Maxims

BelieveLand

1. People who do not do the caregiving may have opinions but the ones who do the caregiving have the votes.
2. There is no strategy for family caregivers of the bi-polar. Only tactics. The job of a caregiver is to be like the captain of a ship travelling the ocean with a hole beneath the waterline. Your job is to get the ship pointed in the right direction.
3. Families reduce to one caregiver for the bi-polar relation.
4. Virtually every article you will read about being a caregiver for a bi-polar parent will be useless if it addresses symptomatic emotions rather than causes.
5. Social workers will not help the caregiver until the caregiver is also a mental patient.
6. The best a bi-polar caregiver can do us install processes to reduce the severity of damage caused.
7. The bi-polar parent can end up respecting family caregivers in inverse ratios to the amount of contact had with those people.
8. Therapy doesn’t CURE anyone, it really just gives an individual a forum for feedback where possibly awareness and insight on how to change thinking and behaviours may result. (I realize that this is a sweeping statement but this is a blog for caregivers to family members with disabling mental illness.)
9. Calling people on their lies accomplishes nothing. So, if a bossy relation makes demands, and you’re in private, say nothing. The person is in a point scoring game about family politics where only they know the rules.
10. To paraphrase Batman, you don’t have to save anyone.

 

Get You and Your Parent on a Do Not Call List.

Telephone marketing is a huge deal in the United States. Unfortunately, it can be taken to excess by some companies which is why a recent feature in America is the Do Not Call List.

If you’re new to caregiving you and your parent  may be at home all day, a prime target for telemarketers.  If you and your care receiver have had enough of irritating and potentially dangerous sales solicitation calls from telemarketers, add your telephone numbers to the National or state Do Not Call Lists. This is a good idea for several reasons:

• It is annoying and time consuming to be interrupted by telemarketers all day.
• People may be talked into paying fees for prizes.
• There is a risk of revealing social security numbers, credit card numbers, and other personal information to crooks.

The National Do Not Call List is a function of the American Federal Trade Commission. There is no cost to enroll. For information on identity theft and other consumer issues, select For Consumers. There are a few exceptions to the national list, including calls from charities and political candidates. Telephone solicitation is less of an issue in Canada, Australia and the UK.

 

Caregiver to the Mentally Ill Maxim #2

A while ago, I put forth a maxim in a post. It was essentially people who do not do the caregiving may have opinions but the ones who do the caregiving have the votes.

• Maxim #2 – There is no strategy for family caregivers of the bi-polar. Only tactics. The caregiver is like the captain of a ship travelling the ocean with a hole beneath the waterline. Your job is to get the ship pointed in the right direction.

There is no strategy. Just tactics.

The Barometer

I started this web diary because I had no-one with whom to talk about being a bi-polar caregiver. I seriously have no idea how others cope but I have noticed one thing: when I start posting more, it’s because things are getting harder.

What’s your barometer?

Things are going easy now but my bi-polar parent was in the hospital recently in account of pneumonia; but even that was comparatively simple since it merely involved my stopping by after work daily and so in addition to being busy, there was little impact on me since I wasn’t having to anticipate things six moves in advance. I have noticed that things get hard when she is ‘control’ or at least has veto over something. The sale of her house was a colossal effort because every single thing that needed to get done was the end of the world. She’d periodically call people involved to cancel instructions or give strings of contradictory requests and orders clearly counter to her own interests. (Like remove the fireplace, thus devaluing the house. Great job, Mum.)

Things like managing her mother’s bank account are a source of conflict. She has power over her mother’s finances and every once in a while we need to do things like order cheques or move money about. Driving my mother to the bank results in a predictable drama. She gets out of the vehicle and then starts making demands, holding the process hostage for some out of proportion ‘reward’ like a vacation in some warm country or the like. She’s accomplished nothing with her life, so any power she does have, she swings like a claymore.

As that her house has been sold and her money locked away in investments where it’ll be hard for her to do anything foolish, I guess the next major point of conflict will be her will and mandate — again.  She had a will but when I criticized her treatment of me, she wrote a libellous letter, full of invented incidents and half-truths and so it’ll probably not stand a legal challenge if my sister, the drugs-addicted stripper, decides to contest.

I’ve told my mother to shove her will up her arse; I shan’t be blackmailed because at 11 p.m., she’s decided I must drive across town to bring her an orange. Having been through the will process, and the mandate process, I fail to see why I need to take more days off work to certify paperwork that she’ll rescind the next time she gets in ill humour.

Another issue that has come up is tax time is when she is suddenly throwing her not inconsiderable girth about. She is suddenly in charge and demonstrates it though tantrums and nonsensical demands.

Back in the day when she was living at home, and her husband was alive, every family event was a fireball with plenty of secondary spot fires. Lots of engineered dramatics, basically I’d come stay in the kitchen, eat in silence, wash up and leave. Now that house finally sold, and she’s in a retirement home, her finances are regularized, perhaps a regularity will develop.

Still, if I am writing here a lot. It probably means I am on a short fuse.

Identify your barometer. For my father, it was alcohol, incidentally.

The Typewriter

The Burned Out Care Giver’s Mantra: V.O.M.I.T.

