b.i.d.

Me: Do you have any medical or physical health problems?
Client: None
Me: Do you take any medications?
Client: Oh yeah, Metformin, Adalat for my blood pressure, Clonazepam, and one for my cholesterol...

What Makes Me Happy

This is about a client I had when I first started this job. I may have reflected on this story before in my blog, so bear with me if it sounds familiar.

He had been in the system for years, and had previously been supported by a coworker who left for another job.  He was a young man with schizophrenia and developmental delays.  He lived with his family (who wanted the best for him) including his grandmother who brushed his teeth for him even though he could do it himself.  It is fair to say there was a lot of learned helplessness going on.  

I was a little more eager and a lot less experienced then.  This man was more ill than anyone I had worked with previously.  My normal tactics did not work.  We were down to real basics - getting him to remember who I was, and remember his appointments.  Our appointments consisted of me trying desperately to make some kind of conversation while he was more interested in watching soccer or getting me to take him out for pizza.  All the while granny is knitting in the background and making me hyper aware of my youth and inexperience.  

I don't remember what the incident was, but somehow he ended up in hospital.  The family and I worked with the doctors to get a med review and he was started on Clozapine.  While he was still admitted I advocated to get him in with our ACTT program (Assertive  Community Treatment team - a more intensive level of support than what I provide) and he was accepted, so I never really saw him after his discharge from hospital.

Until one day I was in the waiting area of a psychiatrists office with another client.  I recognized this man's sister and then he came out from his appointment.  He looked me straight in the eye and said "Hi Nectarine" and then proceeded on his way.  

That was it.  But it was so much!  This person, who had met me at the door with a blank face week after week, giggled when he couldn't remember my name for months over a year prior at this time had said HI and addressed me by name!  He now attends one of our drop in programs and I see him over there from time to time.  Every time this same thing happens.  He says hello to me the same way, and then walks away.  It's all I'm likely to get, but it's so much.  It makes my day every time.  

Will this client continue to recover?  Probably.  Will he recover to a level that other people find "normal"?  Probably not, but to me, all the work he and his supports have done is so worth it to bring this human being out of the bubble his illness and medications had put him in.  I'm grateful to have been a small part of it.

Newsflash: Stubborn Man Defies Death

What do you get when you forget your insulin daily, and subsist on a diet of cookies and Ensure?  A blood glucose level of 55!  Along with a panicked call from your doctor telling you to go to the hospital RIGHT. NOW.

But do you go to the hospital?  No, of course not.  Because nobody is going to tell YOU what to do.

*headdesk*

Language Matters: Non-compliant

This post is a part of the Recovery 101 blog series. The series will explore ideas, philosophies, language, tools, and questions about mental health recovery. Submit any ideas for topics in the comments section of any tagged post.

We in social services know the importance of language. We know that words can hurt or empower. We know that labels may stigmatize. And yet so often our work comes from a place, system or history that promotes these very problems. As one part of the Recovery 101 series I want to explore the language and word that hurt the work we do, as well as the people we work with.


One of my greatest pet peeves is the term “non-compliant”. Direct from the medical and clinic model of treatment, it is usually used to refer to someone who stops taking their medication against medical advice. It may also refer to refusal to participate in other forms of treatment.

When I hear non-compliant I hear:
1) that medication is the sole or primary method of improvement
2) that the treating physician knows what is best
3) that the patient or person is doing something WRONG or even deviant
4) that the patient or person does not have the right to determine how they want to recover
5) the reasons the person has for not taking medications are insignificant compared to what professionals or others perceive as the benefits of the medication
6) the patient or person is sick and must be made better

What alternatives exist to these words:
1) person has decided not to take the prescribed medication
2) person does not find the medication effective, or finds the side-effects unpleasant and is seeking alternative methods
3) the person is comfortable/prefers not taking medications at this time
4) the person has difficulty taking their medications consistently and may need help in this area

How do you view or support clients or others in their decisions around taking medications? Do you use the term non-compliant or have an alternative to suggest? Have you as a patient or person dealing with mental illness felt you have agency or decision making power with regards to medical treatment?

Cleaning Out and Cleaning UP

A client of mine who has some, ah, let's call it "moderate" hoarding issues recently made it a goal of hers to clear out her kitchen enough that she could set up the table and chairs that she has.  I am helping her with this, and we began by tackling a corner where she had numerous plastic and paper shopping bags stacked about knee high.  In many of these bags were old empty prescription bottles she hadn't wanted to throw out due to her name and address being on the labels.  In all of the other bags were FULL prescription bottles of medication she hadn't taken, including some serious pain killers.  Apparently her doc has continued prescribing her 3xday when she only takes them as needed (maybe one a day a few days a week).  She had these from the past 4-5 years.  The mind boggles to think of what the street value of these things would be.

