Imaginary Friend

When I was five years old and my second younger sister had just been born, I began to talk about a little boy no one else could see. He was close to my age, wore blue bib overalls and tennis shoes.

According to Mom, she became aware of him as we were sitting down for one of our frequent reading sessions. I announced in horror: “Mom, you’re sitting on Cocker-Dukey!”

Mom says she quickly apologized, got up, then cupped her hands and pretended to move him over so she could sit between us to read. Cocker-Dukey attended all our reading sessions, was tucked in at night and had his own place at the dinner table.

Researchers have theorized that children with imaginary friends may develop language skills and retain knowledge faster than children without them. This could be because these children get more linguistic practice than their peers, a result of carrying on “conversations” with their imaginary friends.

Research further reported that 65% of people say they have had an imaginary friend at some point in their lives. Usually before the age of seven. Its further reported imaginary friends are an integral part of many children’s lives.

They provide comfort in times of stress, companionship when they’re lonely, someone to boss around when they feel powerless, and someone to blame for the broken lamp in the living room.

Most important, an imaginary friend is a tool that young children can use to help them make sense of the adult world. Another researcher dispelled some results suggesting children with imaginary friends might be superior in intelligence; it is not true that only intelligent children create them.

Humor the child, Mom had been told and that’s what she did until it seemed she hadn’t heard about Cocker-Dukey for a while. When she asked, I told her he had gone down the street one day, turned, waved good-bye and was gone.

I have vivid memories of my old imaginary friend. I like to think that was the start of my penchant to surround myself with the wonderful, funny and thoughtful friends who have always inhabited my life.

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Making an Exception

While working in the Naseau Project, I was part of the research team and explicitly told not to provide social work services. We were there to develop new and effective programs and that would take all my time and planning. I adhered to that until the day I had to make an exception.

A resident showed up at my door, looking worried. Perhaps a bit scared. He said he really needed some help. I listened to his story. He had two patients downstairs in the clinic, in two separate rooms, and was unsure what to do with them.

In one room was a fourteen-year old who had just found out she was pregnant. In fact, she was due in a couple of weeks. In the other room was her mother. Her very angry mother who was threatening to “cold cock” someone. Not clear who. Her daughter? The resident? The absent father of the unborn baby? The world in general?

The resident had separated them but was now unclear what to do next. Did he have reason to report this to the police or as possible child abuse? What if the mother actually became physical?  What would happen if he released them from the clinic and there was trouble later? I agreed to help.

I went down to the clinic with him and took a social work student along with me. A good learning experience this would be, I was sure.  The three of us went in to see the pregnant girl first. She was scared and in shock at the news, hadn’t been sure she was pregnant. Probably in denial, she’d hid the weight gain from everyone by wearing baggy clothes.

When questioned about her options, she said she wanted to keep the baby but was so worried how she’d manage. I told her there was lots of help and introduced her to the social work student who would set her up with programs. There’s not much time but it can be done, I assured her. We all nodded affirmatively.

Her biggest concern was her mother’s reaction. We’d never met her or her mother before so we were unsure of everything. I told her we were going to see her mother next and would come back with a plan. I had the social work student stay with her and begin planning.

The resident and I met with the mother who had calmed down a bit but was still seething. The resident reported on her daughter’s condition. After the anger, the concern and caring came through. No more mention of “cold cocking.”  We talked about the logistics and I assured her they were not alone. By the end of the conversation we were all laughing about the challenges and joys of being a grandparent. It would be her first time.

We then reunited mother and daughter and could see the support was real. The resident outlined a plan of care and future appointments. He explained that as a resident he was in and out of the hospital and clinic, could not guarantee he’d be on call when the baby was born but one of his team would be.  However, both she and her baby would continue as his patients.

This was probably one of the most memorable new-patient visits this resident would ever have. Throughout my career, patients/clients have entered and exited my life; they’re usually with me for a very short time and I’d never know how it all turned out. But for this case, I know the end of the story.

That social work student finished her MSW, then got her PhD at UW-Madison. She now teaches at the Helen Bader School of Social Welfare at UWM. That fourteen-year old pregnant girl is now an adult, married with two children. She has a college degree and works in a community program.

I know this only because over twenty-five years later, she searched out and called that former social work student and invited her to attend a presentation of a community program she had organized. So, is this exceptional? Or an exception to the rule? Or do our clients/patients figure things out and do okay in the end? Throughout my long time working in the field, I seldom got to hear the rest of the story. So, I sure enjoyed this one.

