I am having a hard time getting my mind around this one, folks, and I need your help.
In my almost 30 years as a nurse, I have some across some pretty interesting patients. I do my best to show empathy and compassion to every last one of them. I make it a habit to get to know them, and their histories. Get inside their heads, so to speak, and assist them with whatever issues that plague them.
I have taken a patient, or "resident", as we call them in the Nursing home, to AA meetings, on my own time, after he was found making homemade booze out of Hawaiian Punch and bread in his room.
I have taken lonely residents into my home on Christmas and Thanksgiving, because they have no family to celebrate with.
I have collected money to buy a bus ticket for a resident's daughter to come see her in her final days.
I have sat with a myriad of dying elders, holding their hands as their life slipped away, so they wouldn't leave this world alone.
But I don't know how to handle this one, and it frustrates me to no end. Being a woman of size herself, I am finding it really difficult to relate to one particular patient.
Let me tell you about her:
Her name is Claire (not really...there ARE HIPPAA laws I must respect), and she is 45 years old, younger than me. She is married and has two children, 10 and 13.
She ended up in the nursing home because of bedsores, or Decubitus Ulcers, because she literally cannot move without assistance. She has been bedridden for four years. It took six ambulance attendants to get her into her bed. It takes three staff members to hold her abdominal curtain (belly), so the nurses can change her bandages. She weighs 739 pounds.
This is my frustration. She is a very sweet woman, but has no intention of participating with Physical Therapy, Occupational Therapy, or the Dietician's recommendations. She insists on triple portions at meals, and just yesterday, as I was trying to build a rapport with her, witnessed her husband empty an entire 32 oz. bottle of Hershey syrup into a large plastic cup, and fill it the rest of the way with Coke for her to drink. This was to accompany the large sack of White Castle hamburgers he had brought in. mind you, this was at 2:00 in the afternoon, just an hour after her three portion lunch.
Did I mention that she is also Diabetic?
I have tried every tactic imaginable to cajole her into participating with her plan of care, which includes following her 1800 calorie a day diet, and participating with the therapies.
She says that "it hurts too much" to work with therapy. She is addicted to narcotic pain killers, but with her weight, higher doses could kill her. We are still not sure if the pain is real, or if she is merely "drug seeking". According to her history from the hospital, her actual Diagnoses do not indicate a need for the amount or frequency of the Fenanyl, Vicodin, and Oxycontin she receives.
How do I get through to this woman, who is slowly killing herself?
I have tried using humor, which I can get away with, being a person of size herself. I have tried playing upon her love for those two darling boys of hers.
I have tried everything in my bag of tricks to make her see she is not going to live long if she continues on this path.
She refuses to see the Psychiatrist, Counselor, or Clergy.
Her husband is no help. He is an enabler of the first order, and does what he does out of love. I don't think the poor guy has it in him to tell her "No!".Frankly, I think it might be a relief to him if she would die. He has stated that Claire has tried Weight Watchers, and a multitude of diets in years past, but couldn't stick with any of them.
Her goal is to get her wounds healed and return home to her bed, her drugs, her food and her TV.
I am heartsick beyond belief with this one. Have I finally met the one I cannot help?
Any ideas?
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Is the husband getting any counseling? He MIGHT be the key to her problem. Despite what he says, he may be more than an enabler. He may want her gone so he can start another
"project."
Is there any way to keep them apart for a few days? Can the nursing home get a court order to keep him away if he keeps feeding her? Can the home refuse her extra food?
She gets the portions she asks for because or "Resident's Rights". By law, she has the right to refuse any treatment plan offered up to her.
HIPPAA deals only with privacy issues.
Another idea would be to limit how much her husband can visit, and what he can bring in to her, and then force her diet and treatments. Like the old saying says, "Sometimes it takes a 2X4 to make a mule listen", that might be what it takes to get her to work with you (not the literal meaning). Just being hard and removing the nice attitude until she starts trying to help herself.
I know that is not an easy thing to do, but there are times it is needed, and this sounds like one of those times.
No, we can't get a court order. She is in her right mind, and we have offered to get counselling for her hubby, but of course he doesn't need to tlak to anyone.
