The role of “new mother” has been quite a learning experience. Of course before the birth of Marina I was full of ideas on how things would be, and should be, but having a baby is something you must experience firsthand to fully understand. I am grateful for my background in OT, and for Darren’s background in child psychiatry. Our educational and professional backgrounds have given us a lot of valuable tools and information.

One of the most challenging things about babies is listening to them, and trying to discern what it is they are telling us. Babies tell us so much. They communicate their feelings, their likes and dislikes, and they tell us exactly what we need. It is our job as parents and caregivers to listen. Imagine how difficult it must be to be a baby. You can’t control your movements very well, you can’t speak, you have almost no control over your life. You are completely dependent upon your parents for everything. If your diaper is wet and uncomfortable, you can’t change it, or even shift to a more comfortable position. If you have an itch, you can’t scratch it.

We were blessed with an incredibly calm, easily soothed baby. Yet, there have been many times when she has cried inconsolably, and we have been at a complete loss. This is where we have learned to listen. Through listening I have learned that my daughter doesn’t tolerate me drinking cow’s milk very well. She is also not a huge fan of fast food or pasta. She also has a hard time relaxing and falling asleep unless she has a cozy warm body next to for cuddling. She doesn’t like to look at things that move too quickly, and when she is focusing on something that interests her, she doesn’t like for me to talk too much. When she is having a hard time winding down at the end of the day, she likes for her daddy to sit with her on the theraball and bounce.

There are millions of other examples, but I won’t bore everyone by listing them. Our culture devalues the art of listening. We are not taught or encouraged to listen to our intuition, or even to our babies. We are told “babies just cry.” While there is some truth to that, I believe that babies always cry for a reason. I also believe that we should listen, and accommodate. Infancy is not the time to enforce schedules or instill independence. There will be plenty of time for that later, when they are more developmentally capable and ready to meet such societal demands. That is just my opinion though…

In a previous post I posed the question of whether or not health care is a right, but I did not include my personal opinion, so here goes… I do not agree with free health care provided by the government. There are numerous reasons why socialized medicine is a bad idea, at least in this country. Let me begin by saying that I believe the current system of health care is terribly flawed. I believe that a government system would be similar to the current system, with the only difference being that everyone would have at least basic coverage. I do not believe that universal health care would, or could provide unlimited services to everyone.

First, I do not think that non-medical personnel should be making decisions and policies about health care issues. For example, where to draw the line on treatments, what medical interventions should be provided to what groups of people, etc. With the current system, there are frequently non-medical personnel making these decisions, and the results can be frustrating for all involved, especially the person who needs the treatment. In addition to non-medical personnel making health care decisions, there is the issue of bureaucracy. Valuable dollars would inevitably be spent on managing the health care machine, which seems to be an inefficient use of resources.

I am a strong believer in that people need to be held more accountable for, well, everything. This includes their health. Part of the problem with today’s system is that millions of people are receiving costly treatments for preventable conditions, and only paying a small co-pay per visit. Having worked in health care, I have seen it over and over again. There is the person with obesity who develops diabetes, continues to eat unhealthy and not exercise, and then develops further complications. There is the person who is addicted to drugs, who is in and out of the psych hospital, and who develops medical complications from the drug use. There is the avid athlete who develops numerous orthopedic injuries and requires repeated surgeries and recovery periods in a rehabilitation hospital. I can’t help but wonder, if these individuals had to pay for all, or at least more of their health care costs, would they be more motivated to take better care of themselves?

I speak from personal experience. When I was 21 I got the flu. For years my doctor had warned that I needed to get a flu shot every year because of my asthma. Being so young, I felt invincible and ignored his advice. I had never experienced asthma symptoms that did not respond to a quick squirt from my inhaler. As I developed the flu, my respiratory status deteriorated over several days until I eventually wound up in “status asthmaticus.” I was intubated for several days, and when my mother asked if I would live, the answer was “we can’t be sure.” I eventually recovered and vowed to get a flu shot every year. That particular incident included a trip to the urgent care, two emergency room visits, one ambulance ride, one week in the ICU, and one more week in a step-down unit. The bill was in excess of $40,000. The following year, feeling invincible again, I found myself short of breath one afternoon. I drove to a nearby urgent care, and sat in the parking lot. I talked myself out of going in, not wanting the hassle of nebulizer treatments or oral steroids. Plus, I had plans for that night. Several hours later, there I was at a bull ring in San Antonio, sipping on a beer, surrounded by friends who were smoking. Later that night I found myself at Brook Army Medical Center (the nearest hospital), intubated again. This stay was only a few days, and I was discharged straight from the ICU. The bill was $10,000. In one year’s time I used more health care resources than I will probably ever pay out of pocket for in my entire lifetime, and it was all preventable had I followed my doctor’s advice of getting flu shots and staying away from asthma triggers. I acted incredibly irresponsibly.