 

Working in the NASEAU PROJECT

The Naseau Project was named after Marguerite Naseau (1594-1633) who died before The Daughters of Charity were even founded; in France, she cared for the sick and poor in the Confraternities of Charity with St. Vincent de Paul and St. Louise de Marillac. St. Vincent thought she was “an ideal daughter of charity.”

The Naseau Project was a five-year pilot program located at the St. Mary’s Family Practice Center, a residency program of the Medical College of Wisconsin. The project’s mission was to develop and implement high-quality low-cost health care for the inner-city poor. We specifically targeted two of the most-needy cohorts coming to the clinic: the frail elderly and mothers with new babies.

The Naseau Project clinical team was comprised of a clinical director, a social worker and a family nurse practitioner. We worked under two principle investigators, one from the Medical College and one from St, Mary’s.

I was told that though I was a social worker and this clinic served a very needy population, I was not to act as a social worker but as a researcher. The idea was we needed to identify and develop long-term solutions rather than fill in the gaps or adopt a band-aid approach to patient care.

It was the use of students that gave us the manpower to serve these patients and conduct our research. All educational programs are looking for ways to teach their student so we reached out to the Medical College’s family practice residents and various medical students on monthly rotations.

Combine this with Marquette University College of Nursing who assigned faculty to incorporate our activities into a community health course. I became a field supervisor for the Helen Bader School of Social Welfare at UWM and this activity was part of their assignment.

We became an Area Health Education Center (AHEC) site.  AHEC has been a leading provider of continuing education for healthcare professionals since 1988. One day a week these students came together and were assigned in pairs, mixing up the disciplines, to visit one of the clinic’s elderly patients in their homes. Each team was required to write an assessment note of their findings and a plan of care.

Writing that note was probably where students learned the most. Trying to put both perspectives into the same note was a challenge. And learning to speak up as a representative of a discipline with a different viewpoint was one of the most important lessons.

This program highlighted, for students of all disciplines, the strengths and weaknesses we all bring. A stark reminder that doctors and nurses usually focus on labs and other definitive results while social work deals with more vague and less easily defined issues. I remember a nursing student saying to me that she’d considered becoming a social worker but decided it was too hard.

After lunch a staff meeting was held where the clinic Medical Director presented a topic germane to the care of the frail elderly and then each team presented their case for discussion and questions. These case notes were then added to the patient’s medical record.

In our work with mothers with new babies we focused on completion of vaccinations. Social work students provided case management services to ensure proper post-natal care with attention to the accomplishment of such milestones as weight gain.

To further improve outcomes and build relationships, we scheduled a monthly meeting held at a church in the neighborhood. Called, Lunch Breaks, the program offered educational sessions on subjects chosen by participants, a medical check and lunch. What was the most gratifying was when these women began to show up and leave with each other. Our goal of improving their social relationships was being met.

Our basic finding from this project was reasserting previous conclusions that case management works. The special attention mothers with new babies received resulted in a 100% compliance in the vaccination schedule, acceptable weight gain and reaching other important milestones. For the frail elderly, our work resulted in less use of the emergency room, fewer rehospitalizations and a longer time between hospitalizations.

An equally important finding was the value and efficiency of the inter-disciplinary team. The doctor cannot and should not be expected to do it all. They say hindsight is twenty-twenty and that applies here. Throughout the project’s five years, we were seen as an outsider. That we were judging the established system and represented radical change. Perhaps if clinic leadership had been part of the research team, we could have had an easier time.

The Naseau Project didn’t change the medical delivery system much. Maybe not at all.  Our findings were lost in the hustle bustle of twelve-minute doctor visits. We had to be satisfied that our work added to other studies with similar findings and might someday support real change.

But for me, this was one of the best jobs of my entire career. A chance to develop and test new things.  And being given the time and money to accomplish that. I came away with a new understanding of how to design,  implement and evaluate effective programs. I wouldn’t’ appreciate until later, how this experience would lead to and prepare me for the next step in my career.

my career.

Working in Gogebic County

It wasn’t until eight years after finishing my bachelor’s degree that I began my first job in social work at the Gogebic County Department of Social Services in Bessemer, Michigan.

When I socially met the Director of the local county office, he was interested in me since I had a college degree which qualified me for a social work job in his office.

