Malingering

This last week, an inmate saw me in the corridor and told me he's been falling out of his upper bunk due to his new psyc med dose. He wants a bottom bunk restriction. I told him to write me (on a request slip) and I'd talk to him later about it.

Several inmates have been thinking of reasons why they need this bottom bunk now and/or a 1st floor cell. I can think of one good reason why they might. Prison is not airconditioned. The only way you get a fan is if you have money (someone sends it to you from the outside). If you're indigent, you're just hot. Heat travels up, right? A bunk on the 3rd row, even a top bunk, in this heat, with no air circulation is more than uncomfortable. So I've been fielding lots of "reasons" why they need me to move them.

I got a call that the inmate I mentioned above was been seen as an emergency in the infirmary area and security needed me there asap. They were photographing huge bruises on his body. He got the bruises from falls off his top bunk - due to his psyc meds. I authorized his bottom bunk - a little late, huh?

To treat? Or not to treat?

So yesterday, a colleague in Mental Health Services (MHS) and I were discussing malingering. Some of the stories I get, reasons for needing on the psyc caseload or needing medicine or whatever - well, some are so bad and lacking in imagination I want to say, "hey, go work on your act. I'm here all week." Others are VERY good at manipulating. I do believe we have some of the world's best actors in prison. Think about it. They've been manipulating parents, teachers, "marks," probation officers, judges, prison guards, you name it -- all their lives. And what they didn't know about manipulation and game playing before, they learned in prison.

We in MHS have real challenges every day. Do I diagnose an inmate based on the symptoms with which he is presenting? And even if I do request free world records, can I believe that he didn't manipulate that provider into a diagnosis? So if I err on the side of caution and give him the diagnosis and meds, here's what I'm risking: He can be procuring the drugs to sell or drug another inmate (for easier assault), he can be trying to get a diagnosis from me so that he can qualify for SSI when he gets out, he can be wanting what he sees as extra privileges for being on my caseload, or he could just want a good reason to come to the air-conditioned infirmary on a regular basis. And if I diagnosis him as malingering, will he not get the attention his mental illness needs? Will he hurt himself or someone else as a result? Will what he sees as callousness prevent him from seeking MHS again?

I've spoken to colleagues who've been doing this a lot longer than I have and they tell me there's no easy answer. We all make mistakes.

Stories

Thought I would share some more specific stories. For the sake of confidentiality, some of the below information can be considered a composite of more than one patient. How's that for a disclaimer?

Let's talk about "John." John was born to a mom/dad (although it's usually only the parent who is raising them who does this) who had some serious mental illness issues of her/his own. Mom/Dad continuously told him they wished he had never been born. Nothing he did was ever good enough. This changed when he hit puberty. Then the parent realized that he could be valuable to them. They would sexually abuse him in front of their friends (entertainment value?) and then let the friends do the same. The only time they ever praised him was during this abuse. He grew up thinking the only value he was to them (or anyone?) was sex based. He feels soiled and ashamed. Who can he tell? Everything hurts so much, he begins to drink and use whatever drugs he can find. Sometime during this period, he also begins to hear voices. Guess what? The voices are degrading too. Hello Schizoaffective Disorder/Schizophrenia/Schizotypal Personality Disorder (take your pick). More illegal drugs to drown out the voices. A life of crime (centered around getting more drugs) ensues.

Don't get me wrong here -- I never say that people can excuse their illegal drug use or criminal activities just because they had a bad childhood. That one doesn't work with me. But we have to admit, it doesn't make things any easier to do the right thing.

So the guy's in prison and not for the first time. The psychotropic drugs help with the voices/depression/visual hallucinations/hell that is mental illness, but they certainly don't make him normal. And through it all, he continues to ask himself, why didn't my mom/dad love me? What did I do wrong?

So even in prison, he self-mutilates. Releases the pressure of all the questions. He puts up with other prisoners asking questions about his self-inflicted scars. Make fun of him when they hear him talking back to the voices. Give him a hard time when he tries to get out of his cell to take his psyc meds. This in addition to the guards who point him out as a psyc patient and may deliberately prevent him from going to his psyc appt or getting the meds he needs to be close to normal -- just because they can.

Sometimes it seems like these folks never had a fighting chance. You just want to go back in time and help the child. Trying to heal the broken adult is an up-hill battle. Still, because they keep trying to heal, we keep trying to help them.

