Love Makes A Family – Part X - We Are Family

One would like to think that the process which determines how the lives of Wards of the Court will unfold is there to protect them and insulate them from the slings and arrows of the circumstances that put them into their predicament. Of course, that would assume that a government agency has a heart and the requisite feelings that we assign to humans. There are, no doubt, many well intentioned humans working for the system, but the system is in charge and laws control its every decision. Wards of the courts are provided for by the most economical means possible until they reach the age of 18; no more, no less. At 18 you are no longer a ward. You are on your own. You don’t get a degree or certificate or $200 for passing “go”, or get an out of jail free card. You are now legally an adult. Have a nice life. The county thanks you for your participation, please drive through.

Mike and I just could not envision the girls being stuck in that “maturing process” while we dutifully visited for the next 3 years. We really wanted more than anything to convince the court that we had every intention of doing a better job than the system could do. Luckily for us, we live in a very progressive state where the laws are a teensy bit less discriminatory. Actually, California was light years ahead of other states in this area of human rights. It was 1987, which to me, doesn’t seem that long ago, but Mike and I became a pilot program for the LA county foster care system, without our ever knowing it. We were the first male, same sex couple that was going to be granted a foster care license. We got the word and the final road map from the county in June. If we followed it and passed all the mile markers, we would have Cari and Anna in our new home just in time to enroll them at Chatsworth H.S. for the fall term.

They were going to allow us to take the girls on overnight visits to West Hills, where we lived. There were some very unusual conditions set on these visits. Our application for a foster care license was just for these two specific girls. Yet even with the preliminary approval they had given, the L.A. County licensing board was antsy about granting a foster care license for two adult males who would be providing care for two adolescent girls. Someone in the department, thinking way outside the box, thought “What if they are not really gay and they just want to set up a situation where they can prey on young girls”? I suppose their over cautiousness should be expected since the LA County child protective services staff have witnessed some very twisted acts. Obviously we still had to go through a vetting process so they could feel comfortable that we would provide a “stable home environment”, but come on! We’re gay; they are girls! I mean, really?!?

So, for the visitations to our neck of the woods, the girls could spend all day with us, but had to spend the nights at Mike’s sister Betty’s house. LA County had interviewed Betty and her husband Dave, and their 22 year old son Jerry, toured their house, and given them the stamp of approval as a normal heterosexual household. It seemed strange to us that they thought two young girls would be safer from possible sexual malfeasance in a home with two adult, straight males that had never met them, than they would be with two gay men who were completely changing their lives in order to give them a home. How does that make any sense? It's the system. You have to go with it.

To be fair, I think the county’s concern was that the girls have a female to turn to during the transition. I suppose that was a legitimate concern. But if we were going to be getting the girls eventually, the issue of a female influence was going to be moot. There would be no adult female living with us. We had already tried to reassure the two involved counties that Mike’s two local sisters, Betty and Patty were totally on board with the effort and would be there for Cari and Anna. Betty and Dave were a few blocks to the north and Patty and Bob were a few blocks to the south and both just a phone call away. The fact that we had this extended family available may have been a bigger factor in the counties decision than we knew.

Over the next few months Mike and I went to Santa Barbara every week-end to bring the girls back to the San Fernando Valley. Even though the house was almost ready to move in we weren’t allowed to keep the girls in our house overnight until that final inspection happened. They continued to sleep at Betty and Dave’s, about 2 miles from us. The girls would spend many hours hauling out dry wall, painting, and going to thrift stores looking for room décor over the next few weeks.

After many more trips to SB and jumping through many bureaucratic hoops, we finally had our inspection. We passed! We were the first male same sex foster parents granted a license in LA county. In the evening, on August 26th, 1987 one of the many social workers involved in our case delivered the girls to our house. He stayed for just a few minutes to let us know he would be the one doing periodic and drop in inspections. He congratulated us and wished us good luck.

After he walked out we all stared at each other for a few seconds in silence. It was a moment frozen in time. Had this actually happened. Were Mike and Cari and Anna and I alone in our home and about to enter the biggest roller coaster ride of human existence; family life? I am sure the social worker was barely off the porch before he heard the uproar from inside, which I know sounded like a party at which the favorite team had just scored a touchdown in the Super Bowl with no time on the clock. There was a lot of jumping, yelling, hugging, laughing and running around; followed by Cari and Anna just walking in and out of their rooms and looking at everything and looking at us with the wonder of a newborn in their expression. That night our adventure as a family unit began in earnest.

The girls started school four days later and in the coming months and years we were introduced to parent/teacher conferences, tap shoes, drill uniforms, football boosters, Depeche Mode, Guns N Roses, boy trouble, prom dresses (loved this part), Algebra II (not so much), and eventually caps and gowns.

The social worker only did one more follow up visit. He had dinner with us and after interviewing the girls in private he told us, “I see no point in coming back. You guys have made a safe, happy home. Anna and Cari give you two thumbs up. I gave them my card and here’s one for you.”

We did it. We beat the odds. We had been through a trial by fire that lasted two years. We were four people who came together under extraordinary circumstances, from three very different families and backgrounds. No logic could explain why or how our paths all crossed. It is one of those inexorable mysteries of the human condition. We weren’t related by blood or family lines, but we learned something about life and families. Blood and inheritance don’t make a family. Love Makes A Family.

Love Makes A Family – Part IX - The Big Risk

“Coming out” is a nerve wracking process. At least it was for me in the 70’s. It seems like it should be less traumatic now, in the post-Will-and-Grace era. People today may hate you for being gay, but no one can deny your existence anymore. Of course I realize that it can still be traumatic. Because gay people are more visible in our society today, when teenagers start to realize that what they are going through is not just a phase of experimentation, they are coming out much younger than in days of yore. This has created a tragic subculture in our county, the homeless gay child.

Just one generation ago, no-one in their right mind came out of the closet until they were financially independent. This was partly a function of the fact that there were no gay role models, no “out” gays in positions of power, and no organized support groups. So, you only found out that there were more of you out there when you were in college or beyond and by that time you could support yourself and had a network of gay contacts. Today’s gay teenagers have very few options if their family rejects them.
Today almost every television show has gay characters and there are “out” gays in just about every job, in every company in America. Of course, there are still those bastions of manliness and testosterone where you don’t ever reveal your sexual preference, if it is anything but macho, until after retirement; professional sports for instance.

For the most part, this only holds true for men’s sports. Women in sports were the pioneers in this area. Of course, no one in the locker room at Wimbledon was going to pick a fight with Billie Jean King or Martina Navratilova. But professional male athletes would not survive if they were to come out during their careers. Several NFL and MLB players have come out after long illustrious careers and to a man have said there was no way in hell they even considered coming out while still playing.

