Mental Health First Aid

Mental Health First Aid

Laura Begin

Springfield School of Social Work

MSSW 612 Policy II

People with mental illness are discriminated against resulting from both personal and public stigma associated with mental disorders (Cummings, Lucas & Druss, 2013). This was demonstrated by a group of participants from a Mental Health First Aid Training class when asked to develop an “A to Z” list of adjectives describing mental illness. The following is the list they composed: agitated, ballistic, crazy, depressed, extreme, frantic, grandiose, homicidal, insane, jumpy, killer, lunatic, manic, neurotic, oppressed, paranoid, quirky, resistant, scary, traumatized, unstable, violent, withdrawn, extreme, yo-yo and zany (personal communication, 2014). None of the attributes are positive or conducive to improving the perception of mental illness and treatment.

The purpose of this paper is to illuminate the stigma surrounding mental illness. The intent of the Mental Health First Aid Act 2013 is an effort to educate, inform and activate the general public toward eliminating bias and barriers to humane care for mentally ill individuals. While some components of stigma may reach beyond the scope of federal legislation, augmenting previous legislation aimed at eliminating discrimination of the mentally anticipates breaking down stereotypes and prejudices that prevent just provision for this growing population.

According to issue five, the latest of the Diagnostic Statistical Manual (DSM), there is more than a 50 percent chance that you’ll have a mental disorder within your lifetime. The previous version, DSM-IV, put the approximate numbers of Americans being diagnosed with a mental disorder at 46.4% based on a study from 2005. The new manual will likely make getting a diagnosis even simpler and include more of the population. (Rosenberg, 2013).

There are several reasons for the increasing numbers. The swelling epidemic can be attributed to better detection of mental illness. Also, more of us are becoming mentally ill than in previous generations and with earlier onset in our lives. Another rationalization for amplified incidence of mental disorder is reflected in our culture. Some behaviors once considered within normal range of human practice are currently regarded as pathological in the continuum of mental health care. Essentially, the definition for mental illness now encompasses more people (Rosenberg, 2013).

DEMOGRAPHICS
The National Institute of Mental Health (NIMH) states that:
• 61.5 million people; 1 in 4 adults, experience mental illness is a year
• 13.6 million live with a serious mental disorder
• 20 percent of youth experience a severe mental disorder in a year
Substance abuse – like alcoholism – are not in the estimates despite being in the DSM-V.
It may be argued that with the most current data, nearly 1 in 3 Americans suffer from a mental illness, which translates to over 75 million people (Grohol, 2010).

The Centers for Disease Control (CDC) reports there is still stigma surrounding mental illness despite the widespread affliction of mental disorders affecting Americans. A 2007 survey reported that only 57% of Americans considered people to be sympathetic and considerate toward persons with mental illness. More importantly, only 25% of people with mental illness believed that people were concerned and supportive of them (“Burden of mental,” 2013).

PUBLIC PERCEPTION
It is no secret that what makes headlines and floods social media is what influences public opinion. With the rash of mass shootings in the U. S. over the last few years, the mental health of the shooters is what has drawn mental health into the spotlight and as a result, has been the focus of public opinion and new legislation. As recently as the first week of April 2014, mental health deliberation continues. There has been great attention and legislative action in our nation’s capital. Under comprehensive legislation, Medicare reimbursement for mental health physicians passed both the House and Senate and is pending the President’s signature. An eight-state “pilot-program” intended to streamline services by community mental health clinics is one component of the bill. The second approves a “demonstration program” of federal grants for outpatient treatment of people suffering from mental illness who are not participating in treatment and have experienced significant adversity such as incarceration, repeated hospitalizations or homelessness. (Carolla, 2014).

At the National Press Club, Virginia Senator Creigh Deeds, whose son died from suicide last year, spoke about the continued need for extensive mental health reform. A hearing that focused on the shortage of psychiatric hospital beds supported Deed’s perspective.
Mary Gilberti, Executive Director of the National Alliance of Mental Illness (NAMI), also acknowledged that in addition to there not being enough beds to meet the needs of people living with mental illness, other services are severely lacking. Those services involve:
• Early intervention mental health screening
• Crisis response and stabilization programs
• Discharge planning
• Outpatient services
• Peer Support
• Assertive Community Treatment (ACT)
• Supportive Housing
• Jail Diversion
Additionally, a hearing for the Helping Families in Mental Health Crisis Act was scheduled for early April 2014 (Carolla, 2014).

