Questions….
So, I worked today and I’m sitting here wondering if I made a mistake in not asking a question. Part of my job entails meeting with patients from the health system’s outpatient clinics (like the physician’s offices, diabetes education clinic, wound care clinic, anticoagulation clinic, ambulatory infusion among others). As an outpatient social worker I’m supposed to provide brief therapy, help locating resources and other problem solving assistance. So, I was meeting with a woman who has no insurance and has a couple of serious and chronic medical conditions. I was helping her complete the forms for our health system’s financial and prescription assistance programs. We were discussing her condition and she mentioned she wasn’t taking birth control because of the possibility that doing so would aggravate one of her medical problems.
Now, I’m wondering if I should have asked her what exactly she was doing for birth control. Certainly given her financial situation, having a baby would not be the past course of action. And I can’t even imagine how complicated her pregnancy would be given her medical situation. I’m wondering if I missed an opportunity at education (I did safe sex education in a former job) or if it was best that I didn’t delve into that subject since the client didn’t seem to be too concerned. I could always call her and follow up, but don’t want her to be offended. Hmmmm…what’s the right way to approach it???
Recently received postcards!
I absolutely love postcrossing.com.
I had taken a long break from sending official cards but have recently decided to send a few a month. So, now I’ve received an official card myself. It came from Germany and it’s an odd little card with a chicken on it. I love odd cards, though. I wish I knew was the little saying was on the front, but alas I don’t speak German.
Official Postcrossing Card from Germany
I’ve also received a card from a woman in France. Isabelle and I trade postcards one at a time and I get some really nice ones from her. She and her family just returned from a vacation in Verona, Italy.
From Isabelle
Bad decisions…
I think all social workers have to learn to come to terms with their clients making bad decisions. I work hard and remembering we all have the freedom to make bad decisions. And of course I think for anyone, realizing a bad decision making only comes from hindsight. In the medical field, I see poor decisions being made all of the time. People who drink too much and end up with liver disease, diabetics who fail to seek treatment and end up with a myriad of consequences from that. Heck, in my short time at my current job, I’ve had at least once very, very ill client who left the hospital against medical advice. And I struggle with these things…knowing how much to challenge a client without making them feel alienated.
The other problem I struggle with is that sometimes clients make bad decisions because they don’t get enough information from the medical provider. Sometimes I think the occurs because they are too intimidated by said medical provider or have been taught that they should trust doctors. Then, they fail to ask questions or let the medical provider know that they just don’t understand a word the doctor has just said and, as a result, don’t even know which questions to ask. But, sometimes, I think that maybe the medical provider just doesn’t truly convey the client’s medical situation.
I think this is the case with one of the clients I saw this past week and have seen several times over the past few weeks. Looking over their records I just can’t believe that the doctor would have recommended the aggressive treatment that this client is undergoing. Granted, I’m not a doctor or even a nurse, but given the extent of this patient’s disease process I just don’t understand why they weren’t offered hospice as an option. And, maybe it was. I wasn’t there when the patient was told of their diagnosis and prognosis. Maybe this was fully the patient’s decision to pursue such aggressive treatment.
Maybe I’m just experiencing some good, old-fashioned counter-transference. It is painful for me to see this patient deteriorate. They have been unable to go home. They have been able to be around their family because of the treatment they are receiving.
The other problem I have in this situation is that the MD handling the case is well known for providing many patients with a rosier-than-real prognosis. And this MD is known for being highly resistant to making hospice referrals. Often, the hospice referrals made by this MD are done at the point where the patient has days to live.
So…I just don’t know where to go with situations like this…where is it the patient making what I feel is a bad decision based on personal choice and where is the patient making a bad decision based on a lack of information?
Death and the 5 year old…
Orange Fish and White Fish at home
So, for the G’s 5th birthday he got a fish tank and two fancy goldfish. The fish have done surprisingly well. We are starting to have problem with “Orange Fish.” (I know “Orange Fish” and “White Fish” aren’t the most original names, but that’s what the G wanted to name them) Anyway, Orange Fish has been having some trouble with his swim bladder. So far, I’ve been able to get him almost back to normal every time by feeding him extra sea weed or worms, but I think he’s getting ready to hit the end of his rope. We’re on a bit of a death watch right now.