Perspective revisited

There are times when I feel that life is passing me by. And definitely times when I'm okay with that. But I see my patients whose lives really are in a holding pattern while they're incarcerated. Some have been in prison for 20 or even 30 years. They've never used a cordless or cell phone, never used a personal computer, or driven cars with all the fancy gadgets they now come with. Never had the fast food so many of us take for granted. Commercials on TV are the only link they have to the outside world - what's called the "free world" in prison. Some havenot held their loved ones in years, have missed their parents' last days on this planet (and their funerals), missed an opportunity for a career, and missed saving for retirement. They've not seen their children grow up or grandchildren be born. When they finally leave prison, the ones who WILL leave, of course, they'll start over from scratch. They'll be labeled an ex-con. With felonies, they'll never vote again, never be able to rent an apartment, may have great difficulties getting jobs or buying cars, and may find their entire families have died or moved away.

It's challenging for me to be their therapist. I can't really wrap my mind around how challenging it is to be in their shoes.

When all is said and done, no matter how hard I've worked, how many people I've made time to see or listen to or counsel, no matter how many lunches I've missed or stairs I've climbed - I go home every day. Home to my own car, my own apartment. I wear clothes I've chosen. I hold my baby. I shop for, cook, and eat food that I've chosen. I watch the TV channels I want to watch. I sleep in my own soft bed. I know I'm safe while I sleep.

I think that having led the life I have, I've always been grateful for my many blessings. These days, I feel my gratitude run so much deeper.

Hopes and Doubts

I've been busy raising Luke. He's SO active and talking and full of curiosity. I'm teaching him and watching him grow and wonder. I wonder...if I'm up to this...how will I ever give him the space to grow when all I want to do is hold him close and protect him? Once you've lost a child, well, you've lost a child. And you never ever want anything to happen to another child. I examine him every day when I pick him up from daycare. "What is this little mark here on his cheek?" I ask his teacher. She tells me he got it playing with the other toddlers. I'll say, "How can we make sure these kids don't get hurt? Are there too many of them together?" When what I really want to say is, "Take better care of my child! I'd better not see one little scratch or bruise on him or else!" When he was coming home with bite marks on his arm a few months ago (twice), I demanded to know which child was biting. The director says she can't tell me. So I look at the bite marks on his arm and casually check the teeth of the other toddlers when they smile. I never found the culprit and have no idea what I would have done anyway. And then I received an incident report one day that Luke had bitten another child. So I think that now he's been taught to bite and he'll be a Biter (with a capital B) and why did he have to bite? Was he protecting himself from the first biter? From something else? But he doesn't bite again and also comes home with arms free of bite marks. And I know that kids play and fall down and even sometimes bite each other. All part of growing up. But there's a part of me that just wants to make sure that his little body stays pristine. No bruises, no scrapes, nothing unhealthy inside or out. I wish I knew how to do this. How to love and protect him but not be such a freak about it.

Shamrocks

What Your Shamrock Says About You

You are brilliant, analytical, and somewhat of a perfectionist. You are ultra competent and knowledgeable. At times, people find you intimidating. You can be a bit sarcastic and harsh. You don't really consider yourself a lucky person. In your view, people create their own luck. You are creative, innovative, and complicated. You definitely have a unique spin on the world.

The Shamrock Personality Test

Borderline

So I have this Borderline patient (therapists: scream with me!). Interestingly, he was at the previous prison where I worked and then got transferred to this one. I was sooooo glad. Then of course I get transferred, too. One week he thinks I'm the best therapist that ever lived and he hangs on every word I speak, reaching for insights. A few days later, he thinks I'm "slandering" him and "holding my condition against me" and "misdiagnosing me." Today he told me he wants another therapist. So I told him sorry, I'm all he's got. Until he leaves prison and then he's welcome to choose any ole therapist he'd like. He says, "so I guess I'm stuck with you, huh?" I so want to say how if this were the free world, I'd have fired him as my patient a long time ago. I mean, referred. So we're stuck with each other. But he says he's leaving prison this summer. Sorry free world therapists. Hurrah for me!

