Since I have a late start to clinic today, I decided that now might be a good time to put up a new entry.
Remember the patient from my earlier blog who I told you that we rode that rollercoaster with one afternoon? She came back to see me last week. She looked well. I put her back on her blood pressure medication and the level of gratefulness that she showed us was phenomenal.
I mean, we have a lot of lame people in this world with big ugly houses and big ugly American-made cars walking around with their noses turned up in the air acting like someone owes them the privilege. Then you have people like this particular patient who, for all the hard knocks she's had in her life, still retains the simple decency in her heart to be able to smile and say thank you. She may not know it in her current circumstance, but that is part of a supernatural joy from the Lord that will help to sustain her.
I have a lot of interesting patients that come to see. And I mean interesting as people. Completely independent of their current circumstance.
A few weeks ago, a patient came in with a weird Czechoslovakian sounding name. Even weirder was the fact that he was really tall, really thin...and black.
I asked him where he got such a last name. He said that the story was that his Great-Great-Great-Great Grandfather was bought by a Russian businessman and taken back to the Soviet Union where he married one of the mulatto slave women who was rumored to be the slave master's daughter. Just after Emancipation in the United States, they were allowed to return to the States with their freedom. When they were asked their names to enter into the ship travel log, they just gave the slave master's last name. And if rumors were true that his Grandmother was the slave master's daughter, only his "Grandfather would go to Hell for telling that lie."
By my count he was something like 7th generation in this country. He showed me a picture of his father, with his mulatto skin, wavy hair and thin nose, sitting with his mother, a tall, thin black woman, wearing polyester bell bottoms, and a perfectly rounded afro with pick sticking out of it. You know? The black one with the fist on the handle. (Yeah. I know you knew). I guess he "went" to his mother's side of the family because his father had obviously picked up some features from that Russian gene pool. If he had not told me, I would have never thought that he was anything other than black. But while I was doing his ear, nose and throat exam though, I did get close enough to see that his jet black hair, that looked like a brillo pad from a distance, was actually really curly and thick. I guess that if you don't get anything else from the white side of your family, you can always count on "good hair."
At the main homeless clinic site, we have one particular patient who we see EVERYDAY. Several times a day. She is not a bother. More of a pleasant nuisance. But still. On most days, ain't nobody got time for that.
She first came to us for treatment of her high blood pressure, diabetes and bipolar disorder. She was on so many medications that I really didn't know where to start with her. On top of that, she could not give me a really clear medical history.
Most worrisome that day was the fact that while I was talking to her, she was sitting on the exam table unable to hold her head up. I would ask her a question and midway through her unintelligible answer, she would nod off on me. Each time I would wake her up and a few minutes later, we'd repeat the scenario.
I finally got what I thought was a complete enough history from her, ordered some lab work, did a referral back to mental health to manage her bipolar disorder, and put her back on the medications she told me that she was taking that I thought were appropriate.
Two weeks later, she came back. In the same state. Wanting refills on her Seroquel. I knew that she shouldn't need a refill already if she was taking the Seroquel as I prescribed it. I took her to the exam room and for the portion of time that she was awake and I was able to make out what she said, I found out that she had been self-medicating and taking way more Seroquel than what I had prescribed.
We established that she was not trying to harm herself. I did a urine drug test on her and she was completely clean for any street drugs, narcotics or benzos.
I decided to take a different approach with her at that point.
We discussed that she should only take the medication I gave her as they were prescribed and that if I was unable to trust her to do that, I would no longer see her. She agreed and I agreed to refill the Seroquel. But I had no intention of doing so. She was also on a couple of other medications to manage her bipolar disorder that did not have the sedating effect on her. I decided that I would give her some time off of the Seroquel and see what happened.
A few days later she came in to ask about her Seroquel. Of course, we did not have it because I had not authorized it to be refilled.
What we did have was a completely different woman standing in front of us.
The usually matted wig that she wore had been replaced by a new, slick, jet black version of a chin length bob. Her weird outfit choices had become a simple pair of blue jeans, a t-shirt and flip flops. Hoops in her ears. Rings on her fingers. A pretty crucifix around her neck. Lip gloss on her lips. Mascara on her lashes. And a look of awareness and lucidity in her eyes that we had never had the privilege of seeing.