As a health care worker, you can have your private life outside of the walls of the workplace, but there is no need for any patient to ever have to hear anything about your private life. It’s just not necessary. Here again we come up against one of those rules of the therapeutic relationship. It’s the patient who is in treatment. It is the patient who should be sharing information and getting the feedback. You are not there to tell your story. You are there to listen and assist them, period.

By the age of 35 I had come out to a lot of folks. Everyone at UCLA knew about Mike and me, except the patients. I have had so many different reactions from people hearing this information for the first time, but honestly, the majority of the people with whom I shared my lifestyle were either not surprised (they wondered why it took me so long to tell them) or they just took a pause and said, “So what? You are still you. You just like guys. I get it.”

I can’t even imagine what it was like for my Uncle Rudy. My uncle Rudy was the Dean of Music at North Texas University in Denton. He was so shunned by my family that I did not even know he existed until I was 27 years old and had been out of the closet for five years myself. When I came out to my great aunt Alta, by then pushing 80 herself, she told my about him. Not only was he an accomplished musician, he was an avid horticulturist and was on the board of the American Iris Society.

Here was this very accomplished, intelligent, well rounded, man of letters, but because he was gay, he was invisible to his family. He got where he got on his own without any support from his family. When I brought this up to my parents they had to really rack their brains to remember how this estrangement took place. They remembered him but confessed they hadn’t thought about him in years and just thought of him as a loner. When I asked why they had never told me about him they didn’t really know; it just never came up.

My aunts and uncles also were foggy about his story. Aunt Alta was the only one who seemed to know anything about him. She said that the distance was more of a mutual, unspoken agreement and that Uncle Rudy preferred it that way; he was very independent. I felt a little better knowing that he chose his path. But still, it made a huge impression on me that the family was so comfortable with this arrangement that I never even heard his name mentioned until I was 27. I couldn’t imagine that kind of separate life from the family that I cherished so much.

Obviously things have changed since 1940. All of my nieces and nephews know they have a couple of gay uncles. They know we live together and love each other. They know we love them and are soft touches for whatever their hearts desire. That goes double for the grandkids. We are putty in their hands. But that’s another story which I will gladly share in a later installment.

Aunt Alta was the wild sister to my Mammaw (straight-laced as they come with a heart as big as all outdoors) and my other great aunt Viola (the intellectual). My Aunt Alta was hilarious, vibrant, loud, mischievous and an alcoholic. She spent some time paying her dues at Big Spring. You Texans know what that means. For those of you in Copenhagen, I will just say, it’s a place with locked doors where you go to get your head together.

Prohibition did not stop Aunt Alta. She knew where all the speakeasies were and she never missed a Saturday night out dancing. Guess who her running partner was? That’s right, Uncle Rudolf, the pretty boy who could dance till the bar closed and then dance some more. Uncle Rudy loved music and he loved the night life. He loved life in general and he did not care who thought he was a little off because he wasn’t into hunting and gathering. He became a scholar, and then a teacher, and then a professor, and then a Dean, and then an Emeritus Alumni, and so on. Uncle Rudy was not a drinker at all. But like most gay people (stereotyping in full effect here) he gravitated toward the party people. It was never a family secret that Aunt Alta in her younger days loved to party.

My point here is how far we’ve come in our acceptance level of alternate lifestyles in just two generations. My coming out to my parents was as strange as it was difficult. I was in my final year at University of Houston. It was 1971 and that was the year that the National Association of Psychologists and Psychiatrists voted to remove homosexuality from the Diagnostic and Statistical Manual of Mental Disorders. Mental Health Professionals use this manual when working with patients in order to better understand their illness and potential treatment. The book is typically considered the ‘bible’ for any professional who makes psychiatric diagnoses in the United States and many other countries. So, it was a big deal that a national association of doctors who use it were recommending it be abridged in this fashion.

There was a news item in the Houston Chronicle reporting this suggestion by the mental health community that perhaps homosexuality was not a disease and I had cut it out and tucked it into my suitcase when I was packing for my trip home to see the parental units during the holiday break. We had a very nice visit and just before I walked out of their house to drive back to Houston, I left that article on the night stand in my bedroom. I thought it was a good way to get them thinking about the subject. At least that’s what I told myself. It was a cowardly move on my part. It had an almost immediate effect.

I stopped along the way back to Houston to visit friends from high school and college. I spent several days in Lubbock and a couple of days in Dallas. When I got back to Houston there were two letters in my mail box; one from Mom and one from Dad. One expressing disgust and claiming nausea, the other was just a newsy letter that ended with the very telling conclusion, “I hope you and your friends have a happy and prosperous New Year”. If you are thinking it was my Dad that was disgusted and nauseous, you would be dead wrong.

My mother was the one that totally freaked. The next time I visited, at spring break, she cried me a river. She literally got down on her knees, tears streaming down her face and invited me to join her in prayer, begging for forgiveness and that I would change. After going through that I was wondering how dad was going to behave, even with the positive tongue in cheek comment he’d made in his letter to me.

My Dad had the diametrically opposite reaction from my Mom. He had done his homework. He accepted me and loved me and told me stories about the Air Force and how he had come to terms with it through a friend in the service that was leading a double life. His stories held me captive because I was so stunned he was sharing this type of information.

It’s that old adage about how stupid your parents are when you are going through your teens and then, miraculously they become smarter and smarter the older you get. I was so blown away by how worldly and wise my Dad seemed at that moment. He knew someone in the service who was on the down low and he didn’t rat them out or try to kill them. He kept their secret, remained their friend and went about his business of being a belly gunner during WWII. He just wanted me to be happy and to know that he didn’t love me less because of who I loved.

I had a really close friend in college, a fraternity brother in fact, who didn’t take the news well at all. He told me I was making a terrible mistake and that I needed to get myself into therapy or I was going to die lonely and alone. People just have varying degrees of understanding and he just wasn’t there yet. Maybe a month later I introduced him to my very first boyfriend, ostensibly to reassure him that I was not going to be alone. It wasn’t exactly the right move at the time, but at least it let him know I wasn’t going back into the closet. We went through a period of estrangement, but eventually the circle turned and we became best friends again We never lost touch and in fact we are as close now as we ever were when we saw each other every day.

Now, the most important "coming out" of my life was looming. I was going to have to deal a double barrel revelation to Cari and Anna. “Hey girls, I have a spouse, but guess what…..?”

I was leaving UCLA and would be spending every week-end visiting them until they became emancipated, or some alternative disposition could be worked out. Mike wanted to get involved and was chomping at the bit to meet them. We had gotten the okay from Pat and Suzy for both of us to visit. Mike had taken the necessary classes to become a childcare worker.

