new year's resolutions thread.

[NopeNopeNopeNope]

Actually I’ll just post the second since I have a bit of time here…

Had a request for a 60ish yr old woman from her bf who doesn’t live with her. He said she is not taking care of herself, an alcoholic, not eating (most alcoholics don’t since they are getting their calories from the alcohol and it upsets the lining of the stomach when used frequently in large quantities), emaciated skinny, and that there’s vommit all over her house (grrrrreeeeaaaat….)

But the dispatcher mentions that the specialist who took the request contacted the client and that she “reluctantly” agreed to accept my service but said she didn’t want anyone coming today. To me that initially sounded like what someone says to a solicitor they are trying to get rid of like “I’ll take your information and call you sometime”

So I’m contacting the specialist who talked to the client and is giving me the request and I’m saying “it sounds like she doesn’t want this service? Why are you still sending me” And I also contacted my supervisor on duty to report that I don’t like this situation. Our entire approach is client-centered and big on client agency and autonomy. So I’m like why am I still going after this person said not today? This feels like harassment

So the specialist who talked to the client on the phone said “well she didn’t want the service but her bf told her if she didn’t accept he would send police and adult protective services”. And I said “so that sounds like coercion and we don’t use that strategy at my agency”. So then the specialist said well they confirmed that the boyfriend has medical PoA on the client and he was the one making the request. And I informed the specialist that medical PoA only applies to authorizing medical treatments for a completely incapacitated (coma, unconscious) person. It does not apply to signing a conscious person up for mental health services. And then the specialist started to get snippy I could tell and I didn’t want bad blood (because they can and have retaliated, there’s politics in this field too….) I said “ok with all that being said I’m still going”

So I get there and she (reluctantly) accepts me in. There’s some vomit stains with some chunks near the entrance in her kitchen but the rest of the house was pretty clean, apparently she pays a cleaner. She’s saying she feels physically sick, dizzy, unsteady, she hasn’t eaten in 3 days, and hasn’t had alcohol in a week. And that she’s eating so little due to stomach issues that she’s gone from 109 to 88lbs in a few weeks. And she looks very very thin, but not quite emaciated

She denies any current safety concerns or mental health symptoms, this is pure medical. So since it’s barely still in business hours I get on the phone with her PCP who gets me a nurse and I run the situation. And they suggest an ER and offer to send transport (I could take her but she’s too much of a fall risk when I can’t touch clients to hold them up)

So her transport arrives and I follow to the ER to advocate because she’s too weak to talk almost, and mostly see that she’s seen. I have no mental health assessment to coordinate

They take her blood pressure and it’s dangerously low, to the point where she gets level 2 status and a trauma room. The ER triage nurse says to her, your blood pressure is dangerously low and your heart is weak, you are not to stand up out of that wheelchair ok?

And I said “she’s been complaining about doing any movement because she’s so drained right now, I don’t think you’ll have to twist her arm on that one”

And the nurse laughs and then goes serious face and says “ok I’m not joking though. If you try to stand you could have a cardiac event”

In the back of my head I’m thinking this lady could have died alone because her bf doesn’t live with her. And my service was forced on her in an unethical way. Yet it might have saved her life. Ends justify the means?

I was happy for her and pissed at the same time

[NopeNopeNopeNope]

Ok NOW I’m going on a run

[NopeNopeNopeNope]

Have to go to mental health court this week on this early 20’s gal I had to force involuntary treatment on. When they show up (escorted by police) that acutely psychotic, and their UA comes back clean, my state has been big on putting them on 1 year court ordered treatment. Meaning instead of pills you get a once a month (usually invega) shot whether you want it or not. And you legally can’t own a gun for that year

I was pissed because that call for her put me nearly 3 fucking hours over shift. Former co-worker security guard said she had been fired last week (wonder whyyyyy) and showed up having walked from God knows where her house is with no shoes, appeared to be having psychosis, and had asked him to put her down like a dog and shoot her with his gun. I was surprised upon showing up there yea he really was strapped. Dude had a legit gun and not just like a rape whistle

This (actually pretty) gal doesn’t know her date of birth, the current month, and couldn’t answer basic questions like who she lives with. She had one of the negative signs of schizophrenia (negative meaning something removed, hallucinations are a positive sign, something added) which was poverty of thought or thought blockage. And I haaaaaaate that symptom when I am over shift. I’d ask a question and get a blank stare for a straight minute, then a flash of panic across her face, then back to the black stare. And I’m thinking whaaaaat is going on inside your brain…

She’s so erratic I’m trying to work out getting her home and she jumps out of his car she was in, yells “I have to poop this is serious!!” And acts like she’s going to walk off. I’m on the phone with the on-call supervisor saying “ok give me the ok to transport her home because we have a bathroom emergency here and she lives close. She couldn’t remember her address but her co-worker has it”

And after I get the ok I go over to tell her let’s get you home so you can poop. And she gives the blank stare like she doesn’t remember. I said didn’t you just yell you had to poop? Blank stare. She says “I need to go to the ER”. And I ask why? And she says “I just need a hug!!” And puts her arms out. And I’m thinking no hug is going to do anything to improve your altered mental state. So I say “sorry I can’t touch clients”

And she gets angry and starts to storm off. So I’m like I can’t have her walking barefoot along a busy city street with cars going 50mph a few feet away while psychotic, erratic, and suicidal

So ok I have to call 911. So I do and it’s just fucking RINGING and no one is answering. For like more than 2 minutes. I’m like WTF is it my work phone, so I try with my personal phone as well. And both are just ringing! What the hell!

