Showing posts with label schizophrenia. Show all posts
Showing posts with label schizophrenia. Show all posts

Thursday, February 28, 2013

Wow.

Two sisters - Paul Gauguin
image credit

"Now come on and move your arm out the way, hear? It's cold out there, baby."

"I ain't cold, Sister. I ain't cold."

"You ain't felt that hawk jump on you yet, neither. Trust me, you'll be thanking me for making you wear this coat. Come on here."

Two sisters facing one another. One already bundled in her own coat and hat, fumbling to get her older sister zipped into hers, too. First, the zipper . . . all the way up to the chin where it stopped. Next, a ski hat was pulled into place, swallowing her silvery curls. The older sister squirmed to move away.

"Sis-terrrrr!" Her protestations were child-like. It was fitting considering their interaction.

They weren't strangers to our clinic at all. Ms. Lolita and her younger sister--whom she always referred to affectionately as "Sister"--had been coming to Grady for years. In all that time, I don't remember a single time that Sister wasn't with Ms. Lolita at a visit. She kept tabs on every medication, appointment, and recommendation and always took care of those things Ms. Lolita could not.

This time, it was getting into a coat on a wintry Georgia morning.

"Uh uh, Lo. Don't get to fighting me, now. Let me fasten these buttons, baby."

Sister dutifully slipped each toggle into its respective loop, pausing only once to pull her own gloves off of her hands with her teeth to help make her fingers more nimble. One by one she marched up the front of her coat until Ms. Lolita was enveloped in a cocoon of wool and microfiber.

"There you go, baby." Sister stepped back and surveyed her handiwork. "See, Lolita? Now you nice and warm, see? Snug as a bug in a rug."

"I ain't cold, Sister."

"I know, baby. But outside it's real cool, okay. Trust Sister, okay?"

"Okay."

I'd left that room five minutes or so before. The nurse had finished discharging them and I was in a nearby doorway watching them from a few feet away. They had just exited into the hallway and were preparing to leave.

The visit was simple enough. One sister with hypertension and diabetes here for a follow up. Brought in by the other sister, her caregiver.

They were nearly a decade apart in age. Growing up, it was Ms. Lolita who was responsible for seeing about Sister. Her mother had given her the charge of making sure her baby sister was clothed, fed, and bathed. And that is exactly what Lolita did, too. She washed out diapers and rocked her in her arms. When she was older, she cooked Sister oatmeal before school in the mornings and packed her lunches, too. She plaited her hair in tight squares and covered Sister's face with petroleum jelly on cold days to keep it from chafing.

But one day, something changed.

Things were fine at first. Lolita got married and had a baby shortly after finishing high school. That was when she was around eighteen or so. It was fine because, by then, Sister was a little bit older and didn't require as much of Lolita. Ms. Lolita could still manage to help out while her mother was working, even with a family of her own. Then, after her second baby came, that's when the voices started.

She wasn't even twenty one.

"I remember it like it was yesterday," Sister told us one day during one of our visits. "I came home from grammar school and went over to Lolita's like always. I couldn't get the door to open. She had blocked it with a couch because she thought aliens was coming from outer space. I looked in her eyes and she meant it, too."

"Wow," I responded. And actually, that was such a long time ago that we had that conversation that I don't fully recall exactly what I said. But I'm guessing that's really close to it.

Wow.

Wow is what I always think when it comes to schizophrenia. I liken it to a perfectly knit garment with one loose string that has been hanging for twenty years. And then--just like that--right on the edge of adulthood's awakening, that yarn gets tugged and an entire life unravels into a big, disorganized pile.

Wow.

Wow in that scary way. In that extra, extra fucked up way that you can only say with a whisper. Because it's too awful to say with anything other than your inside voice. Wow. 

Schizophrenia and disabling drug addictions have always triggered that for me. That anemic wow, so helpless and confusing and anger-inducing. You stand in front of the broken pieces wishing you knew how or where to start putting it all back together but you know you can't. Like a prized piece of hand-blown glass that you've super-glued and placed back onto a shelf.

Wow.

Lolita was hospitalized several times in those early years. No one understood all of this or knew how to even start. But over time, the doctors found medications that quieted the voices and took away the paranoia. In exchange for the silence, the beautiful and vibrant Lolita had become a twitching, lip-licking shell of herself. She was gone.

Wow.

Sister had children of her own and even a few grandchildren now. Their mother had passed on some years back and for all of her adulthood, Lolita had become her responsibility, too. Sister even took on caring for Lolita's kids from as early as when she was in fifth grade. And never once, did she seem to be bitter. In fact, Sister seemed happy to be caring for her older sister.

"I love how you call her 'baby,'" I said to Sister in the hallway. They both swung their heads in my direction and smiled.

Sister chuckled as she pulled her pocket book onto her shoulder. "That is funny, ain't it? What I look like calling you baby and you my big sister?" She cocked her head playfully and looked at Ms. Lolita. She was met with a blank stare by her older sister but it didn't seem to bother her at all.

"I love the way you love your sister." That was a rather loaded thing to say but it was true. I loved the way she cared for every detail and never seemed like she was even thinking of uttering a complaint.

"She raised me. Wasn't even old enough to cook on the stove without a milk crate, but you best believe she cooked me hot meals every single day. Mama worked long hours and had to 'cause our daddy passed in a accident and left her by herself. But Lolita always saw about me, you know, up until she couldn't no more."

"Wow."

"It ain't never bothered me none. I wouldn't be who I am if it wasn't for her. She was like a mama to me and I learned from her that seeing about your kinfolks is what you 'sposed to do. 'Specially in your 'mediate family. Ain't that right, baby?"

Lolita nodded.

"Alright then, Miss Manning. We'll see you next time, okay?"