We just returned them to the pharmacy for proper disposal.

Alternative Medicine...Sweet, Sweet Medicine...

Any changes to your medication recently?

-Well, my doctor says my cholesterol is high. He prescribed me something for it, but I don't think I'm going to take it because of the side effects.

My friend had high cholesterol and his doctor told him to start eating walnuts. He ate a whole bunch and his cholesterol came right down in a week! So I already went to the grocery store and picked up a big box of walnut brownies.

No Problem...

A client I recently started working with had been on our service wait-list for nine months. With such a long wait for support, it’s not uncommon that peoples illness or situation becomes worse between intake and initial service. That wait can be a very difficult time for many.

Before this person came in, I read the intake report. He seemed to have a lot of bad stuff going on, so when he came to meet me, I was surprised to see a very calm, well put together guy. Still, appearances can be deceiving, and I wouldn’t know more until I talked to him.

Through our initial conversation it came out that he is back living with his family (had previously been transient) is working a full time job that he enjoys, spends time with friends and has not had any psychotic symptoms in months. He also stopped taking all of his medications, and stopped seeing his psychiatrist.

After he left, the intake worker who had seen him last summer asked who he was, as she didn’t even recognize him. She asked me what had happened, and I told her what he had said to me:

“I stopped taking drugs. Even though I didn’t want to, I figured things would probably get better, and they did.”

Go figure.

If only it were always so simple…

When Spell Check Doesn't Help

Note to self: when recording how a client copes with their symptoms of depression, there is a big difference between "medication" and "meditation."  While both could potentially be effective, be sure to pick the right one.

Whoops!

Pill Popping

Downed some daytime cold medicine before work this morning.  "Non-drowsy" it says on the box.  So why has my head felt like it's in a cloud for the past 3 hours?  My day is full of client meetings.  This should be...interesting...

See page for author [CC-BY-SA-3.0 (www.creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