On April 2, 2014 the debate concerning mental health and gun control was reignited after another shooting at Fort Hood in Texas. The shooter was identified as having behavioral and mental health issues and was being assessed for Posttraumatic stress disorder (PTSD). Issues of security and gun restrictions at Fort Hood were raised. Rules about carrying firearms on bases were highlighted. Soldiers are unarmed while on post and are prohibited from carrying privately owned guns. After the 2009 massacre at Fort Hood there was a rash of suicides on post and consequently only law enforcement and security personnel have weapons while on post (Krayewski, 2014).

There is no shortage of pundits criticizing the mental health crisis, pushing for gun control while opponents insist responsible gun owners aren’t the cause of violence. Unfortunately, mass media gives these incidents the most attention and by doing so link mental illness with gun violence.

SOCIAL JUSTICE
Nonetheless, diagnosable and treatable mental health illnesses such as anorexia, depression, PTSD, substance abuse, suicidal ideation and more are the leading cause of disability in the United States according to the National Institute of Health (“The numbers count,” 2012). All across America individuals and families struggle. Someone has a parent with depression or a friend who is bipolar. Someone else has a neighbor who returned from war with PTSD or knows a co-worker who is suicidal. Or someone has a sibling trying to get sober. These are real threats to our well being as a nation yet many people suffer in silence and don’t seek treatment because of the stigma associated with mental illness. Others remain aloof and detached from those who are afflicted with mental illness rather than speak up or to offer help. Some reluctance is due to ignorance. Some is due to ambiguity; not knowing what to say or do. And in the case of those with severe mental illness, they are unrepresented unless advocated for by others on their behalf.

HISTORY OF CARE FOR MENTALLY ILL
In 1843 Dorothea Dix submitted her Memorial to the legislature of Massachusetts imploring those in leadership and authority, to advocate for the inhumane conditions that brought unjust suffering to the mentally ill. Dix’s efforts were in stark contrast to Social Darwinism and survival of the fittest. She appealed to their honor and humanity, begging them to “put off the armor of local strife and political opposition” and to “raise up the fallen; succor the desolate; restore the outcast; defend the helpless…” (Parry, 2006).

Unfortunately, not many strides have been made with regard to the social welfare of the mentally ill since the mid nineteenth century. In David Gil’s essay in which he outlines his understanding of social justice on the levels of individual human relations, social institutions and global human relations, it can be argued that the plight of the mentally ill has remained paralyzed. In Dix’s era, ignorance was largely responsible for the callous treatment the mentally ill suffered. Psychology and pharmacology had not developed to comprehend or respond to mental illness and consequently mentally ill people were regarded as incurable (Vinney & Zorich, 1982). That lack of knowledge may explain society’s ignorance in not knowing what to do with the mentally ill, however, ignorance doesn’t justify or excuse inhumane treatment. The responsibility of how to treat fellow human beings lies to individual, societal and cultural character, integrity and morality.

There is a saying that a person’s character is reflected in how one treats those who can do nothing for you. Aside from those who would debate whether or not morality could be legislated, this moral imperative is what Gil alludes to in defining social justice and a society’s response in meeting its member’s intrinsic needs. What a society values is reflected in its social, cultural and technological development. The outcomes determine people’s quality of life (Gil, 2004), thus a social system’s policy is equivalent to humanity’s core values and choices to either address or ignore them. Finally in the U.S. mental health parity is now law, yet mental health care is in crisis.

Article 5 of the Universal Declaration of Human Rights, guarantees that ‘no one be subjected to torture or to cruel, inhuman or degrading treatment or punishment (“The universal declaration,”). Deinstitutionalization of the mentally ill was well intended to uphold human rights by closing mental hospitals and transferring patients to community-based mental health agencies; however, the lack of forethought and provision for patients once released can be reasoned as a societal failure. The consequences of such moved many mentally ill people out of mental institutions and into jails, subjecting many to repeat hospitalizations and homelessness (Torrey, 2014).

The CDC’s findings in their Mental Illness and Stigma study from 2007 highlighted the need to educate the public about how to support people with mental illness and the need to reduce barriers for people seeking or receiving treatment for mental illness (“Burden of mental,”). Actress Glenn Close stated, “The mentally ill frighten us and embarrass us. And so we marginalize the people who most need our acceptance. What mental health needs is more sunlight, more candor, more unashamed conversation “ (Close, 2009). With discussion and education the stigma surrounding mental illness can be dissipated and impediments to treatment minimized.

