Love Makes A Family – Part VI

In a discharge planning conference, Cari’s UCLA therapist, social worker, and the Santa Barbara county social worker all agreed that unit staff should keep in phone contact with her and Anna. They also recommended someone on the staff make supervised visits every other week, if possible, as part of a transition that was going to be difficult at best. It was a little bit of a diversion from most discharge plans.

Usually, no post-discharge contact between staff and patients is allowed for several months, if ever. It would be counterproductive to have the kid still hooked into their relationship with staff when they needed to focus on their relationships outside the hospital. But usually, the discharged adolescent is going home to a family and friends that are anxious for them to return. It is not unusual for adult patients to be discharged to a halfway house, but it was very rare for adolescent patient’s to be discharged directly to a group home.

I was on board with the discharge plan, because I had made the promise to Cari that I would never lie to her, and in the course of her treatment when she would ask what would happen after she left the hospital, I told her I would just be a phone call away. Ex-patients had always been allowed to call the pay phone on the ward and staff was allowed to talk with them for a predetermined time allotment.

Cari and Anna had both been avoiding thinking about leaving because they thought they would be there for several more months. That was the original plan. Now everything had changed. In those last two weeks as in-patients a lot of time went into reassuring them that support would be available and that they were not being thrown out and forgotten; a feeling that they had experienced repeatedly.

Meanwhile, at home I had been talking to Mike in generalizations about the situation at work. Because of patient confidentiality I couldn’t say anything really specific or use their names, but he knew I was frustrated and angry about the two sisters and how their family had abandoned them. He had once again said to me, “It’s a shame we can’t help them.” He understood that I had to follow the discharge plan and that any deviation from it could be bad for them and also I had to protect myself. I did not want to lose my job.

Except for that year during transition from Dallas to LA, when I worked as a waiter, I had been doing this work for 9 years. I loved the work because I learned so much about people and behavior, and myself. When I started at Timberlawn I was so nervous and excited. I couldn’t wait to get the education and training they offered to get the privilege to work with the in-patients, and I thrived in that environment.

In the nursing meetings and the treatment team meetings there were epiphanies on an almost daily basis, and many times those revelations were occurring inside me. When you work in psych, you have to hold up the mirror to your own life and your own childhood. You begin to look back at your relationship with your parents. You start to recognize the developmental markers in your own life and how your family played its part in making you who you become.

There are several jokes about newbies working in psych over-identifying with sets of symptoms and experiencing self image crises. Usually, you hear these after you yourself start to wonder, “Am I passive-aggressive…stuck in the anal/oral/fill-in-the-blank phase of development…..being controlling…..manipulating….being too defensive….rationalizing….etc”. The truth is, most healthy people can identify some behavior in themselves that is mentioned as a component of a psychiatric diagnosis. But just because you can check one on the list doesn’t mean you have that disease.

Honestly, what I learned about myself was that my psyche was quite well defended. A little too well defended for my liking. I found that I wanted to change some things that I learned about myself. I wanted to learn to be more direct and not let my behavior, or situations that I could manipulate deliver messages for me. I wanted to be more honest in my relationships and less evasive. I needed to learn to accept my shortcomings and stop trying to compensate for them. These are only a few items on my “work list” that caused me a lot of angst as a teenager, and I still work on them to this day.

By working on these things in myself, I found I was able to be a more effective Mental Health Worker. I longed to be able to build therapeutic relationships and inspire kids to strive towards becoming strong, confident individuals. I wanted to become as good at it as Karen Gossett.

I told you about Roberta, my mentor at UCLA. At Timberlawn it was Karen. She was the charge nurse on the adolescent girls unit at Timberlawn, and she was amazing. She had long, straight, mahogany brown hair to the middle of her back and dark blue, feline like eyes. Besides having a brilliant mind and Roberta-like empathy, she had that sparkle that you associate with someone that you know will be a star in whatever they decide to pursue. She had a laugh that just made you happy. When you told Karen about a problem, her body language said, “Let me help”. You would immediately be disarmed when she would engulf you with those eyes and without ever touching you, you felt the warm embrace of her compassion.

We had this sweet, little wisp of a girl on the unit named Rebecca, who was admitted for “hysterical conversion reaction”. This is a syndrome where a person develops a physical symptom or illness as a response to inner psychological turmoil. The physical symptom appears real and affects the patient in a real way, but there is no physiological reason for it. Simplistically put, the patient cannot understand or talk about their inner turmoil, so they develop the secondary “psychosomatic” condition as something real that can be seen and felt and takes the focus off of the inner pain.

