Write about our clients

I’m no psychiatrist, or psychologist, or social worker. But I think she is mentally ill: depressed certainly, to the point of suicidal; paranoid probably. Anxiety along with that paranoia. Her apartment is filled to the tops with clutter – we had to stand for the home visit. The blinds are closed.

She has built her own prison of fear, and she can not, will not break out. Yet there’s a glimmer that knows she needs help, and she asks us.

I don’t know if we can help, really. It would take a very special volunteer to deal with her. So if we can’t find someone, it would just confirm her ideas that no one here is compassionate, people are all hypocrites, one more agency that has failed her.

4:45 PM, and I’ve already started packing things up and getting ready to close the office, and the phone rings.

One of those shaky but demanding old lady voices on the other end wants to know if we help seniors citizens. I tell her we only help senior citizens. I end up yelling that we only help senior citizens. After a question about what we do, I yell a description of our services.

She says that she needs help with yard work. She goes into a long description of the roots that she needs cut that are coming up through her porch. After then a history of how it used to be (“all trees”) before the area got all built up, I interrupt and ask her if she also needs transportation services.

Transportation! Well, yes – her car doesn’t work any more, and she probably shouldn’t be driving it anyway. Long querulous description of how Safeway doesn’t deliver what they she told them to buy for her. I shouted that one of our volunteers could either do the shopping for her or take her to the store. I also asked if she needed transportation for medical appointments.

Well yes! Now a long description of various ailments, and how she needs to see a doctor about them. Through this, she mentions that her husband is in a local nursing home. I ask her how she visits him. She doesn’t. I say that if we have a driver, we also might be able to take her to visit him. She thinks that his Alzheimers is so bad maybe he won’t know who she is, but she should visit him anyway because it might be a good day and he would.

I shout that our client services coordinator will be calling her tomorrow about our programs. It takes a while to communicate this and get off the phone.

I get home about a half hour late.

We’ve decided to cut her off from our services and refer her to the state. We used to support her with three volunteers, but the last one of these three has quit. Meanwhile, her needs have only grown. I can’t justify three volunteers supporting one person.

With the economy in the shape it’s in, more people are willing to do chore services further out, so she should be able to get a state chore worker. She just has to deal with the fact that the person might be an immigrant, and/or might not be white.

Edith is 90 years old, and had surgery yesterday – one of our volunteers drove her to the hospital. She is supposed to be released today, at 11:00 AM.

She lives on the second story of a walk-up in downtown Issaquah. She has no one in world – a widow, no children, has outlived everyone else. She has an epileptic cat (another story).

The question was – who was going to drive her home today? We didn’t want to have one of our volunteers do it, because:

a. you know how hospital stays are: you’re supposed to go home at 11:00, but by the time you do everything you need to do to leave, it ends up being more like 1:30. We didn’t want to burden a volunteer with hanging out at a hospital for too long.

b. you know how hospital stays are: they want you to leave as soon as possible. You get ejected at 11:00, even if you don’t quite feel up to it. So then, we have a volunteer taking her home in a weakened condition. The volunteer helps her up the stairs (contrary to our policy, but what would you do?) If Edith slips, they could both tumble down two flights of stairs. Oy.

Edith, independent woman that she is, said that she’d take the bus home from the hospital. Three transfers to get from Overlake Hospital to her apartment. Then, going up those two flights of stairs.

Best use of our resources: making sure the hospital knew she didn’t have family help, making sure they had a REALISTIC discharge plan for her.

Praying for Edith, yesterday and today – hope she is going to do OK.

Dorothy Jean Peterson, of Issaquah, passed away on May 7, 2009 at the age of 84 with her family at her side. She is survived by daughters Jean Hennebert and Peggy (Rick Noethlich); grandchildren Jennifer and Enrique Cervantes, Peggy and Gordon Werdell, and Benjamin Hennebert; and six great grandchildren.

She was born in Toledo, Ohio to Harvey and Golda Shuff. She was one of ten children. Brothers Robert, John, William, and Richard; and sisters Ruth and Mary survive her, along with many nieces and nephews. She loved and was so proud of her large family.