Of course, we had told Pat and Suzy we were already exploring if there were any possibilities we could get custody of them. We hadn’t told the girls anything because we didn’t want to dangle something in front of them that had a chance of falling apart. We had jumped through lots of hoops just get to visit them and didn’t expect the rest of the process to be easy. We had nixed the idea of trying to adopt them directly because it would take years and it would be very expensive due to legal fees.

The quickest way we could get them out of the group home and out of the system was to get a foster care license. This was not going to be easy because we lived in an apartment and, oh yeah, we were two men. So, we needed to buy a house and make it a safe, stable home and somehow convince the department of child protective services that we could be good parents.

Luckily, it was a buyers market in California in 1986. Prices were down. I had an annuity at UCLA I could cash in and Mike had some money in a savings account which added up to just enough for a pretty good down payment.

Fortunately we found a rental fixer upper for sale. It needed a lot of work, but it fit our budget and we qualified for the loan. We got it and went to work. The social worker from L.A. County was now taking us seriously and actually encouraged us to do a good job on the renovation. We took this as a sign that they were not going to throw out our application. We became very hopeful. Some time during the renovation we got word from the social workers from both counties that our application for a foster care license was likely to be approved. Both counties vowed that they would not throw any roadblocks in our way.

It was time to have “the talk” with the girls. We had a lot to share with them and their reaction to it was paramount. Mike and I went to SB together that Saturday and I left him sitting on a blanket in the grass by the east beach volleyball courts while I went to pick up the girls. We had picked this Saturday because none of the other girls in the group home were going to be available to go on an outing, so it would just be me with Cari and Anna.

So, I went to the group home and got the girls, and we drove back to the beach and I laid down a blanket just about 10 feet from where Mike was sitting. The plan was for him to observe and listen. If the conversation went as I expected, which was that the girls would not care at all that I was a homo, then I would give Mike a sign, or say loudly, “ Heeeeeeere’s Mikey!!”. Just kidding. Actually, I wanted him to be able to have a sign for me that would let me know he had seen us interact and he was still all in.

I had told Cari and Anna on the way to the beach that I needed to have a talk with them. That did not set off alarms for them at all because they just came out of an environment where someone always wants to have a talk. I knew they were already very attached to me, but I wanted to make it okay for them to reconsider. I gave a long preamble about how I was telling them something very important and they had the right to react however felt right and to only consider their own feelings and no one else’s, meaning mine.

When I told them I was gay, to my surprise, while they seemed slightly shocked, there was also some relief in their faces. It had never occurred to me that they would be “relieved” that I was gay. But it makes a lot of sense. If they had ever had unspoken fears, or worse, desires regarding sexual feelings about me, they were now totally irrelevant. I then looked over at Mike and waited for his signal. He was smiling ear to ear and gave me the thumbs up, and when the girls asked me if I had a boyfriend, I said, “Yes, and there he is”.

I sat back and watched as the three of them laughed and talked and hugged. They were getting acquainted with such ease. It was really remarkable. Any worries I had about them not hitting it off were laid to rest immediately. They were like three old friends chatting it up. But then that’s Mike’s way. He is so gregarious and such a good listener that people just like talking with him. He knows all our neighbors seven houses down on both sides of the street by their first names! I know like three.

After an hour or so of Q and A Mike and I told the girls we had one more thing, a question we needed to ask them. “Would you be interested in having us work to get custody of you?” On the drive up to Santa Barbara that morning we had looked at each other and thought, what if they say thanks, but no thanks. Well, at least we would have our first home. But for me, it would have been a very empty place if that happened.

Their reaction was explosive. They didn’t even ask if we were kidding or were we sure. Anna screamed and almost tackled Michael. Cari broke out into tears and crawled across the blanket and gave me a long hug. They both cried and hugged us repeatedly and revealed that they had been talking for a long time about what it would be like to live with me. It had been a fantasy for a long time. And now that they knew that I had a partner and that we wanted to make a family with them, they were overwhelmed. They said that for the first time in a very long time they felt that maybe their luck and their lives were about to change.

Love Makes A Family – Part VIII

My head had fallen to my chest and a wave of nausea swept over me. How could this be happening? I thought all the “I’s” were dotted and “t’s” crossed. I was reporting back to Katrin about the visits every Monday and also had kept Dr. Kay informed when I would run into her. Why was Freda asking me who gave me permission for the visits?

I tried to remain calm as I explained that the visits were approved in treatment planning many weeks ago and that both Dr. Kay and Katrin were aware of them and had encouraged them. Freda stared at me; lips pursed, and shook her head back and forth slowly. “Lloyd”, she said, “in treatment team we only agreed in principal to some staff visiting the sisters. The nursing department would never approve of what this has become; just you visiting them every week. It crosses a boundary and you should have known that. As far as the nursing department is concerned you are making unauthorized visits to ex-patients, and that is not okay.”

My feeling was that the visits were not unauthorized. The nursing department stance was that they were aware of the discharge planning conference but were not consulted about the visits to Santa Barbara once they commenced and never would have agreed to anything but phone calls. I did not like where this was going. The knot in my gut was now a double-cinched half hitch with a sailor twist. I felt my heart start to race.

Freda informed me that the nursing department not only wanted me to curtail the visits, they wanted me to curtail them immediately and have no further contact with the girls. I was not going to be allowed to even call the girls and try to explain why they wouldn’t be seeing me ever again. Refusal to do so would require the nursing office to start termination procedures. I would be given a week to think it over and was told I should probably contact my union representative to sit in on any further meetings with my superiors.

At this point I had one of those moments. You know the kind? This was one of those moments in life where everything stands still and your whole life flashes before you; lights flash in your peripheral vision like you just got beaned by a 90 mile an hour fastball; and then some form of epiphany occurs. This was a job that I loved. I was totally invested in it. It was a means of defining who I was as a person. A great deal of my own self-esteem was tied up in being a good mental health practitioner. Which to this day still makes it remarkable to me that I immediately heard myself saying, “I don’t need a week to think about it. You can have my two weeks notice today.” I heard myself saying it, but it came out so fast I couldn’t be sure I wasn’t just thinking it until I saw the stunned look on Freda’s face.

I had just thrown away 6 years of work and working relationships in two sentences. All because I knew in my heart, even in that spontaneous moment, that I could not do what they were asking me to do. I had made that promise to Cari months ago that I would never lie to her, ever. If I agreed to these terms set before me, not only would it make me look like a liar to her and Anna, it would also make me another in a long line of adults who had abandoned them. I just knew I wouldn’t be able to look in the mirror if I had to abandon them to keep my job. As much as it killed me to contemplate leaving a position that I felt I was born to fill, I just couldn’t swallow those terms.