Here’s a handy mnemonic to help you stay focused when caring for your bi-polar parent: VOMIT

Value / Obfuscate / Money / Ignore / Task

Value:

The late Steve Jobs said ‘Your time is limited. Don’t waste it living someone else’s life.’ A bi-polar person will cheerfully suck up all of your life and demand more. Print this out and tuck it in your wallet: My time is valuable.

I don’t care what you do but your time is valuable.

You might be a captain of industry or currently unemployed due to the evils of the current recession. You have every right to make choices about what you spend time on. You are not obligated to become a full-time unpaid psychiatric nurse with unlimited duty hours forever simply because that person is a relation. If you find something of value such as working at your job, parenting your children or wanking to lesbian porn, go ahead and do it. Your caregving obligations must compete for your attention.Bi-polar caregiving does not autmatically go to the front of the queue.

‘But it’s family’ may be the phrase in your head that rings with Pavlovian precision. My reply is ‘And?’

Obfuscate:

Practice lying sometimes. It’s a valuable tool for keeping your sanity. Examples include:

• ‘We’ve a big deadline at work…’
• ‘A friend is coming in to town and we’re meeting for lunch…’
• ‘I’m already bought theatre tickets…’
• ‘Of course I care…’

A wee white lie to help you manage and schedule your many duties is well within the limits of ethical behaviour.

Money:
Money is a tool, nothing more. So, get some or use someone else’s. How? Apply for every government program you can to help you take care of your bi-polar relation. These are paid for through taxes and is there to be used if not by you, then by someone else.

Ignore:
Personally I have found this one the hardest because I try to be helpful.

I am guessing that were I a parent, I’d have learned this lesson much earlier than my 40s. I’ve not much experience with children, but from what I can tell, they talk endless rot. They clamour for your attention and once they have it, monologue about what is in front of them as though it was the wisdom of the ancients. Part of the process, I guess. I probably did the same thing and so did you; and parents, if you watch parents, pretend to listen.

This is a bit of a button pusher for me.

I find it maddening when interacting with my bi-polar parent, because my instincts are so strong to assume that an interlocutor is logical. Instead, train yourself to say yes to what ever is being said, and go on with what you were planning anyway, hoping that they change their minds or forget their latest idée fixe like those knobs in the marketing department. (Years ago, an editorial cartoonist named Gable scribbled an image of a person in therapy, except that the patient had struck a pose and was under theatre lights. Conversation, for the bi-polar, is so they can monologue to you, and it’s all about them. They don’t value you, so you must value you.)

Task:

Be task focused. Interactions should be about doing things, not just a block of time where you show up and hope to fill the time sensibly.

Reframe interactions so that events are about accomplishing a specific thing. For example, taking your bipolar charge out is a task; not socialization. Because, of course, socializing for that person is a one-way street where they monologue in sort of a one-way therapy session with no floor or ceiling as to their time or effort. So, take’em out, and explain that you have budgeted a time for this, and that time must be respected. Taking the person out is about shopping, or dining or some other accomplishment like a scenic drive up the mountain et cetera.

There’s an obvious exception to this; for a geriatric bipolar person living in a retirement residence, dinners out become welcome break to the monotony. Even then, since you’re actually the one making the event happen, you have some say in what the limits are for this. Explain that you have other things you need to do today and the time you have allotted to this is X.

Oh, and choose a noisy restaurant.

Your time is limited

Family Dynamics and Caregiving

Here’s a tool for your toolbox.

I’ve mentioned previously that often the adult bi-polar parent is down to one caregiver — you. Why? Because everyone else has figured out that the ‘pleasure of his company’ is not worth it. That doesn’t mean that siblings and other relations won’t periodically swan in with directives, demands and decisions. Of course, what’s actually going on here is that they’re overcompensating. They’re pretending to themselves that they’re doing their duty and participating in care. From our perspective, it comes in as a barrage of unsolicited demands from someone who is implying we have a duty to report to someone who has no stake in the game or any idea what’s going on.

• Maxim: Relations who are not doing the caregiving have opinions, not input.

If you get a heap of advice coming at you from out if the blue, copy and paste this video link into an  e-mail. To summarize, the family member who suddenly submits you to a heap of instructions like a Commisar can safely be told ‘Thank you for your input, but since I’m doing all of the work and you’re not, I’ll do it in order that best fits the schedule.’

Note the verbal judo there: ‘the schedule’ tells the person that things are underway that she or he doesn’t know about.

Watch out for phrases including ‘But she’s my mother too’ or ‘You’re not the only one in the family’ or ‘You’re not keeping me informed.’None of these phrases actually demonstrate a duty on your behalf to someone who shows up periodically to throw non-existent weight around.

If they person begins to throw a temper tantrum, keep in mind that what may actually be going on here is that the person is not really involved, feels guilty and wants to — perhaps for status reasons, ethical reasons or social reasons — look like he’s involved. The former is easier because you can convert them into useful labour. If they’re just showing up to boost their own egos in private conversation with you, or to build their own social capital by giving you grief in front of others, then all that is needed is one second of bravery to shut them down.

