January 2004: At one time when I worked at a psychiatric hospital with an odd psychiartist patients would often mistake me for being the doctor on the team. The psychiatrist seemed to think everyone had the same diagnosis and should be on a certain medication. She tended to wear frumpy dresses and often would simply leave her overcoat on inside.
A couple of years later there was an article in the newspaper about "back wards" and how the not-so-good psychiatrists were assigned there- that many of the patients seemed to be on the same medication... hmmm.
Later, I saw her again as a hospice patient. I think she was about in her mid-40s at the time.
Life does exact a high toll.
"A voice said, Look me in the stars
And tell me truly, men of earth,
If all the soul-and-body scars
Were not too much to pay for birth."
January 2004: I worked for child protective services when we moved out here to Eastern Washington- the land of hot weather and cowboys. I would go out to homes in response to reports of child abuse or neglect and try to figure out what was going on. Many of the homes were not nice, sometimes the kids ran around barefoot, with snot hanging down from their noses. I remember one father, indignant that anyone should question his parenting, standing outside of his old trailer, his white tee shirt not covering all of his protruding belly, proclaiming that his kids were being raised "the same way I was- and I turned out alright!". Yes, of course.
I was not fond of CPS work and I think it was all the more difficult with little ones of my own at the time. Because I was the only worker with a masterís degree in the office the supervisor decided that I would be their sexual abuse expert, despite my having only completed my degree a couple of months before. I listened to some training tapes and then I was an expert and got to interview several people about these things.
Twice in the year that I was there I interviewed people who were day care providers in family homes, with the local deputy, and I know at least one of those was convicted of child molestation. After that I couldnít even begin to consider a family day care for my children... It was difficult work and the caseload was like a tidal wave.
I moved on to the state psychiatric hospital, where the clients were also vulnerable but in many ways could fend for themselves. I guess at that time I fit in better at the "nut house". I certainly was less stressed there.
The bottom line is that I am responsible for my own well-being, my own happiness. The choices and decisions I make regarding mylife directly influence the quality of my days.- Kathleen Andrus
February 2004: Jay and I ran across Mr. Happy Crack (at left) in an ad today whilst looking through a magazine and so I just, of course, HAD to look him up on his site... click on him if you are curious too.
Seeing the ad's claim that a dry crack is a happy crack led me on my usual circuitous yet somehow direct thought process to a memory from days of yore which I have shared with others from time to time- a perfect fit for my new February page!
Many, many years ago, before the general public had computers at home, before the internet, before walkmans, before cell phones, before CDs, and even before a Bush was president, yes, back about 1985, I was working at a psychiatric hospital. Every morning we would sit and have "report", a common phenomenon in hospitals where the shift coming on is reported to by a nurse from the prior shift to update about the status of current patients. One of the psychiatrists was a larger woman who would often wear a dress, yet when she sat she placed her legs apart and pushed down on her skirt so that it went down between her legs and "covered" her. People are interesting. There happened to be a female patient on the unit that had been focused on an idea that she had a vaginal infection and this had been checked numerous times with no infection found. Apparently the psychiatric medications weren't getting rid of the infection either because one morning we came in to learn at report that she was once again agitated and upset, complaining that she had a vaginal infection. The psychiatrist responded by proclaiming "well she can't expect to have a dry twat!" Hmm, yes, how clever of her to deduce this...
"A male gynecologist is like an auto mechanic who never owned a car."- Carrie Snow
February 2004: NewScientist.com has an interesting article about a new miniscule corkscrew device that they are testing and getting remarkable results with in treating stroke victims. If you would like to go to the article click the picture of corkscrews at right.
Over the years I have worked and done assessments at several hospitals. I have seen and talked with many stroke victims and the ravages of this medical event are pretty staggering. I remembering seeing a woman in her mid-thirties who had a stroke while delivering her baby. She was in a wheelchair and trying to regain skills with the goal of being able to hold her own child. I also remember seeing several people in their thirties who had had strokes, one man explaining to me that he knew the process, the treatments and therapies, because his wife had a stroke in her early thirties, then another, and then had died of a stroke. Another hispanic man had severe expressive aphasia (he could not express/speak even though he could form the words in his mind) and was incredibly angry and frustrated, pounding the wall with his fists because he could not get the words out to tell me...
"I learn by going where I have to go."- Theodore Roethke
March 2004: I met with a guy a while back who was considered a difficult client because he drank, got nasty and scarey, and would get kicked out of programs and then show up again demanding services. It was all true.