There was some stance softening and some backtracking done by Freda as we sat there, but the bottom line was, to keep my job I would have to go back on my biggest promise to Cari. When I got home that day and told Mike the whole story, he was the one who said, “I think you should quit tomorrow, and we should explore helping the girls together.” I was so glad to hear that. It gave me the strength to stick to my guns and not backtrack and start thinking selfishly. I could see myself throwing a big pity party in my head. But Mike was not going to stand for that. He had very little time to waste on self-pity and didn’t admire it in others. His positive attitude gave me a boost.

The next two weeks were a mixed bag emotionally. Most of the staff that I worked with were supporting my decision. They were all a little shocked, but expressed admiration for what I was doing, which made me very uncomfortable. I wasn’t doing it to become employee of the month or to win an award and I just have a hard time with too much praise, anyway. It makes me want to get up and jog somewhere.

There were a couple of staff that thought I had gone mad. They did not support my decision at all and they let me know about it. Paradoxically, I was relieved that they were there. I think it is always good to get a lot of feedback across the spectrum from true believers to detractors. It gives you a chance to possibly identify blind spots and plan for them. These co-workers were dear friends; they just did not want me to give up my career for any reason, even one with which they could sympathize.

They told me how resilient kids are and that Cari and Anna would survive, even without me. They tried to paint gloomy prognosis pictures of both the girls and reminded me that most pathology is so ingrained by the time you reach your teens that changes are almost impossible without in-patient treatment. They cautioned that Anna was probably going to be a handful all her life and that I might be enabling her more than helping her. That hurt. They told me Cari would have intimacy and relationship issues all her life and both the girls would never be able to maintain any long term relationships.

The fact of the matter was I knew all of what they were saying was true. Without in-patient therapy both girls were at risk to suffer through life, struggling with making those lasting connections with objects of affection that most people take for granted. But look around you. That is a common human condition in America. How else could we have a 50/50 chance of marriages lasting? A whole lot of divorce happens because people have no sense of how intimacy works or how to build a trusting relationship with another person.

So, all of these arguments made by well meaning co-workers could not sway me. It still all boiled down to that promise. If the girls were going have some sadness and misery in their lives over relationships, well fine; they would always have my shoulder to cry on; and it looked now like Mike’s shoulders were moving in to support them as well.

Those two weeks dragged by like a walk to the gallows. Finally on my last day I had a really nice going away party and the next Monday I went to work for Staffbuilders, a nursing registry. One of the friends I had made in the orthopedic surgery department left UCLA right after I got the job at NPI and she had worked her way up to LA branch manager at Staffbuilders.

When I first started at UCLA Amy was the ward clerk on 3-11 and I was the ward clerk on 7-3. We became fast friends. Amy is one of the funniest people I have ever known. Everyone that knows her says she could do stand up comedy. She would slay. She is so smart and so quick. You can see it in her eyes and her posture. She is listening intently and just waiting for you to end your sentence so she can comment, and it always makes you laugh.

She has that perfect comedy timing and delivery that always works; sometimes with unexpected consequences. I know of at least three times at dinner with Amy when I was drinking a cocktail, and in mid-gulp, when she said something so hilarious that it ended with me spraying her in the face with Margarita. I know!! But it was either spray her or choke myself. After I sprayed her with Margarita, I jumped up and ran to the bathroom laughing hysterically. She sat there watching me run away and turns to the shocked couple sitting next to her as she is wiping her face off and says in straight deadpan, “I lose more dates that way”. That is just pure Amy.

Amy is another person who I have learned from and admired for her courage and positive attitude in spite of some huge heartbreaking life events. She should write a book. I would buy it. The fact that we were such good friends and she knew my capabilities was the main reason I got the job at Staffbuilders. It really eased my mind to know that while I was giving up the job that had defined who I was, I was still going to be able to survive and pay the bills. Plus, now that I was no longer tethered by the visitation rules of the NPI nursing department, I could now resume visits with Cari and Anna. It was time for them to meet Mike.

Love Makes A Family – Part VII

(The names of some of the players have been altered for obvious reasons.)

After delivering the girls to their destination, the Santa Barbara County social worker called Katrin, the girls’ UCLA family therapist. She told Katrin that both girls cried for about the first 10 minutes of the hour long ride to their new home. She tried gamely to engage them in conversation. She informed them that they were already enrolled at San Marcos High School and would be starting there next week, and she just knew they would be very happy there. Cari finally said, “I know you think you’re trying to help, but we really don’t feel like talking if that’s okay with you”. This wasn’t the social workers first patient transport and she knew the drill. She gave them the space and the silence they wanted. Every few minutes one or the other would burst into tears for a few sobs and then exert the needed effort to pull it back together. Half a box of tissues later they finally arrived at the group home in the foothills of Santa Barbara. It was owned and operated by a man we will call Henry.

Henry was a middle aged man, divorced, with a teenage daughter of his own who lived with him in his 5 bedroom, 3 bath Craftsman style ranch house. There was a long driveway up to the house, which featured a large fenced back yard and an adjacent lot with horses. It was warm in the foothills, but like clockwork in the evenings, the Pacific on-shore flow would sweep in, cooling and cleaning the air.

When Cari and Anna moved in, there was only one other girl there and two vacant bedrooms. The four bedrooms other than the master all had twin beds. Henry’s daughter told the girls that when the place was full, she had to share her room. Apparently, a bad divorce settlement had left Henry struggling financially and he was going to get as many girls as tenants as was legally allowed.

Cari and Anna could have each had their own room, at least temporarily, but decided to share a room rather than rolling the dice on the next court appointed houseguests as new room-mates. The house was bright and cheery and soon the girls settled in, but were still not happy about it. They preferred to pull the drapes closed and block out the cheeriness. After the latest blow life had dealt them, they did not feel it was fair that the sun was so bright, the air was so clean, and that other people had happy, contented lives. They would count the hours till their next contact with the staff at NPI.

Cari was calling me, and Anna was calling Elvia, every other day, all that the group home would allow. Katrin made her official visit, the only one she would make to the group home, a week after they got there. She interviewed Henry and spent a half hour with the girls. She came back giving the group home a positive report card, but said Cari was still looking like a deer in the headlights. All the staff at NPI were relieved to hear that the group home was a nice place and that Cari had not run away yet.

After their discharge from UCLA-NPI there were no more interdisciplinary treatment team meetings to discuss next steps and their transition to out patient life was coordinated by Katrin. Dr. Kay, Cari’s individual therapist made a couple of follow up phone calls to her, but then had to move on to the rest of her in-patient case load. Elvia had opted out of the group home visits. She was going to be leaving UCLA shortly for a new position and didn’t want to prolong the agony of separating from Anna.