Advice:

• If it’s guilt, honest blundering or insecurity – Give that person a specific but non medical task to do like taking the bi-polar parent to the barber or hairdresser, shopping or out to lunch. It’s not critical path stuff requiring long term commitment.
• If it’s guile, status related or other nonsense – Pull the person to one side and ask questions like ‘Name any of her physicians,’ or ‘List her medications,’ or ‘Remind me what her last three medical appointments were,’ ‘Name her favourite nurse,’  or ‘When was her last pedicure’? This’ll shut ’em up.
  Asking those three questions in front of the family is the nuclear option. There is no need for you to escalate. Be mild at first and say that ‘I’m just respecting your track record: you’re not involved and have no interest.’ However, if the fool doubles down because he wants to score points in front of someone else, feel free to push the big red button with my blessing. You have enough faeces flung at you from your bi-polar parent, there’s no reason to also get it from your unhelpful relations.

The Pleasure of His Company – 1961

The Friday File — Advice for Newcomers to Bi-Polar Caregiving

The caregivers of bi-polar parents that I know, and with whom I correspond, are generally helpful people. You wouldn’t know it from this blog but I do try to be helpful, considerate and enthusiastic and generous. Like any other feature of  your personality, it can be made to work against you.

This is a critical tip for newcomers which is why I am making it a stand-alone item despite being very short. I don’t want this to get lost in one of my lengthier articles.

Let us say that your bi-polar parent has been in the hospital for some reason, either for an episode, or because of a medical procedure. If the hospital calls on Friday afternoon, and says your bi-polar parent is ready to be released but you need to stay with her or him for the next 48-72 hours. Well, you have your own family, your own life and work situation.

• The call will come from a blocked number after lunch
• You will be presented with a statement implying your consent: ‘Your parent is ready for discharge. You’ll need to stay with your parent for 48 to 72 hours ….’

I understand if readers of this web site think I am hard-hearted but believe it or not, I do try to be a helpful soul but being the giving people we caregivers tend to be, you’ll say yes before realizing it. Look, I realize that governments need to cut back these days because times are hard and that I’m writing from the comparative luxury of a country with national medicine (sorry to our American friends) but ethically, given everything else you do, you’re allowed to use the ‘no’ word.

Practical advice:

If your bi-polar parent is in the hospital for a comparatively minor procedure, and it is Friday, expect a call from a blocked number from someone very, very, very, very well-practiced at getting you to agree to having you take your bi-polar parent into your home for observation. If you say ‘no’ the social agency officers will find a place for your parent. It may be in an irregular ward, but they’ll find a spot, don’t worry.

What are the ethics of this? Look, you are under no obligation to say yes to something astonishingly disruptive just because someone asks. Given everything else that I do, the ‘no’ word is probably one I should use more often.  I remember once I was giving a speech one evening and I got the call. They wanted to know what the speech was about and where I was giving it.

Prepare for the call on Friday afternoon. I am not you and you are not me so we’ll each handle it differently.

1. If it’s not possible, use the ‘No’ word but be prepared to be on the phone with someone who has a lot of experience in getting you to agree. Have your answers ready. A white lie may be needed here (kids with the gastro, you’re on a trip and are already 400 km away, tell them you’re in the hospital yourself with the Lurgi, or you live in a tree.) Be warned, they’ve heard them all so have your explanation ready. Note that I say explanation and not lie. A legitimate reason to say no is exactly that.
2. If you cannot say no, you just don’t have the personality for it, on Friday afternoon, do not answer the telephone if an unfamiliar or blocked number rings.
3. Visit the hospital late at night after the discharge office is closed, after 8:30 p.m. is usually safe.

The Ambassador

I managed to avoid ambassadorial games until I had my bi-polar parent’s number blocked. I call her every other day, but it was a necessary step to block calls from my parent’s telephone as she was ringing between half a dozen to 18 times a day.

Advice like ‘Just don’t answer’ sort of ignores the problem. A dozen calls a day is 360 calls a month and the total was often higher. They’d also come at all hours of the night.

My bi-polar parent loved voicemail. The maximum length of my phone company’s voice mail recordings was fifteen minutes. Yep, she’d often monologue for minutes on end, winding herself into a frenzy. Or she’d leave three or four messages in a row about end of the world emergencies such as ‘They’re sending me junk mail’ messages every afternoon when the postie made his rounds.

The following paragraph is from a reader’s book review about abuse and not bi-polar caregiving and how making the decision to reduce contact radically will suddenly cause the reappearance of estranged family members. I encountered a sudden spate of ambassadors shortly after I restricted her ability to contact me via telephone.

*Expect to be contacted through third parties. Your abuser will often enlist a friend or relative to approach you for her, and deliver news that she is ailing, depressed, getting old, sorry for all that’s happened, or whatever else she can think of to make you feel guilty and relent. The best response is to cut this right off at the pass, by informing the “ambassador” that he is not to convey any messages to you from your abuser or tell you anything about her. As soon as he starts talking about her, hold your hand up, palm facing him, and say, “Stop right there! I don’t want to hear anything about my mother, so let’s change the subject.” If he persists, enforce your boundary and end the conversation. When you do this, you are actually doing the Silent Partner a big favor. If he feels caught in the middle of your disagreement, now he can go back to the abuser and truthfully tell her that you refuse to listen to anything he says about her, and there’s nothing more he can do about it. This will get him off the hot seat and force your abuser to cross him off her list as a go-between.

Again, the context of that quote is estranged family abusers, not geriatric bi-polar relations for whom you are a caregiver. However, should you find it necessary to manage telephone contact, then you should anticipate the enlistment of ambassadors to run messages.