LEGISLATION
In President Obama’s Now Is The Time report, he called for Mental Health First Aid Training to enable educators and school staff to recognize the symptoms of mental health disorders in young people and find resources for their care. U.S. Representative Ron Barber of Arizona originated a Mental Health First Aid bill after the Tucson mass shooting in January 2011 in effort to decrease gun violence. It received strong bipartisan support. The gunman was diagnosed with mental illness, however Barber has stressed that over 95 percent of people living with mental illness are not violent. In fact, they are more likely to be victims of violence, not perpetrators (U. S. rep, 2014).

Barber contends that 60 percent of people with mental illness are not receiving treatment in part because people are uncertain about how to respond to a person with mental illness (U.S. rep, 2014). Broadening public awareness about mental illness symptoms by training educators, fire fighters and police officers, emergency service workers and members of the public sector about mental health services is the objective of the Mental Health First Aid Act of 2013 (Mental health first, 2013). The Act provides $20 million in grants, which fund Mental Health First Aid training programs throughout the nation. The training aims to teach participants how to recognize the symptoms of common substance abuse and mental health disorders. The program instruction also includes de-escalating crisis situations and introducing appropriate referral to available resources (Mental health first, 2013).

MEDIA JOURNAL
American Psychosis by Dr. E. Fuller Torrey
Dr. Torrey is a psychiatrist who believes the federal government is responsible for ruining treatment for the mentally ill. He traces the history of deinstitutionalization and gives critical analysis of the results. He contends that the development of Thorazine, a drug to treat delusions, hallucinations and manic symptoms of severe mental illness, gave misguided though well intentioned hope to decision makers. He contests that relying on drugs as a panacea for treating the mentally ill has proven to be insufficient and damaging to the mentally ill and society at large. The errors he charges, are in closing mental hospitals, misunderstanding what is involved in community treatment and federal financing of mental health care (Torrey, 2014).

He condemns the change in the American Psychological Association’s original intent from treating mental illness to mainly functioning as a lobby to protect economic investments of psychiatrists. He asserts that the mentally ill have been abandoned. While there may be agreement on what services should look like, there is no consensus on how to organize care or how to fairly fund it. Torrey argues that federal programs prohibit improving mental health care because of conflicting political interests striving to maintain the status quo of a capitalist economic society. He cites the Nursing Home and Home Care industry’s motivation for profit as a major impediment to properly caring for the mentally ill (Torrey, 2014).

Torrey goes further to point out that the public has a mistrust of psychiatry that is further compounded by society’s misunderstanding of the civil rights of mentally ill people. Those that claim the mentally ill homeless have a right to live without an address on park benches, under bridges or in jail are missing the mark. People whose mental capacity is compromised are not living by their free will. Their actions are commanded by delusions. Mental illness is the only illness where the brain can distort reality and prevent the patient from knowing he or she is ill (Torrey, 2014).

Much like the paradoxes Deborah Stone speaks of, when it comes to mental illness there is no clear distinction of how to best meet the needs of the mentally ill and the general public. There is a trade off between a market model and a political model (Stone, 2012). Both populations need protection and provision. As quoted by Torrey, (2014) Psychiatrist Gary Maier has said, “When the personal freedom of the mentally ill is given priority over all other considerations the tyranny of some will jeopardize all.” This illustrates negative liberty where mentally ill persons have freedom to – live according to their free will and positive liberty where the public wants freedom from – security pertaining to the mentally ill (Stone, 2012). As a society we are faced with the dilemma of how to protect the rights of all our citizens.

Nonetheless, failure to provide appropriate treatment to people with severe mental illness is perpetuated by society’s lack of understanding. Torrey emphasizes that much of the public believes mental illness is psychological and not biological in origin, however, schizophrenia, bi-polar disorder and severe depression are brain diseases, as are Multiple Sclerosis and Alzheimer’s disease (Torrey, 2014). Therefore, public education is a vital component in providing comprehensive care to the mentally ill which may in turn reduce the stigma surrounding the predicament.

National Public Radio
A First Aid Kit for Mental Health Emergencies
October 18, 2011

Host: Neal Conan
Guests: Bryan Gibb – Director of Public Education, National Council for Community Behavioral HealthCare

Clare Miller – Director, Partnerships for Workplace Mental Health

The Talk of the Nation program featured two guests who provided information and education for the program entitled: A First Aid Kit for Mental Health Emergencies.
Mental health is a distinct issue separate from gun violence as evidenced by this public radio program. It is important to recognize this interview took place before the influx of the more recent mass shootings linking mental health to gun violence. The key points taken from this episode are important in educating the public and shifting the ambiguity many people feel when it comes to dealing with people experiencing mental health challenges.