She was a lead cost accountant at Haughton Elevator in Toledo until early retirement at age 55, and then retired to Devils Lake, Michigan. She became the secretary/accountant at the Devil’s Lake Yacht Club for another 10 years. She was a founding member of Michigan Lakes and Streams Association for lakes management and preservation. Upon the death of her husband William Robert in 1990, she moved to Seattle to join her daughters.

She settled in Issaquah and was a member of the Issaquah Women’s Club, Issaquah Garden Club, and a volunteer at the Friends of Youth. Nothing gave her more pleasure than spending time with her family and friends. She enjoyed her many friendships at Provident Point and her many card clubs. She was a great sports fan and we lost her every spring and summer to the Mariners telecast schedule. Her keen mind, ready smile, and cheerful disposition will be sorely missed.

The family extends their special thanks to the staff at Virginia Mason, Faith in Action, and to special friends Connie Duran and Diane Lyons. Memorial donations may be made to Faith in Action, Mary Queen of Peace Church, Issaquah, WA 98029.

I spent the first night taking care of him, or should I say, shooting him up with dilaudid and valium until his eyes would roll back in his head and he would fall asleep sitting up. “You should try the PO valium,” I coaxed him. “Oh no, I’m much too nauseated,” he would reply.
I gave report in the morning and the nurse replied, “I’ll just throw the kitchen sink at him, I am not a psych nurse.” True, this is an acute care unit, but still this man is not going home with IV dilaudid or valium. I do not feel comfortable loading him up to a point of numb pleasure. There is no psych plan, the meds are ordered, so be it.
The second night he was a begrudged to have me back. “Nothing personal” he assured me. He was polite, and I was polite. Again I told him that the acute phase of his pancreatitis was almost over and that he should consider taking valium my mouth. “You will give me my pain meds IV, right?” “Yes’” I assured him. And once again I lectured him. His lipase was normal now, they didn’t even recheck it. He would not be getting dilaudid when he went him. “Yes, I know,” but “can I also get my valium IV?” he countered.
On the third night, the doctor made rounds at the beginning of my shift. “You know’” I said, “he is receiving 3 milligrams of dilaudid every 4 hours.”
“Lets cut that back.” Dr replied.
“Then, you need to write it and you need to tell him.”
So the doc offered him a strong pain patch and cut down of the dose of dilaudid not much …to 2 mg every 4 hours.
I gave him his dilaudid as ordered, I put the patch on him and he asked immediately for the valium. “No,” I replied,”let me see all my other patients, and I will come back and give you valium.” So the patient decided to request the supervisor. And decided to leave against medical advice.
I called the doc, and let him know what had transpired, “let him have all the valium he wants and if he wants to go AMA, he can go.” Our supervisor was swamped, so our swat nurse stepped in as a mediator. I explain the situation to him, and he reiterated it perfectly, “so, the problem is that he wants more dilaudid and he asked you to ‘stack’ his meds?”
I had given the patient the valium by now, once I had spoken with the MD. I had the valium in my hand and ready to give when the patient told me of his AMA intentions.
The swat offered to remove the patient’s IV access, a PICC line carefully placed into the superior vena cava at the expense of the American tax payer, a line that would have to be replaced if the patient developed acute pancreatitis again. By this time, the patient’s 70 year old mother had shown up with a sleeply 11 year old granddaughter in tow. (Another sad story there)
His last request was to receive his dilaudid before he left.

She is young by today’s standards. Only 64. She had a stroke in the past so she was placed on a blood thinner only to develop bleeding in her brain. So now as the medical team investigates which approach to take next, she is confronted with the reality that life is fleeting. I spent time at her bedside as she expressed her greatest concern: she was worried for her 42 year old son that is a of the many victims of the down-turn in this economy. Will he be able to survive with out her?

Earlier today, I had visited a client. She is fairly old, even by the standards of our agency, and recently returned home following a fall and a subsequent nursing home stay.

This evening, I took a hot bath. At the end, I had the impulse to use my scrub brush and visualize the scrubbing off of stray energy cords that I might have picked up during the day.

Through this process, I became aware of a psychic connection between the client I had visited and me. Through this connection, I came to understand that she is a little desperate. She lacks enough energy to sustain her whole physical/nonphysical being right now. So maybe she was hoping to draw a little from me.