When I met with him he reported that he had been clean and sober a few months, and we discussed his history and his abuse of alcohol and of others. I told him he needed to keep his shit together, go to AA and follow the steps. Clients like this look at me as if they wonder what the hell I know. A couple of times I have followed up that look with: "My eighteen year old daughter has been clean and sober 9 months." It stops them cold. They know what that means. Sometimes they tell me they are sorry, as if my plight was of their own making. This man became earnest, telling me that he indeed wanted to maintain sobriety because he now had a grandson to think about.
I told him up straight and very simple: "That's good, because both you and your son are alcoholics. Your grandson will most likely have trouble with alcohol, maybe in his teens, and what will matter then is not that his dad and grandpa are alcoholics- what will matter is what he saw you do about it." We talked a bit more and then the gal who was going to be his paid caregiver came in. I told her that he needed help with several things but that the thing he needed the most help with was something no one paid her for- that he needed help staying clean and sober because he was a mean and nasty drunk. He shook his head in agreement and said it was true.
After I mailed his paperwork to him to sign he left me a voice mail saying that he appreciated the assessment and how I didn't just say bad things about him. He also said he wished I wasn't transferring his case, that "those things you said, it helped me". I transferred his case and haven't seen him since.
I haven't seen Kira since Christmas. Haven't talked to her in five and a half weeks. She does not return my messages. She started her sobriety 9/11/02. I hope and pray that it continues, but I have no control over that. Yet, still, it is hard to let go and trust in the process. It is hard, even one day at a time.
March 2004: I met a man recently. He was nice, and articulate. He sat in his recliner, plastic tubing helping the oxygen get into his lungs. He explained to me how he had lived in California, that just a few years ago he and his wife were in the car, himself driving. All of the sudden she slumped over. "We were only five minutes from the hospital so I turned around and drove right there. They tried to revive her for a couple of hours, but they couldn't." He told me that, yes, those were pictures of her above him on the wall. The sienna colors of times past, the young, smooth skin. "Beautiful? Well, she was young then!" Yes, I guess we all were beautiful, then.
He told me how they had diagnosed him with cancer last week, that it was in multiple areas of his body and so when he met with his oncologist later this week he was expecting that little would be done by way of treatment- they already had said that he was not strong enough to tolerate radiation. "Yes, and at 86 I am old enough."
Old enough to die. Life had been good to him. Old enough to die. Simple enough.
Gentleness is not a quality exclusive to women.- Helen Reddy
April 2004: A year ago, last April 2003, I wrote about a woman I had met who was only one year older than myself. She had cancer in her brain stem: she just found this out a couple of months ago, when she started having trouble with her balance and then one side of her face froze. Her adult daughter was helping her and she was planning to start five weeks of daily radiation therapy next week. She told me that she had asked about her prognosis but that the doctors didn't seem to know. "Even they don't know; they are not gods." She was emotional, she was crying. She was struggling to make sense of it all and spoke of having episodes of losing her "will to live". She knew that she might die, she knew that maybe the best she could hope for was a little more time. I told her that it would be alright, that either way it would be alright, because it would have to be. She thanked me and told me that I am kind. It is hard to believe that those words are ones of kindness. Sometimes saying what is true when the words bring tears to your eyes is about as kind as you can get.
She did not say it, minimizing any information about her psychiatic history, but I knew she had problems with anxiety and other emotions that would steal over her, uninvited. Her daughter, a young adult with little chldren of her own, was there with her mom. She was loving, kind and attentive. She amazed me with her strength and courage over the next several weeks. The daughter was a good caregiver and looked as if she knew the role well, repeatedly demonstrating this while helping with the weeks of radiation treatment, the nursing home placement and accompanying her mom on that long unintended walk we are required to take sometimes.
The woman went to stay at a nursing home in another county, close to her treatments and out of my geographical area- the case was transferred. After a while in the nursing home, when the radiation treatments were done, the daughter called me to say that her mom was no better and the radiologist would not tell them anything. They had a meeting scheduled for the next day to review things with the doctor and I encouraged her to be direct in her questions, to find out what she needed to know.
I heard again from her shortly- she was crying and very angry. Her mom had been told, finally, that she was terminal and arrangements had been made for hospice care. "And she is calm!" "It's like she's accepted it- like it's ok!" She was furious with her mom for finally going gently into her emotions. All of these years, all of these decades, she had been ofttimes her mother's care giver, her mother's parent. She had been the balm for the emotions of her mother that needed soothing and now, in what should be her mother's hours of greatest need, she was not able to give that part of herself that she knew how to give. She was having to deal with, to adjust to, a mother who had become an emotional adult, who had become what she had needed all of her years. The loss looming on the horizon had been made so incredibly complex, and more painful than her wildest imaginings.