So, I’ve explained to the G that I think that Orange Fish is sick and that we may get up one morning or come back some day and he might be dead. He asked why and I explained that Orange Fish seems to be getting a bit sick. He hasn’t had anymore questions, but maybe we’ll have to have a discussion about death soon. I don’t know.
Of course I thought that was going to be the case last spring. One of his classmates couldn’t be at the school picnic because her grandmother had died and the family had to travel to New York to attend the funeral. I explained why she wasn’t going to be there. I sat on pins and needles for a few minutes waiting for a question like, “What is dead?” or something similar. I could see the little wheels turning in his head. Then, he asked, “Mommy? If Grandma Wanda or Grandma Sandy dies, am I going to have to go to New York?” I told him that no he wouldn’t have to go to New York…and laughed inwardly that I had gotten myself all anxious over nothing.
Squidoo…
This is something I heard about and I’m giving it a try. I’m still trying to figure it out so if you go to this link …. http://www.squidoo.com/socialworkersrgr8 it doesn’t look so great. It seems like an interesting social networking site, but I’m not sure if I’ll be able to keep up on it…or maybe it will become addictive and I’ll end up staying up until 3am every morning working on it. LOL We’ll see…
A fallen angel…
At least that’s how I’m feeling right now. I’m involved with an organization called ChemoAngels. The website is chemoangels.net. Anyway, the purpose of the program is to set up people who are undergoing chemotherapy and other cancer treatments with volunteers. Traditional angels send their patient small gifts and cards at least once a week. Card Angels (that’s what I do) send their patient cards and letters at least once a week. So far I’ve been a Card Angel to two patients. I’m not sure what happened to my first patient because I was just notified by the organization that she had stopped providing updates and was no longer a part of the program. Shortly after, I was assigned to my new patient.
Anyway….my patient informed me that she would be coming to our area for her job on a certain day that I’m already occupied. I’m being purposefully vague because of a confidentiality agreement. Anyway…I had originally thought that I would be able to go and see her do her job but that was before I remembered the other obligation. Now, I feel bad because I had mentioned that I would be coming to the event in question that she is involved in. Now, I have to tell her that I won’t…I just feel bad…
But, for anyone who is reading this…ChemoAngels is a great organization and I’ve found it very rewarding…you should check it out. So, I guess if nothing else, me venting my disappointment is at least a way to maybe get more people to learn about it.
My dirty little secret….
Tomorrow I go to work. I haven’t worked all week and I am so happy and excited to be going to work in the morning. I feel slightly guilty about this. I had always been adamant that I would stay home full time until both boys were in school all day. I wouldn’t say that I was ever militant about thinking all children needed to be home with their moms until they went to school…just for me personally, I thought I needed to be home full time.
So, I was a bit conflicted about going back to work. I thought I would totally miss my kids all day long, that it would be hard on them, hard on me, etc etc etc. Well, that’s not how it turned out. They love being able to hang out with their grandparents. And I really like being able to have a life outside of the home.
I guess maybe I was getting burnt out being at home full-time and shouldn’t feel even a little bit guilty about wanting to go to work. I guess maybe it’s like any job…I didn’t have any balance and needed to find something to get that balance back. Apparently, it was going back to work.
My older sister said I would like going back to work and would like seeing that I had gotten something completed. Well, I don’t know about seeing things getting completed, given my chosen profession. (She’s an IT professional in the business sector…so she has a job where she can definitely see things being completed) But, I definitely feel a sense of accomplishment at the end of the day, even with all of the frustrations.
Don’t get me wrong, though. I have enjoyed my week with the kids. I got to see G’s t-ball games and was there when he got hurt today. (Don’t worry he’s fine…but it was nice to be the one that wiped away the tears!) And playing with David and all of that. But, I’ve also had to deal with the typical 3 and 5 year old hijinx. That gets old really quick.