Katrin had regular phone conferences with the Santa Barbara county department of child protective services and was doing her best to stay in touch. She still felt somewhat responsible, since it was in family therapy where the schisms in the family began, with disastrous results for the girls. We spent several lunches helping each other deal with the situation. I tried to reassure her that she could not take responsibility for the pathology in that family and it would have been criminal to overlook it and try to gloss it over. The result of that would have been even worse in the long run. She was glad that I was going to be visiting the girls and felt it was their only chance to make the transition successfully.

Finally, the second week-end after the girls leaving came and I was allowed to go visit them. I had been thinking so much about this reunion that I was feeling a little anxious. I would be so glad to see them, but we would only have two hours and I wanted to get some things straight right away, especially with Cari. I wanted to make sure I let her know that I expected her to stay there and follow the rules and not get the idea that I approved of any plans to become a run away.

As I drove up the long driveway I saw Cari was sitting on the porch. She didn’t jump up and run out to the car and get hysterical, which I was sort of expecting. She stood up and walked out to the car, waited for me to get out, and we just stared at each other for an awkward moment. It was as if we didn’t quite know how to act because this was the first time we had been in each other’s company outside the hospital milieu. There was no one monitoring our behavior. There were no four walls. There were no nurses or psychiatrists or other kids. It was just us. Tentatively, I slightly opened my arms and she slowly leaned against me for a brief hug. Just about that time Anna ran, screaming, out the front door and almost knocked me to the ground she hugged me so ferociously. We all three almost collapsed laughing. Anna’s dramatic entrance (one of her hallmarks) was the perfect icebreaker. We all relaxed and had a really nice first visit. I felt we were on the road to recovery.

I went to visit them every other Saturday for 2 hours. Now that they were ex-patients and their confidentiality was no longer an issue, I was allowed to tell Mike what was going on. He had become so intrigued that he wanted to come on the visits with me, but he understood this was not going to happen. First of all, the girls didn’t know I was gay. Second of all, I knew, or thought I knew, that the hospital would never approve of it. I never even brought it up to Katrin.

Even though the group home was not horrible and Henry seemed like a nice man, both of the girls missed the protected environment at UCLA. In spite of the difficulty of the situation Anna was making the transition really well. Cari was not. She was depressed and feeling the sting of betrayal. She was feeling the other side of the double-edged sword of the relationship we had forged. It was great in the hospital when we saw each other 8 hours every day. Now, she was dealing with abandonment issues every week. In spite of her intellectual understanding of our situation and my commitment to her, she still wondered each time I drove away if it would be the last time she would see me.

Luckily, she was starting to hook into the idea that together we could work on things over the phone and she could still conquer some of her demons. But the times between the calls and the visits felt empty and she was distracted, waiting for the next contact. She wasn’t making friends at school and her school work was suffering. At least Henry was providing a stable home environment. At least we thought that was the case.

The girls were moved to another group home after a couple of months because there were allegations about the appropriateness of Henry’s verbal interactions with the younger girls. Apparently, there was no sexual abuse involved. But, the approach taken by child care agencies at this time was to be hyper-vigilant and take action for even the suggestion of inappropriateness. The McMartin Pre-school trial and fiasco leading to child abuse convictions was fresh on the minds of Child Protective Services. This group home would later be closed because of it.

Cari and Anna swear that they never had a problem with Henry and Katrin and I were thankful that they were removed from that possibility unscathed. When Katrin and I compared notes, neither of us recalled meeting the social worker affiliated with Henry’s group home. Each group home is required to have a social worker that acts as a liaison/patient advocate. They are there to provide a safe harbor for the kids in any disputes with the group home staff and they also function as counselors to the kids.

The new group home was owned and run by Pat, a single woman, and her son. Suzy, the social worker for this house was much more involved. She had contacted Katrin about the move and she called me before my first visit to arrange a meeting. We sat down and she went over the rules of the house and told me that although I was on the approved list to visit Cari and Anna, she could rescind that privilege if she felt I was interfering with the house managers programs or behaved in any untoward fashion. Although, I was a little surprised by the contrast of this house to Henry’s I got the message, and I was okay with it.

They were not about to let whatever had taken place at the previous house happen here. They intended to take seriously their charter to protect the kids, and that included Cari and Anna. I felt a sense of relief, and despite her rather prickly approach, I liked Suzy and her spunky attitude. It felt like a good move.

Pat’s house was not a horse ranch. It was a non-descript 4 bedroom home on a cul-de-sac in Goleta at the very edge of the subdivision. Pat’s décor was rather minimalist, but with comfy furniture. She kept it very clean and it always smelled of incense or potpourri. She was a good cook and fresh ground and brewed coffee was always ready when I would arrive there on a Saturday morning. After a couple of visits Pat and Suzy told me I could stay as long as I wanted and didn’t limit me to two hours.

There were huge eucalyptus trees in the subdivision and they were only about a quarter mile from the ocean. You could walk out the end of the cul-de-sac about 300 yards into the eucalyptus grove and find a slough that dropped off about 40 feet. The girls couldn’t wait to show me where someone had hung a big, thick rope from one of the tallest trees. At the bottom of the rope a wooden T-seat was attached. It must have been 50 feet to the top of that rope. You could jump off the edge of the slough and swing out into the air over the chasm in a huge arc. It was like flying.

I remember watching the girls run and jump on the seat of that swing, straddling the rope, pointing their toes and leaning back with eyes closed and hair streaming out behind them, breaking free of the earth and all their cares and woes, if only for that brief moment of total abandon and freedom from control and care. It was at that spot that I remember thinking that the girls were going to be okay. They were going to make it through this rough patch.

My visits continued and after a while, Pat gave me permission to take the girls on an “outing”. We were just about to leave when Pat ran out to the car and said Suzy had called and needed to speak with me. Wondering what in the world could this be about, I walked back into the area Pat had set up as an office in the living room and picked up the phone. Suzy told me that since I was not a legal guardian she could not allow me to take the girls anywhere off the premises. But, she said she had a solution.

She and Pat said they would be willing to list me as a staff of the group home. All I would have to do was get California certification as a Licensed Childcare Worker. I explained about my title and training at UCLA, but they said this was slightly different. They explained that this would entail a few night classes. The classes were 4 hours each night for five nights and among other things, included CPR (which I already had) and first aid classes. Once I became a Licensed Childcare Worker, I would be allowed to take the girls on outings and not be tied to the property. It sounded like a big boring waste of time, but I did it to be able to get the girls out of the house for a few hours on the week end.