Finally I get two dispatchers to answer each at once and I say “oh sorry I had called with a second phone” and both dispatchers say in unison “it’s ok, i’ll disconnect”. So then I had to yell “wait!” Mute one. Ask the other to disconnect. Finally got police and fire out there. Fire takes her to the ER, I do the involuntary pick up order to there

Aaaand now I have court. And it’s always awkward facing the client’s stare as I have to testify against them on the witness stand. I like to make heavy eye contact as I do, jk [You must be logged in to view images. Log in or Register.]

[NopeNopeNopeNope]

Pretty wild request today

Day Program (basically like a combination of school/daycare for DD people) staff said this 23yr old gal was banging head, hitting and spitting on staff

I get there and she seems to have the physical presentation of downs in face and body. She’s still escalated and violently whipping her head into the hard unyielding corner of a wall. Staff had already displayed where she had put holes into the drywall with her head. Now I’ve seen hundreds of adult DD tantrums at this point, the vast majority do not bang their head as hard as she was. It was to the point I was surprised the skin of her scalp or forehead didn’t split just from the impact

I tried giving the staff a pillow I found to put behind her head but she kept grabbing it with her hands and moving it. She was also hitting the staff and wall with her arms and spitting on the staff, screaming. She was incorrigible and not listening to me or anyone else. So I had to request police and fire dep’t and police was able to get her to calm down

I stressed to fire that her head hits were hard enough and numerous enough to warrant getting checked out so they took her to the ER. I was trying to get hold of her group home to get info on her guardian but they were just off the map, not responding to calls or calling back

So after I went to the ER to coordinate I drove 30 min to the group home and knocked on the door like heyyyyy why don’t you try answering your phone? Group home staff displayed multiple pages of paperwork showing she is her own guardian

I was like what the F??? She can only speak single words, she seems to be functioning below a 10yr old level cognitively and she’s her own guardian??? Are you kidding? They also said she’s been having these behaviors frequently for the past 5 years since she’s been there and displayed the most recent holes in the wall she’s done with her head

I was like listen I’m not medical but hits that hard repeatedly over and over for years can cause serious neurological problems like CTE. They were like “what’s CTE?” /sigh

So that was an adult protective service report and a half and APS was also surprised she was somehow her own guardian. They will be investigating both her and the group home as the ER social worker also put the group home on blast for not answering their phone for them for quite a while. You don’t want to ignore an emergency room Doctor calling you, bad idea. The ER social worker also couldn’t believe she was her own guardian when I updated her, the SW said one of the first things she did upon arrival at the ER was completely disrobe for no reason

I felt bad for the girl. She’s not even functioning at a level to understand but I wanted to be like “girl, listen, you have enough problems, don’t create even more for yourself”. Her lifespan is already most likely at LEAST 20 years shorter than the average person and if she continues banging her head that often and that violently, go ahead and take another 10yrs off that [You must be logged in to view images. Log in or Register.]

[NopeNopeNopeNope]

Request today all medical once again

Mom calling for her adult son, with history of pancreatic and kidney failure and a history of transplants, on dialysis for the rest of his life, and just suffered a stroke 2 weeks ago. After the ER went to post acute care (SNF) and apparently checked himself out ama after a few days

Paralyzed on right side of body from the stroke. Can’t get himself to the port o potty next to the couch he’s laying prone on. Can’t get food for himself, can’t even chew solid foods. Lives alone, mom and sis are visiting until tomorrow

Refusing to go to dialysis. Sister got him McDonald’s because it’s the only thing he’ll eat cutting it into the smallest bites she can because every bite is a choking hazard. His legs are swollen and his mom mentioned his testicles are huge. I told her yea he seems to have peripheral adema. Mom called fire department to check vitals before I got there. His blood sugar was over 400 and blood pressure over 180 about an hour before I got there. Fire department said they recommend he go to the ER to not die. He declined

The little he’s willing to talk he’s mentioning getting some in home health service coming. So I’m getting the idea that he’s not suicidal, just dumb to the point of not understanding how he’s not only on death’s door, but he’s been slamming the metal knocker knocking too

