Saturday, May 14, 2005

Grinding wheel

Tuesday turned into a grinding day with more dust produced than corn meal when I met a social worker at Danny’s house in a bad part of the city. I knew that it had been decided that he would have to be discharged but I was avoiding the topic. I didn’t want to let him go. He came to us in August because he was dying of Cirrhosis of the liver and was assigned to the East Team. Last month, the chaplain had all he could stand of Danny’s alcoholic craziness and asked me to take him. I relished the idea because I like hard cases and am usually bored by little ladies in well-appointed bedrooms who are attended by paid caregivers rented by well-heeled children. They’re sweet enough patients and they’re stories can be inspiring and precious but they don’t have enough grit and struggle to keep me fully engaged. Danny and his ilk are a different matter.

One of those of Danny’s ilk was another patient who got my attention named Richard. He was a man in his 40’s who had suffered from spinal meningitis about 18 years ago. He was a Heron addict and was dying of cancer. Richard had lived in incredible pain for years. He also had absolutely no church association nor had he ever had any spiritual training at all in his life. We’d had two visits and had gotten to the place that I identified his description of his religious feeling as “agnostic.” I affirmed that it was a legitimate religious position and that it could be the basis for a healthy spiritual search. That was during the first visit. Amazingly enough, Richard wanted me to see him once a week.

During the second visit, I got Richard to talk about his farm and when I pointed out that his love for the land by asking him about the smell of the soil when he plowed, his face lit up. I told him that the feeling that he had was spiritual. Richard was getting it but when the RN and the social worker got there an hour later, Richard had tampered with the pump and was blitzed. I wasn’t surprised – it was a typical response for an addict after such a hard session. I felt like Richard and I had the beginning of a special relationship and helping him with healthy spiritual formation was going to be exciting.

Both of those men were considered to be problems for their respective teams. Danny especially had made himself a headache with his alcoholic ways. Richard was on his way to sucking the team dry too. But I was making progress with both of them. It was a source of gratification and in the privacy of my car as I drove away from their respective homes; my work was a source of pride. The social worker on the Danny's Team had told me over and over that she was grateful for the way I related to and worked with Danny. It was making her job easier.

So Tuesday morning we sat there in Danny’s one room rent house and informed him that because he was not “declining” we had to discharge him. Danny’s face was incredulous as the information soaked into his mind. He became sarcastic and angry and he began to tear up and grieve the impending loss of the social worker and me. Within minutes, Danny began to decompensate and move into his shell like some hermit crab. I could feel the defenses going up and we were losing ground in minutes that had taken the social worker months and me weeks to build. Just as we began to pull off some pretty amazing work with him, my phone rang.

I cut it off. It rang again. “Go ahead and get that.” Danny waved at me and the damned little box.

“Ken. This is Adrian. Richard just died and the family said that they need you.” I flipped the thing shut and began to find a way to patch up this conversation so I could drive the 25 miles to Thomasville to face Richard’s corpse. It didn’t work. Danny believed we’d abandoned him and this was reinforcing that.

I was swamped with emotions because the struggle to keep Danny afloat was intense. I was angry at the system because while it’s true that Danny was not currently dying we were his only support in the midst of his mental illness. But I also know that the administration can and does often support some patients with special funds but that Danny, because of his difficult mental illness, would never be considered for that. I also am aware that our agency doesn’t do well with mental illness nor does our government. The treatment in our own mental health system in this county is sorry. I was also frustrated because my work was interrupted and I was unable see even the minimal success that I’d hoped for. I got into my car and headed to the farm swimming in frustration, grief and anger that I lost both of these patients in a space of a morning. My one hope was that Danny agreed to let me come back in the afternoon to finish the conversation.

At Richard’s farm deep in a rural county, the cars bearing friends and family had created a parking lot out of the secluded yard around the mobile home. Richard’s sister met me half way across the yard with pain on her face and hurt in her eyes. “Tell me he’s in paradise.” She whispered in my ear as she hugged me. I held her and said quietly, “Of course he is.” My heart ached and at the same time I worried that she would ask me to prove that in evangelical Christian terms and I couldn’t do it. My assurance had come out of my Quaker theology and sometimes that’s impossible to explain to Bible Belt Christians.

The funeral home was already there and waiting for me so we gathered in the bedroom around Richard’s body. My words choked in my throat in a way that they rarely do at a “time of death.” I stroked his hair and noticed how smooth his face was without the pain and spasms of both the cancer and the meningitis. I rarely feel affection for the bodies of my patients but I did for Richard and when the funeral home personnel needed me to help with Richard’s rather long and large body (he wasn’t fat but he was a big man) I was sickened by the placid and lifelessness of his unruly limbs that had to be gathered up and strapped down like meat on that narrow gurney.

Why was this so hard for me? Why do I feel grief for him even as I write these words? At this minute, I wonder how much more I can do in this business.

Later that afternoon, I swung by Danny’s to finish up our conversation. My hope was that we could formulate some hope in him and solidify his sense that he was being discharged because he was not dying and how that was good news. Danny was already drinking.