Practical Advice

1. It may be that they haven’t been exposed to quotidian bi-polar behaviour. Explain that your mobile phone bill has gone stratospheric thanks to the hundreds of phone calls per month. People will think you are exaggerating so have specific numbers. ‘According to my statements, she called XXX times last month, and XXX times the month before that…’
2. Tell the well meaning person that you are in contact with your relation once or twice a week in a schedule that better suits you; and the nursing home is free to call you.
3. Assure the ambassadors that the needs and general administration such as banking and legal stuff, are being looked after.
4. Expect ambassadors to come in the first month any time there is financial stuff, some trivial government letter or the like. Really, any excuse will be used. Other times to expect ambassadors are any time there’s a social calendar event such as the holidays or birthdays, religious feasts or critical life events such as funerals or emergencies like the sun is up or a dog barked.

The Ambassadors – Hans Holbein

The Underpants Gnomes and Compassion Fatigue

Bi-Polar Caregiver’s Maxim #1: Virtually every article you will read about being a caregiver for a bi-polar parent will be useless because these are not action oriented.

This blog is being written by me to organize my thoughts as I struggle and muddle through taking care of my bi-polar parent when I’ve been doing it for far too long single handedly.in part because there is virtually no advice from anyone on how to do it. Consider these various studies and articles

• How caregivers of mentally ill kin can cope
• Preventing Caregiver Burnout
• Caregiver stress

Notice how none of these fine articles actually says anything. Sure, many of them are well-written and have their virtues, and I’ve not actually seen the raw data from these studies so I am not qualified to determine the value of these surveys, but for the most part these appear to be useless. Take a walk? Really? That’s your advice? To summarize them:

• Burned out caregivers must cope better.
• Cope better
• By coping beter, you will cope better.

To put it more formally, this a prepositional tautology. In other words, you haven’t said anything beyond the initial statement. If that’s not clear, think of the Underpants Gnomes of the television satire South Park. If you haven’t seen it, the protagonists of this satire  encounter magical gnomes who travel the world stealing underpants. The theft of these is the first step to becoming rich.However, they’ve forgotten what the second step is to be. ‘Phase 2: ?’has become a bit of an internet meme.

The Underpants Gnomes — Phase 2:?

The mystery of why there is so little actionable stuff is a bit of a puzzle to me. I mean, why write an article that says nothing but there’s no end of unspecific ‘adjust your goals better’ caregiver non-advice on the internet.

I’ve figured out why most writing about caregiving is mush, but I’ll address it in just a moment.

Part of what I do for a living is help technology designers decide what they’re going to do and why. A huge problem in the tech industry is that people build stuff into products for no other reason than they can. In other words, many technology products make it to market as solutions with the vague hope of finding a problem. Ergo, I’m very well practiced upon helping people defining things precisely because I can’t provide an explanation to your end user if you don’t even know why you’re building the darned thing.

Therefore, as I try to sort my own agonies of being a caregiver to the bi-polar,  I try to collate what little useful information is out there for caregivers of the bi-polar, and provide actionable advice. You’ll notice that each article I pen that is tagged ‘advice’ actually has something practical you can do.  I have a theory as to why most caregiver advice is useless but I’ll get to it in a sec.

Practical advice:

1. Never think. Act.
2. Remember a S.Y.S.T.E.M.
3. Failure tolerance

Coping may be thought of as practical or psychological. According to boffins*who study such things, caregivers who are problem focused have less burnout. Here’s an example of each. Recently my mother sold her house and, I’ll spare you the details, did the dumbest thing possible with her money. Do you:

• Scream and cry
• Call her bank

If you feel yourself about to explode, ask yourself, ‘What can I do this second? Apart from dance a jig while holding a pillow over my bi-polar parent’s face?’ Now, it’s a hard thing for me with a philo degree to say don’t think, but I’m sure that when Socrates was on campaign against the dreaded Persians (how little things change) he knew that then was not the time to mediate upon First Causes. When in doubt, act.

I have found that virtually all articles about caregiving are useless because the articles address care burned out caregiver’s symptoms and not the cause. Hence, my advice articles always focus upon the practical. This is why virtually all compassion fatigue advice is uselessly generic. It’s about symptoms and not causes. Hence, there’s no relief since the ‘advice’ doesn’t improve predictability. Most caregiver compassion fatigue articles are useless because apart from your parent being embraced by the sweet release of death, there’s no solution apart from firefighting each foolish incident from now until the glorious day he or she dies or  has the good manners to lapse into senility.

The caregiver is not a mechanic, not a physician or an engineer. You, as a caregiver are a fire fighter. Your job is to stamp out fires. You are always in reactive mode best you can do is set up systems to reduce how much fires can spread on their own, and their overall intensity, but you will not eliminate the fact you’ve got an arsonist permanently on the loose. Stress reduction is about eliminating how bad things can get, not their frequency or randomness. You get to be on permanent stand-by for action stations until the day your mentally ill parent dies.

This is why almost everything written to assist fatigued caregivers is generic pablum of zero use to anyone other than an unusually stupid child of ten or vice-president of marketing because the job of the caregiver is reactive and resistant to predictability. My efforts on this blog are to correct this. 

S.Y.S.T.E.M. 

