Phase V, ACT VI: Child Protective Services, The child catchers

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The story went like this… Neighbors saw two toddlers out in the middle of the street without the supervision of their mother. A call was placed to Child Protective Services who promptly removed the children.

I began seeing the mother through a county program that provided mental health services for people who did not have medical insurance. In order to continue servicing her needs, my work was to be transitioned to the child welfare department as an independent contractor. I immediately found myself having difficulty understanding her rambling, disjointed thoughts and sheer anger with the department. I asked her about the work that she had been doing with another therapist and she was unable to clearly articulate any information that she had been able to retain. I knew that that she was suffering from a learning disability that would significantly interfere with her ability to process any information delivered in a linguistic format.

Through my own digging I was able to find out was that this young mother had gone to a local physician up river after feeling depressed. He had seen her over time for a multitude of issues and prescribed her more than 5 different medications. Because of her depressed state and strange speaking pattern, he diagnosed her with Bipolar Disorder and prescribed her another medication. It was then she began to act erratically. That led to the incident where the neighbors saw her two children out in the street and called CPS. I suggested that she see another physician who changed her medications and her behavior stabilized.

I was able to have her seen and evaluated by a clinical psychologist who formally dismissed the Bipolar Disorder and concurred with my diagnosis of a learning disorder. He suggested that she continue counseling with me and that there was no reason she would not be able to effectively parent.

CPS was convinced by an assessment conducted with the mother that she needed Dialectical Behavioral Therapy. I was able to convince the department that the woman was in need of some accommodation due to a learning disorder. I decided to take the most emotionally salient issue, her CPS involvement, and use it as a teaching tool instilling the best of Dialectical Behavioral Therapy tenets. The approach was tailor made for this woman and enabled her to learn skills that would make her more successful in her interactions with CPS case workers.

Using this adapted modality, this young woman felt more in control of the often contradictory and demeaning treatment that she received by the department. My notes reflected her ability to master awareness in her CPS interactions through noting differences in the people that she was forced to deal with and alternating her approaches to each person, using their responses as a way to gage whether she was being effective. She slowly mastered the skills through witnessing her own ability to meet the incessant demands placed on her.

Despite my positive feedback to the department, it was clear that they wanted her to lose her parental rights. Because I supported my client, I began to be harassed and told that she had NOT done the training because I did not use a book. Since I was not going to continue to work with her, as they saw fit, they were proceeding with termination of her parental rights.

During this mounting pressure, a hearing was held “to transfer the children to a family member” so that she “will be more likely reunited with her own children.”

She turned to me frantically, “I know what they are up to… They want to move the children further away, out of state, so that I cannot visit the kids. Then they can make the argument that enough time has gone by and I haven’t been able to visit…They don’t want me raising my kids. It doesn’t matter what I do.”

Her public defender told her not to worry and so did I. She was complying with the court expectations. You know something? She was right.

At the termination hearing, which I was not allowed to attend, the mother of these two young children was asked specific questions about Dialectical Behavioral Therapy. Of course, she was incapable of responding. Her parental rights were terminated.

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Phase V, ACT III: The Warehousing of the Elderly

ACT III: The Warehousing of the Elderly

The screams coming from the room were deafening. As I walked down the hallway toward the sound, I could feel my pulse quicken, my breath coming in short gasps, my palms sweating.

The male nurse must have seen the panicked expression on my face as he tried to catch up… “What’s the matter,” he asked me as if oblivious to the screeches and moans coming from down the hallway.

“What is going on in there?” I asked him.

“Oh, that is just Helen,” he said rather flatly, “She is old and believes that everyone is hurting her.” He turned abruptly on his heels and scampered away as if to nullify my concerns.

I couldn’t believe the callousness in his voice. Regardless of his lack of regard, and dismissing attitude, I rounded the open door and entered the room.