This sweet, unassuming little 14 year old girl appeared to have a deformed right ankle and foot. It looked like her right ankle made a left turn at the end of her leg. She walked, with a limp, on the outside edge of her right foot. Every pair of shoes she had was almost worn through on the right side of the right shoe. She walked slowly; dragging her turned under foot, and never grimaced or indicated she was in pain.

The parents, believing she had some kind of late onset polio, had thought Rebecca would need orthopedic surgery. They took her to an orthopedic surgeon who examined her ankle and couldn’t detect any anomaly in her bone or tissue structure. X-rays of her ankle showed that, except for the posture, it appeared to be normal. When confronted with the normal x-rays, Rebecca would just shrug and insist that she was unable to straighten out her ankle and even claimed it was excruciating when she tried. She had been walking this way for two years when she came to Timberlawn. Her orthopedic physician told her parents that she would do permanent damage if something was not done to correct her “posture”.

She was a very smart kid, but she was also very guarded. She didn’t give up information very easily. Luckily, Karen took a special interest in her and began to spend time talking with her when they both had free time; building the trust, getting her to let go of all the scary secrets that held the pieces of the puzzle that made up Rebecca’s defense system.

I was there, in the day room that afternoon, playing backgammon with one of the girls, when Karen and Rebecca were having one of their impromptu talks. There were a couple of other kids in there also, just lounging and reading. I think we all sort of became aware at the same time that both Rebecca and Karen were sniffling softly and had tears slowly tracking down their cheeks and falling on the plastic sofa cushions. We all tried not to stare, to let them have what privacy they could, with all of us sitting there listening and watching, afraid to move in fear we’d disturb them.

What Karen had gotten Rebecca to come to terms with was a profound memory she had kept locked away, her twisted foot holding the door to that memory shut tight. Karen had convinced her that although her ankle deformity was born in her unconscious, she could find the root cause through trust and inner strength, if she really wanted to get better; and Karen pledged that she would be there for her to help her deal with facing the real cause. Once Rebecca made the commitment to trust Karen, it all streamed out of her tightly cinched up memory. She had wanted to appear less attractive; she wanted to be a pathetic “cripple” so her father would stop molesting her.

None of us in the day room that day had heard all the details. We just saw Karen stand up, wipe her eyes, walk across the day room, turn around and extend her arms toward Rebecca. Rebecca, now sobbing loudly, stood up and took one step on her tucked under right ankle, stopped, straightened out her ankle and walked straight into Karen’s loving hug. I felt I had witnessed a miracle, and so did the other people who witnessed it. Rebecca had just taken a giant life changing step toward insuring her safety and her own mental health. It changed my life as well.

These types of very successful interventions and “miracle” cures are few and far between. But it only took one, and I was hooked. I admit it. Whenever I was able to see a kid start to open up and reach for the resources in their life that would take them toward health, I got a lot of secondary gain out of it. It made me feel better than any drug. I know that all my co-workers had the same need and got the same rush when one of their patient’s would hit one out of the park in therapy. It becomes so much a part of how you see yourself that you can’t imagine doing anything else.

With Cari, I had laid the foundation, it was starting to happen and now all the rules had changed. We were working on plan B. I hadn’t gotten to have my “Rebecca and Karen” moment with Cari yet, and I desperately wanted it; probably as much as I knew she wanted it.

The day finally came when the girls were to be discharged and sent to a group home in Goleta, the small town adjacent to Santa Barbara. The girls had said their goodbyes to all the staff and to all their friends on the unit. Cari and I had been having daily discussions about how the transition was going to work, with me reassuring her not to panic and her being unsure, but trying to be brave. We had a couple of tearful sessions in the days leading up to this day, pledging to each other that we weren’t going to cry in front of everyone and make a spectacle on discharge day.

A social worker from the county was there to drive them to their new “home”. They walked down the long hall to the door and when they turned to wave one last goodbye, Cari turned and ran back to embrace me and began to sob uncontrollably. In my ear, through gulps of air and tears, she whispered, “I can’t lose you. Please don’t forget about me.” I pushed her away and held her at arms length and made rock solid eye contact with her. “Trust me”, was all I said. She stood up straight and stared at me for a second, wiped her eyes, gave me one more hug, and marched out the door.