Archive for February, 2010

First really, really bad day. Help?

I had a discussion with my team leader yesterday about how I was a little annoyed that when it came to my colleagues handing over 5 of their existing clients, they gave me a few real difficult ones in the 5. In one girl’s case, all 5 she gave me were her worst. Gee, you don’t see that coming when fresh meat comes into a community organisation.

It’s fair enough, I understand it’ll give me a lot of experience dealing with clients that are a massive challenge, and I’ll have something concrete to take into another job without searching for answers to interview questions.

On the other side of the coin, I was hired primarily to pick up new clients. As it stands, to date, I have taken on 2 of the 6 that have been given to me, because most of my time is preoccupied with the existing clients.

One of these existing clients is a 53 year old man on the disability program (the only disability program client we have) who has MS and lives in a nursing home. His family doesn’t visit because he’s incapacitated and they’re scared of seeing him this way. His own mother, also on the CACP package, has dementia and sometimes doesn’t remember he exists. She hasn’t seen him since he deteriorated drastically.

He has an Anglo financial power of attorney, let’s call her Pamela, who started off as a care worker for him. Pamela fell in love with him, had a sexual relationship with him, and is now so emotionally invested in the relationship that she would willingly kill off everyone that’s not doing the right thing (in her mind) by him. She has this belief that the nursing home he’s in is a terrible, horrible good for nothing place, with sneaky, suspicious nurses and manager. “They just want him to die. They just want to pull the plug and let him die. I won’t allow that.” Hearing her talk this way, before going there and meeting them and seeing the place, I was convinced she was right. I was wrong to do that. I was wrong to ever fall for it. “The terminal wishes they have on file is NOT correct. It says that he is not to be transported to hospital if he has an infection.[The client] wants an ambulance to be called immediately, not wait for this idiot doctors’ orders.” Pamela is one controlling, demanding, dominant person. “Oh and another thing, this doctor has to go. He’s doing nothing, he’s useless.”

Yesterday, I attended the nursing home for the first time to finalise his terminal wishes. In attendance also was his nurse, and our organisation’s male care worker. I was a little useless in the whole affair, because I found my language skills failed me significantly. Also, before I’d even set foot inside the place, I was panicking. The seriousness of my visit, coupled with my intense fear of entering overtly institutionalised places for the first time, made me nauseous. Pamela had painted the place to be a death’s waiting room. I didn’t want to go in, and I half thought of backpedalling the whole affair and going another time. In hindsight, maybe I should have.

The visit went well. The nursing home was paradise compared to some aged care facilities I’ve seen in the past. I spent an hour and a half with my client, and we tried as hard as we could to converse. I am confident the answers we got were the correct ones. As in, we explained, he understood, we signed the document, done. However, they will definitely not be correct in the eyes of Pamela. What ended up being signed was CPR to be conducted if heart or breathing stops (Pamela said he wants NO CPR), and instead of transportation to hosptial, for doctor to make decision but ultimately be treated at nursing home. I, as an addendum, added that client has own choice to ask for ambulance and transport to hospital. It is still his right to do that, but I thought it paramount to put it in.

When the nurse left to get the document prepared, I asked my client whether he currently liked his doctor. No, he shook his head. Do you want to change your doctor? Yes, nods. Are you able to tell us why you don’t like him? “Doesn’t do anything. Never comes. Doesn’t understand my needs” in a croak. Would it be helpful to have an interpreter or one of our care workers present for whenever the doctor visits? Yes, nods. We can try that, in if you don’t like it, we can change the doctor? Yes, nods. (On a side note, it rubs me the wrong way entirely that an interpreter has never been present when the doctor has attended. Talk about fundamental fuck-up)

Leaving the nursing home, I felt positive that what I’d done was the right thing to do. I felt as if I’d left with a good outcome. But as soon as Ihad gone two steps outside, my legs felt like jelly and the realisation hit that Pamela wasn’t going to be happy with any of this. I panicked. I felt nauseous. I felt sick.

Upon return to the office (after an hour long drive just to ‘clear my head’), I went to talk to my team leader. After one word, I bawled my eyes out. I realised, this is not because of this meeting I had at the nursing home. It was the thought of having to pass on the details of it to Pamela. I knew she wouldn’t like any of it. Even with the ammo of arranging interpreting/care worker presence during doctor visits. I knew she would be on my case. She would say I’m useless and probably demand her old case manager back. In my mind, hey, you’re welcome to. I’d be relieved if that happened.

So the team leader, seeing my distress, offered to call Pamela for me, and tell her I would set up a face to face meeting with her and someone else from my end. I was relieved that I didn’t have to talk to her, and I was rendered pretty much useless the rest of the day anyway because of how much life it sucked out of me. I was a fucking mess. Team leader told me to leave for the day, at 1pm, but I had about 432 phone calls that were all of equal urgency to make. I left at 4.15pm.