Spring

So many thoughts on my mind about Spring, Easter, and all that entails. I'm not so keen on the Christian ideas on Easter and the "Resurrection" and all. I mean, who could even enjoy the chocolate and the dying of eggs when you have to think about Jesus dying for it to happen? So don't know about that whole dying on the cross thing - I like to think he survived it, married Mary Magdalene, and lived in France. Sounds much better, don't you think? But I do like to think that Easter symbolizes new beginnings - and even a resurrection (read transformation) of the spirit. Yes, I do like the spiritual component of Easter. But I also get excited about the new beginnings in Nature - plants and animals. Little baby bunnies symbolize this nicely, don't they? Does anyone remember when they used to dye the actual live bunny? Not so nice for the bunny, it turns out. Many of them died from the dye. No pun intended. But nice pastels colors and all.

Holidays are hard for me. God knows I miss Rachel even more on holidays. I think that's true for everyone who has lost someone special. And when I dye Easter eggs with the kids, I know Rachel will pull up a seat and help out. She's real picky about the intensity of the colors! I'm looking forward to doing the fun stuff even so. Shopping for Baby Luke an Easter outfit...choosing (and eating) Easter basket candy, the aforementioned eggs and the hunting thereof, and everything that goes with it. One of the kids asked me about meeting the Easter Bunny (capitalized because he meant THE one). So I guess a trip to the mall is in order to stand in line.

I found myself talking to Luke tonight about all the fun stuff we're going to do together when the weather gets warmer. Like go to parks, swim, see the beach (his first time!). All the firsts that he has coming up. My new son. New beginnings. Life goes on. And on the days we choose to look for them - and the days that we CAN look - we'll see all sorts of new life and new beginnings.

Updates

Since I last wrote about baby Luke, he has been hospitalized as inpatient last weekend, has undergone ultrasounds, more x-rays, and a barium enema. Been outpatient once again and seen his pediatrician once more, too. Still no explanation for his tummy pain. He is on a 100% dairy-free diet and using stool softeners twice a day. But here's the miracle of miracles: no more stomachaches in 1 week now! I guess we'll keep the appt with the pediatric gastroenterologist as a just in case and maybe he/she can shed some light on things. But I'm just so relieved the poor baby has not been in pain this week.

An update on prison - well, last month I got urine thrown in my face by an offender. I'll tell the long story later but here's the update on that: now prison security is requiring that I and other medical/mental health staff wear flak jackets when we go on medium or high security cell blocks. I could see if they were requiring face shields but the jackets? So in case you guys don't know what those are, it's a heavy jacket that looks sort of like a life vest. It's not bullet proof but is supposed to keep a shank from going in. Except that the underarms and neck areas are exposed So I guess it keeps a shank from going in to my chest area or between my ribs. I don't feel any safer, just more cumbersome. Ah well, as the signs there say, "security is never convenient."

I've got quite a few things done on my to-do list but somehow it never seems to get any shorter. More things keep getting added and it wouldn't be so bad if there weren't time constraints on them. I'm doing the best I can, though, and have to refrain from panicking. Sometimes I look at couples and think how nice it would be to have two people to do the things that are required to run a home and family. I know that's not the reason to be a couple and I also know what obligations come with a relationship. Still, I wonder if I'll ever be part of a couple again. And I wonder if I'll ever be willing to pay the price. Until then, it's me and Luke. And a grandchild here or there.

Today, my 5-year-old grandson had his birthday party. It was one of those elaborate pizza/game/indoor go-cart deals. I kept thinking that his mom would be so proud of him. I know she is still but there's always this huge gaping hole in any room when we're together as a family. Her vibrant, fun little self always added so much to any occasion. There are so many "firsts" to get through when grieving. The first Halloween, Thanksgiving, Christmas, children's birthdays, Valentine's Day...and then more to come. Rachel and I always had such fun with planning, decorating and baking for holidays. I am doing the best I can to keep the traditions going myself. I wonder if the second time around things will get any easier. She's been gone 6 months today.

Aggression, continued

I've been thinking more about aggression lately as you may have noticed from the previous blog. For the last several months, I've been facilitating Aggression Control therapeutic groups at the prisons. The curriculum I was given to work with was bare bones at best and while it all makes sense on paper, explaining these concepts to these guys is a real challenge. I add my own material and make it as alive and relevant as possible. Can you imagine walking into a room of about 8 to 10 violent offenders and telling them they have choices? My first group rule is ALWAYS that the therapist (me) stays safe. Then they have to promise not to hurt each other.

