Thursday, February 26, 2009
Wednesday, February 25, 2009
I realize this makes two book reviews in a row about medication, and I promise the next one won’t be (although it is about healthcare, and then comes suicide, it is a social work blog after all). I tend to have many books on the go at once, and I happened to finish 4 almost at the same time.
I liked Prozac Diary. I enjoy reading memoirs about people who have dealt with mental illness, disease, disability, abuse etc... I find that I learn a lot more from people’s stories then from any text book I’ve ever read or lecture I’ve attended. That being said, Prozac Diary was almost a little too “booky” for my liking. I don’t tend to consider myself a linear thinker, but I’m beginning to think I like my books that way. My main complaint about the book was that it jumped from past to distant past to present, and had some sections which seemed to be a bit metaphorical.
The book talks about the author, Lauren Slater’s life as a child and then as an adult as she begins taking Prozac before Prozac became a “thing”. After spending time in hospitals and trying a variety of the other medications out there, Slater finds that Prozac is her “answer”. Almost immediately after starting Prozac, the author begins to find relief from her overwhelming OCD symptoms. She no longer has to wash her hands multiple times or perform rituals simply to get out of bed. Despite her doctor’s assurance that Prozac could not be working so quickly, Slater knows it has changed her life forever.
By exploring Slater’s childhood, the reader learns that Slater’s issues began at a young age and were not precipitated by any one event. However, it is easy to see how the author’s family constellation had an effect on her emotional wellbeing. Through 10 years of Prozac we see Slater experience drug poop out, the party scene, a PhD and meeting the man of her dreams.
While the book isn’t exciting exactly, it provides a nice middle ground, an “average” experience on anti-depressants one might say. At the end of the book, Slater isn’t cured, and she still takes those little pills while struggling with the ups and downs of life and mental illness. While it wasn’t my favourite, it’s definitely worth looking into if you or a client is struggling with the idea of taking medication long term.
Tuesday, February 24, 2009
For the most part, I’ve been doing pretty well working without any proper supervision. As I’ve said before, it’s nice not to have to over analyze every single little thing I do. Most of the people I work with are completely uninterested in debrief and reflection and are simply there to do their job and go home again. I really wish there was something more though. After the whole CPR thing my boss got me to come “check in” with him about how I was doing, but it just felt, empty... So now, you get to hear all the things I wish I could have said to my boss or supervisor (oh wait, I was the supervisor that night... well, to my boss anyway).
For starters, I feel like I handled the whole situation really well. I’m quite proud of myself actually. I’ve been put in this position of authority with no extra training, no extra feedback, no nothing, only “seniority” which really isn’t very much. It’s just been expected of me that I’d be in charge, because I’ve been there longer than other people. This particular night showed me that I can be a good leader, but that there are also areas that I need to work on. Yes, the CPR/live saving/hero thing was a part of that night, but it wasn’t the only part of that night, and it was actually one of the least frustrating parts, if I was honest.
I am not pleased with the way I treated one of my coworkers. I’m not upset with what I did persay, because I think it was necessary, but I still wish I’d been able to do things differently. Asking me about letting the drop in clients in for coffee when I’m literally in the middle of doing chest compressions just doesn’t sit well with me. I’m sorry, it doesn’t. And while I’m not a rude person generally, it’s hard for me to be polite when I have a guy with no heartbeat on the floor beneath me. So, yes, I snapped at you, but seriously, can you say bad timing??
I’d love to talk about whether that was where I should have been. I have a tendency to insert myself into situations, although I’m really trying to work on that. As the shift manager, should I have been down in a drunk tank cell doing CPR when there was still the rest of the building to worry about. If I’d been upstairs and sent this co-worker down, there wouldn’t have been any questions to snap at, but is it right to ask someone to do CPR? I mean, it’s part of our job, but I also know they’ve been a bit lax on that lately, and I remember him saying recently that he was “about” to take his training... I am confident in my CPR abilities (and managed to remember lots of important stuff – even head tilt/chin lifts). So I felt like I needed to be there. Plus, I sort of stumbled on it when I went to check on what was happening. So, what exactly should the role of the shift manager be, or is it again situational, as I wrote about a few days ago.
Finally, there’s the fact that only 1 in 7 people whose hearts have stopped and CPR is performed on will live. So realistically, if this happens again, and if I stay at my job, it will, the person probably won’t live to try and assault the paramedics.
Things to ponder, things to ponder...
Monday, February 23, 2009
Most of the people reading this have probably taken CPR at some point in their lives. Most employers require it these days and even if they don’t, many people take it for personal interest. Most of the people reading this have never had to perform CPR... I used to count myself in that number.