Remember this: Save Your Self: The End Matters.

Here we stray into exactly the generalist rubbish that is the problem that makes virtually all writing about caregiving useless. Keep your eye on the larger picture. One day, there will be a glorious day when your obligations end. When in doubt, save yourself. Is your life your own, or will you sacrifice it for someone else who frankly doesn’t care? No! Save yourself. Fulfill your obligations to ensure that your bi-polar parent has her or his health well managed, finances in good order and other sundries met, but your needs matter.

• If it helps lift your mood, practice writing your bi-polar parent’s obituary. It’s good fun.
• Practice saying ‘no.’

When my dad was diagnosed with the pancreatic cancer that eventually killed him, my mother announced at a holiday dinner that her sister, who was visiting from nearly 750 KM away, should think about moving in with them, meaning ‘take care of me when my husband dies!’ Well, my aunt — a shrink, by the way —  wasn’t about to give up her career to do that.

When my dad finally died, my mother expected me to quit my job and move in with her. The bi-polar parent has needs, sure, but if you have to choose between your needs and theirs, choose yours.

Let’em Fail, Properly
Thirdly and finally, mentally ill or not, we are all ultimately responsible for our actions. You must accept that they are too and you cannot keep them from repeatedly making nonsensical choices. In technology, we often discuss ductility. This is a fancy way of describing how pair shaped things can get before they break. Take steps to ring fence how badly your bi-polar parent can fail:

• Get a mandate from the bank
• Reduce the credit card limit
• Have groceries delivered
• Set up auto payments for bills

All of these things will reduce the amount of contact you need to have, and ergo, improve your own quality of life.

* Forde OT, Pearlman S.: Breakaway: A social supplement to caregivers’ support groups. Am J Alz Dis. 1999;14:120–4.

Pro Tip: On Mother’s Day, look in the funny cards section

My bi-polar mother is particularly fixated upon on cards. The tackier, the better. All of us have social quirks and for her, cards loom large. All of us have social rituals that matter more to us than our peers. A friend of mine goes bananas if you don’t make a big production of saying thank you after dinner. Another pal of mine is big on giving flowers. There is never an occasion for which flowers are not appropriate. A woman I know is big on complimenting other women on jewellery. Every conversation grinds to a halt for 45 seconds while she trots out exactly the same compliments like clockwork.

We each have social fixations, that, for us, loom a little larger. If your mother is like mine, cards are the grease that makes society tick along without any squeaking. Every occasion requires a card. Worse yet, she keeps bins of the damned things. I guess in her mind it’s a physical demonstration of her social currency.

If you’ve read other entries on this blog, you’ll be aware that I have a rather one-sided relationship with my mater matris. But, it costs me little to maintain the social graces, so I buy the darned cards as it makes her happy. May I suggest the following tip: look in the stationary shop’s humorous card section. Even the humour section have cards for all of the major occasions like birthdays, the religious and social holidays.

Why?

Because those cards typically don’t have the phrase ‘I love you’ in them.

Social workers and you. Well, actually, just you.

Social workers aren’t there to help you, the caregiver of bi-polar parents. You are free to ask for help, but be warned, there’s a catch.

Catch-22

Read this next part slowly: since you’re competent, and you’re capable of calling on your parent’s behalf, that means from the perspective of a social worker, you can manage your bi-polar relation. Ergo, social workers will close the dossier on you in order to work on someone else who doesn’t have anyone competent nearby to help them. Let me put it another way:  If you want to get social services for your bi-polar relation, never speak to social services. Instead, get your bi-polar relation to speak to social services.

Social workers are there to help the most incompetent and weak. That’s entirely correct. If a helpless person has no one to ask for help for them, that person can get help. However, if the bi-polar person has someone, they’re not helpless and are therefore not eligible for help. You’re not the patient, remember? And, I hate to admit it, I agree with the social workers. Our parents have ‘only’ bi-polar disorder. If the social worker has to choose between makin my life easier because I have a bi-polar mom, and trying to help a patient with suicidal ideation, I must get pushed to the back of the queue.

I understand.

Again, social workers are there to help the weakest and most vulnerable members of our society. Fair enough. However, since you appear to be a reasonably functional family member, and are capable of pursuing long-term complex actions for the benefit of the aforementioned relative, the social worker will coo sympathetically into the handset while putting your documents into a shredder. Never under estimate the skill and practice they have at making it seem like they’re doing you the grandest of favours when they’re actually putting your parent’s file in the recycling wheely bin.

They’re at the Grand Master level of saying tough luck, you’re on your own while making it seem like they’re pals. Being a trusting soul, I fell for this a few times before catching on. It’s no accident. It is deliberate.

Mr Bond, they have a saying in Chicago: ‘Once is happenstance. Twice is coincidence. The third time it’s enemy action’.

— Goldfinger, Ian Fleming, 1959.

That you, the caregiver, are trying to get help may be at wit’s end, be ulcerous, or be forced to quit your job, become alcoholic or something else because of bi-polar caregiving, may often be outside this or that social agency’s remit since you are not the patient. However, of you do have a nervous breakdown because of exhaustion related to being a caregiver,then you may be eligible for help.