However, this resident sounds like she likes the attention & is selfish. She is diabetic because of her weight no doubt. I can not image as a wife & a mother making my family go through that. I think she won't change no matter what you do, but we can always have hope!
I have asked her "Are you suicidal?" She laughs. We cannot "force" anything on anyone. Its how the system works There are laws prohibiting forced treatment on anyone. It goes against their consitutional rights. I WISH we could...there about a dozen patients I would LOVE to force to do one thing or another. ..ha ha.
But about Claire, there are issues I feel that your not seeing th husband as you said enables her for what reason??? WHen I was married to my ex and being to heavy for him, and him complaining about it, I lost 40 pounds, we went out, and everyone was saying how good I looked, etc, I was getting less depended on him also, the next day he started bringing home pizza, ice cream etc. When I gained the weight back, he again started yelling at me that i am fat and that i cant even keep the weight off.
SO Husband needs to see someone too, He might need to be a care taker, or have her depend on him, he is a martyr with a sick wife.
Claire, might be hiding behind something, and it is easier to "eat" her problems away then face them, by being this heavy she doesnt need to be there for her kids, or her husband or anyone else. Emotions are running wild here and she is hiding, do you think she is abused, emotional abuse doesnt show? things like that
And if she cant/wont seek help
maybe at least you can try to limit the sugar food for her diabetic status
Good luck
I know I sound cold, but I would rather see someone there that would accept the help, or use it as a place to recieve the last few days of care they could, than waist it on someone that does not care.
You're preachin' to the choir, hon. I agree she needs an inpatient stay at a psych facility, but her hubby is unwilling to sign the papers, and she is(legally) in her right mind. Yes, she is addicted to the meds, but she DOES have pain, and it is very difficult to tell what is REAL and what is DESIRE. It would be cruel to totally withhold them. We are trying to take it slow with the drugs, and slowly wean them down, but it takes time. As ofr the facility being responsoble for this, that is why i have written this piece. I need ideas that I haven't already tried.
Unfortunately, we are coming to that option. By law, we have to give a 30 day notice for discharge. I wrote this to help find some other option, because my first , second and third choice is to help her if I can. I'm beating my head against the wall, to no avail.
I agree, but I was hoping against hope at somehow getting through to her. Unfortunately, you can't help those who refuse to see there's a problem, or are too lazy(There, I've said it) to help themselves.
She IS on an antidepressant, two, to be exact. Gastric bypass was one of my first thoughts, but unfortunately, in this state, Medicaid, which is her funding, doesn't cover it, and they cannot afford it otherwise.
The other day, I was in her room and asked her 10 yer old what he wanted to be when he grows up. He said he wanted to drive in NASCAR. I made an offhand dig at her condition, by telling her "Now, THAT will be something to see, huh? I sure hope you get to see it."...She knows she won't be around to see it. I could just cry when I think of those boys.
Here's hoping.
Liz,
I thought about Richard Simmons, but her husband is kind of "redneck", so I don't know how that would be accepted, even if Richard agreed to help her. I personally can't stand Dr. Phil, but thanks for the idea... I'll reserve it for now. I have just seen too many of his shows where I thought he was dead wrong in his assessment.
I have tried this. The therapy department has created a plan to get her moving at a slow but steady pace, right from her bed, but she refuses to even try. She just wants to lie there and watch TV, and be left alone. I talked to both of them, in private and was quite blunt in telling them the eventual results of her actions. That is where the "brick wall" starts. They both agree that something needs to change, but neither is willing to do it. Her hubby cowtows to her every whim, and has for years.
So maybe you need to look out for yourself on this one and just give her the support you've given others who were not going to make it. It's sad the boys are not going to have a mom, but it doesn't sound like they've ever really had parents to begin with. Find them a grief counselor.
Know that you are damned skilled and professional at what you do. It's just that sometimes people come in too late to be helped.
He was told that several times, but he "sneaks" it in, and we can't bar him from visiting his wife, and can't search him either. He knows what he is doing, but wants to make his wife "happy"....
I know, hon. That is why I wrote this. This is the first time in my 30 or so years as a nurse, I haven't been able to help someone, and its driving me nuts. Yeah, I have issues of my own here..lol
As I have stated above, Ohio's Medicaid does not cover bariatric surgery.