A Day in the Life

Thursday February 3, 2011

8:30am – park a block away from first appointment and check messages on office phone and cell phone. Remarkably few, possibly due to yesterday being a “snow day”.
9:00 – pull up to client’s building for first appointment. He’s a big guy (with severe back, neck and knee problems) who struggles to get in my little car, but we make it. We head off to check out a new grocery store, a figure out a route for him to take the bus there on his own next time.
9:45 – take same client to coffee shop for a caffeine fix and quick chat about plans for next week’s meeting.
9:59 – return to client’s building, help him load his groceries in.
10:00 – back in the car, call the pharmacy to see if next client’s prescriptions can be made ready for pick up. Ah, crap – there are no more refills. The pharmacy offers to fax a request to the doctor’s office, and I call the client. He swears that he did see this doctor in the past few months (can’t remember exactly when, but…) and forgot to ask about those prescriptions.
10:10 – Call the pharmacy back, they say it might take awhile. Call the client again, tell him it might take awhile and is it okay if I drop his meds off this afternoon. Yes, that will be fine.
10:20 – Eat my lunch in the car trying to ignore the fact that it’s -10 Celsius outside but I’m dressed in several layers so that’s okay. Relish the fact that I have a few minutes to listen to Q on the radio.
10:45 – Head downtown to start searching for a parking spot.
11:00 – Find parking, dash across the street to the church to set up for the Outreach lunch program. My co-facilitator has beat me there, as have several of the clients, even though we don’t officially open until 11:30, but hey, it’s still -10 out!
11:30 – Serve chili, chips, and veggies to familiar faces, and some new ones. The attendees are mostly male, 40+ and kinda rough around the edges. They make loud conversation about politics, people they know, their plans if they won the lottery, and “the way things used to be”. They’re a good natured lot, and the lunch tends to run a lot more smoothly than its breakfast counterpart at the other church. Breakfast gets a bigger crowd, and there is sometimes “trouble”.
12:30 – start tidying up as people leave. Spend some time supporting an elderly couple whose son lives out east and was recently diagnosed with bipolar. They’re frustrated that “the system” out there isn’t giving him the support he needs, and they wish they could do more to help. They went to visit him last fall when he was in the hospital, but the motel was expensive, and it’s hard for them to travel.
1:08 – I realize that I’m late for my next appointment, and try to call but get the answering machine. The outgoing message wishes me a “happy new year” and remarks about the date 01/11/11 for several minutes before cutting me off, so I don’t get to leave a message.
1:15 – I arrive to my “happy new year” client’s building, but there’s no answer when I buzz the intercom. I wait inside the front door for several minutes then try again. I call her phone, and the answering machine seems to work this time so I leave a message asking her to call and reschedule.
1:30 – Back in the car, I drive to the neighbourhood of my next appointment, and park across the street to check messages again. One marked “urgent” from a new client whom I have met only twice telling me that he found a room to rent and is no longer living in the shelter, and he’ll call me later to set up an appointment, because he doesn’t have a phone. Another from a current “high needs” client crying and upset because she’s lost all her ID. This could be pressing, but I know if I call her back it’s possible I’ll get stuck on the phone for a long time so it will have to wait for a more opportune moment.
1:40 – I check my email and notice a message from a client I did an intake with a couple weeks ago. He let’s me know that his housing arrangements “didn’t work out” and he, his wife, and their two children are now in the family shelter. He sounds pretty desperate for help and is planning to rent a truck to go sleep in. I remember him as extremely depressed, anxious, and suicidal. I email him back quickly to ask if it would be okay for me to refer him on to our outreach program which can meet him right away.
1:55 – I call my 3:00 to see if we’re still on because he often cancels. He has schizophrenia, and is also going through cancer treatment so he’s not always in the best of shape to meet. He asks if I can come earlier than planned and I say we’ll see.
2:00 – I check in with my next client. It’s dark in her apartment as the balcony door is blocked by the snow and she never opens her curtains. She finally let her dad know that her cat died, so he’s not worried any more about why she’s acting out of sorts. She missed her psychiatrist appointment last week because she’s scared that if her taxi runs out of gas it’s winter and she’ll be stranded in the snow. She’s scared that no one will save her. I try to understand, and try to support as best I can.
2:30 – Back in the car, call Mr. 3:00 and let him know I can come now. He wants to go to the grocery store and has his list ready.
2:35 – I pick him up, and off we go.
2:50 – I’m getting a grocery cart while my client starts his shopping inside. An older gentleman is trying to light his cigarette with a burnt out lighter, and I suggest to him that he’s probably not allowed to smoke in here and needs to go outside. He asks me for a match, but I don’t have one. He goes back to trying the lighter.
3:45 – Groceries are done, and after a stop at the post office I take my client home. We make arrangements to meet next week if he feels up to it.
3:50 – In the car I call the pharmacy from this morning and learn they finally got the refills, they didn’t think they would cause this doc has said no before. I call my client to update him, message my boss to update her about the changes to my schedule/location (for safety purposes, understand) and head off to the pharmacy.
4:05 – At the pharmacy we commiserate for a minute, and they tell me my client called them about 20 times today, anxious about his medication. They’ve known him for years, since he was homeless down the street from their store, long before I came around. They want to know does he also need his foot cream, I call, he doesn’t, I take the bag of pills (these have got to be worth $$$ on the street!) and zip over to his place.
4:20 – I get there (just in time) hand over the drugs and apologize that I won’t be able to stay and chat. I’ll call you tomorrow to schedule a check-in appointment, okay?
4:30 – I finish my day on time somehow, and call home to let them know I’m on the way.

I take it back.

I’ve changed my mind.

Quote of the day for August 31 goes to the pharmacist I called yesterday:
Me: Um, hi, I’m calling to see if some medications could be made ready for me to pick up.Pharmacist: What’s your name?Me: They’re not for me, they’re for my client Mr. Lotsofmeds.Pharmacist (presumably looking up Mr. Lotsofmeds refills): He’s got some good ones here, are you sure you don’t want them?
Maybe I was in poor humour, but it seems to me that pharmacist making jokes about giving away serious meds to random people should kinda be like making a joke about a bomb when you’re in an airport.  Don’t even go there!
And all this as it’s all over the news that Ontario has the highest rates of Oxycontin addiction in Canada, one of the highest rates of abuse in the world! 
A place to live, a place to grow, Ontari-ari-ari-o!(sorry, anyone who wasn’t in an Ontario public school in the latter half of the 20th century might not get that song reference.  Consider yourselves lucky!)

Pills

I've just decided.

My main hope goal in life: to never have a med list as long as those of some of my clients.

Yikes.

Sticky notes are also unacceptable

Note to self:

Do not write client's med lists on little scraps of paper. You WILL lose them!

*headdesk*

Social Work Brain Fart

I had hopes of getting into the office today between client visits, but no such luck. WHY? I have to fit in an extra visit because I forgot to bring a client his meds on Tuesday.

*headdesk*

Fortunately, I remembered yesterday and called him, and he hadn't run out yet.

*sigh* this is what happens when you rely on memory and don't check your calendar. You forget what Tuesday it is.

Off to the pharmacy!

Ultra-long-lasting-super-side-effects!

(woman I met with yesterday discussing being overweight)

“Well, see, when I was a kid I had three cortisone shots after [physical injury] and that stuff makes you really swell up. And it takes a long time to get out of your system. I still can’t figure out how to get it out of my system!

BTW, cortisone is an anti-inflammatory.