Practical Advice:

1. Talking to social services on behalf of your mentally ill geriatric parent is the kiss of death for assistance.
2. If you cannot avoid talking to social workers, be focused on problems and not solutions.
3. Have some sympathy: social workers cannot control their workdays
4. Put it in writing.
5. It’s only bi-polar disorder.

Let’s take those points in turn.

Firstly, always have your bi-polar parent ring social services. Make those sorts of calls their responsibility and be like HG Wells’ the Invisible Man. If you find yourself surprised by answering an unfamiliar number and find yourself on a call from a social agency on behalf of your parent, hang up. Find any excuse — tell them you’re walking into court because of a mandate to appear for pinching a policeman’s helmet or tell them you’re being deployed to Afghanistan but ring off without saying anything. The sanity detectors of social workers are very good. If they detect competence, they’ll close the dossier on your parent. If you’re trying to shake loose some program spending on behalf of your bi-polar parent, treat the social worker authorizing this approval like an enemy intelligence gatherer. Pretend you’re talking to a Nazi from a film. Say nothing.

In short, be like Major Major, the over-promoted laundry clerk from the afore-mentioned Catch 22.

The second point is, admittedly, obscure.

Normal people have what I will call a belief in their own powers of efficacy. You believe that somehow, you’ll muddle through no matter what life throws at you. So, when there’s a barrier, you focus on going over, around, underneath or through. This is why you’re capable of holding a job. People with no concept of self-efficiacy treat every single problem as being insurmountable. The universe ends at every complication. Talk like that when you’re speaking with a social worker on behalf of your bi-polar parent. It may convince them that you’re also a helpless bi-polar person and ergo help dislodge some program spending on your parent’s behalf.

This sort of Sir Humphrey thinking can be a bit of a brain twister but it’s similar to documenting technology research and development for government tax credits. In order to qualify, the industry ministry doesn’t want to see solutions, they want to see intractable problems.  Why?  Because if solutions are obvious, there’s no intellectual property being added to the nation so there’s no R&D. In other words, the development diary needs to do the opposite of what it normally does: you need to document the problem and demonstrate its complexity. If talking to social workers is unavoidable, focus on problems, not solutions.

• Pro Tip: Keeping in mind that the latent assumption of this article is that you are trying to shake loose some program spending to benefit your bi-polar parent. If you must meet with the case worker, a great tip is to exercise. I am a great believer in running but what ever your sport is, exercise is very good for you and you should probably do more of it. In this particular context, if you must meet with the social worker, work out strenuously for the previous two days but don’t wash and wear an out of date suit from the Sally Ann with unpolished shoes.

Thirdly, if you must talk to case officers, don’t call before 9:30 AM. Ten is great. 11:30 AM is too late because they may be behind already and Heaven knows when they’ll eat. The latest you should call after lunch is 1:30 PM. People in social services are often dealing with doctors, lawyers, parole officers, pharmacists, judges, nurses, hospital administrators and an alphabet soup of other national, regional and local agencies all within the same hour. All of what I’ve written above may not make it seem as though I am sympathetic, but I am. Many of these people work very hard, with limited budgets and are not able to control their in-boxes.

I’ll say it again to be explicit: social workers have my respect and admiration and there’s not enough tea in Cathay to get me to do what they do for a living as it’s hard and critical work of great beneift. So, call early in the morning because by the end of the day they’re haywire.

Fourthly, put everything in writing. Take minutes, get copies of reports and then MAIL PAPER LETTERS confirming what was discussed and formulating your request.

In the grand scheme of things…

Again. I hate to say it but our parents have ‘only’ bi-polar disorder. If your parent is not suicidal. schizophrenic, violent, unfed, toxic on meds or otherwise in grand-mal mania, your parent is not acute. By definition the social worker must push your bi-polar parent to the back of the queue to service people who are suicidal, schizophrenic, violent et al.

We’ll have to suck it up.

Sorry.

The Painted Bird and Captain Picard

There’s a great novella by Jerzy Kosinsky called The Painted Bird, about a boy who is separated from his guardians during a war.

You can probably read it in one Saturday afternoon sitting. As I recall, there’s not even a sentence of dialogue. It’s all told in the past tense from the perspective of adulthood as the boy wanders the countryside, staying in village after village with this or that family of illiterate peasants. All the while, the distant war moves like a weather system over the landscape. This city boy, who went to school, is schooled instead in superstitions and gradually it becomes clear that this is taking place in the middle of WW2.

We are shown that the pesantry are effectively living 16th century lives and the modern world has passed them by.*  When I think of how utterly unprepared my bi-polar parent is for modernity, I’ve remembered that 1965 book.

The violence in the book happens off stage for the most part. The war is effectively a large weather system in the background. No, the awfulness is depicted as being done with relish by the uneducated peasantry upon each other and anyone who happens to be within sight. Why? For petty reasons and for what can only be described as magical thinking. If someone knows how many teeth you have, a spell can be cast to make you ill, that sort of thing. They have so little control over their lives that they rely on magical explanations.

It’s at the level of ‘so and so’s cow gave more milk today, so I should put a hex on his wife so that she votes Tory or something.’

Silvano Arieti described how creative people think as ‘magical thinking.’ He meant it to mean that an artist or scientist can see connections between ideas that result in new understandings. On this blog, I’m writing about tending to bi-polar people in such a way you don’t cut your own throat to escape, so I use’magical thinking’ to mean the knotted tangle of yarn in their heads. Programmers use the expression ‘Garbage in, garbage out’ with the bi-polar, all outputs are random, no matter how high quality and regular the inputs.