Jessie,
Thanks for your kind words. She is getting the pain meds because of long standing neuropathic pain, and the ulcers on her backside, and abdomen. I know, if I had two young kids, I would do everything in my power to be around for as long as I could. She is there to heal her wounds...and she refused admission several times while she was still in the hospital, until a doctor FINALLY talked her into it.
"project."
I agree, as her caregiver he should know better
I had a wake up call and relised I do not want to smoke no more but it is uneasy to me because I know that I want to loose the weight and yet I have always got money to eat and drink and smoke. I need a lift style change.
Last week I finally broke down and asked the nurse to help me loose weight, and I wanted to quit smoking.
I finally bought the pack of nicorette gum and I finally got to ask my doctor for a nutritionist. I am seeing the nutritionist next wednesday. I hope everything goes well.
Got to dash amy
Rest easy
Seriously.
But if she is not willing, I can see no way to help her.
Especially if her losing her children through dying does not reach her.
Wish I could help.
Keep your professional emotional distance honey, this one could hurt you much more than you could help her.
Since she is not incompetent, the motivation to change can only come from her. I'm sure that her many problems have been addressed at all levels as she got to her current weight. Nobody wakes up weighing 700 pounds. This is a problem that has been going on for years. She must have a death wish, whether or not she is aware of it.
I applaud your unselfishness and compassion, but I agree with Wanda. You are much more likely to get hurt than she is to get well. I imagine clergy has tried to appeal to her, but there may be a minister who would be willing to try.
I promise to keep you all posted as to how this poor woman's saga plays out.
You said up above that this is the first person in 30 years you have not been able to help. But YOU ARE helping her. Every thing you do, though it may seem small or ineffective, is powerful. Keep at it. Don't give up.
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Kudos to you, and congratulations on your own success. I am no "Skinny Minnie" myself, and to be honest I was in the same boat you were in with your first husband. My late hubby was verbally abusive also. He constantly told me how fat I was, that no other man would ever want me, yet consistently sabotaged any effort I made to try to lose weight. After he died in 2001, I lost about 60 pounds, and while I'm never going to be svelte, I feel 100% better, not only physically, but my self esteem has improved also, which in my book, is more of a boon than losing weight.
Keep it up, darlin', you have a lot to live for.
Did you object to the subject matter?
Are you weight phobic?
Do you fear nurses?
Did I misspell something?
Did I not conjugate a verb correctly?
Are you merely an asshole for the fun of it?
As far as I can tell, the children are not being harmed or mistreated, other than watching their Mother eat herself to death. Why would DFCS even consider taking them away? And why would anyone consider even trying to do such a thing?
In cases like this I do soul-talking in the middle of the night. I affirm the soul's ability to heal itself, and to call to itself any kind of help it needs.
If the subconscious is holding a picture of neverending weight gain, then I encourage the soul / higher self to delete that picture and put in a picture of perfect health instead, if it chooses.
Never use your personal willpower to override another's will; simply provide encouragement and knowledge, in a vibration of unconditional love.
With the ego / personality, we often have to use "tough love."
With the soul, pure unconditional love/truth is all that's needed.
I'm assisting you and your patient right now, as are many of the commentors here, by picturing the possibility that this patient CAN choose to change her subconscious pictures and drama patterns.
Soul talk! Simply invite her soul, if it chooses, to meet with your soul - and let your soul carry energy and information to the meeting, to help her soul remember its healing power.
You as a personality don't need to be awake for this. Just program the event for sleeping time - for the dreamtime.
I've seen this work inside 2 weeks.
Do not do "soul talking" directly to the person in question. It must be done at a distance. Your heartmind to their heartmind, with no eye contact or physical contact or sound contact at all. This is a form of healing meditation or prayer-warrior work. You can speak aloud, but NOT where they could hear you.
Essentially you're using divine love-light as your transmitting mechanism.
You need to sit him down, and try to convince him that his wife's life is worth living.
You can't get to her, without first getting to him.
He has to stop helping her die. Because that is what is going to happen. You might have to practice tough love with this guy.
She can't move forward, if she has her husband feeding her food that is killing her.
