Cleaning the Sunshine Off My Shoe!

Okay, Lefty, I will tell you about my place of work.

I work at a specialized geriatric acute psychiatric hospital.  Basically, when geriatric clients have mental problems, we are where they are put on a 72-hour hold.  They come from many places: home, the hospital, children's homes or the nursing home.  For a 72-hour hold (or more) with us, they need to be suicidal or potentially dangerous to themselves or others or are suddenly delusional.

The lady at Mom's nursing home that was intrusive and affecting other patients probably went somewhere like us for diagnostics.  We had one lady who accidentally took too much prescribed medication that had personality difficulties with other patients at the assisted living facility where she was living.  Another client was in the hospital for an amputation, and was constantly out of his bed and taking off his bandages.  We have some clients that are violent.  They hit other people, bite or spit.  We had one suicidal one this week.  She was discharged the next day.

Unfortunately, some that come to us have physical problems that manifest psychologically.  They can see people in the room if they have a urinary tract infection.  Some of them are in more dire physical health.  I have asked about reporting some of this, as we get some in bad shape from nursing home that should have detected a problem sooner.

We have a staff of experts in geriatrics.  We meet each morning, sometimes until noon to discuss our patients' statuses.  There are often obvious medical issues that do not affect the clients' mental health and we address it.  One woman was tested for PCOS that is obvious should have been caught years ago.  Some people have not been to a doctor.  One lady we admitted was yelling in pain.  After all kinds of diagnostics, the fact was her body was shutting down.  She needed to go to hospice close to her family where they could manage her pain.  She was only eating 10% of her food.  They are surprised her vitals are as good as they are.

I do nine groups Monday through Wednesday.  My clients are mostly geriatric with a couple younger ones.  There is a man in group who uses his humor to avoid emotional topics.  His wife is in the memory care wing of the senior campus.  She has Alzheimer's and he could no longer care for her.  He holds a special spot in my heart. There are so many older adults with undiagnosed mental illness.  This is likely due to that generation hiding mental illness and not seeking help.

We do all sorts of assessments to determine if it is dementia, stroke, medical conditions or unaddressed mental health issues.  One lady was diagnosed for the first time in her life with bipolar disorder.  I am not sure I am on board with that diagnosis.  Maybe a personality disorder, but I am not seeing bipolar.  She has lived with a mean abusive husband all her life.  Many older adults lose their filter as they age.  I think she has a case of that as well.  I enjoy talking to her.

People in this hospital are only supposed to stay 7 to 10 days.  Sometimes we have no place for them to go.  If they came from a nursing home, the home may not want them back.  Then they are "stuck" until we or their family find a place for them.  Nursing homes have cliques, too.  Sometimes the "in" group doesn't want the person back because they don't fit in.  So, even if they do get batter...

By the way, I got an award today.  I haven't even been there a month!

Stepping into a Pile of Sunshine

I began my new job on December 23, 2013.  Since then I hit the ground running.  Unusual circumstances have led to my working full-time (for now) conducting structured outpatient groups.  I am still considered "casual time", but that is likely to change soon.

Yesterday I sat in on a meeting my supervisor would have gone to.  Friday, I attend another one.  I am leery of blogging about the circumstances that have taken place to bring me to that point.  What I can say is that my supervisor is gone indefinitely.  That is basically all I do know.

I have learned so much since I started.  I did not know that a urinary tract infection can lead to symptoms of dementia, hallucinations, and psychosis.  I did not know that general anesthetic can greatly speed up the process of dementia.  I have been taking notes and absorbing so much!

I have also learned that it is so important to have a health agent whom you can trust to make decisions for you as opposed to power of attorney.  Power of attorney is fine for financial matters, but the health agent trumps the POA in health matters.

I laugh at work, and sometimes I should not.  The male nurse leered at me when I laughed about a patient calling him a "son-of-a-bitch."  When the current (supervisor) of our department found out from the rest of us that my supervisor was off indefinitely, I also laughed.  Not that I wasn't concerned, it was just another change the department is surfing.  In my old age I see that change happens fast and you need to "surf" change, knowing you will pull through somehow.

I've got to run.  I have a new adventure to prepare for.