A universe inside one ego. Or id, as the case may be.

Essentially, you and the universe are extensions of their egos. Basically, they’re in the grip of a universe ruled by unknowable magical forces.

If you’ve never experienced it, see Patrick Stewart’s excellent Macbeth. In the dinner scene, Macbeth is tormented by Banquo’s ghost. However, in this version of the play (which I saw in London  –gosh– a few years ago) we don’t see Banquo. Instead, we see Captain Picard freaking out to something no-one can see. Poor Macbeth is, as Stewart said in many an interview at the time, utterly in the grip of emotional and superstitious forces driving him to disaster. Objectively, you and I look on to see a man going to pieces.

Please consider this illustration.

That’s what it’s like dealing with a severely bi-polar parent.

If you tell a story to my bi-polar relation about something that took place without that person around — at my office, for example —  the next time the subject comes up, expect to hear about it as though that person was there. Stories are always viewed from the  perspective of them as central actors.  It seems quite a dull universe with only them in it. But, their egos are the centre of gravity for all things.  The solution is to not tell them anything, and provide no narcissistic supply.

Dealing for decades with someone who relies entirely on magic for their operational understanding of the universe is exhausting. For the mentally ill person, everyone and everything is an extension of the ego. Other people aren’t real to then. I’ve developed a theory that Christians re-wrote history in a PR stunt when they took over the Roman Empire. Some marketing exec in the early Christian Church claimed that the Romans had been throwing them to the lions; I am convinced that this is not the case. I am sure it was bipolar people being fed too the great cats by their relations.

Practical Advice

• Don’t tell them anything.
• Limit them to yes and no choices. Open-ended conversations about causation and choice — the Devil with it. Not worth the grey hairs.
• If they need to choose between options for major things, you choose the A or B options and ensure that these are presented. My parent has a way of choosing M or Z — some irrelevant nonsensical constellation of responses that have nothing to do with anything. Give’em A or B or walk away.

What do you mean A or B?

Back when I was a reporter, I knew a complete prick who was the senior civil servant for a regional government. All of the mayors and reeves of the area were on this council. Lots of big-fish-in-small-pond egotism. When the politicians met for their monthly event, they’d vote on this or that policy. He’d always present the motions with an A, B or A, B and C option. He’d trained them well. They could choose from the options but never get to mix and match. If they didn’t like the policies presented, the motion and its policy were withdrawn and tabled until next month so he could redraft them accordingly. As much as this ‘Sir Humphrey’ was arrogant jerk, he was very good at his job.

You may wish to consider this.

When presented with a decision, and the average person would choose between one or two reasonable options, my parent would always choose some irrational unrelated option that made no sense. Learn to prep the ground ahead of time: Choose A or B, not M or µ. Have your A and B ready for any bank or legal work ready ahead of time on paper if necessary. The magical connections the person makes in her or his head may otherwise be random and therefore frustrating to you.

What about the charge of paternalism? Well, this is a question of ethics not to be discounted. If the A, B and C options are defensible in that the options are reasonable and practical, I think you’re on sound moral ground.

* Not that surprising, really. By and large, only one third of the wehrmacht was motorized and in Canada at least, literacy wasn’t a requirement for the Infantry in WW2. The Great Depression in America proved devastating to public education, too.

Advice for Newbies

Once you’ve been a caregiver for a bi-polar person for several decades, your perspective will change. People who are dealing with a newly-diagnosed bi-polar person have enough to deal with; so if you’re participating in a caregiver support group that meets occasionally, you have to be clear of where you are. Newcomers to the unending joys of caregivers to the bi-polar will be at sea still; that the moderator may ask the more experienced among you to stop being so, umm, blunt.

This is why this blog is about multi-decade caregivers. I have little practical advice for anyone who is a newcomer to caregiving for the bipolar because that’s a distant memory but here goes.

If you are a newcomer to caregiving for a bi-polar adult, you may be in the shock phase, or in the grateful phase now that your partner or parent is over the crisis that finally got a doctor into the picture. You will be so grateful that the person is in treatment that you make the mistake of thinking he or she is better.

Get over the immediate crisis, pick up the pieces and get on with your life. You will reach a few points in the next few years where the person may become toxic on medications, so watch out for that. No, seriously, watch the blood levels because these are strong medications and need to be respected because they can knock a patient off her or his feet if the levels creep too high. The result may be psychosis or falls and kitchen accidents.

What will happens is that once the meds kick in, you’ll have comparative relief. The extreme highs of the person’s mania and oceanic lows are mediated — and you think it’s better. Incorrect. It’s merely less bad in the way that if you have both hands on two bunsen burners until your palms start burning.

Now remove one hand. Doesn’t that hand feel soooooo much better?

What the meds to is make it hard for the patient to alter affects quickly. In other words, they change direction like a bus rather than a sports car. They can still reach those manias and depressions but not as quickly, and therefore not as often. They will still lack common sense, good judgement, a sense of proportion or any ability ability separate needs from wants; i.e. the rest of the universe from their egos. The medications will do nothing to correct this.