I would say that most people I know, in the Free World, are not aggressive types. Yes, they may become verbally aggressive at times but how many of you get in fist fights on a regular basis? But take the population with which I work. Some of these guys were born into aggressive households, been physically (and otherwise abused), been removed and placed into foster care and then continued to be abused or fight back until they were placed in TYC. That's when they really learned to fight just to stay alive.

There is one inmate who had a background similar to this and then killed a man while under the influence of narcotics. He has no recollection of the murder. He was sentenced to 35 years in prison. He was 17 at the time. When he entered TDCJ, at 17, someone tried to rape him. He knew that if he allowed himself to be raped by this one person, he would be the target of many more assaults. So he killed that person, too. And he got more years added on to his sentence. But he was not the victim of any further attempts at sexual assault. When I met this man, who is now in his early 30s about a year ago, he was handcuffed and shackled, being dragged into a solitary cell and about to be gassed for becoming violent with security guard. I've worked with him for about a year now, both individually and in group therapy. I've witnessed the bravado, the fears, and the vulnerability of a man who was never allowed to be a boy. He has come such a long way, he now uses humor instead of threats of aggression. He's learned that not everyone is a physical threat to him. But make no mistake, in prison, these guys never know when the next attack is coming. He "graduated" from group therapy a few weeks ago and credited me with the changes he's made. And when I reminded him that he is the one who did the work, I think he really believed it. But despite all the work he's done, despite the changes in behavior and attitude, this young man will probably still spend at least 15 more years in prison. Think of all he will have missed. High school, dating, the first job, marriage, children, a home of his own, friendships and relationships. He doesn't engage in self-pity and I, for the most part, don't pity him either. But I have to wonder, what are we doing here?

We allow children to be brought up in aggressive homes, they watch aggressive television and movies, play bloody video games, and then when they act aggressively we punish them by putting them into prisons where they must use aggression to stay alive or at least stay unmolested.

Well, I do my little part. I teach the principles of assertiveness rather than aggression. I teach long-term consequences and payoffs. We do role plays and analyze previous situations they've encountered. I tell them the only appropriate time to use aggression is when either they or someone they care about is being threatened. That part they get. I'm not teaching pacifism here.

Sometimes it irritates me when I hear people talking about the inmates as an us/them situation. As if only monsters would behave aggressively; surely civilized people would never do these things. Now don't get me wrong, I always teach choice. Sometimes our choices are rather limited but we do have them. And even being brought up in a terrible home and foster care and everything else does NOT give anyone an excuse to be violent toward another person. And there are plenty of inmates in prison who did have good homes and all advantages and still made terrible choices. I'm just saying, can't we look at these problems as affecting all of us? An aggressive society costs us so much in terms of money spent housing inmates, the legal processes, thefts, injuries to victims, and so on. And it continues to cost one young man who has been in prison for 17 years and has no chance of leaving anytime in the near future.

What are you doing to create a more peaceful world?

Aggression, Violence & War

I was checking out something on the APA website yesterday and came across an archived statement that was of interest to me. I'm sharing in case anyone else finds it thought-provoking.

First of all, this APA is the American Psychiatric Association and when I read this "Position Statement" I thought it had just been posted. Everything seem so relevant to today's international environment. It wasn't until I was about halfway through that I thought to look at the date - it was written/approved on June 23, 1948. I'll just recreate an excerpt here but I encourage you to check out the entire statement on the website.

"The American Psychiatric Association is seriously concerned about the unusual psychological features which are part of the present international tensions. It believes it has a duty to offer a statement on these matters for the attention of national leaders in all countries and for the general public, whose health and welfare are intimately related to international tensions.

The American Psychiatric Association makes this statement because psychiatrists are expected to understand the psychological causes of difficult and faulty interpersonal relationships, and should be able to offer some advice on their improvement. Such knowledge and advice should be applicable whether the adjustment difficulties are between individuals or groups of individuals, even national groups of individuals.

Basically, antagonisms are due to the activity of the self-preservative tendencies and their accompanyng emotions of fear or greed. The original biologic value of such reactions was to insure progress and development and increasing superiority of the species. The utilization of this primitive behavior, harsh and cruel as it may have appeared to the weaker strains, has led to the evolution of Man.