I feel that there needs to be some level of personal accountability for use of health care resources, and financial accountability is a one place to start. Additionally, there ought to be a shift toward prevention, which is much less costly than treatment after the onset of illness or injury. Another important consideration is that the health care industry needs to move away from being for profit. Insurance companies and pharmaceutical companies make billions in profits each year while people who really need treatment suffer and even die. By eliminating the profit component, the cost of health care would inevitably be driven down.

The government can play an integral role in allowing access to health care as well as promoting wellness and prevention. Regulating the industry, particularly pharmaceuticals, would encourage more affordable health care options. Healthy living could also be promoted by subsidizing organic farms, providing tax deductions for healthy foods and gym memberships, etc. What if every tax payer had the opportunity to receive a significant deduction for maintaining good health??? This might include eating healthy foods, exercising, getting early screenings as needed, and complying with medical recommendations. Imagine if it were cheaper and more convenient to get healthy food on the go than it is to get whoppers, big macs, and french fries. Our government has the power to facilitate such things. It is up to us, however, to hold the government accountable. More importantly, however, it is up to each individual to take care of their health.

My fascination with schizophrenia began at a very young age. At age 8 was sitting in a parked car with a family member, who shall remain anonymous. That person asked me “do you hear those voices?” I said “no, what voices?” The response was “those little kids playing, do you hear them?” I strained to listen, and only heard complete silence. I wanted to hear the children playing, something on this person’s face made me want to hear the children. After listening, and even trying to imagine hearing children playing, I had to admit that I did not hear the voices. I was met with a facial expression that embodied fear, anger, frustration, and a plea…for what I do not know. That face is seared into my mind more than two decades later.

I went home and asked my mother who hears voices that other people cannot hear. She replied that she thought people with schizophrenia heard voices. I immediately went to work with the dictionary, the encyclopedia, and my mother’s medical books. This was, of course, before home computers and the Internet were widespread. I was hooked, and determined to learn as much as possible about this mysterious brain disorder. That family member continued to display signs of psychosis over the years, including seeing bugs crawling on their skin. I now know that this person does not have schizophrenia, but has experienced intermittent episodes of psychosis. In the future I will write another post about other causes of psychosis.

I remained fascinated with mental illness, the brain, and particularly schizophrenia. I felt, and continue to feel, a deep compassion for those who suffer from this disorder. I majored in psychology during my undergraduate education, and my first job upon graduating was in an adolescent residential treatment facility. My first day was spent reviewing charts, and I read every single word documented in two particular charts, which were two teenage boys with a diagnosis of schizophrenia. This was my first time meeting someone with the diagnosis, and I must admit that I was fearful.

I developed a lasting relationship with one young man, and worked with him every chance I got on developing insight into his symptoms, helping him to discern what was reality based and what was part of schizophrenia. I could not get the other young man to talk, or even look at me. He sat huddled in a corner most hours of the day with a blank expression on his face. One day I decided to try a different approach and asked him to write a story. I cannot remember the topic I gave him to write about, but for the first time, he responded to me. He took the pen and paper and began to write frantically. My jaw dropped when I read the disorganized, tangential, violent themes on the page. It provided a glimpse of what he was contending with there in the corner day after day.

I eventually began working with adults in various settings. My role was to “rehabilitate.” I worked with adults in the hospital, at home, at work, on the streets, in homeless shelters, individually, and in small groups. While I worked with a variety of diagnoses, I remained most drawn to those with schizophrenia. I was always happy to take the most difficult cases, and didn’t even mind venturing under soggy bridges filled with frogs and crack pipes.

Through the years I have found two discernible groups of people with schizophrenia: those who have insight into their disease, and those who do not. Those who have insight seem more likely to live a more normal life, while those who do not, tend to be fully enveloped in the world of psychosis, delusions, or disorganized thoughts. I have had lengthy conversations with individuals who fall into both categories. Those with insight have universally claimed that having schizophrenia is like being in hell. I remember talking to one man who I would have categorized as not having insight, until one day he looked at me and said “I’m just a schizo, and I can’t stop that terrible music.”

