed him that the subject was no longer unbroachable, that reality could be acknowledged and not destroy the world in the process.
When I left the client thanked me for coming, I reached over and rubbed her shoulder, saying "you take care, sweetie" (corny but she smiled) and that was that. I left, I will have no more contact with them, I just have to assume that what I felt had happened did happen and that I did ok.
Maybe not that much of a story...
June 2002: One time I had a very depressed, elderly gentleman on my caseload. He had chronic back pain but that did not explain his melancholy, although it fairly quickly became apparent that he was also overwhelmed with grief at the death of his wife a few years earlier. He simply did not respond to antidepressant medications or group therapy.
One day I met with him and he told me the story of how his wife had gotten ill and had to go to a nursing home. He missed her so very, very much that he admitted himself there also. After a while his wife died and yet for the next several years, until now, he had chosen to remain at the nursing home even though he did not need that kind of care. He had been a diligent saver and despite having been only a blue collar worker he had amassed enough savings to privately pay for several years of nursing facility care.
This lovely man cried as he told me how he and his wife were very good friends with another couple- that he and his wife had talked often of how foolish that couple was, spending money on cruises, vacations and gifts for each other. And then the secret pain came out, as he said to me "there are so many things my wife and I could have done and enjoyed together, but now she is dead and all of our money has gone to pay for a nursing home the government would have paid for anyway...".
He did slowly begin to connect to others a little before leaving our care. The memory of that interaction with him serves as one of the reminders that life has given to me, to not catch myself simply looking through the window at life, waiting to experience the joys of love and friendship "later", when there is time or when there is money. I have too often seen that "later" never comes, that life often writes a different chapter in our book, different from the one that we had planned. Be with your friends, love like there is no tomorrow, have a racoon tea party... this is life today- c'est la vie.
Regret for things we did
can be tempered by time;
it is regret for the things we did not do
that is inconsolable.
- Syndney J. Harris
"Don't cry because it's over: smile because it happened."
"They say it takes a minute to find a special person, an hour to appreciate them, a day to love them, but then an entire life to forget them."- (both from emails Carol has sent me)
July 2002:There are many diseases in this world, many that either slowly or quickly kill you. When I first started doing medical social work in hospitals I found it very difficult- I remember telling a friend that all of my clients were either sick or dying, as if that was a surprise. And all of the other social workers there seemed to me, a psychiatric social worker, to be depressed. Back then, 13 years ago, I thought dealing with patients with new cancer diagnoses was the most difficult and maybe those new terminal diagnoses still are the most difficult, but now the addicted clients are the ones who try my strength, who defy my ability to help, who make the heart of the caretaker ache. One of my daughters is an alcoholic. She has been an addict for 4 years now and the phrase "living in hell" has a much deeper meaning to me now that it did before. There is always the hope that she will grow enough to understand and control her disease, but as of yet I donít know if she will make it there and every alcoholic client I meet who is on the road to early death echoes words I have heard from my own childís mouth.
Terminal diagnoses are terrible, their victims cut down, losing the lives they have made, losing loved ones, losing the only really important thing in this world- our connection to others and our self. Addictions are very different, striking in the teen years and early adulthood, tearing apart the individualís ability to connect not only to themselves but to others, destroying, piece by piece, the hopes of their parents for them, and making them forget the hopes they ever had for themselves. I am really not sure which is worse, losing the life one has made or never having been able to embark on an adult life at all.
I guess as she stood before the firing squad Mata Hari said "Life is an illusion" and you hear that said at times, sometimes making you wonder what it means and other times making a great deal of sense to you, but I think for addicts life truely is an illusion, or at the very least it is illusory- deceiving; illusive.
I have been including at least one client story every month on my pages; the next few stories will be about addictions- clients I have worked with and what I have seen. I have no answers for anyone, only stories.
I used to do all of the referrals from the hospital, setting people up for services, either at home, in an adult family home or at a nursing home. Even though I had worked with many chemically addicted clients in the past who also had mental health diagnoses, I hadnít really worked with those clients whose addictions were in their final stages, the ones hell bent on dying. The first client I saw at the hospital like that I came to call "the yellow lady". She was an alcoholic, and she had end stage liver disease. She would periodically come into the hospital requiring extensive medical stabilization and then need to go to a nursing home for IV antibiotic treatment, eventually getting well enough to leave the nursing home and start the cycle all over again. The first time I saw her she was lying in bed, her skin bright yellow next to the bed sheets, and I thought I would make a stab at "helping" her. I asked her about going to inpatient alcohol treatment and she vaguely motioned to the hallway, saying that someone had mentioned that and that she believed someone might be checking on that for her- her manner caught me off guard and, astounded, I said to her "were you expecting someone else to quit drinking for you?" in an incredulous tone. She did not bother to respond to me and the several times we did our dance after that, me sending her to a nursing home and her coming back in from the community, I asked her no more about what she wanted to do- her answer, though vague, was quite clear. I canít remember how old she was- 37? 39? 40?, I am not sure. I know for sure she was younger than myself. She died after a while, I canít remember if she died in a nursing home or on the street, or even how I learned she had died, but it seemed to be true- I never saw her again.