It always sucks to be short staffed on a Friday, and when it came to me to be shift manager on Friday the 13th I had this nagging feeling that something was going to go wrong. Of course, I didn’t want to be so convinced of this that it would up becoming a self fulfilling prophesy, but still, there was something that told me the night just wasn’t go off as planned... and it didn’t, but even though we were busy, things stayed calm until around six in the morning when I overheard the phrase “I’m calling 911”. This is never a good sign as we try and avoid calling it as much as we possibly can. So I went down to the drunk tank...
In the drunk tank, one of the staff had a discovered a c/n not breathing when they went to check on them (this being why we check on people every 15 minutes). The staff member had already begun CPR and the client had started breathing again... and stopped again, twice. So I joined in. 2 person CPR is SO much easier then 1 person CPR and my co-worker was just a little panicked. And when I say a little, I mean he was definitely in need of a deep breath. So I got him to do the breathing, because you have to take slow deep breaths.
After the third or fourth time we revived him I felt his pulse with my fingers, to time it, and to reassure myself that it was there...and it was, until it stopped. My co-worker started doing chest compressions and I could feel those, each one created a pulse of its own (which I find fascinating, even though I know that’s what it’s supposed to do). I lost count, but my co-worker says we revived the man seven times. By the time the paramedics finally got there he was sitting up, conscious, holding my hands as we breathed, in and out, together.
Then the paramedics arrived. And the guy FREAKED out. It took six people to hold him down while they gave him some haldol. I have NO idea what he was on, or how a person can go from no heart beat to seemingly psychotic within such a short amount of time, but he did. I’ve never seen anything like it, and I hopefully never will again.
Sunday, February 22, 2009
When I was a child, my parents taught me that there was a consequence to each of my actions, good or bad, and often, if I did the wrong thing, they were the ones to enforce the consequence. For example, leaving my room in a mess despite repeated warnings to clean it up might result in not being allowed to watch TV until it was clean. And more serious for me, my mom almost took my entire collection of books away because she caught me reading after lights out one too many times. As adults, there’s no parent standing over us handing down consequences, but that doesn’t mean they are no longer there. Bestest bud, for example, expected the house to be clean when she house sat this week and so because I hadn’t cleaned in ages I had to spend the two days leading up to my vacation cleaning like mad trying to make a dent in months of clutter.
Many people believe that the homeless are simply living out the consequences of their actions and because of that they do not need our help. Rather, they simply need to take new actions which will have more positive consequences. If unemployment led to loss of housing, finding yourself employment will then lead to housing. This way of looking at things looks at things on a more macro level and is easily generalized to many different situations.
On a micro level however we look at individuals, their situations, their actions and what the consequences of those actions are. It can become easy for my coworkers and I to take on a parental role (often quite unintentionally) and become the one who hands out consequences. A client does something wrong, we punish them. Sniff in the shelter, kicked out for 24 hours for example. One would expect this to be a deterrent, but if losing housing wasn’t enough to force someone to find employment will 24 hours outside force someone to stop sniffing? I think that’s what gets to a lot of us. We kick people out over and over and over and over again, and they’re mad, really mad, and yet month, or a week or even the next day, they’re doing it again.
One reason for this is addiction. Addiction is very powerful. I didn’t really just how powerful until I started working in detox. I hear people whose hearts are just breaking because of the horrible consequences of their addictions, who want more than anything to stop, and yet are somehow still held captive by their substance of choice. Further, after you use drugs/alcohol for a while your brain starts to go. You actually kill brain cells and damage parts of your brain, including your memory. Further you may not remember what happened as you “blacked out” from drinking.
Another reason is FASD and/or other brain damage. One of the frustrating things about working with children with FASD is their inability to understand the consequences of their actions. This is true for adults with FASD as well, only we expect adults to have mastered this concept. No matter how many times we tell someone, they may simply not get it (one of the reasons we tend not to use sliding punishment scales in which the punishment increases each time the action occurs).
A third reason people do not seem to learn from their consequences as we expect them to is mental illness, bet that depression, anxiety, schizophrenia or anything else along the spectrum. It’s hard to care about the consequences when you don’t exist in the same reality as the one who makes the rules. Sometimes a person can be so depressed they just don’t care, don’t care at all. Watching that can be scary, people with zero regard for their own lives are not only a danger to themselves but to those around them as well.
So, how then do we create a safe environment for all people?
