7 Days

Last Friday: Served as translator (English/Spanish) for patient complaint to administration meeting.  The person I was translating for spoke 2 sentences total…at the end of a 2 hour meeting.

Next, I went down to emergency department to speak to a pregnant woman who may be referred to our Maternal Addiction Treatment (MAT) Program. Me (at the bedside): “Hi, I know you’ve had a rough last few hours…I’m here to talk to you about treatment and a way to recovery.”  Patient: “Can you come back? I feel like shit and I have to go to the bathroom.”  I still did my behind the scenes thing….coordinating with the psychparmacologist, the other half of the MAT dyad to review the case, get the labs and meds she needs ordered, arranging for an inpatient bed, informing ER doc & psychiatrist of status, getting OB online.  If it wasn’t for my MAT partner who kept checking her chart and coordinating care with MD and nursing staff, I wouldn’t think of her again until Tuesday.  Once she got admitted to the unit, reports say she was irritable, uncooperative and refused OB monitoring.

Saturday: Took Soncy to the park.  Read about fluorescence spectroscopy. Thought about toxic nudibranchs. Probably cooked some pasta and definitely watched lots of Scooby Doo.

Sunday: Took Soncy and Gomez to the Dog Beach. Read about how time is a feminist issue and found this gem from the Lancet.  As a person who believes feminism is for everybody, this key message from the publication almost made me cry:

Sustainable development needs women’s social, economic, and environmental contributions, which will increase when women are healthy, valued, enabled, and empowered to reach their full potential in all aspects of their lives, including in their roles as providers of health care.

According to the publication, women’s paid and unpaid contributions to healthcare in 2010 amounted to $3.052 trillion.

Monday: Danced the DBT dance of acceptance versus change with my client: pot may help her deal with her emotions but actual filled medication scripts may get her disability.

My DBT skills group co-facilitator suggested we delve into traumatic invalidation.  The skills group intervention that resulted was a detour from Interpersonal Effectiveness but a breakthrough for each of our members.  Each was able to connect current behavior to past experiences of traumatic invalidation. As a reminder that DBT does not promise a perfect treatment environment but instead the tools to accept and deal with reality as it is, while group was going on someone became combative in the hallway, yelling expletives in a louder and louder tone until at least 3 staff called 911.  I locked the group room door as a thin promise of safety as we practiced group exposure to trauma.  The women in our group were magnificent and even participated in an impromptu grounding exercise after the lesson ended.

Tuesday: Team intervention with the pregnant woman from the emergency department.  Not much was accomplished in terms of treatment.  She was clear she cared only for herself and she didn’t want recovery.  The baby was an afterthought: “I don’t want this baby, I’m giving it up for abortion as soon as it’s born.” She’s probably counting on child protective services to remove the newborn from her care for in uterine drug exposure. This goes against the goals of MAT: mothers in recovery giving birth to healthy babies. Before the meeting we decided I would be the bad guy so my MAT partner could split and be the good guy.  30 seconds into the meeting, after screaming and accusations from the patient, we both became bad guys.  I think she won the prize for most reviling feeling engendered by a patient.  Ever.  Discharge planning ensued.

Wednesday: Presentation to the new PhD Social Work cohort.  7 eager faces.  I talked too much as usual.  Aside from introducing them to the concept of Creating A Research Space (CARS), this was the gist of my entire presentation:

For me, the PhD journey has been about discovering three things: 1) becoming a writer; 2) becoming a researcher; 3) grit.  These three things, done continuously, day in/day out is what my PhD is made of.

 Thursday: Thought about the Pope. Ate a sandwich with prosciutto and avocado.  Battled primary care on integration metrics.  I said colonoscopies and mammograms were irrelevant when people with serious mental illness (SMI) are actually dying of type II diabetes, respiratory disease and hypertension.  A follow up meeting was scheduled.  I stayed scrappy.

Friday: Another DBT client…after 4 months of hard work (with some 2-3 week absences from her along the way)…she finally recognized a feeling: fear.  Prior to that when I would ask, “What are you feeling right now?” She would always reply, “I feel tears running down my face.”  She wasn’t wrong.  She was crying.  But she wasn’t feeling.  Until today. We agreed to continue the work for a full year of treatment.  I’ve never believed in long-term therapy.  Until DBT.

Then I interviewed a candidate for a job interview.  I found him a perfect fit for the job.  He told me something about practicing DBT in a community of therapists:

We eliminated the word “but” from our vocabulary.  We said “and” instead.  It created this sense of expansion…of possibility.  We embraced the dialectic, even in our speech.

When I reflected on the job interview, I was reminded of a quote by Bukowski:

the free soul is rare, but you know it when you see it – basically because you feel good, very good, when you are near or with them.

I think he will do very well with our patients and our team.  Later, in consultation team, we debated an angry patient.  I noticed my own anger and rejection of her: “She’s still in precontemplation.  Should she even have started skills group?” So made myself occupied the “and” as listened to the team present their differing views on how she’s responding to treatment.

The day ended with a call to the front of the clinic.  “This guy was discharged from the hospital two weeks ago and he’s still detoxing!!”  I reviewed the chart and examined the facts:  ER visit 1 month ago, abusing Flakka, told to go to the county substance abuse treatment center.  I walked outside to speak with him, ready to send a combative young man to another provider in the community.  I stopped when I found a young man sitting with his dad.

Me: “When is the last time you used Flakka?”

21 year old Haitian American man: “Today.”

Me: “How are your parents dealing with this (looking at dad)…father upset, mother crying?”

(he nods, looks down)

Me: “Heres the number to the county facility.  We have a program.  7 days a week.  Get here by 9am, stay until 1pm.  Every day.  I think it will help you.  But I can’t get you in until 2 weeks from now.  Do you want it?”

Him: “Yes.”

Me: “What are you going to do in the meantime? What do you have to replace the need to pick up? Do you have G-d? Do you have work? Do you have school? Do you have a girlfriend?”

Dad: “I don’t understand, we are a family who lives with Jesus.  How did this happen to him?”

Me: “He may still have Jesus in his heart. It’s not about that. He’s still a good person.  He just hasn’t figured out how to stop.”

Him: “I used to love to work”

Me: What did you do?

Him: I was a cook.

Me: Lots of pot, crack, Flakka among cooks.

Him: It wasn’t that, I wasn’t involved in that.  I really liked it.

Me: You can find that again.  That sense of purpose. You will.  In the meantime, hang on for the next two weeks. If you can’t, go to the county program.  They have a 24 hour crisis unit.  They may put you on a waiting list, but they will see you in an emergency (hand him the appointment card).

Him:  I understand. I will be back.

Me: I hope you will be.

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