August 2002: I recently saw a client of mine for the second time, I looked back over my pages because I thought I had written about her before but I had not, I must have written about my last meeting with her to my patient and kind friend Ken way back then in February or March or whenever... She does not speak english so both times I met with her I had an interpreter, the first time was interesting in that the interpreter brought his wife who was from the same country and he thought that would help in understanding her. She has some significant dementia but it is not late stage, she is very verbal, was a teacher, and spoke at length, rarely answering any of my questions, mostly talking about her life, what she had done and felt, where she had come from, her story. The interpreter and his wife were not used to talking to demented people and were instantly charmed by this intelligent woman and all that she had to say, and I would have to stop them and ask what she was saying because they would forget their own task. After a while I stopped asking them so much, and I just watched, I saw how she responded, I saw her animation, I saw her looking deep within herself and within us, I saw her lonliness and the joy she felt at having people simply stop and ask her about herself. I knew she was not answering the questions, I knew she was very intelligent, I knew I had seen the place she was coming from before, but, as always, it is hard to just go with the gut and I would ask the interpreters what she was relaying to them, and they would, with delight, tell me the gist of her communication, and I knew then that I really did not need an interpreter to recognize this woman, that I did not need an interpreter to tell me her meaning. She was pretty fixed upon me and in between her stories she would stop and look at me and motion to my face, the interpreters didn't have to tell me what she was saying, I knew, I had heard if before. "She is saying that you glow, that you have a kind heart. She says that you are beautiful." Yes, I knew that was what she was saying. I did not get any of my questions answered directly, but all of them were answered.
I saw her again recently, the facility she lives in had asked me to come by, they were puzzled by some things and felt that I could shed light upon what was going on. Again I met with her with two people, this time one interpreter and the facility manager, and again she answered few questions, and spoke at length about other things, but this time she mostly talked about me. She touched my chin a million times, she "read" my face, she said she had learned face reading in her own country, that I glowed. She loved my chin, said the forehead showed childhood, the chin the older years. She said that my forehead showed that I am very intelligent, that my teachers loved me for this, that I was a straight "A" student. She said that I would find great happiness, that many men would want me and that I would be the one to choose, that I would find great happiness in love with that man, that I would have financial security and that this, the chin readings, were for my older years, maybe after 60. Yes, ok, that is good. She was not interested in the faces of the other people, again her focus was on me. I got few answers once again, yet, once again, I got all of them. She had to go to a nursing home, and that was going to be ok.
"Old" women, even those without dementia, tell me things like this about myself all of the time, the older men usually just smile, talk more than they have for a long time, let me touch their hand or help them up when normally they just growl at the staff, and they thank me for coming, ask me if I will come again. Yes, we, men and women, are two different beings, yet we are the same, we react to the same things, we see the same things but we "see" them differently, we "talk" about them differently. When I see clients I am completely present, I don't know how to tell you what that means, but time does not exist.
My wish is that this lovely lady is right, that when I am an older woman (hopefully she is right and it will be by 60!) I will find great happiness with the one man, the one who sees me. I know that I will have to wait for that, because it seems that to "see" you have to be "old", and having dementia helps that process apparently. What is that all about anyway? Ciao.
August 2002: So, continuing on from my July page and stories about addictions, there was another client I worked with a few times when I covered the hospital referrals. He was quite thin, looking like he could blow away in a stiff wind. He was also a late stage alcoholic and would return to the hospital over and over, requiring nursing home care at those times.
He was kind of charming or disarming or something and nursing homes would put up with him for a while, then they would not want him back. He would sneak out of his bed at night, they would realize he was gone, and then later, sometimes a day later, they would come upon him in his bed, having also snuck back in. They would tolerate this only so long and then kick him out, or other times he simply would not return.