“Are you offended if a man takes a drink?
“No, but I’m offended if he poisons himself.”
“You ARE offended.”
“Yes, I’m offended that you are poisoning yourself with alcohol.”
“That’s not true.”
“It IS true, Danny. Your liver is dying because of your alcoholism and every single drink is poisonous for you.”

“Well, I’ll just take this to the kitchen then.” He pulled a bottle of cheap liquor from beside his chair. And walked sideways to the kitchen like a dog whose rear end is trying to get ahead of the front end. “I can’t talk to you without a drink.”

The visit got no more productive than that and I became anxious to get out of there because I was on the verge of telling him off. My anger was beginning to simmer at the top of the pot and it might spill down the side and into the flame.

The social worker was sorry that the visit went poorly and my frustration was coming out of so many different directions that I couldn’t figure out where to aim my anger. I snapped the phone shut after our conversation and didn’t know which direction to point the car. I just sort of followed the bumper until I ended up somewhere.

Wednesday, May 11, 2005

Losing the Goo

My doctor has been after me for years to go to Weight Watchers to loose weight. She swears by the program as do a lot of people. I don’t know, maybe I didn’t go with an open mind. But at any rate, here’s the letter I wrote her after I checked it out.

Dear Patty,

I won’t see you for a while so I wanted to let you know that I checked out Weight Watchers just as I promised.

It was a very interesting meeting and I’m really glad I went. I’d had a bad day having lost two patients that meant a lot to me and was really wishing it wasn’t so late in the day because I needed supervision. I decided to swing by the Weight Watchers office to see if I could attend a meeting for a distraction or maybe even a little amusement.

A little lady in her 70’s met me at the door and invited me to stay for the meeting and if I wanted to join, I could sign up and pay at the end. I took her up on it and the room eventually filled with all sorts of people (mostly women). The lady in her bright yellow shorts and blouse eventually went to the front of the room where she began cavorting around the room grinning so broadly that I thought her nicotine-stained teeth would flash a welcome sign. Her voice was that of a long-time smoker and sounded like sandpaper on a rock. “Hi every body!” She graveled.

“Hi Zoe.” The crowd cheered back

“Why’s everybody so grim? Come ON people – I mean REALLY…. Did somebody DIE?” (I started to raise my hand and say with a cheery voice – “Yeah, Zoe – wanna list?” But I didn’t, I just flinched.)

“Well, we have a WINNER tonight! Come on up, Karen! She’s a 10 percenter! Yeaaaaaaaa! Everybody give her a hand. Yeaaaaaaaaaaaa!” Zoe’s face was forced into a game show host’s smile that utilized every crack in her nicotine-thickened epidermis. She smacked her hands together with her fingers all splayed, her hands vibrating out a fleshy tattoo that matched her cracked and yellowed grin in an odd Stephen King sort of way.

Zoe went around the room handing out a generous smattering of plastic gizmos and sticky stars to reward the crowd for whatever she thought might generate a “yeaaaaaaa” from the group like a second grade teacher. I should have been nauseated by this time but I found the whole thing kind of amusing that the room was full of adults who paid to be there and seemed to be caught up in getting gold stars for “only gaining .8”

She started on the other side of the room. “Do we have any celebrations in this section?”

“Zoe,” one girl spoke up, “I graduated from college last Friday.” Zoe sucked air and covered her mouth with the tips of her fingers.

“You did? Isn’t that WONDERFUL! Come ON everybody! Yeaaaaaaaaaaa! (smack, smack, smack, smack, smack)” Zoe ceremoniously tore off another star and handed it to the young woman. One section at a time, Zoe made her way around the room, not hearing a damn thing anybody said except what she could turn into a cheap cheer with her prancing and gooey demeanor.

“Everybody. This is Ken. He’s our guest tonight and a hospice employee. Hospice people are soooooo wonderful! I just love them. Lets welcome him. Yeeaaaaaaaa! (smack, smack, smack). Oops, you know what? I left something in the back room! I’ll go get it!”

Zoe disappeared stage right and reappeared with a miniature basketball and a swimming pool noodle. “I brought these things out so that we could talk about something very special tonight (her voice lowered dramatically so that it sounded like it was grating on a bigger rock). Do you remember when you were 7 and you played? What did you play when you were 7?” She pointed to one of the three men in the room.

“I played soccer.”

“I played softball” one woman volunteered.

“I rode bikes.” Another said.

“OK. I want everybody to break up into small groups for 10 minutes and talk about how you played when you were 7.

I waited until she was grinning the other way and scooted out the door without paying. When I got home, I jumped in the shower and washed the goo off. Then I weighed myself and you know what? You were right! When I got all the icky sap off, I weighed .8 less! Yeaaaaaaaaaaaaaa! (smack, smack, smack, smack) I did lose weight at Weight Watchers.

Tell you what I’ll do. I’ll go back if you’ll give me a script for an unlimited supply of nausea meds.

Dr. Ken Bradstock

P.S. Dottie reminded me when I told her this story that Zoe was our dentist’s office manager and embezzled thousands of dollars from his practice. She also failed to file hundreds of dollars of insurance claims on our family’s care along with many other families. “Yeaaaaaaaaaaaaa! (smack, smack, smack, smack)