So I figure I know the answer to this and point blank ask him “do you want to live?” and he says yes. He’s not that engaged, didn’t even want my service, so I figure there’s no point in going round and round about why then he’s refusing dialysis and going to the ER. His mom and sister and fire department already covered that exhaustively with him and he wasn’t budging. He didn’t even want me talking to his family but wasn’t in any position to stop me

So his mom asks about forcing him to go to dialysis. That can’t be done. A person can refuse invasive medical procedures like chemo or dialysis without being considered suicidal, that’s their right. You can’t drag them to a medical treatment kicking and screaming

I told her your son reminds me of a client I had a long long time ago, probably 15 years ago. It was a guy around his age who had given himself some horrible infection in both legs from shooting heroin. His legs were covered with open sores seeping fluid, and swollen to twice their size. His family was desperately trying to get him to go to the ER but he also had declined fire department and going. It wasn’t because he wanted to die. He just had a very naive idea of what he needed, in his case it was to put his legs in sunlight from the window and take a multivitamin every day. And he thought that would heal him

So I said to her the same thing I told the other guy’s parents: all you can do at this point is watch him until he either goes into a stupor or unconscious, and call fire department back. An unconscious person cannot decline treatment anymore

And of course I called Adult protective services, and the supervisor called me back within a few hours, when normally their investigation takes 5 days. He was like “wow, this sounds really bad”. And I was like “yup, it is”. He said he can’t get out there till tomorrow, should he request a welfare check before then? I said sure, if he’s conscious he’ll decline any help but may as well try

Even if she can get him to the ER, he doesn’t want to continue taking the meds he needs to keep his body from rejecting his organ transplant. Or to go to dialysis. So she’s buying him a few days

This one is not long for the world. I give him at most a week or two. I was in a bit of a hurry to get out of there, expecting him to code at any moment. And I haven’t had to do CPR yet on a client….

[NopeNopeNopeNope]

From work:

I have an idea. Maybe….maybe you could….um….take the money you are spending on alcohol….

…..and umm….

….maybe you could try buying food with it??

[NopeNopeNopeNope]

Had two fucking CPS reports today

Second one was by far the worst. School counselor says this 17yr old was taking forever in the bathroom so other students asked the counselor to check on her. When the counselor came in the kid was nearly passed out drunk from vodka she snuck in in a monster energy can. She also had a razor and had covered her left arm with about 15ish cuts. Apparently she did even more to the tops of her legs. The counselor said there were dozens of cuts from her thigh to her knee all done that day or the previous day. None needing stiches but with a razor so all had bled some. There was a good amount of blood in the bathroom

So I’m talking to the kid a few hours later and she’s more sober and calm which is good. I ask her to rank her stressors and the biggest one she says is home. At home it’s dad, dad’s gf, her younger 13yr old sister and brother, grandparents, aunt and aunt’s bf and their kids. She said grandparents yell at her and dad often, and her aunt and aunt’s bf are doing fentanyl in the home

So gearing up for my inevitable report I start gathering details. “How do you know it’s fentanyl, have you seen it?” She says they smoke it often enough she can tell by the smoke smell. She says she has seen her aunt leaning way over like this and she demonstrated. I said yes I’ve heard that called the fenty lean. She said her younger 13yr sister is one of her biggest supports but described her a mini alcoholic. I said did you have alcohol before today? And she says yea me and my younger sister drank an entire bottle of vodka last night. I said the entire bottle? She said yea my sis drank more she was throwing up

She also said she smokes weed about 2ish times a week for the past few years. I said wait, hang on, you said you just stay inside all the time and never see your friends in person, so who’s giving you this weed? “Oh it’s my dad’s weed, he leaves it out for me because he knows it calms me down”…….weeeeee more for the report. I also go over healthy coping alternatives to cutting and substance abuse with her. I remind her that I talk to adults who didn’t care as a kid but now regret having covered their arms and legs with scars from cutting because the stigma of people seeing the scars has impacted their life as an adult

Her dad is at a funeral and not willing to come meet me. I said sir your daughter was shitfaced at school riddling herself with cuts today, this is a high risk category, she needs to go to a behavioral health hospital (in a nicer way). He’s like ok you can take her, have them call me I’ll sign her in. Unfortunately there is actually one hospital that will do that and the dad knows that

It is funny how schools will just release their teenage kids to me (despite me not being on any approved pick up list) to go transport away in my van. So I take her to the hospital, talking about her pets and my boa snake pet I had as a kid, and the dire wolves she heard about them cloning to keep her anxiety down on the way. I mention that my new dream pet is a cheetah, formerly a Savannah cat. I help her get signed in

Then I do the mandated report to DCS and who da thunk, they said it would be investigated. Shocker…

[shovelquest]

Originally Posted by NopeNopeNopeNope [You must be logged in to view images. Log in or Register.]

Had two fucking CPS reports today

I hope you get one for H3H3 and can give us the behind the scenes gossip.

(this is a callback to internet drama)