This happened over and over, then I placed him in a nursing home two counties up and for a while we thought we would not see him again- but once again he surprised us. He had been up to his old tricks there too, leaving and then showing back up, and when they laid down the law he did not return from his next foray out into the world of endless alcohol- but he did show back up at my hospital, having made it not only back to town but back to town on his little electric scooter- how, we will never know. The hospital called me, asking me to assess him for nuring home placement again, and I said I would be up there in the morning, but the next morning they called to say "never mind", he had disappeared during the night. But that did not last, and in a couple of hours I got another call, that he had showed back up and was in his bed- ah yes, his trademark. I went up to the hospital and there he was, thin as ever, lying in his bed. I told him I had been called the day before but that they had cancelled the call because he had disappeared and then they had called saying he actually was there and I asked him what was up with that. He looked at me seriously and explained that the nurses were not giving him good care and so he felt he needed to leave. I looked back at him and said, "Hmmm, and I thought you left to go drinking"- to which he smiled and said "you know, I think you may just be right".
I once again found a nursing home for him, one in Seattle that had a lot of mental health clients and I thought that maybe they could tolerate him better at the least, and at best maybe someone could work with him. A couple of weeks later I heard that he was doing ok there, and in a few more weeks I heard he had died. He was a character, we all are characters. But those characters with addictions are led down different paths by the substances they think they are using and, instead, the substances use them and, in the end, use them up.
September 2002: I first started working in social services at Ypsilanti State Hospital in Michigan in 1975, as a kind of fluke. I had taken every state employment test I qualified for the last couple of winters in hope of getting a summer job between semesters and the summer before had worked on a survey crew for the highway department. When they called me for the interview at the state hospital I kind of cringed but thought "what the hell", figuring it would be weird but paid decent money... When I interviewed they asked me what I knew about working at such places and I told them that I had read One Flew Over the Kukoo's Nest and they just nodded- I think that they had no idea what that book was.
I worked there as an Attendant Nurse from that time until late 1981- YIKES!- finishing my Bachelor's degree in 1977 and staying on because the job was easy and paid well. "Ypsi" was quite an experience. I worked on several different wards, some of which made the ward in Kukoo's Nest look actually therapeutic. On one all male ward there were large "dorm" rooms with maybe 20 guys in them and working the night shift I found that they were hearded into the rooms in the evening by that shift and the doors were locked, being left locked for the night. There was no bathroom access for the patients. In the morning the doors would be unlocked and urine soaked men would come out, there would be a lake of urine on floor. It was very interesting. On the same ward was a client who had a foot fetish and in the morning, when he was allowed out and about, and he would periodically reach out to my foot, wanting to touch my shoes. On the same ward the supervisor slapped one of the patients about one morning- seems the patient had filed a complaint about one of the other workers being abusive and the supervisor did not like that... yes, very interesting.
I also worked on a geriatric ward for quite a while, again on the night shift, and I remember the first patient I ran across having the diagnosis of Alzheimer's Disease and his chart was flagged with that because they were not sure at that time if it was transmittable... he had been sent home once but returned after shooting his wife... One of my favorite patients was an elderly black man from the south, tall and strapping, who would walk around saying "cotton" all the time, and a sweet little confused lady who would stand in the hallway at night saying her mom had sent her out to catch the school bus...
So, how I ever ended up staying in the field is still a bit of a mystery, perhaps mostly a kind of personal inertia. In observing the professional staff I noted that the nurses had to work all shifts, weekends and holidays while the social workers worked days, Monday-Friday... hmmm.
If you click on the picture of "Ypsi" above it will take you to a site about historic "insane asylums".
If you click on the "gears in motion" at left it will link you to a video of pictures of Ypsi patients taken by a friend of mine way back when... in the '70s.
(Click "cancel" and then "exit" for the RealPlayer prompts, if you get them...)
October 2002: Ok, back to the state psychiatric hospitals theme... I worked at Western State Hospital (click on picture to connect to site about historic psychiatric institutions) from the mid to late '80s. It was a "nicer" institution than Ypsilanti State Hospital in Michigan that I wrote about last month in that patients had some privacy and basic respect. It too was an interesting place to work and has given me a couple of stories...
Let's see, yes, I remember that I also had a patient with a shoe/foot fetish there too. He was gaunt and looked kind of like that Manson guy... he wanted to reach down and touch my shoes at times and I had to set limits. He was actually a service-connected vet but was not at the VA hospital- they were paying for him to be at WSH because he had injured too many of their staff attacking them- always interesting to have him alone in my office, but we did fine.
Once while I was alone in my office I heard something bang on the floor and some yelling, I went to the hallway and staff from the unit above us were coming in the door, having heard the noise up there too. In the dining area were several overturned tables and a couple of patients being held back from attacking each other. Seems we had two "Christs" sitting next to each other and they had difficulty with there being more than one of them.