Bringing training to the workplace is instrumental for eliminating stigma. Many human resource departments welcome and provide training for traditional physical health emergencies such as CPR for heart attacks and the Heimlich Maneuver for choking, but when it comes to emotional first aid there a void. Co-workers need to know how to respond to mental health crisis as well because there is more chance for a mental health issue arising in the workplace than a heart attack or choking incident (“A first aid,” 2011).

The mental health first aid course prepares the participants to be aware of subtle changes in a person and how to respond to them. The human resources department has responsibility to protect its valuable resources, its employees. If a person were to develop symptoms of diabetes, he or she would be directed to services in an effort to help maintain the employee’s viability and productivity. The same model needs to be applied to employees with mental health concerns. The employee needs to have intervention which includes addressing what is observed and if necessary directing them toward resources. Often this is in the context of employee assistance programs (EAP’s) (“A first aid,” 2011, “National survey on,” 2013).

The mental health first aid program doesn’t impart diagnosis or treatment methods. It teaches participants to recognize, confront and refer the same way a supervisor observes, informs and recommends. In the workplace privacy can be a concern. The program doesn’t deter from legal or professional obligations. In a definitive emergency when someone is at risk for harm to self or others, standard emergency protocol prevails (“A first aid,” 2011).

Job security is an issue for employees who are reluctant to seek help for fear of being fired if they reach out for help. The double standard between physical and mental illness needs to be eradicated. If diagnosed with a mental illness, job security, hospitality and support from co-workers are usually hard to come by. A listener who called in to comment illustrated this. She had experienced mild psychosis over a two-day period because her meds had been altered. She was fired. If she had experienced a heart attack, she would have been welcomed back and probably had casseroles delivered for a few weeks after the incident. Firing an accomplished employee for a treatable mental health issue is an injustice that must be corrected (“A first aid,” 2011).

Employers and business owners of the free market can be considered penny wise and pound-foolish when their highest priority is their profit margin and at the expense of their employees health. Depression costs $50 billion in lost productivity every year while substance abuse costs $200 billion a year in lost productivity. Employers need to work smarter and invest in their employees by funding mental health care and preventing unnecessary loss (Impact & cost, 2013).

The New York Times
Sunday Review Op-Ed Columnist Nicholas Kristof
Inside a Mental Hospital Called Jail

Mr. Kristof highlights the irony of the truth; that the same society that detested locking up the mentally ill in mental hospitals now locks them up in jails. He summarizes sobering statistics from the National Sheriff’s Association and the Treatment Advocacy Center: three times as many mentally ill people are housed in jails as opposed to hospitals. Forty percent of people with severe mental illness have been arrested. They aren’t incarcerated because of their psychiatric issues directly, rather indirectly. They end up getting arrested because their violations stem from offenses that result from their mental illness The Justice department reports mentally ill inmates are preyed upon and receive more injuries than those without mental challenges (Kristof, 2014).

Kristof points out that incarceration of mentally ill inmates costs American taxpayers between $300 and $400 a day. Often the mentally ill will stabilize and be released, and once back into the community without supports, they go off their medications and their symptoms escalate. They eventually re-offend and break the law again and the cycle repeats. He argues that fiscally it doesn’t make sense to incarcerate because it would be more cost effective to manage their mental health care in the community and maintain their stability with caseworkers and other community supports (Kristof, 2014).

SUMMARY EVALUATION

The National Association of Social Workers Code of Ethics focus is to improve
the well being of humans by meeting their basic needs and enabling the vulnerable, oppressed and impoverished (“Code of ethics,” 1999). Social workers are distinctively prepared to advocate for the dignity of every human being by upholding basic civic and political freedoms at the micro, mezzo and macro levels.

Being agents of change, social workers commit to work on the behalf of vulnerable and oppressed populations, particularly toward fostering social justice. The construct and implementation of the Mental Health First Aid Act promotes this objective as well. Educating about mental health by providing information, directives and resources for the public to recognize symptoms, intervene and refer compromised individuals to professionals is critical for the benefit of everyone in society.

The implementation of the Mental Health First Aid Act is foundational toward affecting positive change toward the mental health crisis in America. Shifting the focus from sensationalized media reports linking the mentally ill with gun violence to promoting factual information to the public is the first step of many in combatting the personal and public structural stigma of mental illness. Engaging the general public to aid the mentally ill serves both populations. Given the anticipation of the numbers of persons who will develop a mental illness in a given year, the demand for mental health care will be staggering. This legislation addresses early intervention, crisis response and peer support, but doesn’t impact the present problems of stabilization programs, discharge planning, out patient services, supportive housing or jail diversion.

