Archive for September, 2011

September 12, 2011

a job well done

” Dear Ms. H,
Thank you for your recent assessment note, which I found to be thorough and astute.  I am in total agreement with the management plan and will look forward to further updates as to your patient’s progress.  Please do let me know if I can be of any assistance in her ongoing care.

Yours sincerely,

Sheila C, MD CCFP ”

big thanks to my dear dr. friend who understands my crazed sense of humour and isn’t afraid to fuel my slightly personality disordered fire. le sigh.

it’s amazing what the subtle encouragement of friends can do for the spirit, no? ohhhhh, yes. now, move over imaginary play brain. it’s back to life time. chin up, shoulders back, forward motion, go!

September 12, 2011

save her soul

reason for referral:

patient is a 30 y/o woman presenting w/ emotional instability secondary to ? clinical pms and healthcare worker burnout syndrome. quick response team to ax and refer as appropriate pls.

reason for social work involvement:

psycho emotional social assessment, therapeutic intervention, resource counselling.


patient is a 30 y/o married mother of one toddler aged child and is currently employed in healthcare, part-time. pt describes her marriage as rewarding, her partner as supportive, and significant enjoyment of her mothering role. positive hx for mild post partum depression and anxiety, no symptoms since her son was an infant. other psychological / cognitive issues unreported and hx of same unremarkable as per chart except for notation of minor ptsd, transient anxiety, and  short & long-term memory loss secondary to head trauma and resulting post concussion syndrome, all result of hvg sustained significant mva in 2004. response considered appropriate and all but memory impairment has long since resolved, as per gp. no active medical issues though pt does suffer from chronic pain and is easily fatigued post multiple #s and soft tissue injuries. additional familial and informal supports exist, are present, and offer both emotional and practical contributions. pt has, however, faced recent increase in vocational stress, having accepted a number of additional shifts as of late as well as having  embarked on a part-time direct sales venture, which pt admits is detracting from her ability to effectively manage home life. pt reports  increased sense of pressure (internalized) and that she has been experiencing sleep disturbances, both in amount and quality. pt self reports deteriorating mood and an increase in negative thoughts, specifically with regard to her employment. has thought control and does not find thoughts intrusive, however. denies suicidal ideation and denies any contemplation or interest in harming others. pt admits to some chgs in behaviour, mostly an increase in the use of expletives and a tendency towards keeping her office door closed as often as possible. no chgs in appetite, which pt finds unfortunate.


pt is a tired looking, overweight woman, who presents w/ a flat, heavy, and restricted affect and was tearful on occasion across the interview. hygiene intact, dress appropriate for season and context. some disinhibition in verbalization reported by coworkers however none displayed on contact, this date. as per spouse, pt can be histrionic at times. positive for high emotional output but continues to employ regulation skills. thought pattern organized; speech clear, coherent, and content on topic. no perceptual or cognitive distortions observed or disclosed. insight and judgement appear intact. reflective thinking capacity evidenced. future focussed and goal orientated. has established self-care and sleep hygiene routine. behavioural changes consistent w/ diagnosis and to be expected. of note, affect brightened and full range revealed when speaking of her son.

protective factors:  age, education, socioeconomic status, formal and informal support network, strong identification with mother role and obvious pleasure received from said dynamic. this woman has taken the proactive measure to remove herself from professional responsibilities, this date, so to mitigate risks to career, self, and others, which should be commended.

high risk indicators include, but are not limited to:  this woman has stopped wearing mascara to the work place.


– avoid the workplace for 24 hrs; priorize mental health.
– drink morning coffee slowly.
– mandatory morning dance party.
– pick wild blackberries with son.
– mingle with neighbours.
– for lunch: salad, salmon, and avocado.
– nap.
– tidy and feel on top of it.
– casually prepare dinner, no need to rush.
– run, baby, run.
– have an extended bath.
– read in bed or, alternatively, rent a sappy movie.
– go to sleep early.
– try again tomorrow.

should the above listed recommendations not achieve intended therapeutic results, additional recommendations include: connect via phone with soul sisters situated in tofino, nanaimo, vancouver, and halifax; add 1 glass of wine to daily self-care routine; purchase and thoroughly enjoy multiple fashion or pop smut magazines; and attend as many yoga classes as possible until feelings of doom subside. consider re-ax and referral for ongoing supportive counseling if doom persists.

thank you for inviting my participation in this woman’s care.

hh, csw ba bsw rsw.

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September 9, 2011

budgets and buddhists

i recently read a tip, no pun intended, on a money-conscious-mom-blog, that in order to save money, you should never pay anyone to do what you can do yourself. thing is, that woman is a bitch. ha!

in all seriousness though, i get her point, it’s obvious logic. unfortunately for me though, in order to keep my personal, marital, familial, vocational, and domestic life up to a standard that i can be at peace with, something has got to give and that ‘thing’ has been my mental health lately. no bueno.

so, impulsively, i contacted a pleasantly advertised cleaner who had posted her contacts in our complex and was delighted that she was willing to detox my home for a relatively reasonable cost and would use green products to boot. done.

on scheduled start day i was en route home from a morning run, mega grocery shop (run # 2), and was in the local liq purchasing festivus for a week of post employment social events we had to look forward to when i received a phone call from my husband, who sounded combo annoyed/suspicious. “um, there is a monk at our door” he whispered to me hurridly, “where are you?”.

nothing like the element of surprise. i am always ready for a little dose of crazy and, in this situation, it only supported my expense further- cleaning and entertainment package deal. who doesn’t like a good bundle?