Good Morning, World...
I'm without my right hand this week. KB is out of state at a church convention all week. I'm a bit on edge waiting for there to be some big fire to put out at work while she's gone. We had one or two smalls one yesterday, but nothing major. So we press on with prayers that this week goes smoothly. And I mean smoothly in the relative sense.....
About a week ago, it was the end of our day and I had just seen my last scheduled patient. KB was out doing a pharmacy run and AF was working at another site that day. It was CK, HL and myself in our "office" going over what follow-ups needed to be done for the day's visits. All of a sudden I see this flash of yellow out of the corner of my eye and I hear a voice say, "Can someone f---ing help me?"
It didn't really faze us too much. We get the F-bomb dropped on us almost daily. B-words. Mofos. Take your pick. There are only very rare cases in our line of work where we make the decision to fight fire with fire (and I'll tell you about one of those instances one day soon). The key is to never take any of it personally and read past the profanity to figure out what the patient is actually asking for. And this particular patient? She had just asked for help.
When I finally turned full face and got a good look at her, I also found myself close enough to her to pick up the smell of alcohol. She had on a simple yellow t-shirt and jeans and was holding what I recognized to be a prescription from one of the local hospitals in her hand. I asked her what we could do for her. And off she went...
For the next 15 minutes, we sat and listened as she told us her story. She had been raped 3 weeks ago while she was living on the streets. She did not report it because she has lived on the streets since she was a teenager and she has a well-known history of prostitution in the area. No one would believe her. And it wasn't the first time she had been raped. In her words, she just decided to "keep it moving." She had a long history of severe mental illness and had spent time in inpatient treatment too many times to count. She was a drug abuser and an alcoholic. She self-medicated regularly. And yes, she was drunk and high right now. She'd gone to a local mental health office for help that morning. They took her in for an emergency mental health assessment, but someone decided that her blood pressure high and it was more important that it be brought under control than for her mental health to stabilized. So a social worker put her in the car, dropped her off at the emergency room...and left her there.
Pause.
I spent 2 years working as a mental health nurse in a under-staffed, under-funded outpatient clinic. Whenever I had a patient in crisis that needed emergency stabilization, we had a either a family member or the police bring them in for an assessment. If we decided that they needed inpatient stabilization, it was our responsibility to find that patient a bed somewhere. And when I tell you that it is one of the most difficult processes in the world to maneuver, believe that difficult is an understatement. What I also know is that there were some members of our staff at that time, when they could not easily find placement for a patient, they would just pawn them off by sending them to the emergency room. But because the hospital did not designated "mental health" beds and most of the patients did not have insurance or a means to pay, it was not in their best interest to keep them there. On rare occasions, a sympathetic emergency room provider, would come up with some benign medical diagnosis, like "dehydration" to justify an admission. But that was on the very rare occasion. Most of the time, the patient was sent home. In the same condition as they had come.
Now, where was I?
Ok. So standing there listening to this lady talk, I knew that is how she ended up standing in front of us. She said that she had been told that her blood pressure was sky high and was given a prescription for blood pressure medicine. I asked her if I could see the prescription and when she handed it to me, I saw that is was for Hydrochlorothiazide 12.5 mg once a day. I asked if she had been given anything to bring her pressure down while she was at the hospital. She said no. Now, I am new to this nurse practitioner thing. But what I do know is that you only prescribe that dose of a water pill to someone with the mildest level of hypertension and no other co-morbidities. Not to someone with a history of uncontrolled hypertension, who has been off their medication and presents to the ER with ''sky-high" blood pressure.
So I asked CK to check her pressure. 156/98. Not great. But not awful considering that she was not on medication and her distraught state.
I explained to her that we would be happy to see her and help her get on the right blood pressure medication, but that she had to go through the enrollment process. That meant that she would not be seen today and we could not get her prescription filled today.
This news sent her into complete hysteria.
"I knew it was a f---ing lie when they told me you mother-----s could help me. Give me a piece of paper and a pen."
We obliged and handed her a piece of paper and a pen. She proceeded to write:
"To Whom It May Concern:
All you mother------s can kis my black a--. When you find me hanging..."
When I realized what she writing, I tried to take the pen from her hand because if I let her finish writing what I thought she was writing, this would become a whole other ball game.
I got a hold of the pen and began to explain to her what it would mean for me if she implied that she was thinking about hurting herself. At first she resisted what I was telling her, but after some coaxing she tore the note up and threw it away.
We sat her down. And then we just listened.
She was a crackhead. A prostitute. An alcoholic. She had 10 children. She could only speak to 2 of them...and they were in prison. The other 8? She had no idea.
Her mother was a prominent business owner in Columbia who would take nothing to do with her because she had an image to uphold. Her younger brother was a lawyer who had threatened to have the local dope boys kill her if she ever made trouble for her mother. She had a stepfather who would beat her severely and then make her stand in the trash can as further punishment when she was a little girl --- that is until she ran away at 13.
Since she'd been on the streets, she'd been raped by strangers and so-called friends. Beaten to within an inch of her life by men who said they loved her. After one beating, she ended up with a head injury that kept her in coma for a month and required her to have a part of brain removed.
At that point in her story, something gave away inside her.
Have you ever watched someone cry without crying? You know when they just sit absolutely still and quiet and the water just pours down their face like there is some kind of supernatural fountain flowing from behind their eyes?
As the tears rolled off her cheek, her face and body relaxed and she began to tell us about the days that she was in that coma. How beautiful her dreams had been while she was in that trauma induced sleep. How blue the sky was. How green the grass was. How the juice from the sweetest strawberries she'd ever tasted ran out of the sides of her mouth and onto the blindingly white dress that she was wearing.
In her coma, she had experienced something that she could never remember having experienced in real life.
Peace.
And her one wish, she said, was to just go back there because she had "a big old sore in her chest" that would never heal in this life.
There are million other things that I would like to share about this extraordinary story, but I don't have the time or the space here.
HL gave her hug which seemed to make all the difference in the world to her. CK tracked down her case manager who was able to find her temporary housing. And I agreed take care of her medical needs.
It was all we could offer at the time. It seemed to be enough for the moment. But she needed so much more.
That is the day that I went home and updated my Facebook status to read:
"I came up against something at work today that I couldn't handle. If anyone has the remedy for a truly broken heart, please share it with me."
I am not sure what has happened with her since then. We left her in the care of her case manager at the shelter when we left that day.
She is scheduled to see me on Friday.
But all the blood pressure medication in the world won't heal her broken heart.
I'll keep you posted.
Towanna
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