Normally, they say that only the patient can heal thyself. But, in this case, I say that he is the biggest obstacle that she faces.
He can not continue living the lifestyle, of the defeated doormat.
Keep on him, and if he can finally change his ways..
Then, have him work on her. See, if anything turns a corner after this.
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Is there any kind of eating disorder treatment facility anywhere close by? Does Ohio have the rule where two-psychiatrists-in-agreement have the power to commit her involuntarily?
I wrote an article a while back on my own food addiction, it's probably time for an update. One thing I've discovered: where one key personality has an addiction, the other probably has a problem with co-dependency, because unhealthy people don't generally attract healthy partners. This plays out in all types of relationships; parent/child, spouse/spouse; siblings, ,friends, etc.
My son left for college last month and I have discovered that living alone is a very good thing for me; it effectively eliminates any excuses I might come up with for whatever I'm trying to avoid dealing with. It is very difficult for me to maintain 'abstinence' (of trigger foods which set me off into compulsive behaviors) with someone else under the same roof. Now I am learning how to give to myself in a healthy way...and one day I hope to be healthy enough (physically, mentally and emotionally) to stay that way while in a love relationship. For now, living alone is my present and it's good. The physical results are higher activity level, a cleaner house (it's getting there) and slow but steady weight loss. Emotionally, I am much calmer and sleep much better at night (no 3 a.m. panic attacks though the bladder still gets me up) and am much easier to get along with (so I'm told).
It's work. I haven't always been willing to do it but I couldn't avoid seeing the whole problem when I came back home after taking my son to college. Just me and the truth, staring at each other in the mirror. And the truth can hurt...but acknowledging it, accepting it, can turn it into a loving guide for my journey to a new future.
Donna, whatever happens with Claire...your having posted this article helped me immensely, as did all the other open and honest posts from other people dealing with the same problem from different viewpoints. God bless you all.
Some people are stubborn, and won't listen to other people's opinions. They think they know what's best for them, and the more you try to convince them otherwise, the more they will dig their feet in and not budge. Sometimes if everyone just leaves them alone they will finally "see the light" on their own.
This might just be one that you'll have to "let go".
1. Get a therapist to back you up on this: put as many mirrors in her room as possible and require that she eat in front of a mirror. Just tell her that it is required and that her food will not be restricted.
2. Use the mirrors to show her the bedsores and wounds whenever they are being dressed.
Reasoning: she is using food and pills to deaden any physical sensations of emotion and hence is completely out of touch with her body. Making her look at it while she is eating will show her what she is doing to it while she trys to anesthetize her emotions out of existence.
3. The husband: provide him with funeral brochures and if possible, get some information on the costs associated with burying the remains of someone so large. Shock value just might do it.
Brutal, yes. But there's a life at stake...more than that, the lives of everyone in that family.
Sincere thanks for your open and honest words. I hadn't thought about funeral brochures, but I might just make a stop off at one on my way home tomorrow, and present them to her hubby when my friend the minister talks to them on Weds.
BTW...I lost my weight after my husband died, and I didn't have to cook a big meal every night, so I know how hard it is with someone else in the house. After he passed, I still had a 16 year old daughter at home, but she was tickled to have more salads and stir fries than meat and taters..lol
Good luck and please keep us in the loop with what happens....
I cannot contact any type of media on her behalf, unless she were to sign a waiver agreeing to have her personal information made public, Which she won't. There are strict HIPPAA (privacy) laws that must be adhered to, or I could lose my Nursing license.
For an update:
In the past week, Claire has started participating in her therapies. I think the kicker was her realization that she could not get out of bed to have a birthday party for her son at the home this weekend because she cannot tolerate sitting up in the special bariatric wheelchair we obtained for her. I think my friend the pastor may have hit a nerve in her, because she is really trying. Her husband is still bringing in food, but we have convinced him to bring in healthier choices, like gelati versus ice cream and chinese stir fries versus burgers...It's a start. Only time will tell if she sticks to her plan of care, but the whole staff has joined in being her cheerleaders. We had a meeting last week and told the entire staff to pile on the praise when she is compliant with her care. She loves the extra attention, and so far it is working. yesterday, she tolerated sitting up at the bedside for 5 minutes. it doesn't sound like much, but for someone totally bedridden for the past 4 years, it is HUGE.