She said that she was sorry that she did not come back to check on her medication earlier. But in the last few days she had been out looking for jobs and working on the goals that the shelter staff had set for her in her program plan. She'd gone back to the cosmetology school where she got her degree to see what she needed to do to get her license reinstated.
The more she spoke, the more in awe we became of the difference in her from those first visits.
Who was this well-spoken, intelligent woman?
And what was she doing here?
Since those days in April, we have found out a lot about her story.
There has been violence and heartbreak in life. She's had to overcome
many things just to be in the place where she is now. What is really amazing is that she has been great at teaching the clinic staff important lessons about ourselves and our interactions with our homeless patients.
I remember one day I had a disagreement with a another female patient who had been diagnosed with schizophrenia and a personality disorder,
That day, I think I'd forgotten my Rules for Mental Health 101.
1. Never try to reason with a schizophrenic
2. There is no treatment for a personality disorder.
The patient was upset that I refused to feed her habit. I explained to her that I was a primary care medical provider. Not a mental health provider. Her diagnoses were of a sort that I did not feel were in my scope of practice, but I would be glad to refer her to the appropriate care.
Homegirl looked at me and said, (and I quote):
"That's cool and all. But are you going to give me my valium, flexeril, lithium and adderall?"
Funny thing is, she'd started off asking me for Effexor and Lortab.
I refused and she left very upset.
Later I found out that the personality disorder she'd been diagnosed with was of the "multiple" kind. I guess "Brenda" had asked for the Effexor and the Lortab. But by the time the request for the valium, flexeril, lithium and adderall had been made, "Jackie" had taken over.
Apparently, she was upset enough that she'd gone outside and went into a full on rant about how she could not stand me. I was a B-word and I did not like female patients. (I'm not sure if it was "Brenda" or "Jackie" who was responsible for that, though).
I'd already been accused of not liking "people like" them.
Not long before that, I had also been accused of not liking white patients.
Yeah. Biggest chauvinist, elitist, racist in the world.
What the EFF ever. Is that all you got? Chile, puh-lease.
Anyway, my patient who I'd taken off of the Seroquel came in for her daily drive-by and asked me if I was ok.
I explained to her that things like that didn't bother me, so much as it reminded me how careful that I need to be about not allowing my personal feelings to overcome me in a situation like that.
This is my job that we are talking about. Not my family life or my social circle. There was no need to fight fire with fire.
We stood and talked about a few others things. And while we talked I noticed that she was kind of giving me the "up/down." You know, like she was sizing me up.
I asked her what was wrong and she said, "Can I tell you something?"
I said yes and she made me promise that I would not be offended.
I promised.
But I didn't really mean it.
She said to me, "You have a sweet spirit, but there is an edge to it. Like you got your guard up and if someone rubs you the wrong way, the sweet is gone and the edge will cut them like a knife."
She was right. The sweetness was planted there by nature. The edge had been cultivated by nurture.
I wanted her to keep talking.
"You have a hard time dealing with people because most people can only see clearly enough to see the edge."
Bingo.
But then she caught me off guard.
"But you need to take responsibility for that."
Ok. So its my fault?
Now I'm a little offended.
But (and in my Kanye voice) Imma let you finish.
I asked her to explain that to me.
She continued, "Look at how you are standing. The whole time that we stood here talking, you had your arms folded. It doesn't bother me, but other folks might take it as you not being open to what they are saying to you. You lead with that edge and you got better things to lead with."
Anyone who knows me, knows that I fold my arms when I am thinking really hard. I also frown and purse my lips together for the same reason, which I inherited from my Mama. The problem is that I think that I just assumed that people will know those things without them knowing me, me actually telling them...or them being psychic. (SN: Where is Miss Cleo?)
When I realized that she was right, that I had stood there with my arms tightly folded and my face in my concentration grimace, it hit me.
Its like the moment I realized that not everyone has (or appreciates) my
brand of humor. There have been plenty of occasions when things that I
find hilarious have made Facebook folks "feel some type of way" and I
ended up with my status hijacked by someone who misinterprets my intent.
Nobody knows who I am until I show them. If I always led with that "edge" that she had just talked about, that is who people will think I am and I will never have the opportunity to present myself as a complete package.
Wow.
And all this time, I was thinking that she was the one lacking in awareness and lucidity.
Towanna
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