Momentous federal legislation has made headway in defeating discrimination of the mentally ill within the areas of healthcare, education and employment. The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) targeted the health insurance industry to provide equal coverage for mental health and substance abuse disorders treatment. Where the MHPAEA lacked, the Patient Protection and Affordable Care Act of 2010 (PPACA) filled in gaps by requiring inclusive coverage for substance abuse and mental health disorders within benefit package plans by insurance companies and with coordination betwee Medicaid plans (Cummings, Lucas & Druss, 2014). Building on these landmark pieces of legislation, the Mental Health First Aid Act may serve as an impetus for radical change toward refurbishing the present complications that resulted from deinstitutionalization of the mentally ill.

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Out of Suffering

coelho-fear

I woke from a sound sleep. I was in pain. It was too familiar. I knew what it was yet in my thought process I needed to invent a myriad of other possibilities hoping it would disappear or morph into something more manageable. And by morning I was thinking I could deal with this level of discomfort if this was as bad as it was going to get. In hindsight, my tolerance and threshold for pain in all its forms seems to be limitless because I’m still here. Growing. Engrafting. Being.

I had things to do. I had to get my roots done and get my daughter to her piano lesson. Those were the essentials and pretty much all that was accomplished that day. It’s hard to remember now. I think my fever coma eradicated a lot of connections and memory. Or maybe the fuzziness is from head trauma since I passed out?

The pain, it was not leaving, it was deepening; reminding me I wasn’t getting off easily. Having another kidney stone journeying through my ureter uninvited and unwelcomed wasn’t something I could manage on my own. I relented in fear. I wasn’t afraid of the pain. I was familiar with what that felt like and knew what it would do to me. I was mentally pacing myself for the process. My issue was not having insurance. I’m not stupid. Stubborn? Yes. Is this where I should plug in don’t judge me?

I stopped carrying insurance because I was paying over six grand a year and not using it. Essentially throwing money away. My alimony income is finite hence the push to get as credentialed as I can because I’m going to be sitting across from some thirty something telling him or her how valuable my life experience is to them and that they should hire me even though the last time I signed a paycheck was when Reagan was in office.  I’m reasonably fit and make effort to maintain my health. I had minimal “coverage” through my undergrad school as a student, but that expired with graduation. So technically I’ve only been without medical insurance since June. I will be on my grad school’s required coverage in a matter of days so it wasn’t complete negligence on my part; more of just the way my life tends to unfold.

By day three, a Friday, I was getting anxious. In the medical and business world the weekend is not a good time to seek treatment. I knew I could play the system by going to the ER. They have to treat you even without insurance. But I knew I needed a CT scan before anyone was going to deal with me. I wanted to be treated with some amount of dignity I knew was absent in the ER of most major hospitals. So I surrendered to my circumstances and I texted my Urologist. That may come off as a minimalistic no brainer to you but for me, it took a lot of courage. I started out apologetically by saying I hoped I wasn’t interfering in a vacation or something, but was pretty sure the stones were active and that I was trying to discern whether or not I needed to be seen. I’m still suffering from put yourself last syndrome and I don’t want to bother anyoneitis. As it turned out, she was in the Caribbean.

In my August 2005 kidney stone attack I was rushed by ambulance to the hospital. By then I’d already endured several hours of agony, had turned blue, passed out and I don’t really know what else happened. This was after my morning run and my Kashi breakfast. So not fair. It was a rapid onset and yes as they say the pain was worse than childbirth because kidney stone pain is relentless. It doesn’t rise and fall and let you catch your breath. There is no reward at the end that makes the effort expended worthwhile. For me it was not knowing what was wrong with me that made the anxiety as consuming as the pain.

They told me my stone was a big one, a centimeter and not likely nor advisable to pass. I had Ureteroscopy surgery to break up the mass. It wasn’t completely successful so I had to be scheduled for lithotripsy surgery. I left with a stent in and the lovely little apparatus to strain your urine through. I was somewhat uncomfortable from what I remember. I was still bleeding from somewhere and doubled over in pain while at the Rolling Stones Concert that same day I’d been discharged. We had 9th row seats. That’s something you don’t pass up. I didn’t make it through the entire show. I was more concerned about being vulnerable to jabs and shoves if the crowd erupted into a mosh pit. I had the lithotripsy surgery two days later. My urologist was good to me and took out the stent on her day off because true to form, my schedule didn’t allow for illness or down time. I was starting Massage Therapy School and could not take the time off.