"Yes, ma'am."

"Take care, hear? And make sure you dress them boys warm."

"Yes, ma'am, I will."

I headed down the hall but still watched them as they headed out. Sister was walking with an arthritic limp that I hadn't even noticed before then. Just as they reached the swinging doors out of the clinic, I saw Sister stop to fish something out of her purse--I travel-sized jar of Vaseline. She scooped a bit out with her finger, quickly emulsified it into her palms and wiped them over Ms. Lolita's cheeks and forehead. Then she popped it back into her bag, held the door open for her sister and followed her out.

Out toward the reality that continues well after the mornings at Grady Hospital.

Wow.

***

Now playing on my mental iPod. . . ."Come to My Window" by Melissa Etheridge. Juliette Lewis' haunting portrayal of the ruthless thief, schizophrenia, in this video has always grabbed me by the neck. Her youth and her beauty, so lonely and wasted. . . .all against Melissa Etheridge's throaty voice. . . .makes this one of my favorite videos ever.


Friday, August 21, 2009

Listen to the Patient: Reflections from a Tuesday at Grady


serendipity: (n) the faculty of making fortunate discoveries by accident.

pseudo-serendipity:
(n) the faculty of making not-so-fortunate, ironic, Murphy's law-type discoveries by accident. (my definition)


"Take these damn ties off me right now before I jump out of this bed and kick somebody's ass!" this agitated gentleman yelled in my direction. He was in the first bed in room 15, and I had to pass by him to get to my patient in the second bed. "Yeah, YOU, nurse, doctor or whatever you are! I'm talking to you." I guess he recognized my looking over a shoulder as a "you talking to me?" gesture.

"Sir, I'm not your doctor, but I can get your nurse," I calmly replied. Nice, but not condescending. I have learned that pouring on the kindess is the way to go in these situations.

"Well dammit, go get her right now, then. Find my damn nurse and ask her to get my damn doctor! And get this lady out of here!" he screamed back while pointing to the nurse's assistant seated next to his bed. She'd been given the delightful task of serving as a one-to-one "sitter" for a patient that was probably psychotic. "She's plotting against me! You probably part of the plot, too!" At that point, he began thrashing his hands all about in a futile effort to remove the four point restraints that had likely been placed on his limbs for safety while in the emergency department.

"I'm really sorry you're upset, sir," I carefully offered, "I'm not your doctor. . . but as soon as I finish with my patient in here, I'll try to get you some assistance." He didn't like that too much as exemplified by the litany of hard-core expletives that soon followed. He even heaped up a nice, big loogie in his mouth that he then hocked across the room, just narrowly missing me as I slid around the pink curtain separating him from his neighbor. Eeeeeewww.

You'd think that I would be really shaken up by such a thing, but admittedly, I'm not. This was clearly a patient with an active psychiatric illness complicated by something medical--which is why he was on our floor instead of the psychiatry ward. Not an unusual occurrence at Grady, and definitely not one that I felt particularly threatened by. When I first started doing this, I probably would have been somewhere between mortified/afraid ("Oh my gosh! What if this guy gets loose?") and angry/mad ("Oh no he DIDN'T just try to spit on me!! Oh NO HE DI-IN'T!!!") Now, I know how complicated psychiatric illness can be, and I've learned not to take any of this personally. I've also learned how not add insult to injury by further agitating an already agitated patient.

I examined the patient in bed two, and hoped to tip-toe past the loogie-hocker without getting called a female dog or being nailed with some other kind of bodily fluid. He had been ranting the entire time I was in there, and as soon as he saw me again, he focused his attention back on me. "If somebody don't get me out of here, I'm gonna call Mayor Shirley Franklin and President Obama!" (He really meant that.) He tried to grab the phone, but again was limited by the restraints. He glared back at the sitter. "And get this heifer out of my room!" This time I decided not to bite, as I knew it was all a part of whatever had him hospitalized. Instead, I just looked at the poor nurses' assistant with an expression of pity. It was only 3 pm. Boo, it's going to be a loooonnnggg shift, I thought while raising my eyebrows and shaking my head. I quietly left the room.

I could still hear the agitated patient hollering at the assistant as I stood by the nurses' station some twenty minutes later. I did, at least, keep my promise and told his nurse that he needed some assistance.


About 18 hours later, I returned to the wards the next morning to round with my team on the new admissions. The first thing I heard when I walked up was the booming sound of an angry and impulsive male voice. I winced with every profane word that escaped the door to his room. That unfortunate young nursing assistant from the day before came walking down the hall toward me. Another "f-bomb" came flying out of his room, and we all cringed once more. It looked as though she was heading to his room when we briefly made eye contact. "Lord, have mercy!" I said while placing my palm over my chest, "You're assigned to him again? Bless your heart!" Feeling bonded by our shared spit assault, she placed a hand on my shoulder and happily reported to me that today he was under another assistant's watch. We then collectively chuckled as I added, "Phew! I was about to say! Did y'all ever reach his doctors? Whoever it is, they definitely have their work cut out for them!" My team looked amused as they all shared knowing glances and grew quiet. It took me a few minutes and a few snickers to catch on. Finally, I opened my eyes wide and covered my mouth. My intern nodded slowly. "You've got to be kidding me!" I said with an incredulous gasp.

Nope. Not kidding. It was indeed true. After all that, I was his doctor after all. See, if I had just done what he'd initially asked, that is--"found his damn nurse, and told her to go get his damn doctor"-- I would have found out that the "damn doctor" he was looking for was me--close enough for him to spit on--literally.

Take home message: Never underestimate the power of Grady pseudo-serendipity. Oh yeah, and more important, like we tell our medical students over and over again like broken records: Listen to the patient.