But if Man is to survive and develop to still higher levels of intellectual and social achievement, should he not now utilize friendly cooperation rather than aggressive antagonisms?

This question is directed to all national leaders because they so largely guide the feeling, thinking and bevahior of the gneral public in their respective nations.

Those who have had the opporutnity of observing the general public in countries other than their own, realize there are only minor differences between the citizens of various countries. The friendly kindness of the common people, their willingness to work for the common good, their love of their children and their homes, their diligence and their self-sacrifice - these virtues and values are shared by nearly all people in all civilizied countries.

But if the common man begins to fear he may lose these necessary values to the good life, either by actual or threatened aggression from without, or by unfair propaganda from within by unprincipled leaders, the masses of the people may easily be induced to take a position of antagonism. They may develop anxiety and fears to and even incorrect beliefs about the common peple in other countries. To overcome these fears, to overcome this sense of insecurity, actual warfare may result...mutual confidence between leaders of the people in all countries, combined with mutual honesty, mutual forbearance, mutual support - positive healthful attitudes, conveyed from the leaders to their followers - should lead to a higher, better and healthier civilization than any we have known in the past."

Kinda makes you wonder, doesn't it, what the authors of that statement, written 60 years ago, would think of how much "higher" our civilization has evolved.

A long night's journey

Baby Luke has been having some health problems. I would say mysterious because no one seems to know exactly what it is but I think that word connotes something pleasant -- and this is not. Can we just say the scary unknown? It started a month ago with him waking in the night, arching his back, and screaming bloody murder. I called the 24-hour UTMB nursing number and waited for a call back. By the time it came, he was calmer and even smiling. So I just considered the episode a fluke.

Forward to a few weeks ago when it happened again. The screaming lasts anywhere from 20 to 40 minutes. Nothing I do helps. I've had suggestions to use massage, foot reflexology, warm baths, you name it. Nothing helps him. All I can do is keep him from hurting himself while he thrashes about.

We went to see his pediatrician but had to see another doc in the practice. She suggested cutting out all dairy in case it was an allergy. So we did. Do you have any idea how difficult it can be to teach daycare workers that dairy can take many forms? "All we gave him was the cheese goldfish. No dairy, see?" Then, even off the dairy and on soymilk, he continues to have the episodes. This doc also said he may be having night terrors. But I look that up in my little ole' DSM-IV to find that he does not meet the criteria for that. It happens in REM sleep, lasts more than the 10 minutes, and he is responsive to stimuli.

Back to the doctor (his, this time). I'm told he may be having Reflux again. Or it could be Intermittent Intususseption (spelling?). If it's reflux, these handy dandy prevacid tablets will work. If not, and it's the long thing, he may need surgery to correct his intestines "telescoping" into one another. If it's not corrected in time, he could lose part of his intestines or get an infection and die. I was voting for the reflux here. So onto the prevacid last Friday. And lo and behold, no painful episodes for Friday, Saturday, or Sunday. I even call his doc and leave a message that the prevacid did the trick!

About 2 hours later, after the doc has closed, we have another episode while he's playing. He suddenly falls to the floor, screaming, tears running down his face, and he's arching his back so far I'm worried about an injury. I decide to take him to the hospital. We go to one of the nearby hospitals and find it is full to the brim with folks. Do you know people actually bring in take-out and have like picnics in there? Yuk! After an hour, with no triage, I asked how much longer. Luke was feeling fine then and hard to keep away from the weird chicken eating people. The receptionist/nurse asked, "what was he here for again?" So I left. I figured I'd be better off at home and how likely was it that he'd have another episode before Tuesday?

Right. I had just put him to bed and took some meds myself. I've been sick all weekend and running about 102 fever. I'm just about to lay down when it starts again. Since someone had suggested I actually film what he looks like doing this, I did. I could not stand seeing him crying and watching me filming him. What a terrible idea. So we jump into clothes and back to a hospital but not the same one. This time I take him to the other local hospital. A better one. You may ask why I didn't take him there to begin with. But then you may not know that my daughter died in that hospital. So I took him there and just did what I had to do. We were triaged in pretty good time there. I think we arrived about 10:30, were triaged by 11:15 and then...well then we waited. We were taken back into the exam room at 2:00 a.m. He had an X-Ray of his tummy. We waited. At about 4:00 a.m., after another episode of pain, we were finally seen. It may have helped our case that I carried his screaming body into the nurses' station asking how much longer. The doc says there is some obstruction and he thinks there may be constipation in spite of the several diarrhea diapers he's had over the past two days. Something about having both? So we got an Rx for pain meds and suppositories. He also said that since their hospital is not really equipped for pediatrics, we'd be better off going into UTMB if we need more tests. And that's what I had been thinking. He also said that UTMB radiologists literally wrote the textbook that pediatric radiologists all over the country use.

