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