Traveler, there is no path. Paths are made by walking.- Antonio Machado
July 2004: I am feeling a bit better, the antibiotic is starting to work...
Setting: Secure Dementia Unit
On Stage: Three Older Women, Seated for Lunch
Sound: Fire Alarm
Lady #1: "What are they doing that for?"
Staff Person: "They are testing the alarm."
Lady #1: "Well they should stop- it's working. They are going to have to send all of us to the doctor's office to check our hearing!"
Staff Person: "They want to make very sure it is working fine."
[Alarm sounds again]
Lady #1: "Well, I'm very fussy- and I would stop!"
Social Worker: "That can be helpful, to be particular about things."
Lady #1: [Looking reflective] "I don't know, it isn't always." [She smooths her napkin]
[Alarm sounds again]
Lady #1: "They're going to have to send us to the doctor's..."
Social Worker: [Interrupting] "What?"
Lady #1: "They're going to have to send us to the doctor's to..."
Social Worker: [Interrupting] "What?"
Lady #1: "They're going to have to send us to the doctor's to get our..."
Social Worker: [Interrupting and touching her ear, pushing it forward as if to help her hear] "What?"
Lady #1: "to get our hearing" [Stops talking, looks up at Social Worker and laughs] "Oh you!"
Lady #2 and Lady #3: Seated at table, laugh along, the startled look on their faces combined with a pleased look, as if surprised and pleased that someone would not only make a joke for their benefit, but think that they could "get" it.
Most conversations are simply monologues delivered in the presence of a witness.- Margaret Miller
Click on the rabbit cartoon- courtesy of Mr. Will
August 2004: I recently met a man heading into his late 80s. He was originally from Norway, and I wasn't clear on how he made it to the US, but he told me he had been in the US Army and fought "in the war". He had been a dance instructor, and a merchant marine- "I've been around the world twice, been through all of the canals." He loved to ballroom dance and loved to paint little figures depicting soldiers and other military things- neither of these could he do anymore.
He talked about using his hundreds of war figurines to re-enact big battles, such as Waterloo, studying different strategies to see how Napoleon could have fared better. I told him that I am currently reading a large volume about Teddy Roosevelt that had won a Pulitzer- he liked that.
He had blue eyes that danced, and he clearly enjoyed having a woman sitting with him on the edge of his bed. He was also kind enough to share with me what he had discovered about life and its meaning: "Life is a joke." I looked at him, most likely looking somewhat surprised at this summation. "Life is a joke. You are born, you live, you die. Someone is having a good laugh at our expense." He smiled and asked when I would be back. I told him I come around about every 15 months. "Oh." I guess he wasn't sure if he woud be there the next time I came.
"I'd like to get away from earth awhile and then come back to it and begin again."- Robert Frost
September 2004: I met a lady not too long ago- she verbally accosted me, spitting as she told me how I was, well, not good. Since this appeared to be one of "Cindy's kind" of clients (as Mary refers to them), I was, of course, interested and all ears. "They" just want people drugged up, not walking, not able to think, I was told. She pointed out that now her mind was clearer and her walking better since she was not on so much medication, which apparently the government wanted her to be on. I assured her that I was indeed happy to hear this. She was doubtful of me. "I've been in terrible places, places where they kill you if you don't think what they want you to think." Yes, I told her I believed her, that I had worked at a psychiatric hospital in the '70s. "Oh..." Her body told me with its slight movements that she had heard, heard beyond what the simple words themselves contained in meaning. "I've seen people killed for what they thought." I nod. As she went on to assert that the government shuts down homes and makes people move for no good reason, the lady next to her shook her head in agreement. I told her it is hard, hard to listen to people's stories about watching their friends carried out in body bags after the building they lived in burned down, hard to weigh everything knowing all that, hard to try to always make the right decision... She shook her head. "I talked to you more than I've ever talked to anyone". I thanked her for the information and told that it was helpful for me. And then I left.
It was an intense interaction. She was angry, biting off her words as saliva popped out of her mouth. It was also a calm interaction- she needed me to be calm so that she could say the words in her heart. Yes, I believed her experience. She was right that she knew what she had experienced. The world, and life, isn't always pretty, and it isn't always what we had thought, or hoped, but it always is. At least I think so, and I think it always is, well mostly always is, best to start from that point, to start from how it is.