I really like this client on several levels. And maybe because I am fond of her, this is why she had hoped to draw from me. I can’t allow that. I just know what my psychic limitations are, and it has to be no.

Instinctively, though, it feels like she would benefit from not holding all her energy so tightly. If she simply let go a little, loosened the knot, she would benefit. I think she’s afraid of completely falling to pieces at that point. But maybe she can just let it go a bit, more deeply relax, without losing her psychic coherence [1]. This would further her healing and help her more in the long run.

In consonance with my goal, Affirm change that comes from a positive place, I affirm that this client can indeed loosen the knot, and that this loosening will allow things to unfold in a way that is not destructive or harmful to her, or anyone else.

I wonder if this is what the Christians would call, my “ministry” with this agency. The agency provides practical help: volunteers to clean a house or drive someone to the grocery store. But maybe my job, when I’m not raising money or recruiting volunteers or writing grants, when I do have a chance to visit clients like this – my ministry can be to provide people with support in this way. It is something that will always be sub rosa.

[1] _{We really don’t have language in our culture to describe what I mean here}

Phyllis is elderly, mobility impaired, and crippled by arthritis. She lives for her cat, equally elderly and not doing so well. She has no known relatives in the area – the only emergency contact we have on her sheet is the cat’s vet. We have had three volunteers supporting her: one doing things for her inside her home (like housekeeping); one doing things outside (like trimming trees); and one doing transportation.

One of her volunteers left the area, and so we recruited a new volunteer. The new volunteer came in with fresh eyes, and reported that the cigarette smoke was so thick, she could barely breathe (the woman’s a heavy smoker, and hates to ventilate the place – she says she burns a scented candle, god help us, to help deal with the stink of the cigarettes when volunteers come in the house); that there were rodent droppings in the laundry and kitchen; and that the stench is so great from the cat “doing his business” inside the house that she could barely stand it. Oh, and there’s implications that Phyllis hasn’t taken a real shower in ages.

Phyllis is the sort who won’t leave that house until she’s carried out, flat on her back. She’s very low income, and what assisted living place would take someone on medicaid and let her take her incontinent cat with her? She refuses the state’s in-home services (even if they could find someone to go to her remote home in the woods) because she’s suspicious of “foreigners”. There’s no family to go to. And it’s not quite bad enough to contact Adult Protective Services.

The volunteer providing transportation says that he can’t stand being in the house for more than 15 minutes at a time, but doesn’t have to worry about it, because his time spent with her is in the car and out and about, not in the house. The other remaining volunteer is fiercely loyal to her, and says that all of these issues are non-issues. Rather rightly, he says that she can’t continue without the volunteer help.

So, I put this situation on my prayer list – what’s the best thing to do for her and for our agency? We’ve been just enabling her to fake it on her own for years. I doubt we can recruit another volunteer for her. Have her go on with just the two? Cut off her services and say, “it’s time for you to face facts – you and Fluffy just aren’t making it here on your own any more”?

While it’s her choice to live in a potentially unhealthy environment, how do we feel about sending our volunteers into it? If they want to continue to help her out, should we still have that happen under the auspices of our agency?

I want to write a little bit about our clients here. Here’s what I want to do:

1. Our clients have great stories. They’ve had careers when women weren’t supposed to, raised six children, fought in the second world war, agitated for peace, toured the world, and have been here in this area since it was mostly just forests. I’d like to relate some of these stories.

2. As we know: as people get older, they deteriorate and they die. I would like to process a little how I feel about all of this.

3. Sometimes I have tough decisions around clients. I am ill-equiped to deal with these decisions. I am not a social worker. I am not a gerontologist. I am a jill of all trades – I have to be for this job – but I know more about fund-raising than I know about service delivery. I would like to write about these decisions as a way to reflect on them, and find the right course of action.

What I don’t want to do:
1. Violate anyone’s privacy. All names will be changed. I will change details, locations. I will fictionalize some things: write little fancy additions that aren’t true, and not put everything in, so no one can say, oh, that’s got to be Deloris or Norma or Dorothy.

2. Endanger the agency. I don’t want anyone to stumble upon this and use it in a way to say that the agency isn’t doing its job right.

Do you think this is possible?