When Mike heard about this latest task that I was dreading, he decided to take the classes with me. I was digging it on the misery loves company angle alone. For him it wasn’t drudgery. He was toying with the idea of volunteering at one of the halfway houses in our neck of the woods. He had become so enthralled with the stories I told him about the amazing turnarounds I had witnessed working with kids. He really wanted to be a part of something where he could have a direct positive impact on individuals in need. So, we took a week of evenings and completed the course together. It was nice having him there and he was so enthusiastic it made it easier for me.

Pat and Suzy had failed to tell me until after I completed all this training, on my own time, at my own expense, that there was a catch. They told me I could not take just Cari and Anna on the outings. I would have to take all the girls in the house. They had noticed that I was driving a beautiful, blue, metal flake painted, Ford Econoline van with custom interior. They saw it as a resource and they totally worked me. If I wanted to spend any time with Cari and Anna doing anything besides sitting around the group home, I had to function as the group home’s week-end tour director. I had a new found respect for Pat and Suzy. They worked well as a team.

It was about this time that Freda, the nursing supervisor for the child and adolescent services at NPI approached me on the ward one day with questions about my visits to the girls. She asked me who had given me permission to visit with ex-patients. Her tone did not indicate simple curiosity. It almost sounded like a trick question. I was very puzzled, and filled with dread, wondering why she was asking me this now. I had been visiting the girls for almost 3 months. Didn’t she know who gave me permission? This was discussed in treatment team meetings prior to the girls’ discharge, and the family therapy department in conjunction with the girls’ individual therapists had approved of the visits and knew all about it.

“Lloyd, you know that fraternization with ex-patients is strictly forbidden”, she said. “Please come with me”. I followed her to her office in stunned silence. I was reeling and confused with this blindside, out of the blue confrontation. I felt as if someone had punched me in the gut. Freda directed me to a chair and sat opposite me, leaned toward me and said very compassionately, “Would you like to have union representation?”

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.

Love Makes A Family - Part V (Michael)

Love Makes A Family – Part V

Michael James Tompkins was born in Columbus, Ohio in August, of 1946. His parents, like many of their generation, heard California calling them to a better life, lived in a balmy climate, with limitless opportunities. So, in 1951 his parents packed up all their belongings along with Mike and his two older sisters Sandy and Betty and they headed west. They ended up settling in the northern end of the San Fernando Valley. In those days the area now known as Canoga Park, West Hills and Chatsworth were fertile farmlands with citrus and avocado groves as far as the eye could see.

Along with the citrus farms were a few very large horse farms and ranches. Many of these ranches were owned by Hollywood actors, directors and producers. The Tompkins kids quickly made friends with the kids from one of those big ranches down the road from their small 3 bedroom home. They grew up thinking it was normal to be playing with the kids of Roy Rogers and Dale Evans.

They were lucky that their days were filled with sunshine and the sweet smell of orange blossoms mixed with the pungent odor of the horse barns surrounding their neighborhood, because their nights were filled with the constant bickering and crazy-making demands made of them by their inebriated parents. The opportunities the young couple had hoped would fall in their laps had not materialized and their coping strategy was to drink. They drank daily and they drank a lot. Vodka was their poison of choice. It got them to a numbed state of consciousness quickly and they rarely remembered what havoc they had wreaked the night before. Michael and his sisters stayed as far away from their house as they could.

When Mike was 10, his little sister, Patti was born; “our little mistake” the parents called her. He was no longer the baby and because of all the attention being focused on Patti, Mike used the diversion to gain a little freedom for himself. He started doing odd jobs for local horse owners in exchange for riding time. He had his favorite horse in every stable in the north valley and he soon became a very skilled horseman. He rode bareback and barefooted and the ranchers all said he reminded them of a young Sioux or Cherokee warrior.

Mike was always smallish, but from mucking out all those stables he became very lithe and wiry. When he entered 9th grade he tried out for the swim team at Birmingham High School. He made the team, as team manager. But he didn’t give up. He did the team laundry and then swam after the team practice was over. He eventually made the team mainly because his work ethic impressed the coaches. He seemed almost obsessed with being the hardest worker.

By the time he was a junior he was one of the two fastest swimmers on the team. He was racking up trophies and ribbons, and was featured on the sports page of the Daily News several times setting records in the 100m butterfly.

The Tompkins kids were lucky in one respect. They had good neighbors. Sandy, Betty and Mike were all smart and engaging, motivated and energetic. Their neighbors could see, and hear, what they were up against at home, and they reached out. Sandy and Betty would spend as many nights at friends’ homes as they would at their own. They made themselves perfect houseguests, helping with housework, always making their beds, doing dinner dishes, even vacuuming. They did not want to jeopardize these oasis relationships within the neighborhood. Their relationship with neighbors was more like normal family interactions than they could ever get at their own home. Mike, being the youngest, wasn’t granted that freedom. His Mom wanted her little boy at home to wait on her, hand and foot. She berated him if he didn’t get the vermouth to vodka ratio just right. He remembers burying his head under pillows to drown out her shrill threats hurled at him and his dad.

When Mike started gaining notoriety as a swimmer, his father, who had never supported his endeavors in school before, began to show up at his practices and swim meets. This would normally be every boy’s wish, to perform and achieve great things in a sport with his father watching and encouraging him. It would have been so for Mike had his dad not shown up at these events stumbling drunk and slurring his words; yelling at Mike to “do what I taught you, you little sumbitch!” Of course, his father had never taught him anything about swimming. In fact he had given him precious little fatherly guidance about anything, much less affection. But, he was now living vicariously through Mike and getting massive pleasure out of lording it over the swim coach and Mike.

One of Mike’s other traits, besides being extremely ethical and big hearted is that he does not deal well with BS. He suffers fools, not at all. He proved this in spades at the Olympic time trials in 1964. Mike was a senior in high school and had just missed making the Olympic swim team. He was still in training because the cumulative times of the candidates for the final alternate were inexplicably tied. He still had a slim shot to make the team. His father showed up at one of the training sessions, drunk as usual, and was hurling epithets at Mike for “not being man enough to make the real team”.

The swim coach had reached the limit of his tolerance for this blowhard who bullied everyone with whom he came in contact. He told him to leave or he was calling the police and having him removed. It was too late. Mike had also reached his limit, and he knew what would pull the rug from under his father. He slowly turned around, picked up his gear and walked away from the pool without looking back. He never swam another stroke competitively. His father went apoplectic. Mike was grounded for the rest of his senior year, but he went to bed smiling every night knowing that he had finally gotten even in some measure for all the abuse he had endured at the hands of this cruel, bitter alcoholic.