So I guess that may be our next step. I have to call the pediatrician and get further instructions.

I kept telling myself last night that since one of my children has died, surely I wouldn't lose another one. And if I were at the same hospital, wouldn't that remind the cosmic forces or something? Except I really don't believe it works like that. All I know is that I have to take the best care of this little guy that I can. Enjoy every minute of his life I get to spend with him. And pray for the best.

I'm back

I noticed when I logged on that it's been almost a year since my last post. Unbelievable. Of course, the last year has been unbelievable in many ways. My friend Candice is fond of lists so perhaps that's how I can summarize and get back in the stream.

First, the Bad Stuff...

1. Losing Rachel - my lovely daughter died suddenly 5 months ago. My world ended and like so many others who have survived the death of a loved one, it was unbelievable that the world continued to exist. Other people laughed. I was expected to eat, sleep, work, and care for the little ones. I miss Rachel more than words can express. Nothing more on that now. Maybe later. Maybe never.

2. My work life was almost unbearable there for a while. Not the work itself but the supervisor I was dealing with. I had to file a formal complaint and go through all of that process. He has apologized now and there's some comfort in that. Still. He made my life (more) miserable.

3. My health. My back is deteriorating but the pain gets stronger. Weird, huh?

4. I had to put my dog, Chance, to sleep last May. I had him for about 12 years and so of course, I still miss him. I guess I always will.

5. Luke had health problems. He was sick almost all the time. Taking off work, doctor visits, trying everything to get him better. Found out he had allergies so I guess we can put this into the good list -- he's been much healthier since he's been on the Claritin and inhaled steroids.

6. Since the last posting, my other daughter has got clean, relapsed, and then got clean again. Attempted suicide. She's alive and getting healthy. Again, with moving to the good list stuff. That or I'm just an eternal optimist.

Let's go on the good stuff.

1. I moved into an apartment that I love in Friendswood.

2. I still love my work. Yes, I'm still at the prison. I'm facilitating several group therapy topics. Great to see a few folks actually learn stuff.

3. Luke is developing so well. I had concerns about him and know he's not out of the woods yet. There are still some things he has trouble with but overall, he's a dynamite kid!

4. I'm getting to adopt Luke!

5. I get to have my two "big kid" grandchildren almost every weekend.

6. I haven't had to use my cane in months!

7. I have good work friends.

8. I still have good friends from other areas in my life. This is a big GOOD one.

9. I'm taking the exam for my LPC soon.

10. The sun is shining today. We're going out to play now.

So, if anyone still checks in here or will again, just know that I appreciate all of you. Writing about anything was tough for a while. But I'm getting stronger and healing. Okay, wait a minute. What does healing mean? Not hurting so much? Not hurting so often? Finding happy moments again? Yes, maybe that's it. In that case, I'm on my way. I still miss you, though honey. Always will. Until I see you again. I'll always be your mom. Unless, of course, you want to be the mom next time around. Whatever.

Some days...

I've been really sick for the last 3 or 4 days. The doctor thought I had hepatitis. I was beginning to think so, too. And being sick, with a baby, not easy. Plus worrying about him having hepatitis, too. But today I found out my tests are negative. Probably just all my usual chronic illnesses, coupled with lots of stress. So I figure my body is trying (really hard) to tell me something. Slow down and remember what's important. Taking more care to eat right. To do some yoga - how many years have I been talking about that?

Anyway, I made it through my first day back at work today. And got rewarded by seeing Luke's sweet face waiting for me at daycare. Our little routine of his dinner, play, bath, story, bottle, and bed. What an incredible joy he is in my life.