Another young man that I worked with had a great deal of insight, when he was taking his medication. He embraced his schizophrenia, and felt that it fueled his creativity. We worked together unrelentingly to pull his life together. He got his dream job of a barista, went to open mic night at a cafe to read his poetry, and found a roommate who was also a love interest with whom to share an apartment. One day he came into my office looking wild-eyed. He said that he couldn’t swallow his medication, that his throat closed every time and caused him to gag and vomit. I put in several messages to his psychiatrist, to see what options we had, whether it be to grind the pills, or if there was an alternate form of the medication. This occurred during my last few days working for this organization before moving to another state. As I handed over my case load, I asked the other therapist to immediately follow up with this young man, as I knew he was headed down a slippery slope. Several months later I received an email from the therapist saying that the young man had hanged himself. These are the tragedies of schizophrenia. Fortunately, there are some success stories as well.

I think I have seen as much of the dark depths of schizophrenia as one can see, without actually having the diagnosis. There is much more to share, including the treatment process, the decompensation process, etc. More to come later.

Many of my experiences working in mental health care have been shocking.  Interestingly, it is not the patients that have been shocking, so much as those who get paid to work with the patients, as well as the “system” that “cares” for the patients (aka consumers, aka clients, aka individuals with mental illness….I say patient because it is easier and because those outside the industry may not be familiar with the politically correct trends within health care.  Please know that I do not use the term “patient” with any derogatory intent whatsoever.  I am an supporter of those with mental illness and have expended much energy through the years to advocate for this population).

Here are snippets from some of my more horrifying observations:

• A mental health tech who gave drugs to a patient on a substance abuse unit
• A psych nurse who slapped a patient across the face for not staying in her room
• A delusional patient who was scared to go onto the unit upon admission was rushed and slammed onto the ground, and then put in a headlock and dragged onto the unit, even when he had not shown any signs of being dangerous, but had simply verbally protested to going onto the unit
• A van driver for an adolescent residential treatment facility who spent most of his work hours sipping vodka mixed with Gatorade
•  A psychiatrist who spent an hour shaming a woman into tears in front of all of the other patients on the ward
• A psych nurse who withheld a patient’s methadone for several hours simply because he asked if he could have it right away, and then when he protested she called the “team” to physically drag him into the seclusion room
• A mental health tech who taunted and made faces at an adolescent in locked seclusion
• A patient with acute psychosis left naked in a puddle of his own urine on a tile floor for several hours, when he attempted to leave the room he was physically blocked by large mental health techs
• A patient who was involuntarily sedated with medications fell asleep outside during a cigarette break, but was not noticed to be off the unit for several hours and suffered severe sunburns (this was a patient who was supposed to be checked every 15 minutes due to risk of suicide)
• A patient, also supposidly on 15 minute suicide checks, who died in their room and was not found for 7 hours

Those are just a few incidents.  Sadly, this population is among the most vulnerable.  Because of the negative stigma in our culture, these type of scandalous occurrences do not receive the media hype that more socially acceptable populations receive (e.g. the elderly, children, abused wives, etc).  There is little consequence to those who abuse or neglect this population.  Typically, the worst that happens is that they lose their job, but even that is rare.  This population is largely reliant on others to advocate on their behalf, because many of them are not able to self-advocate, and many of them have lost family support.   One place that every person can start is by doing their part to reverse the stigma.   More on this in another post…

The story of schools issuing oral contraceptives to middle schoolers in Portland, Maine has been a hot topic in the media over the past several weeks. As a new parent of a baby girl, this certainly evokes strong opinions from both my husband and me. We also have the medical perspective, since we both work in health care and particularly with Darren being a physician.

In general, it is probably safe to say that “the pill” is relatively low risk. It is not completely without risk, however. One major risk is that of blood clots. I remember when I was in high school, a friend of mine was rushed to the hospital with calf pain. She did have a blood clot, which doctors said had the potential of being fatal. She was ordered to quit taking birth control pills, and informed that she should never take them again. What if she had been issued those pills without her parents’ knowledge or consent? And what if she had chosen to keep them a secret upon arrival at the hospital?

Medical risks are only one area of concern with giving children medications without parental knowledge or consent. Is it really okay for us to hand over such decisions to complete strangers? Children are not equipped to make these decisions on their own. Granted, some of them do, and some children will have sex “no matter what.” That is not the case with all children. As a society, we continue to diminish and invalidate the powerful role that parents can play in the lives of their children. We also continue to de-emphasize parental accountability. Case in point: the 10 year old boy in California who was playing with matches unsupervised, which resulted in catastrophe, death, injury, and enormous loss for thousands of people. Not once in the media have I heard mention of parental accountability in this case.