Both Mike’s parents had threatened him with a life of servitude to them as soon as he graduated from Birmingham. They constantly harangued him about all the servile jobs they had lined up for him and that he could kiss his jobs working with horse’s goodbye. By this time Mike had no respect for them and felt empowered by quitting the swim team. He knew that he could always outsmart the two lushes when they would try to control him. He joined the U.S. Army the day after graduation from high school and more or less told his parents where they could stick their summer jobs.

Mike was actually enjoying his time in the army. After boot camp he was lucky enough to get assigned as a driver for a general in military intelligence and he spent most of his time sitting outside high level intelligence meetings. After one year, 4 months and 14 days of military service, word came that his father had died, apparently of alcohol poisoning. He was forced to go to the funeral, but didn’t shed a tear. He was only angry that he didn’t get one last time to tell him how much he regretted getting stuck with him as a father.

Michael had become quite cynical due to all the disappointments he had dealt with in his life. He was bitter about his relationship with his parents, but he was not a negative person at all. He had a very dry sense of humor, but was not humorless. He loved to laugh and loved to make other people laugh. He had a quick mind and an acerbic style when delivering a punch line. If he had been a comic, his style would definitely have been in the vein of Don Rickles or Paul Lynde . People at his father’s funeral remember Michael cracking jokes at the reception. It was his way of dealing with his ambivalence about the loss of his father.

He went back to active duty after only a week of bereavement leave. A few months later, his mother followed her husbands lead and drank herself to death. Cirrhosis of the liver was the official cause of death. Because both of his parents died and because his older sisters needed him at home, he was given a hardship discharge from the army. No matter what your relationship with your parents, when they leave you abruptly, you can’t help but have abandonment issues. You are an orphan at this point. Knowing about abandonment would play heavily on Michael’s consciousness in the future. He would always automatically empathize with people who suffered rejection and abandonment.

Patti was now 8 years old and Betty and Sandy needed help to keep the family together. Mike became the man of the house just before his 19th birthday. Various aunts and uncles contributed what they could but the income for this parentless household was completely on the shoulders of the three older siblings. The older girls worked as waitresses and Mike became a trash man for the city of LA. The next five years flew by as they all worked hard so that Patti could have a stable home and get through school. The three of them were making enough to pay rent and buy the groceries and Mike worked a second job at a gas station to start a savings account.

Sandy and Betty both had boyfriends and were starting to think about getting married. Patti, had reached the age of 13, that wonderful age when we all think we now know it all and resent being told what to do. There was a struggle going on in the house because of Patti’s normal urge to rebel, and her older siblings thinking they were supposed to quell this rebellion by being ultra strict. Patti began to act up and act out. She was hanging with a bad crowd and had begun to smart mouth her older siblings when they set limits. She would run to her room and slam the door, screaming, “You are not my parents, you have no right to tell me what to do!”

Her problem was that they did have that right. Michael was her actual legal guardian and he wasted no time intervening on what he perceived as her path to self destruction. If you read the book or saw the movie “Mommy Dearest” you may remember how Joan Crawford dealt with her maturing daughter when she felt threatened by her budding sexuality. That’s right. She put her in a convent. Well, Mike put Patti in the same Catholic boarding school and convent where Joan Crawford sent Christina.

Patti was mortified and went there literally kicking and screaming. But to this day she says it was the exact right thing to do and she has thanked Mike over and over again for caring enough to take drastic action. She saw the error of her ways, got a great education, and she is a devout Catholic to this day. She has sent both of her children to private Catholic schools from first grade through to high school graduation.

As I said earlier, Mike identifying with anyone struggling with abandonment issues was only natural. So, I shouldn’t have been surprised to hear Michael expressing a wish to help Cari and Anna. Reaching out to help other people is one of his traits. At the time it was just a gleam in his eye. He didn’t even know their names yet. He only knew what I had told him and yet he knew that they had gone through some life experiences with which he could relate. His heart ached for these two sisters whom he had never met.

I told him that even though the girls were being discharged precipitously with their treatment plans less than half way complete, all wasn’t lost. Ex-patients were allowed to call the pay phone on the unit and I had already been told that I would be allowed to make and receive two phone calls a week from Anna and Cari, once they were situated in the group home in Santa Barbara. Because Cari’s threats to run away from the group home had escalated, there was also some discussion among the treatment team that it might be good to plan some supervised visits to help support the transition. You know what they say about the best laid plans of mice and men? They often go astray? It is one of those sayings I hate because it has come true so many times in my life.

Love Makes A Family - Part IV

If you have ever lived with someone or had someone as a friend who works in any kind of treatment setting, be it medical or behavioral, hospital or clinic, you probably already know that patient confidentiality is a very big deal to caregivers; and it should be to you also if you are ever a patient. You may have even heard about HIPAA regulations because of your friend or because you have had to sign a document in a doctors office making you aware that due to HIPAA regulations your information will be protected as much as possible with the understanding that sharing your information with other medical professionals may happen as a course of your treatment.

I mean if you are sitting in a doctor’s office filling out paperwork, just about everyone in the waiting room knows you are there to see the doctor. So, your confidentiality is already out the window, right? But, the doctor and his staff are liable if they don’t protect any documentation of your visit according to those HIPAA regulations.

Those patient confidentiality rights are taken very seriously when it comes to psychiatric hospitalization. You talk about a patient outside the confines of the workplace and you do so at the peril of loosing your job the same day that anyone finds out about it. This is why most treatment teams in these settings must have supportive staff structures that provide time to the staff to be with other staff to “detox”. You are responsible for providing healthy, therapeutic support, and many times initiating intervention, on some very confused, angry, and sometimes bizarre behaviors.

Now, I know that every physician, psychologist, RN, LVN, MHP, MHW, social worker, dietician, and even custodial staff that has ever worked in psych has gone home after work at some time and talked about something that happened that day on the unit. They may have talked to their spouse, their significant other, their own kids, or their parents. They may have described very specific events with a lot of detail. If you know someone in psych who tells you that they never did, don’t buy anything from that person. That disclaimer aside, I believe that all of us follow the 1st Cardinal rule of working in psych, “Thou shall not mention the names of thy patients”; ever, to anyone.

Speaking of the Cardinal rules of working in psych; let me put rule number 2 out there right now. “Thou shall not ever socialize with any patient, current or ex, outside the unit without special permission by the interdisciplinary treatment team; or the Chief of Staff; or the Director of Nursing; or someone of equal big cheesiness”.

Of course, nursing staff members take groups of kids on off campus outings all the time. Sometimes staff members are allowed to take one kid on an outing, once a certain privilege level is gained by the patient. However, these outings are part of the treatment plan. They are scheduled and they occur on the clock and are generally limited to an hour or two, max.