This evening I'm just so incredibly grateful for so many things. Neither of us has hepatitis. I'm smart enough to figure out what my body is trying to tell me. My comfortable home and pets waiting for me. Just stuff. Just another day in paradise. Gotta go make some baby bottles for tomorrow's day in paradise.

tribulations

I know I complain a lot about my job at prison. Some things about it are really nice. Like the people I work with. Being able to find your "no-shows" and fuss at them, because they're locked up somewhere in the dadgum prison. I also like the paycheck and of course, the benefits.

Yesterday, I thought I was being smart by getting to work a half hour early. Just to have a head start. Had to work in the morning at the prison next door. Fortunately, I only work there one day a week. Walked in and found they had a homicidal patient waiting for me. Evidently he had been waiting over an hour. The nurses had called the on-call psyc doctor, who had told them to just wait until the psychotherapist came it. I had barely turned the computer on when I had security officers in riot gear bring the offender to my office. Then, get this, they left. That's right. The offender was such a danger they had to use shields and all sorts of protective gear to get him to my office. But apparently once he sat down in the office with little old me, he was no danger at all! I would have put up a fuss about it but I really didn't feel any danger from the guy. He was definitely a strange one though. Said he was feeling bad and he wanted to hurt someone. Then he would feel better. He had no preference on who he hurt. And from a few questions I asked, he had a long history of hurting others in not-so-pretty ways, then feeling much better about it all. Now when you get a truly antisocial personality disorder guy talking to you, you realize that they have absolutely no conscience. They recount these incidents with no more passion than they would read a grocery list. I didn't argue with him. Just transferred him to a crisis mangement unit. Bye-bye.

Saw a few other offenders there who have figured out that I go on Fridays. My boss, a male, covers the other days there. These guys try to time their sick calls to be seen by me. Trust me, I don't feel special. Just female. And a bit yukky about it.

On to my own unit after I finish there. I walk in to find the offenders walking around in their underwear. Please remember, my own unit is a medical one. Mostly old guys or just severely chronically ill guys, a lot of AIDS and Hepatitis C. Seeing these guys in their underwear is NOT a pretty sight. Turns out the unit is on lockdown. Someone saw a handgun and everything gets real serious until they find it. There is a lot more drama about the incident that I am not at liberty to discuss. Not due to patient confidentiality but due to me wanting to stay safe personally. Working in prison may be many things but it is rarely dull. Turns out I transferred another patient to crisis management yesterday. The intake folks at that unit were getting a little curious when I was calling from different units.

I started out to mention something about personal and professional conflicts. So just briefly, I sometimes treat offenders (my most frequent patients) who are convicted of sexual assault of children. Most of them tell me they are falsely convicted. And maybe they are, who knows? The others tell me they offended because they were victimized as children so it's not really their fault. Still others will say the children looked much older. I don't encourage them to discuss their crime. Pedophiles will never change. And talking about it sometimes excites them in ways I don't care to participate in. Here's the thing, when they get to prison, obviously their population of sexual preference, children, is not available. So they get frustrated and depressed. Then they come in for medication and/or counseling. They just want to feel better. As a therapist, my job is to treat the target symptoms. So I help them get access to medication. And they feel better. As an individual though, there is a big part of me that does not want them to feel better. I want them to feel very, very bad.

Even if you can't personally relate, can anyone give me input on how they would handle the conflict? Any suggestions?

Luke has a new tooth!

While I was sitting in the dental surgeon's office yesterday, awaiting the removal of two teeth, I actually got a pleasant surprise! We found Luke's first tooth! I know, I know, this is not my first baby and it sounds a little silly. But...it's amazing all the same. He laughed so hard when I felt it. Like he is incredibly proud of growing a tooth! Well, he should be. He's been working real hard at it, with lots of discomfort and drool, for a while now.

By the way, anyone who knows me and my mouth (I did not say my BIG MOUTH), will not be surprised at this other development. When the surgeon was removing my teeth, he accidentally broke off another tooth and had to remove that, too. So now I'm recovering form the removal of THREE teeth. Ouch!

No, candance, it's not Castle dental this time.

Yes, the weekend!

Another really crummy day at work - struggling not to absorb all the yucky stuff.

But....it's Friday! And I have all weekend to spend with my grandchildren. I'm going to play games and read books and make fun snacks and rediscover my inner child!

Anyone else have great plans for the weekend?

Today at work I...