There she was…. slightly propped up on on her right side supported from behind by a long pillow, facing away from the door. She had a bony, tiny frame whose thin, frail skin bore red abrasions over her exposed protruding left scapula that had escaped the confines of the hospital gown carelessly thrown over her. She startled at the sound of my entrance and retracted, her already curled up appendages seemed to pull up closer, as she let out a horrifying scream..

“Mrs. Medlar,” I said to her as soothingly as I could, “My name is Nanaymie and I am the new charge nurse here on the 3rd floor”.

Her neck, as frozen as her bent appendages, strained to move and her eyes looked up at me in terror.

“Honey, I don’t want to hurt you.” I touched her lightly and felt her flinch. I removed the gown to expose the large bed sore over the end of her spine.

The nurse manager entered the room, “Just do the dressing change,” she told me loudly above the wails coming from the frail and writhing frame lying in front of us, “you can’t get involved with her issues. You just don’t have the time.”

“What happened to her?” I asked imploringly, in a vain effort to understand the foundation of the fear being evidenced.

“Helen was the wife of a man who spent most of his time beating her. Now that she is old, she can’t understand the physical pain that she is in and everything we do to help is torture”.

While that might have explained the mental status, it did not even begin to illuminate how this woman’s physical needs had been severely neglected as evidenced by immobile, bent limbs and bed sores that eviscerated healthy skin and tissue to reach the bony prominences over which they lay. Mrs. Medlar was in a perpetual fetal position, a metaphor for her imprisonment in a body that had been ignored, a mind haunted by a lifetime of trauma, warehoused in a nursing home where her caregivers “frankly don’t give a damn”.

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Phase V, Act II: Nursing Training at the Expense of Those who cannot Object

ACT II: Nursing Training at the Expense of Those who cannot Object

I had reentered the Nursing program at Rutgers University after a 7 year hiatus, being traumatized by being placed in a position to protect the life of a young mother in my Maternity rotation. Since that time, I had moved to Vermont , owned a restaurant and had my first of three children that I chose to birth at home. Abandoned by the father of my child, I returned to South Jersey to finish my training….

“I want you all to come into this room here,” the instructor called to the nursing students from the door of a room down the hall where an elderly man lay whose breathing was raspy and audible from the location of the central desk.

All 8 of us filed in the brightly lit room to find an old man propped up on pillows to facilitate his visibly difficult breathing…

“We are going to sink a nasogastric tube. We have been given the go ahead to do so,” she triumphantly blurted out.

The old man barely moved, seemed in and out of consciousness, and completely unaware of what was going to happen.

“Who wants to try?” the instructor asked us.

I was barely aware of the student who volunteered and proceeded to wash up and don her gloves. The instructor’s voice faded as I focused in on the raspy breathing body lying in front of us. He was a portly man sitting at a 45 degree angle just barely aware of his surroundings, though he seemed mildly distressed at the accumulation of bodies standing around his bed. His eyes opened and flickered briefly and then closed again.

“This is Mr. Salinas,” Dr. Romeo told us, and without a moment hesitation cranking the bed to almost a full seated position,” Mr Salinas, we are going to be inserting a nasogastric tube so that you get some nutrients that you need.”

She turned and addressed the nursing student by her side, “Now lubricate the tip of the tubing and insert it into his nose.”

Everyone leaned forward to get a better view as the man seemed to jump at the sensation of the foreign object entering his left nostril. As soon as the tube past into his throat, the gagging began. His face quickly turned red with the added strain to breathe.

“Swallow” the instructor yelled to the gagging, frightened, semi-conscious man in front of her, “swallow!”

I could feel the fear well up in me as I watched the scene in horror. Everyone else around me seemed oblivious to the sheer terror being felt by the struggling form in front of them. It felt like an eternity…

“Well done,” the instructor said to the student as she beamed with pride at the successful placement of the nasogastric tube.

At what cost, I wondered to myself as I followed the entourage as they left the room. I looked back to see the color return to the man’s face and wondered how many more procedures he would be forced to endure “for his own good.”