So here I am eight years later. I’ve been home for a week after my healthy vacation with family, which consisted of exercise, good nutrition and rest. I’m anticipating the start of grad school and wanting to tie up a thousand loose ends and then~whammo. I’m forced to put life on hold, a hostage in my own body. Only now, I’m both divorced and widowed, insuranceless and friendless, living on my homestead, climbing out of a black hole from several years of trials and loss. I don’t live in an estate anymore, I don’t have the army of support I had then. And I’m removed from civilization.

As the day progressed I knew I needed to take action. I made an appointment with the Urology group. I had to see the doctor who was on duty. I needed a CT scan and was able have that done in the same building. I had to decide which credit card I was going to put it on. $900, plus the office visit fee. My cortisol level was climbing because I am just a couple more months from being on task with paying off debt and it seems like there is always something to derail that goal. I mean I’ve gone to great lengths to save where I can. I stretch out my root job appointments and commit chemical malpractice on my hair to save money.

I was getting ready to leave for the appointment with my arsenal of credit cards in hand when I got a call on my land-line. I rarely if ever answer that because the only people who call on it are business related. I only have it for my security system. But for some reason in the middle of my turmoil I felt I needed to answer it. That was confirmed when I heard the caller ID say North Carolina. My mom lives in NC. I could feel my pulse quicken and my throat tense.

But it was my step-father. He went through the polite formality of hello while we both knew he needed to get to the punch. We don’t talk or call each other… unless. I asked what was wrong. There’s something that happens as soon as you know your loved one isn’t dead. You immediately muster the resolve to brace yourself for what you don’t want to hear because you know what’s to  follow is still bad.

Hearing my mom suffered a heart attack and stroke and was paralyzed made me envision her as one of the many patients I worked with in nursing homes. One of the bitchy nasty hostile ones who would scratch me and try to smear their feces on me. Her carotid artery is 98% blocked. She is a ticking though erratic, time bomb. I know full well what her future may look like. A part of me will have to deal with the reality that my mom, who has never been here for me, will be even less available now. My pollyanna dream of some sort of reconciliation or semblance of a relationship is shot. I hung up and tried to pull myself together and shrug it off since that is a battle I surrendered to a long time ago, or so I had thought.

The flood of tears came. I couldn’t hold them back. My first thought was that I couldn’t even call anyone because no one cares about her. My two brothers hate her. I wouldn’t know how to reach them anyway but that wasn’t the issue today. She has no relationship with any of her living siblings. And my cousin, who she once took in, has no love loss for her either. I’m it for my mom.

In radiology I waited in the overcrowded waiting room trying to be grateful because I was discounted a percentage for paying up front. My radiologist was real. I could tell because I was able to pick up on her energy. I spilled my reader’s digest version of my scenario and asked her if she could shoot my ovaries too while she was at it because after eight pregnancies I know they are in revolt.  I’m certain my uterus is on strike as well. I suspect ovarian cancer, but that’s for another story. I was grateful to have an authentic exchange with a real person amidst the craziness of my life. It gave me hope to continue on and go upstairs.

In the Urologist office upstairs every socio-economic demographic of class was represented in the waiting room. There was a sweet man in a wheel chair with an aide waiting for a transport company to take him to what I assumed was some sort of home. I was preoccupied with what his life might be like. He stood out to me. His warmth and his positive energy struck me. He was probably someone often overlooked by many. He was so personable and intent on making contact with everyone. He included me in his chit-chat with the other patients. When I pulled away by taking out a book he commented that I must like to read. He did too.

The doctor on duty told me that I was indeed passing another stone. This one was about 5 mm. He said I was scheduled for surgery on Monday and I’d need blood work done down the hall. I interjected with my questions. Wasn’t there something I could do at home, what if I could pass it? He said the stone still had a long way to go. He handed me a packet with a few pills in it and said he didn’t want me to get an infection. There were no labels or instructions for dispensing them. He exited saying if the pain subsided I should call early Monday to cancel but I might need lithotripsy as well so I should keep my schedule open.

I was supposed to go sailing Tuesday and Wednesday.