Michigan is a civil service state so I had to take a written test and designate which counties I’d be willing to work in. The only one checked was Gogebic County. Then I got onto a list and waited. When I got the call with the offer I realized my life was about to change forever; the beginning of what would turn out to be my long and rewarding career in social work was actually happening.

My first assignment involved managing a caseload of over one hundred adults, elderly, disabled or mentally ill, who lived in the community; it was my job to keep them there. I’d arrange and pay for support services so a person could avoid being placed outside their home.

I was required to see each client once every quarter. Or whenever there was an emergency. And there were many. Often, a crisis was needed to convince someone they needed more help than they could get at home. These were difficult and emotional tasks.

Some of these people will be embedded into my memory forever. Often, I was the only social visitor they had.  Some insisted on having coffee or tea and several baked just for my visit. I now realize, for many, my visit was seen a test; they had to prove to me they could manage in their home on a day to day basis.

I vividly remember standing in the living room of a woman who described, in great detail,  each of the decorative plates on her wall. Her daughter later informed me her mother was blind but wanted to hide that fact, lest I suggest she go to a nursing home.

I also recall a ninety-year old man who didn’t want to let me in because I was from the welfare. He woudn’t believe me when I told him his social security wasn’t welfare, that he’d earned that from his many years working in the mine.

I also went to the Lac Vieux Desert Indian reservation once a month. I asked one of our staff to accompany me. She was an Ottawa Indian woman who worked in our office as a homemaker aide. Looking back, I’m surprised I knew enough to do that; because she spoke the language and was an Indian, she got me into their homes.

After some time, I switched to family services. These were cases that didn’t meet child protection criteria but the family still needed some short-term help. After that, I also had an assignment in foster care and doing on-call child protection.

This type of work was difficult but especially so in this economically depressed and isolated area. With limited resources it was often not possible to get families and individuals what they needed to manage their health and other family issues. Their resiliency was impressive.

This was a good start for my future career. I became familiar with working in a government bureaucracy. That’s important for all social workers, no matter what area you work in, to understand how the government system works in order to get your clients what they need.

Then the unbelievable happened. I was laid off. As the last hired, I was the first fired. That’s how the government works. The Governor of the State of Michigan and the Director of Social Services disagreed; the Governor froze the budget which resulted in a huge statewide layoff. My office lost two and every county in the state lost at least one position. So much for the security of a government job.

Drug of Choice

While on a three-day riverboat trip, I wandered up to the top level and found that the concessions also had alcoholic beverages for sale. I wanted a brandy Manhattan and through the clerk’s questions I realized he was a professional bartender. He made me a very good drink.

Priscilla, my traveling companion, is a photographer. She was interested in him as a subject. Over six feet tall with grey hair, long, almost to his shoulders, with an earring on both sides, a baseball hat worn backwards. But what intrigued Priscilla were his tattoos.

Both arms were covered down to the wrists. When he stood in the doorway of the concession stand and reached up to the top of the door, tattoos could be seen that covered the entire underside of his arms. Joyce and Mary, our dinner and drinks new friends, joined me and Priscilla in getting pictures and in general conversation.

He was friendly and talkative and seemed okay with having his picture taken. In fact, he said he’d wear shorts the next day so we could see the tattoos on his legs. Sure enough, next day there he was. And there they were.

His thighs were covered with long, thin tattoos. He commented these were hard since he had to sit in a twisted position while the tattooist did his art. At first, I’d been hesitant about this. I wasn’t sure if we were embarrassing him or making his day. We decided he was having as much fun as we were.

Then I noticed a tattoo peeking out from the collar of his shirt. So, there must be more. I wasn’t sure about this but I asked: why do people get tattoos?  Turned out he wasn’t bothered at all and instead told his story:

It’s my drug of choice. I don’t do drugs and don’t drink anymore. When I started, I wasn’t going to go below the elbow but then I did. It’s just what I do.

I probed further as I pointed to his collar: so, there are others that we haven’t seen? He grinned and shook his head, then told us about the full back tattoo of a waterfall. But it wasn’t colored in yet, he said. I should have asked what he would do when he ran out of body.

We probably could have gone on talking but the call for dinner came so that was the end of our interaction. I still don’t understand it. While tattoos are fairly common, there’s a lot of judgement that goes along with it.

This guy was very nice but is probably misjudged due to his looks. He told us he works the boat in the summer and is a full-time bartender the rest of the year. So, who am I to judge? And maybe that’s the lesson. About judging someone before we know them.

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