FYI. Your post and everyone's comments inspired a post titled "Dear Claire" about the roots of food addiction (or at least one that is true for many people). It was painful to write since I could see myself going down the same road "Claire" has gone in the history you related here....becoming totally dependent on someone else because 'life' was too "difficult" and painful. A lot of what I write (that I don't necessarily post) is therapeutic in nature; this one I thought might strike a chord with some and provide food for thought, if you will.
Congratulations on getting through to Claire! I hope she continues to make good progress....
On Thursday, Claire complained of "feeling something in the right side of her abdomen. She said it felt like she was laying on something when she was turned to her right side. As it is impossible to palpate her belly with all that flesh, we had to send her to the hospital. She was admitted. We were trying, at the time to convince her to go to a Bariatric inpatient facility (which accepts Medicaid) about 150 miles away, at the time she left us, and we are encouraging the hospital to keep trying. She was refusing, because her family could not afford to visit her very often. She has to lose at least 250# before surgery will even be considered, because it is too much of a risk. I'm worried, about her, becaue she is too big to fit into even the largest CT or MRI machine, to diagnose the mass she feels in her side. I don't know if I will ever see her again, if she agrees to go to the bari facility, but if she doesn't, we will get her back after the hospital stay.
BTW...Richard Simmons is personally involved with the place we're trying to get her to go to.
I'll keep ya posted...
"Claire"s story sparked something for me, in dealing with my own food issues. I don't really know how to explain it but it's as if some circuit breaker that had tripped long ago has suddenly been reset. Since reading about Claire, my eating patterns have changed--I won't say effortlessly but I'm not having to think that hard about what and how much I want or need. (And yes, I've lost weight, but I don't know how much. I don't own a scale. I can tell, however, because my joints hurt a little less and most of my clothes are somewhat looser and I feel lighter--more mobile.
You GO, girlfriend. I'm rootin' for ya.
Well, Claire came back to us last week, as she wouldn't go to the Bariatric center. I'm not exactly sure what happened in the hospital, but she is rarin' to go now. She is working with therapy, and doing her exercises like a mad woman..lol This is how good she is getting..It now only takes 3 people, instead of six to get her to the side of the bed, and she stood on her own for 11/2 minutes yesterday. I know it doesn't sound like much, but its a huge accomplishment for her. I saw her hubby bring in a SALAD from Bob Evans the other day...sure beats burgers. This weekend, we have arranged for her 10 year old daughter to have a "sleepover" with Mom , because the girl is having some serious separation issues, and her grades are slipping, she is in a "gifted" program, by the way.
We're bringing in a rollaway bed, DVD player and movies, and ordering pizza..and yes, Claire has agreed to only have a couple pieces..lol Her motivation has really taken a turn for the better, and I think her daughter has a lot to do with her progress.
I'll keep ya posted.
aaaahhh! gifted kids...some of the most perceptive people around (my son is gifted). It can be startling to hear adult questions from such young people...and it's much harder to give age-appropriate answers since they may well understand intellectually but the emotional development hasn't caught up with their intellect yet. (If that 'informs' the direction any conversations with her should go.)
This is so great!
I'm keeping my fingers crossed for ya...and toes, and eyes, and whatever else I can cross without breaking something.
I'm anxious to see how the weekend went myself, but I won't find out till Weds., because I'm taking a much needed 4 day weekend this weekend...woohoo!!
Results from my appointment: lost 3 lbs. (I thought for sure it would be at least 5, but hey, it's moving in the right direction!), A1c was stable (which is amazing since he had to take me off one of my diabetes meds several months ago) and blood pressure was better than it has been in 3 years. Yep, things are definitely looking better!
Claire went home last weekend. We were not too thrilled, but she had had her fill of Nursing homes, diets and being away from her family. She signed out AMA, or "Against Medical Advice". She really did well for a little while, and was able to tolerate sitting up for about 2 hours, and she could stand and pivot with only 2 people to steady her. She is still too heavy to walk. I wish her the best, but I'm afraid I will be seeing her again.