"You can't change what you don't acknowledge."- Phil McGraw
September 2004: There are times when people are overwhelmed and simply cannot hear, cannot process information given them. I have seen this over and over in the health care setting, where something seemingly simple is explained to someone, yet later it is realized that they did not retain some or all of the information. It happens with emotionally difficult information and with complex information- like explaining how to negotiate the maze to apply for public assistance or some other social service or housing program.
The most memorable of these incidents happened when I was doing some emergency room social work one evening and was called up to the cardiac unit- my expertise was needed because a man had just died and the staff needed me to be there when the family was told (this in itself is interesting, as I had never met the man or the family and had not been present for his care or death, yet his actual caregivers needed me to convey this information). I went up to the unit, saw the body in the bed, and was told that the family was in a little waiting room. I went to the waiting room and introduced myself as a social worker to the man's wife and adult son and daughter. Soon a doctor came in and explained to the family that the man had had a cardiac arrest, that they had tried to save him but could not, then left. I sat there as the information sank in, and then the wife said, "well, that doesn't sound too bad- does it?" The children murmured something in agreement. I was surprised. I knew that I was used to medical lingo, but the message had not sounded too convoluted to me. Somehow they had not heard the doctor's message. "The doctor was saying that your husband had a heart attack", their heads shook, "and that they could not save him", the heads shake more, "he passed away, he died". Thus calling upon my extensive training and insight to deliver the oh-so-complicated message. "Oh, yes.", and then the tears came.
They did not argue my interpretation- it did, after all, make sense. It was the same message that had fallen upon their ears, but not their hearts, a little earlier. And so, after a bit, I pursued one of the purposes of my visit, one of the reasons I am sent to talk to people in these interesting moments of their lives- did they know if the husband/father wanted to donate parts of his body? Yes, they were sure he did. We filled out the forms, read the directions together, and reviewed the process. I had never done this before, did not know the form, did not know the process, so we made it through this together. They asked if they could see the body, and I arranged this. They thanked me and I left. Later the organ donor place sent me a thank you note. I guess I followed the directions okay.
If you get a new, serious diagnosis, take a friend or family member with you to talk with the doctor about your options- if you're lucky you will hear at least half of it between the two of you.
"We are slow to believe that which if believed would hurt our feelings."- Ovid
October 2004: People are interesting and I am lucky to be able to peer into others' lives as part of my job...
Recently I met a longer-haired, bearded fellow who, even though only in his early 60s, had a stroke that left him with some physical disabilities. He was a simple man who had worked as a carpenter. He told me how he enjoyed going to a day program, how he admired people who work as caregivers- how difficult it must be for them to watch their clients decline and die. He also talked about how he enjoyed watching the joy on the face of a lady who came to the program, how she just lit up when she won a stuffed animal for her BINGO prize ("old people and Bingo, it's true"). He said that he had remarked to her about how much she liked her stuffed animals and that it had saddened him when she said that her caregivers had told her that stuffed animals were for children.
One day the lady had asked for a book from the bookshelf and was told that the books were from the library, so could not be taken home. He gave her a book he was reading and she was thrilled- "I had read the introduction and the first couple of chapters and already knew the story...". He said it was a book about "The Greatest Generation" written by some TV guy. "Tom Brokaw?" "Yes." He expained that he had read the introduction, which was a brief biography of Tom, and then read a couple of chapters about men from the WWII generation- "They were all men like himself, he was just patting himself on the back. The 'Greatest Generation' my foot." he said disgustedly. He told me that he was proud of his own adult children, how they had stepped up to the plate to help him with his new disability, and he wondered if every generation had something great to offer the world, if maybe his childrens' generation would be the greatest yet, would help this world with its problems, would help this world that seemed to have lost... he trailed off. "It's way?" "Yes", his clear blue eyes widened slightly, "Yes". His analysis of this book was different from any other that I have come across.
As I went to leave his room I noticed a bumper sticker on the back of his wheelchair that said "Regime Change 2004". "So you're looking for a regime change?" I asked. "Oh, yeah", he replied, with much less enthusiasm than I had expected. "You know, my dad was a union member, Irish, working class man- a Democrat all the way. We grow up and think we are wise, think we have figured things out for ourselves, but yet, after all, we tend to think just like we were taught by our parents."
I also recently met an eloquent speaker, 94 years old and going strong. He had a lot to say, but only one thing did I write down to keep for myself: "Everyone is something, and together we are everything". It reminded me of the line in the movie "Contact" that I have written about before on my pages, and that I now can't seem to find, but it says something about, having encountered beings from all over the universe, discovering that, after all, all we really have is each other.
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