Saturday, February 21, 2009
Jared is a man whose burned a lot of bridges, and when I say a lot of bridges, I mean it. Jared is not welcome, ever, at any of the other shelters in town, and has been permanently restricted from many of the hotels, medical clinics and rooming houses along the strip. There are not a lot of places left where Jared is able to go. He’s been given a lot of chances, but this physically disabled man has done A LOT of horrible things in his life, and he’s not even all that old. I mean, it takes soooo much to get yourself a lifetime ban from our services, and he did it.
Of course, it is always possible to appeal your ban, and so with the help of a hospital social worker, he did just that. See the thing is, when Jared isn’t drinking, or sniffing, or smoking crack or taking whatever the substance of the day is, he’s a nice guy! However, he’s one of the very few clients I am actually afraid of, very afraid of. See the thing is, staff have seen Jared sexually assault another client...but, since she didn’t press charges...
So, Jared’s back in. He uses our services just like any other client and gets the same punishments for drinking/using in the shelter as every other client, 24 hrs out. What happens when Jared sexually assaults another client, this time in the shelter, in front of witnesses and under a camera? What happens when the police say there’s not enough evidence despite the camera? There’s no charges, what do we do with Jared then?
Personally, I want to see Jared out. Out. Out. Out. Out. Out. But, as I said before, I’m scared of him, and I like to defend the little guy. Management doesn’t agree with me. Management wants him to sober up. See, the night of the assault, Jared spent the night on the street in frigid temperatures. He begged ambulances to take him to the hospital, he tried to assault police so that he could get thrown in jail. But no one would do anything for him. By morning, Jared was a freezing cold, sober, sad person who begged my coworker to let him back in, just to warm up... and how could we not? And then, then he said he didn’t remember a thing. He claimed to have to memory at all of anything until sometime in the middle of the night when we wouldn’t let him in (looking at this, even my language shows my bias).
So, what do you do in a situation like this? Because it is situational... if it was summer, or if he wasn’t disabled, or if he wasn’t kicked out of everywhere else, or if he acknowledged wrong doing, or if there was better evidence, or if there were charges, or if, or if, or if...
Living on the streets is not easy, it’s really not...
Friday, February 20, 2009
One of the convenient things about having the drunk tank located half a flight of stairs away from the shelter is that when clients are intoxicated and behaving badly it’s very easy to have police or downtown watch who are dropping someone else of put them in there. For the most part they’re fine to do it and don’t ask a lot of questions, they simply trust us that they’re being disruptive and need some time to sober up. The thing is, that we of course do not have all clients who are not following the rules thrown in the drunk tank, and I was thinking about how the situation really determines our course of action rather than a set policy. Some people might even call this situational ethics...
The last person I had put in the drunk tank was not so much being loud as just unable to settle down. They were up and down (and all around) and despite repeated warnings, had not laid down to go to sleep. This person was just stupid drunk, not particularly violent or insulting, but I have to admit, they were just plain annoying. Factors which led me to ask the police to put them in there: It was a quiet night so the drunk tank was not anywhere near full, it was really cold out so I didn’t want to throw them out in the snow, they were keeping other people from sleeping, I thought it would be really good for them to have a chance to become fully sober before using again (see and that, is where my bias comes in, what I think). Another shift manager in my same situation might have simply thrown the person out, or, being more patient then me might have just allowed them to continue and given them some more chances until they sobered up enough to calm down.
So, what’s the right answer? When does having the drunk tank give us inappropriate power? As usual, I’m not sure there is an answer. I truly believe it all comes down to the situation. Other people might disagree with me, looking instead for a black and white answer, but I really don’t think there is a check list of things that mean someone gets kicked out, locked up, or allowed to sleep. That’s where experience comes in, and I often don’t feel like I have enough of it to be left in charge.
Monday, February 16, 2009
Thursday, February 12, 2009
Wednesday, February 11, 2009
Tuesday, February 10, 2009
Sunday, February 8, 2009
Saturday, February 7, 2009
Friday, February 6, 2009
Somehow my pictures posted backwards, the one at the bottom is supposed to be the first one etc... but in anycase, it was time to give the Sophie cat a bath today. She REALLY needed one, she smelled all dusty/musty. Maybe that's a sign I should vacuum more, but I'm going to blame it on the cat. She was surpringly good in the bath, I just plunked her in with me (wearing long pants and long sleeve to prevent being clawed to death), closed the curtain and soaped her up. She was pretty displeased afterwards though, as witnessed by these pictures (which she wouldn't pose for). I think she's recovered now, but she wouldn't let me help dry her at all. Apparently she thinks this is what her tongue is for!