Anyway…shhhhh…don’t tell anybody…but I’m going back to work tomorrow and I’m totally thrilled about it!
Stuttering…
My younger son has developed a problem with stuttering. It has come on very suddenly, within the past week or so. It seems somewhat severe and is really frustrating the poor little guy. He’ll be trying to say something and then he’ll stop and say, “I-I-I-I can’t talk!” I’ve done a little bit of internet research and most of what I’ve found has said in children his age (a little less than 3 1/2 years old) it can just be a sign of a child being ready to start to use language in a different way. Apparently, this can come and go and the child usually outgrows it within six months or so. Apparently, though, if it hasn’t run its course in six months we should get him evaluated to see if he needs some speech therapy.
I don’t know if I’ll be able to wait six months to help the poor guy. He’s been so frustrated by this in the past week. At the same time I hate to have to take him in to the pediatrician in order to get the referral. With his medical history he gets a little traumatized every time we have to go to the Clinic. Hopefully this will run its course soon.
And it just keeps coming….
I just got a call from the child abuse specialist (an MD) wanting some more information on the case. I gave it to her. She is also very frustrated with the agency the reports for this kind of thing go to. Apparently they determined they didn’t need to investigate and then turned it over to the police at 5:15 the evening before a big holiday. What is up with that?? I reassured her that the only concern was the type of injury involved, everything else was appropriate and of no concert. I provided her with the name of the admitting MD and hopefully more information will be gathered to let the police know to call of the dogs.
I mentioned to her that this whole situation was giving me second thoughts about having reported this case to that particular agency at all. I said I had told the family that all of these types of injuries are reported because while there are some “legitimate” injuries, it allows for the actual cases of abuse to more likely be caught. This in theory of course. This agency’s inconsistent response causes people to think twice before reporting what they should. So, how many cases of actual abuse do not get reported because they’re assumed to be “good people” and professionals don’t want to traumatize them unnecessarily? I don’t know but there are probably more cases that end up like that than the agency in question would like to admit.
So, now I have to figure out if I can get paid for the 90 minutes or so that I have had to spend working on the case tonight. I also won’t be actually working again until Friday the 11th, so I need to figure out how to get this documented so if some one else in the office has to deal with it, they can figure out what is going on.
Just got a call from work….
I’m a little bit frustrated with myself and with the system after this call. There was a difficult case this week and now, in hindsight, I think maybe I just fell under the spell of peer pressure from some coworkers. The coworker who I fell under the spell of was not another social worker but a couple of nurses. They felt the case needed to be reported to the authorities and I was just a bit unsure. I deferred to their experience and made the report. I made myself as clear as I could that we were reporting simply because of the type of injury, not because we had concerns about the home environment or family situation. I was told by the agency I was reporting to that it sounded like nothing other than a reportable injury and probably wouldn’t be investigated. This was yesterday, late in the morning.
Tonight, about an hour after I got home from work, the evening house supervisor (YIKES! I said to myself) called me. Apparently the POLICE!! were at the hospital wanting to talk to the social worker and see pictures of this injury. I was dumbfounded! First of all, numerous supervisory type people have met with the agency in question and have asked them to notify us if there is going to be further investigation so that we can have the appropriate people available to them. They’ve also asked that it be done, except in extreme emergency situations, during normal business hours. For example, social workers are only on staff at our hospital between 8:30 and 5:00. Anyway….I talked to the police officer over the phone and let her know that I had no concerns and neither did the treating MD…it was just reportable simply because of the type of injury.
I also asked her why they got the referral from the agency after business hours. She stated they got the referrals whenever the agency decided to send them over and then they would investigate them at that point.
So, now I’m sitting here worrying that the poor family has had to be interrogated by the police when I had told them, based on the info I received from the agency, that most likely nothing was going to happen. And I’m wondering how to document my conversation with the house supervisor and the police. All very annoying!
And I’m second-guessing myself about whether I should have made the report at all. I didn’t have any concerns, so why make the report simply because it was a reportable injury? I don’t know…very frustrating!