In the middle of my melt down in my car in the parking lot I got a call from the surgery scheduling people at the hospital. The woman was very empathic. Someone from the Urology office must have warned her about my emotional overload because she knew about my mom. Then she dropped the bomb. Didn’t anyone tell me I needed to have someone pick me up from surgery? I thought I’d be  able to drive myself there and back. I could get a cab there but that wouldn’t fly for the ride home. That was when bitter reality set in. I live in a rural area that everyone else considers the boon docks, so far away. I don’t have family close by. My cousin just moved out of state. I don’t have close friends. I have acquaintances but no one I felt comfortable enough to ask, “Hey would you mind ripping up your Monday commute to head to Hartford and then out by the airport and sign off responsibility for me after you’ve worked all day just to bring me home?” No I couldn’t do that. I don’t have that luxury anymore. My divorce extinguished those who I thought were my friends. My relationship with my now deceased fiancé and subsequent move finished off the others. Of my life-long friendships, one I let go of because it was a toxic relationship. My last surviving friend is literally that. She is now living with emphysema and on oxygen. I couldn’t ask her either.

I felt like my mother. That’s the worst possible thing in my world. In black and white my situation looks a lot like hers from the outside. She is a woman with no friends who isolated herself and pretty much said F… Y.. to the world, I don’t need you. In contrast I don’t know anyone who hates me, and contrary to her lifestyle, I have tried to maintain the relationships that matter, yet my circumstances mirror hers too closely for my liking.

People loathe her. I know who she is, who she isn’t and who she was, but I still hold out respect for people just because they are human. We are all fallible. She is my mother. I don’t feel like she did much mothering with my brothers or me, but I have managed to hold on to some of the good I was able to find in her. I used to joke because selfishly I was relieved my dad died instantly from his heart attack. With him in Florida it would have been very difficult for me to care for him if he had a long term illness. I knew I wouldn’t be so lucky with my mom. She will hold on and fight forever. She has amassed ample resources and insurance to maintain her island status especially at the end of her years. I’m sad to admit that I’m breathing a sigh of relief that she has serious health issues before my step father because if he went first, I’d be left to deal with my mother. I know I can’t take her on. This woman has her head stone erected in place just waiting to etch in the date of death. The story she’d like us to believe is that she didn’t want to put me through trauma of making decisions when I would be emotionally compromised. That sounds commendable, but the truth is that she doesn’t want my step father buried next to his ex-wife. Even in death she’ll be calling the shots. She isn’t expecting me to intervene in her care. She wouldn’t allow it.

I knew I was desperate when I contacted my ex-husband because Mr. Fix It or Forget It would offer some solution and I needed one.  I had to tell him I wasn’t going to get my son for the weekend. Ours is a strange relationship after thirty plus years of battle. It’s quite humbling to have to resort to depending on him in instances like this when in relationships he doesn’t have what it takes. He’s usually good at grounding me in base emotions. (I’m being sarcastic here.) When I hung up with him I tried to collect myself for the commute home, then it hit me. I remembered and felt the pain.

Once home I busied myself with household tasks and collapsed on the couch and wondered why the MD hadn’t given me anything for pain.  I live on Motrin and Allegra on a daily basis for my perpetual sinus issues. I thought I’d pull out the big guns and try Advil PM since I knew I needed to sleep. Yeah right.

I went to bed in sweat pants and long sleeves. And so began what I call my fever coma. I vacillated between profuse sweating and chills for days. I didn’t do anything but shudder and keep my eyes closed. I only got up to pee. Thank goodness I only had five steps to the commode and the path is committed to memory even in complete blindness.

At some point during the night I got up to refill a water bottle and in my feverish stupor passed out at the threshold of my bedroom door. Should I have known that since I hadn’t walked that far in a couple of days maybe the odds weren’t in my favor? I was woozy and nauseous and had to brace myself along the way. I knew I had to strategically support myself in intervals just to get to the refrigerator, but rational thinking wasn’t my strong suit just then. Breathing, sipping and shuddering were all I could manage.

I kept thinking about passing out. I thought you sort of knew when it was happening like when you’re dizzy, but you don’t. I just wanted to get back to my bed. I felt my face hurt and I think I felt insulted or offended by that. Then I felt my face on the floor and at the edge of the carpet and knew something wasn’t right. Then I realized the rest of me was me on the floor. I felt around with my hand and found the carpet. I figured I should go in that direction. My bed was on the carpet. I crawled back to my bed. A tidal wave of a rush overcame me. The sweat trickled from my matted hair and ran down my face. I could taste the salt in the droplets. I couldn’t open my eyes. My college age daughter has since informed me that she could identify since passing out is what she considered a good night of drinking. Sigh. I can’t relate. I never had the typical childhood or college scene. I’m not regretting that.  I’m just reminded of God’s sense of humor with that child. I used to pray for people like her and keep my children from them, now I have one of my own.