Another area of concern with schools issuing oral contraceptive is the fact that it does not protect from disease. It may protect against pregnancy, if taken correctly. Let’s be honest…how many 11 year old girls are mature and responsible enough to manage a medication regiment? And while it may be beneficial that pregnancy is avoided, what happens when she gets HIV, chlamydia, crabs, or any of the other sexually transmitted diseases?

One woman on the Portland school board who was a proponent of this bill stated that only about five girls per year were asking for birth control. Since when is legislation passed, and laws changed, in response to five pre-adolescent girls’ wishes?

The most I can say is that this is complete absurdity. Both my husband and I agree that if we lived in that school district, or if something like this were passed where we live, that we would be moving. Marina is our daughter. Not the school’s, the city’s, the county’s, the state’s, or the country’s daughter. She, her well being, and her best interest, are ultimately our responsibility.

We had a late appointment with our accountant this evening, we were hungry, and there were the glorious golden arches.  We make a concerted effort to minimize our intake of fast food, but sometimes we do cave in.  As we sat in the line, which snaked around the building, I remembered a recent McDonald’s commercial on television.  The commercial consisted of carrot sticks, lettuce leaves, and tomato slices making their way across the screen, with something along the lines of “it’s what we’re made of” flashing amid the dancing vegetables.

I find the whole thing rather appalling.  Sure, they put some wilted lettuce and tomato on the whopper, and they do offer some salad options.  The commercial, however, really should have shown slices of processed american cheese, fake-ish chicken with the consistency of foam, and vats of bubbling oil for deep frying.

As I thought to myself that they must think the masses to be complete morons,  I came across a study that yielded frightening results.  In the study, McDonald’s food items were given to preschoolers.  Some of the items were plainly packaged, and other items were packaged in traditional McDonald’s packaging.  The preschoolers rated the food in the McDonald’s packaging as tasting better.

Does this mean we are complete morons?  Would we have stopped at McDonald’s tonight if we weren’t bombarded with their advertising?  Who knows…  Yet as I sit here and polish off my 1/4 pounder with cheese, what can I say except…..”I’m lovin’ it.”

The concept of health care as a right has become an increasingly hot topic, particularly with presidential elections around the corner. There are many legitimate arguments to be made on both sides of the fence. First, we must clarify what that question means. Does it really mean “is FREE health care a right?” When something is determined to be a “right,” does that mean it becomes the responsibility of the government to provide, uphold, and enforce that right? Rights are dynamic and subjective. Therefore, the answer will largely depend on current cultural trends.

Health care is an area that is very near and dear to my life. I have worked in health care for most of my adult life, as has my husband. I have also been a lifelong consumer of health care, including several hospital stays. Let’s assume, for the purposes of this blog entry, that we are talking about “universal health care.” That is, health care that is managed by the government, funded by tax dollars, and equally available to all citizens.

There are numerous questions to consider related to the concept of free health care as a right. Most rights have responsibility attached to them. There has been an increasing trend in this country, however, to emphasize rights while simultaneously de-emphasizing individual responsibility. When imagining a United States with universal health care, I cannot help but wonder whether there would be limits, or whether it would be an “anything goes” system.

Is it society’s responsibility to provide free health care to the drug user who has overdosed for the fifth time in her life? What about providing a free leg amputation, free prosthetic leg, and a year of free rehabilitation to the diabetic who chose not to correctly manage their disease? What about providing ongoing prescription sleep medication for the person who has a hard time falling asleep at night? Or how about providing free viagra for the man with erectile dysfunction so that his self-esteem will not be eroded?

Where should the lines be drawn, and who should be in charge of making such decisions? In this post I present questions. I am refraining from including any personal opinions, as I feel that warrants a separate post.

I am an occupational therapist, which means that many people have no idea what I do for a living. This blog should serve as an excellent forum to promote and increase awareness of occupational therapy. Being such a broad profession means that even occupational therapists sometimes have difficulty explaining what it is that we do. One description is that we give people “skills for the job of living.” Regardless of how we describe what we do, it is one of the best professions out there (my humble opinion).

Often, when people hear “occupational therapy” they are misled into thinking that we help people with employment. Yes, we might help people with some aspects of employment, but we do much more. The word occupation in this context refers to anything that a person does that is meaningful to them. There are many things that are meaningful to us that we may take for granted, like being able to go to the bathroom independently, or getting into the car and driving to the grocery store.

So, occupational therapists help people to participate in meaningful occupations. We typically work with people who have some sort of disability, either from illness or injury. We also work with people of all ages. Some examples of what we might do include helping a premature infant to safely feed, finding a way for a child with cerebral palsy to fully participate in her day at school, or training an adult who had a stroke to use adaptive equipment in order to continue to live independently.