It is Saturday, and half of me is thinking I was a little gutless to not call Pamela. The other half is panicking about getting an even more irrate, even more upset Pamela on Monday, being left in the lurch for the entire weekend wondering what the outcome of the terminal wishes were. Then there’s the meeting. I don’t even know how I’m going to explain to her that I was too scared of calling her with an outcome that didn’t match what she had wanted. She will scream my head off. She will call me selfish and unprofessional and inexperienced and not completely aware or understanding of the situation. I will, most probably, cry. Further to this, if he died, she may even sue me for negligence or something equally fucked. The thought of this scares me more than anything.

So. I had some advice given to me by a friend of mine (ex-boss and good friend) about empowering her during this face-to-face meeting. Giving her a chance to let off steam, then asking her to list exactly what SHE wants, in dot points, and be able to meet her halfway with it. Try and arrange what can be done and what can’t. Miracle question – magic wand, what do you want. At the end of the day though, she’s not my client. Nor is she classified a carer. Her role as financial power of attorney is black and white and that’s it. So how far am I meant to go for someone I’m not even funded to be putting in serious case management hours with?

I would love some feedback here.

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I know it’s been over a month since I touched base. I find it really hard to blog when I’m working fulltime. No excuse, I just come home and crash. There are occasional moments where I am still thinking about work, but I really don’t feel like spilling my soul online. I even once thought “I should blog this”, and then I don’t.

Anyway, enough explanation. Let’s get to the post.

So I said I was unsure on my very first day, and now that I have had some time working there, well, I’m still unsure. I have had mini breakthroughs along the way, but essentially feel a little let down by my fellow countrymen (countrypeople more like). There is still a lot of iciness/bitchiness evident in all the workers, with the exception of the one I’ve been sat with, who shares the same first name as me (she is also the same age, and has the same previous qualifications, bar social work). It seems like they have something to prove, and are testing me. On top of getting 6 new clients (only 2 of whom I’ve assessed, one of whom keeps refusing services), I get 5 each from the other case managers. A couple of workers have decided to be really cruel and give me all the most difficult, most dependent, most difficult family members, most advanced in their chronic illnesses… The others have been a little more subtle and hid the hard one or two clients within 3 others that don’t require so much following up. I guess I’m whinging. I knew from the start I wouldn’t have an easy ride.

My language skills are being tested daily. I know that I need to practice, I know I need to read (more than anything, they say that reading skills help greatly with all other aspects), but it doesn’t come so easily. Like blogging. Ha.
I have all the best intentions, I have about 5 or 6 language books, but I guess my childhood frustration comes out whenever I start giving it a shot. Any tips?

Workload-wise, well… That’s another pickle. Despite not having assessed all my 6 new clients, I am finding the ‘difficult’ ones that I’ve been handed over are sapping all my strength and time at work. Having said that, for the most part I’m handling it. I have two clients with very progressed dementia, a lady with MS, a middle-aged man with MS (wheelchair confined and no communication ability), a lady with quite bizarre delusions and poor cognitive ability, a man whose dementia presents mostly as aggression (and, I might add, who spends most of his life savings on prostitutes), a lady who has three dogs she beats (one Pomeranian has a disgusting sore on his leg) and a lady who believes she is owed services, and treats many of the workers as such, her servants…. And those are the ones I can just pick off the top of my head. I actually really like working with my clients, they really challenge me, and for the first time I feel as though I’m actually using my social work skills.

The organisation is not without its faults. In fact, it has plenty of them. The CEO is, for want of a better word, a bit of a tyrant. She needs to be, but sometimes I wonder how much she isolates her workers because of her dictatorship behaviour. I understand her duty to keep the place going, however it may be an idea to include her workers, to make it less of a chore to come to work. For eg, our team building morning was convened by a guest speaker who specialises in teamwork and effective communication. The whole event was, very basically, a public grievance session, coupled with some weak attempts at problem solving. Not many felt it safe to express their views for fear of some sort of retribution. Ok, I didn’t feel safe. I wasn’t happy with quite a few staff members who never gave me the time of day. The receptionist for one. I requested a stationery order not once, twice but three times. In email and verbally. So I went out and bought them myself and claimed for it. There was no other way to get things done.

During this grievance session, it appeared that what most of the workers felt was a ‘good thing’ about working for the organisation was that everyone was ‘friendly’. I had to laugh. That is one of the things I strongly disagreed with, and many others felt the same way, I know for sure. Sigh. Also, there was nothing essentially fun about the team building. It was like it had been taken out of the textbook. To me, team building is about having fun, whilst problem solving together in certain situations and contexts. I remember at my previous job, the team building we had was one of the best days ever. We really felt like we’d gelled.

Not here.

I have had quite a few heart to hearts with both my partner and my ex-boss (now a good friend) discussing the future of my tenure there. I am in two minds. Although it present me with many challenges, on some days those challenges make it impossible to work effectively, on other days they almost fuel my drive. The bad has outweighed the good for quite some time, but now I feel like I’m making more of a gain on my own, and for the first time recently feel as though it’s changing for the better. I thought I could give it another month before I decide whether it is a definite yes or no.

It is now 10.08am and I haven’t eaten and feel a little woozy.

I hope that the next entry doesn’t take another month to post!!