The next day my other adult daughter came up. She made me a smoothie, made me laugh and changed my sheets. I made myself get out of bed and try to get some sort of nutrient content in me. While she sat on the couch yapping, I felt semi coherent and present but not fully. I was able to engage in conversation but I felt disconnected like I was having an out of body experience. I even looked at my phone, but didn’t have energy to do more than that. I was still nauseous and feverish and barely functioning.

I didn’t know if the fever was from the kidney stone moving or what, but I didn’t have flank pain anymore. It had been replaced by body aches and a massive head and neck pain and pressure.

I cancelled the surgery. I could barely get up and walk to another room besides the bathroom, and my head felt like it was in a vice. The sweating and chills kept me horizontal and with my eyes shut for another day and night. I felt like I’d aged a lifetime, my muscles were atrophying. I understood why an elderly person needs to rest after doing the most minimal task.

The next day I took a shower and got dressed; a major accomplishment. I even made an appointment at the medical group where I’d had a physical done for school. I was leery of the drive. I mean I hadn’t been upright and coherent for more than twenty minutes at a time in a several days. I didn’t want to endanger myself, or anyone else.

The office visit wiped me out. Thankfully I had dressed in leggings and long sleeves because the temperature in there made me feel like I was in a refrigerator. I had to lie down in the exam room. I was in a fetal position and teary when the PA walked in. I didn’t care. He asked how I was feeling and I just looked at him and asked, “really, do you want to know? Look out because I’ll tell you.”

I told him that in a matter of a few hours I learned about my mom and was scheduled for surgery and that ever since, I‘d been in a fever coma. When I told him about my no insurance woes he remarked he didn’t understand why someone like me wouldn’t have insurance, since I was attractive. That didn’t make sense to me. I think I was still suffering a time delay effect because it took a minute to register. I thought he must have meant to say that I looked smart.  I replied by saying I was smart, just not always practical.

He diagnosed me with the flu and said that the kidney stone had probably moved or I’d passed it. He was more concerned with my current status with my head/sinus/ear issues that have plagued me for several years. He showed me the billing code and ended up charging me the least amount he could without being fired. Then he gave me his card and told me to call him because if we could work out health issues that didn’t require an appointment over the phone, he’d be willing to do that to help me out. What a deal.

Yesterday I woke and finally felt like my body and mind were in synch operating in unison again. I felt hunger and had an appetite to taste food again. I stretched and moved my body beyond mere necessity. I haven’t done much of anything except to organize an area in my kitchen. That took all of ten minutes. I did get back online and plugged into the things that had evaporated in my health hiatus. I listened to music, and I knew I needed to write.

My first venture out was my favorite type of venue, a small intimate concert. The fact that this was a Christian concert was comforting. I needed a spiritual fix and part of me needed to take baby steps and to be inside a church enveloped by Christian people and music. Inside those walls I can let tears fall and not be conspicuous. So many spiritual life and death issues have been weighing heavily on my heart. I’ll need to work out the issues surrounding my mom and how this turning point in her life will affect both our lives.

It’s when life comes to a stand still that I’m reminded of what I value and my thought pattern is redirected. It is through suffering that I am most appreciative for the simple aspects of life I’ve taken for granted. Not being able to do anything but be conscious of my pulse and breath was sobering. Much of my experience lately has been drawing me to be present, in the now.

I’m thankful to get out of bed on my own. I am grateful to have an appetite and taste buds and the ability to keep food down. I was reunited with my dental floss and was giddy. I delighted in doing my dishes. I took stock of all the visual clutter around my home and while it has been burdening me because of the emotional drain in getting rid of it, I choose to see all of it as a lot of life lived and an abundance of blessing. And if I let my thinking evolve to the bigger picture, I’ve survived another nasty battle. I have relative health, enough resources, a home and family and opportunity.

But more importantly, I know what it feels like to be without insurance. I know the fear of needing medical intervention combined with not wanting to go into debt to receive it. I know what it feels like to be completely alone and desperate when you can’t even get out of your own way. I know what it feels like to be betrayed by your own body. And I know the dreaded ambivalence of waiting for the dawn while uncertain of whether or not you want what may come with it.

I continue to grow stronger because I’ve been down and out. I’m grateful this latest hurdle is behind me.

I am a bit more seasoned and that’s a good thing, right?