..Resolved several patient psychotropic medication issues

...Provided crisis counseling to an offender who believed the microphone in his housing unit was beeping at him through the night - and suddenly discovered that his requested "faith" unit annoyed the heck out of him because he couldn't stand hearing about Jesus all the time

...Transferred a patient who suddenly decided he needed to cut someone, himself or an officer or just anyone

...Provided crisis counseling to a severely depressed patient who hears voices telling him awful things (they never do say anything nice), including telling him not to trust me

...Handled a patient who suddenly discovered his change in work assignment was going to devastate his daily schedule

...Made rounds in the solitary cells, providing counseling to one patient who is facing life endangerment issues (other offenders are trying to kill him)

...and then saw my regularly scheduled patients, charted on everybody, and then scheduled about a zillion more patients for tomorrow.

Not complaining. Just venting. Big difference.

Fantastic Women

I've just got to plug my Women's Group here. We met tonight, as we do about every two weeks, for our book discussion. Part of the meeting ends up being about the book and the rest is about our lives and what's important to us. I love that we can talk politics, world events, women's rights, you name it. We disagree with each other about as often as we agree. That's what makes the group so special to me. When everyone thinks entirely alike, how can you learn from one another? The other part that I like is that we are all women with metaphysical beliefs. No real fundamentalists here. Not that there's anything wrong with that (insert Seinfeld moment here). Just that we all have the same overall perspective and share the same basic spiritual beliefs. How great is that???

So tonight we briefly got off on a tangent about the choices we make before we're born and the choices we continue to make that affect every aspect of our lives. Told you we're cool! Then I get home and check my email. There's a message from the Universe. Yep, we correspond. We're tight. Actually, it's a service offered (free) through www.tut.com. So here is my message for today:

I'm alright with the concept of Karma as it's generally understood, Cheryl, kind-of, sort-of.

The idea of spiritual contracts is pretty nifty, too. You've always been a wheeler-dealer.

Except, of course, if either were laws, you wouldn't be unlimited.

Not even a little.

Oh well, they were cute ideas for awhile.

The Universe

Me again. That Universe! Always so timely! So where do you stand? Spiritual contracts? Karma? Law of attraction?

P.S. Emily has really great stories about being a Colonel on the drill team - and she's only 12!

Self Love

I read this last night in this month's issue of Indigo Sun, www.indigosun.com. The article is titled, "A Gift for YOU: Five Steps to the Ultimate Love Affair" by Jody Howard. Here is an excerpt from the intro:

It amazes me how much easier it is to give our love and compassion to someone else rather than to our Self. We are quick to hold and comfort someone hurt and crying. When we experience our own pain, we feel frustrated with our self and with those that caused our pain, instead of comforting our self. We believe we heal our self by justifying our actions or blaming others, when in truth we heal by loving our self.

I tend to do that, you know, the being frustrated with myself part, when I make a mistake. Wonder how many of you out there do the same?

Thing is, I bought a hog about 2 weeks ago at work. Read previous posts for what buying a hog entails in prison speak. I've blamed myself because I knew the patient was selling me something and I just thought it would be easier to go along with it. He was threatening suicide and despite my efforts to calm him down, he insisted he needed to go to the crisis management unit. So I sent him. It was a Friday night. I was late for daycare. As soon as I started the process, he changed his entire attitude. You see, I believe he knew that once started, the process cannot be stopped. I don't care if God herself came down and said, "it's cool, he can stay," that patient HAS to be transported. So he began saying really awful things to the nurses. Making threats. Getting a serious attitude with me. I found out later that if he is transported to a crisis unit, all of his disciplinary cases get dismissed. That includes the ones he had pending before the "suicide" threat and the ones he got right before being transported. When he came back from the 3-day "vacation" he had the nerve to come in my office and thank me for making all of the cases go away. So not only did I allow this manipulator to get off without any consequences, I also feel I let down my co-workers who went to the trouble to write disciplinary cases against him. They don't hold it against me. They know I regret my decision. And they didn't know either, what would happen with the transfer. So I'm the only one who has been kicking myself.

Plus, he's still my patient. A little tough to have that old unconditional positive regard here.

This article spoke to me on so many levels. Why didn't I just comfort myself for that awful Friday evening? Why wasn't I more understanding of myself? Yes, I've got a lot more to learn about Self-love. (For helpful tips, be sure to check out StaceyG's blog - she's got some GREAT stuff!)

For me, I'm beginning to dislike the taste of pork.