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My Patient Isn’t Doing Well. Is It My Fault?

Discussion in 'General Discussion' started by In Love With Medicine, Feb 19, 2020.

  1. In Love With Medicine

    In Love With Medicine Golden Member

    Jan 18, 2020
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    The front-desk clerk, Ruth, comes to me and says Rose Henderson wants a cab voucher signed — which guaranteed payment. Rose could not be made to understand, Ruth tells me, that we are not permitted to sign vouchers when the person, the client, comes to our offices solely for the purpose of picking up cash … which is Rose’s purpose.

    We are Rose’s payee, which means we handle her money. I knew of this rule, but with Rose Henderson, I sensed somehow it would be unwise not to approve the cab voucher. I understood I could do this without undue consequences.

    I am Rose’s case manager. I find Rose, red-faced, and practically in a rage at the front desk. So I sign the cab voucher and send her on her way.

    Of course, this gets me a few points with our front-desk clerk, Ruth.

    Nevertheless, I decide it has to be done. I don’t explain my reasoning to Ruth, my unwelcome challenge to her authority, which at times is considerable.

    Rose is white, 65 years of age. She is stocky and has a very fat with a pale face and small dark eyes embedded in all that flesh. Her hair is white. She repeats herself often, a further indication of her growing level of dementia.

    In addition to her severe mental illness, she is diabetic. Her condition is sometimes controlled poorly. She lives in a subsidized public housing project. Her apartment rent is $164 a month, but she gets less than $600 SSI (the federal program for the elderly and disabled).

    Rose handles her money well, though. She is never short of cash in her account. If she comes in looking for extra money, I seldom refuse her.

    She tells me her mental illness began when her husband left her many years before, left her for another woman. She suffered a nervous breakdown and confinement for a few months at the state mental hospital. We were in my car recently going to complete an application for heat assistance, if I remover correctly. She said to me, “You know, my ex called me the other day and said his wife is sick and might not survive, and he wants to know that if she died, would I marry up again with him?”

    I laughed. I couldn’t help it.

    “So, what did you say to him?”

    “I told him where to go,” she says with a big grin.

    “Imagine him wanting to marry up with me after all the trouble he caused me.”

    I don’t know this for certain. I suspect Rose’s life has always been fairly stormy, even before her husband’s exit.

    Rose’s daughter, Brenda, called me one day recently.

    Rose often says how her kids have little to do with her. She has three grown children, two girls, and a boy. The son, I believe, lives in Florida. The two women are nearby.

    Brenda is supportive of her mother’s efforts to live alone, to live independently, but she has her grievances.

    I hear some of them. She says while growing up, Rose was abusive with all of her children. This happened, she says, even before their father left. She offers few details. And nothing about her father who lives, by the way, in nearby Indiana.

    “All my mother did to me, that is in the past,” she continues, “I do what I can for her now, but I am busy.” She tells me next that she is in training to become a “crematory technician.”

    “I plan to help her clean her apartment tomorrow.”

    Her mom did not pass her annual apartment inspection — a housing authority requirement.”

    That’s good of you, Brenda,” I say, and I mean it. But I know too Rose is likely to pay Brenda $50 or more for cleaning the apartment. I will be asked to authorize the payment, thus the reason for the call.

    Brenda sometimes brings her daughter, Rose’s granddaughter, to the apartment.

    Rose loves having this child around. The “baby,” as Rose calls her, sometimes spends the night, at least she did.

    The child is of mixed race, the father being Black, and I know this only because Rose tells me, over and over again, how this little girl is part Black (Rose may have said “part colored”). All the same, she says she loves the child and that she is as smart as a whip.

    Rose has not done so well since Brenda, upset with her mother about something, stops bringing the little girl around. I don’t have the details.

    It is obvious Rose is slipping.

    The VNA nurse, Miriam, who sees Rose twice a week, keeps leaving messages on my voicemail.

    She says, “I worked with Rose 10 years ago, and she was so much better then.”

    Weren’t we all “so much better” 10 years ago, I think.

    Of course, I don’t say this. I get her point.

    Yet Rose’s choices are limited.

    If she can’t continue living in subsidized housing — where little is required of her — she will almost certainly have to go to a nursing home.

    Last time she got sick enough to go to the psychiatry unit at University Hospital, less than a year ago, one of the social workers wanted to place Rose in a nursing home right from the hospital.

    Rose didn’t want to go — she would have made them go to court — and I made a successful pitch for Rose to return to her apartment. I promised more careful monitoring. That may have been a mistake on my part, a bad choice.

    My plan hasn’t worked out well. It hasn’t at all.

    Raymond Abbott is a social worker and novelist.




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