I had another client that I worked with more than once. I remember one time him telling me how he would go through openings in our reality and talk to people in other dimensions and interact- it was very interesting and I told him so but advised him to be very careful about who he shared this experience with. Later he told me how he had been on one of the "back" wards and a male staff person did not like him (he seemed to make a lot of people not like him) and he showed me a scar on his arm from a hot cigarette lighter being held there- which he said was done to him by this staff person. He also said that once this staff person, who worked the evening shift where there is less supervision around, locked him into a craft room with a large, aggressive male patient who proceeded to rape him while the staff person and some other patients watched. I reported these things, and I do know that staff person was moved to day shift for "re-training", as is the custom with such things there, and later moved back to the evening shift when he was finished "re-training". The workers' union there always supported staff members accused of abuse- it has tainted my view of unions. Once when I was no longer working there but was screening patients for a community mental health center that were ready to leave, I ran across this client on a unit with the same male staff person working there and the client was beside him self in terror. I complained to management and caused a rucus, they did move the client and felt that I was just causing trouble- guess I was.
For about a year I managed a residential unit on the grounds there at the hospital. One of my social worker friends referred a client to me from his caseload that we normally would not have accepted but my friend assured me that the fellow would be fine. I came over to his unit to interview the man and he was a huge, Baby Huey kind of guy, who spent the whole time saying "Don't worry, I won't hurt anyone". I kept hoping no one would overhear the interview as they would think I was crazy to accept the man. He came to my program and did fine, stopping by my office daily to tell me a joke- the jokes were always rather pitiful and lacking but he was trying hard to entertain me. He was profusely thankful for the opportunity to be in our program and we were able to transition him to a program in the community- there are a lot of people that have a place in life if given some support and a chance.
Another client I remember was not even on my caseload but on the caseload of a friend and co-worker on my unit. The client had a manic-depressive disorder and was quite manic on this admission. She was fairly young, in her mid to late 20s and while manic was acting quite promiscuous and male clients were at times waking to find her naked on top of them. She refused her medications because, like many manics, she enjoyed her high. Her treatment team was at a loss and worried about her and I overheard her nurse saying that. At that time we could involuntarily give medications to patients if a second psychiatrist agreed that is was in the client's own best interest, but that was normally done with medications for psychosis that you could give in shot form. All of the medications for manic symptoms were in oral form. I matter-of-factly suggested to this patient's nurse that they get a second opinion and give her liquid meds via a feeding tube- crude but effective. The treatment team did pursue this and she stabilized, eventually being able to be discharged back to her home community. The reason I am telling this story is that it did not have a happy ending, and life threw us a curve ball. When you work with severely disturbed psychiatric clients you are sometimes able to get them doing remarkably well and moving on in life in a more normal fashion, with hopes and dreams that then become actually possible. But those times are also very dangerous- because once people are "clear" they begin to realize what they have been doing, what their lives have been, what time they have lost- they are at risk for suicide. This client did not make it through the period of questioning how she had spent the last 10 years of her life, through the period of coming to terms with her past actions, through the period of re-forming her direction in life. She committed suicide. She was intelligent, attractive and she became lost in this complex maze of emotions, feelings and needs that we all try to find our way through, some of us faced with what seem like insurmountable tasks that we must complete in order to continue on the journey. We all need the support of others, we all need connection in life to grow, and sometimes we simply need those things to keep living.
November 2002: The month is ending; it has, once again, gone fast. Time seems to be moving on more quickly these days and I wonder if there is some sort of acceleration factor as we age that scientists have yet to define. Perhaps as our skin becomes thinner light goes through it more easily and therefore faster- maybe the speed of light is not a constant and so our experience of time does change as our skin thins... Hmmm, maybe I should hold those thoughts to myself.
I have not put a client story on yet this month, and so now here it is, late but not forgotten in this busy, busy month. I will keep it simple.
Back in 1988 I went to a training on documentation skills when I worked in commmunity mental health. I don't remember anything that they told us about documenting our work, but I do remember the speaker talking about how difficult our work is. He said something about how so often we get no thanks from our clients and in fact we may no longer be seeing our clients when what we have done with/for them has a positive impact. Many times we say things that have no impact, yet later, at the right time, our words may come to their mind and be of help. It was an interesting thought, at least to me.
When I worked at the state hospital and then again at geropsych I would often tell patients that I enjoyed working with them and hoped never to see them again. We did not have a lot of success with some clients and they would return. Most clients never returned and you had no idea how they had fared, if what you had done had helped. It can be work with little positive reinforcement.