Visits with ex-patients outside the hospital are much rarer. They happen, but they are done judiciously with clear expectations regarding the benefits of having a nursing staff member be in contact with a discharged patient. Patients are supposed to have said all their goodbyes by discharge day. Those strong emotional bonds built with the nursing staff have to be severed. It's not always easy by any stretch of the imagination. Still, the patient must have distance and separation from staff to reconnect with family and to test their newly learned coping strategies on their own. They are less likely to become independent if they still have access to the treatment team. Besides, they will still be going to individual and family therapy after discharge for as long as necessary. At least that’s the usual discharge plan.

I sometimes would tell Mike amusing stories, or sad stories, or amazing stories about the patient’s foibles and triumphs. Working in psych can be very sad and draining, but it can also be extremely uplifting and fulfilling. It is a fascinating job to have, in so many ways, and Mike was always interested to hear the anecdotes about this kid or that kid. There is always something interesting to tell and people always ask you questions about the experience when they find out what you do.

Michael knew something was different about the way I was talking about the anonymous sisters though. He knew I was talking in a different way this time about the intricacy of the transference relationship and how vulnerable it makes both parties feel. He had commented several times that he had never heard me talk so much about any other patients. I was aware of that and I think it was because it was the first time I had been encouraged by an individual therapist to foster a father/daughter transference. I was getting a lot of help from Dr. Kay, and from Judy, the nurse practitioner, and Roberta, my mentor.

Roberta was, and still is, the standard by which psych nursing staff shall always be measured in my book. There were several other psych nurses with as much knowledge and skill and I admired them just as much. But Roberta, she had a certain style of relating that appealed to me and she became my mentor at UCLA. Roberta knew empathy. She knew its meaning, its value as a therapist and she had a vast store in her heart. She tried her best to help me stay the course during my relationship with Cari.

You see, the other Cardinal rule of working in psych is, “Don’t let your emotions get involved; remain objective.” This is absolutely of the utmost importance for the therapist. That time and that space in the therapists office has to be for the patient and their feelings. It cannot be for you and your feelings. This is why therapists have therapists. Because it is an impossible feat; no one can do this work and not feel. Psych workers, if they are being honest, will tell you that they have cried to each other, sometimes alone, when a patient leaves after a long stay, or worse, offs themselves a week after they are discharged.

Working through the issues and feelings that cause people to be hospitalized is like walking a high-wire and trying to help someone else cross over it with you while you are both walking sideways with no net. It’s exhilarating; and scary. But, it is enormously satisfying when the product of the work is an improved outlook on life by someone who was circling the drain before you started. I miss it, sometimes.

At any rate, I had kept Michael fairly well up to date on the sisters’ progress and my great good fortune to be working with patients who I could see were clearly benefiting from treatment; at least Cari was. Anna still seemed to be coasting. She would sit with her therapist and talk about inane topics, twirling her hair and checking it for split ends. Her therapist who had decided to turn up the heat on Anna before the news of the abandonment by the family, now knew it was too late. Anna would not reap the reward of a completed treatment program.

The vast majority of in-patients in psych wards make infinitesimal progress that takes “forever” and the recidivism rate is very high. When you get to work with someone with the intellect and the desire to change it’s gratifying for both of you. Anna was fighting an uphill battle with borderline personality syndrome. At UCLA the treatment for borderline personality followed the teachings of Dr. James Masterson, the guru of the disorder. It’s a very tough road to hoe and requires some extreme limit setting on what may appear to some to be “normal” behavior. It required a lot of time outs with time alone in a room thinking about your behavior and then talking with staff about it. Anna was getting the time outs and she was doing the alone time, but her ability to dig deep and accept what she found was not happening.

Cari and Anna both had the intellect in spades. Although in her toddler years, her family and foster parents thought Cari was “retarded”. Cari was born with a cleft palate, which made her speech very lispy, when she finally tried to start speaking. This was just after she lost both parents. She had a lot of difficulty with certain hard consonants that required a glottal stop (you speech therapists know all about this). Because her voice sounded strange to even her, she stopped talking. She would never utter a sound except when she was alone with Anna. This may be another reason that the family did not immediately rescue her and Anna from the system. They didn’t want the responsibility of having to care for a special needs toddler. Cari had IQ testing when she was 12 years old. She tested out at 134.

Just being smart was not going to be enough now that she and Anna were facing this newest hurdle life had thrown at them. Anna was certainly not going to be able to complete her treatment. Cari was smack dab in the middle of her program, totally invested in her relationship with me and two weeks was just not enough time to wrap it up. It was a disaster. Their impending discharge was approaching at warp speed. They were now at their most vulnerable emotionally, because that’s where we, as their treatment team had led them. Now, with this curveball from the family we all felt we would be sending them out to certain failure. It was not a happy time on the unit.

They would be abruptly leaving an all-inclusive 24-hour a day treatment center, which included: individual therapy 3 times a week; family therapy and music therapy once a week; daily occupational therapy, recreational therapy, and school; and the constant companionship of a team of trained psychiatric nurses and mental health practitioners.

Santa Barbara County would be sending them to a group home, with a county social worker they could call if they needed to talk. Once again, the cycle of shuffling from one place to another was about to repeat itself. They were going to relive their previous foster home experience. Both girls were stoic on the outside, but panicky in therapy. Cari, appropriately was expressing a lot of anger but began to talk about eloping from the group home and going back to life on the street as a possible option. She was ready to cast all the hard work and the changes to wind.

Anna took on this strangely brave external persona. She did not appear to be nearly as upset as I thought she would be. I was talking with her about the change, trying to empathize and feeling really lousy about how ineffective I was when she said, “Well one of us has to be brave, and it sure as hell isn’t gonna be Cari.” I wondered where that statement was coming from. Then it dawned on me.

During all the foster care and the stern, abusive family situation, Anna had functioned as Cari’s protector. Instinctively, she had shielded her little sister from the teasing about her funny talking by always being her confidante. Because custodial caregivers thought Cari was “slow”, the brunt of work and responsibility fell on Anna. She had shielded Cari from punishment at home by always doing as she was told and being overly submissive and compliant to appease the punisher. It was partly self-preservation, but it was not selfish. It had tragic consequences for Anna because she had the more difficult diagnosis to treat and the gloomier prognosis as a result.

Mike was transfixed when I told him at dinner that evening what was going on with the sisters. At the end of that conversation he got this look in his eye and he said, “It’s too bad we can’t help them”.

I had seen that look before. “What are you, crazy!” I retorted.

(End of part IV)