On Wednesday before Thanksgiving I was at one of the facilities I work with and was getting ready to leave. I saw a client I had seen a couple of months ago ahead of me in the hall and selfishly hoped she would not interact with me so that I could get out and head home for the holiday weekend. But she recognized me and asked if I was leaving, to which I simply responded "yes". She smiled and said, "Thank you for what you did for me, it has improved my life immensely". Life is odd isn't it?
December 2002: AND SO IT IS CHRISTMAS...
Let's Hope It's A Good One...
The holidays, family, friends, time, life. I hope everyone gets a chance to stop and reflect- it is the best thing to do on these holidays, these days of meaning. We have filled them with so much of what is not important that it is once again hard to connect to life.
We all get e-mail jokes and stories; many are not worth our time, some are interesting. Here is one Doreen sent to me recently:
The story goes that some time ago one Christmas Eve a mother punished her 5 year old daughter for wasting a roll of expensive gold wrapping paper. Money was tight and she became even more upset when the child pasted onto the gold paper so as to decorate the box to put under the Christmas tree.
Nevertheless, the little girl brought the gift box to her mother the next morning and said, "This is for you, Momma." The mother was embarrassed by her earlier over reaction, but her anger flared again when she found that the box was empty.
She spoke to her daughter in a harsh manner, "Don't you know, young lady, when you give someone a present there's supposed to be something inside the package?"
The little girl looked up at her with tears in her eyes and said, "Oh, Momma, it's not empty. I blew kisses into it until it was full."
The mother was crushed. She fell on her knees and put her arms around her little girl, and she begged her to forgive her for her unnecessary anger.
An accident took the life of the child only a short time later. Tthe mother kept that gold box by her bed for all the years of her life. Whenever she was discouraged or faced difficult problems she would open the box and take out an imaginary kiss and remember the love of the child who had put them there.
In a very real sense, each of us, as human beings, have been given a golden box filled with unconditional love and kisses from our children, family, friends and even strangers.
Last week at work I went to see an elderly woman. Her daughter and son-in-law were present and the love and caring they shared for each other was striking. During the course of the interview I asked about her other children and she explained to me that she had had two sons and the one daughter, that one son lived in California and the other had died in an auto accident at the age of 26. Her husband had been out of town dealing with issues regarding his own elderly parents and they did not want to burden him with the news, so the two remaining children and her waited for him at the airport. When he saw all of them there he immediately knew that something was wrong. She helped to raise that son's child. She cried softly as she spoke of these things, not in unresolved grief, not seeking pity, but simply cried for the loss she felt and will continue to feel for all of her days.
I remember the scene from a movie that I do not know the name of, with an older Kathryn Hepburn in it, and that scene has become part of my psyche. The movie was about her relationship with the man she married, their wild young years and the years that followed. One day they were at an ocean beach and they were preoccupied with taking a picture or something with their daughter and told their son to go play, to keep himself busy. When they stopped later to look for him, he was gone. They spent days looking for him, encouraging the searchers to continue. Later the couple, now in their 80s, were at the beach and they spoke of that thing that they shared, and the husband choked as he said, "I still miss that boy". We do not always appreciate how very much our children, family and friends are a part of us, of who we are.
Time flies... Be Here Now.
Today is the day.
Every moment is part of the whole that we are creating.- Hazelden Meditations
We are so lucky to be alive, to get to experience these incredible emotions that color our lives and our selves. I am so incredibly lucky to do the work that I do, to get to peek inside the lives of so many people who grace me with their experiences, their lives, their selves.
And so I end with a poem shared with me by Jay, who colors my life these days that are now.
By Gerard Manley Hopkins:
Felix Randal the farrier, O he is dead then? my duty all ended,
Who have watched his mould of man, big-boned and hardy-handsome
Pining, pining, till time when reason rambled in it and some
Fatal four disorders, fleshed there, all contended?
Sickness broke him. Impatient he cursed at first, but mended
Being anointed and all; though a heavenlier heart began some
Months earlier, since I had our sweet reprieve and ransom
Tendered to him. Ah well, God rest him all road ever he offended!
This seeing the sick endears them to us, us too it endears.
My tongue had taught thee comfort, touch had quenched thy tears,
Thy tears that touched my heart, child, Felix, poor Felix Randal;
How far from then forethought of, all thy more boisterous years,
When thou at the random grim forge, powerful amidst peers,
Didst fettle for the great grey drayhorse his bright and battering sandal!
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