Here’s that point again

The meds reduce the rate at which mood varies, and a few other things such as sleep patterns, anxiety and restlessness. All of the underlying personality issues are not correctable through medication. Their inherently poor thought processes, lack of judgement, insight, and character issues such as narcissism and immaturity,  are not treatable through pharmaceutical therapy. What the meds to is add inertia to mood.

The severely mentally ill never really get better. They only get slightly less bad. You will be holding your breath for the rest of your life, waiting for the next artificial crisis. Imagine Woody from Cheers having power over family finances and you’ll imagine your stress levels. It will be the most unsatisfying, frustrating relationship you have in your life by any measure so be dutiful bit distant is my advice.

I know how cruel this sounds but you have every right to live a satisfying life, too.

Practical Advice for the Bi-Polar Care-Giver

I’ve been to a number of events put on by social services to help families coping with the mental illness of a loved one or at least a family member. Social workers at community groups will give you generic advice, but it’s of no practical use for someone who has been run ragged by a bi-polar person for decades. For example, they’ll tell you to reduce stress and other paint-by-numbers advice, but nothing concrete.

I have distilled my experiences into the following. Keep in mind, I’m in my 40s, am unmarried with no children and am dealing with parent diagnosed with bi-polar disorder a long time ago and has been in treatment for it since; geriatric issues are slowly beginning to appear. Your own experiences and mileage will vary.

Your soul in 20 years

Basically, you’re fucked

Why are you fucked? Because you’re the only one left. Your relations and your bi-polar person’s friends have figured out that life is too short to endure the agony of close contact with the person in question. You know what, maybe you can take some of their advice. The agony will end when your bi-polar parent slips into permanent senility or is in the sweet embrace of a casket. Until then, you’ll be dealing with an uncooperative paleologic tangle of need who will create an endless string of manufactured emergencies about random subjects between temper tantrums and periods of operatic self-pitying.

You don’t need to be in daily contact. If the person is capable of bathing, you’re fucked but not completely. To quote the great Admiral Nelson, ‘Desperate affairs require desperate measures.’ Don’t worry about what other people think as they are not the ones with their arses on the line.

What you need to do, is reduce the amount that your are fucked. Essentially, damage control. You are fucked in two ways: damage to yourself and damage the mentally ill person will to do him or herself. This essay covers some of each.

1. Control contact

Assuming the mentally ill person can manage bathing and other sundries, there is no reason to have daily contact. Print that and stick it on the kitchen door. You are in no obligation to be in contact with this person every day.

• Reduce the amount of telephone contact
  If the person is a phone-a-holic, find out which mobile phone service will allow you to block calls that way you are in control of when you communicate and how often. I required this step myself and I should have done it years ago. My parent would fill my voicemail by lunchtime and if I deleted the messages she’d only leave more. Finally I arranged to have her inbound calls blocked but I needed to switch phone companies to do it. (I’ll return to this topic later.)
• Reduce the amount of direct contact
  Contact shouldn’t be free therapy sessions. Instead, make your visits task oriented events such as the weekly shopping. Or have groceries delivered and have the task oriented visit tackle something else. This way, when the task is done, you and the mentally ill relation can part company and it’s been productive. This also prevents the ‘you don’t do anything for me’ complaint because that is specifically why you are there.

2. Ring fence the amount of financial damage the mentally ill relation can do to him or herself.

Contact the bank and have a reduced credit card limit on the person’s card to ensure that she or he cannot do much damage to the family finances. After all, unless you are buying a car or renovating a house, how much credit do you really need at a moment’s notice? Get the bank manager to sell the mentally person on a bank mandate. This will ensure you have administrative access to the person’s finances to a) monitor for irregularities and b) ensure bills get paid. I am suggesting that you get a bank mandate first because it’s an easier sell than a general mandate in case of incapacity. As you are no doubt aware, bipolar people have moments of incapacity and general times when they’re on the ball. The general mandate in case of incapacity is really the nuclear option and should only be employed in extreme old age. You should probably get one but it’s a separate step and it’s a big one; wait a few years.

Use your meeting with the bank manager to ensure any concerns about a cash grab by relations are discussed. There is usually one in the family tree. The bank should have some pamphlets about financial abuse of elders handy.

In my case, I’m dealing with a geriatric bipolar person and the bank was more than happy to have me take over for her. She was using the bank as her place to socialize. If your bi-polar relation monologues as much as mine, the bank staff will be overjoyed to help you and even arrange for a marching band to celebrate the event.

Obviously, set up automated payments for bills. If you’re not good with this sort of thing, the bank will help you with this happily.

3. Documentation

What ever bi-polar parent’s medical condition (i.e. any comorbidities), get the doctor to document all diagnoses on what ever certificates and forms they think best. Being able to wave a piece of paper under sundry noses can be very useful for obtaining various services from the various levels of government in your area. There are all sorts of classifications for medical conditions, and your bi-polar relation doubtless is on one or more of them.

Documentation is key. You never know what programs will be announced or  — in these days of austerity — cut. Having your mentally ill parent classified, named, stamped and certified on this or that form ahead of time may can be a good idea. As program spending is reduced, being the first one in line with a piece of paper documenting your bi-polar relation’s acuity may prove vital.

4. Ignore what social workers say and watch what they do, which will be nothing. 

Social workers are wonderfully adept at holding your hand and cooing sympathetically while doing nothing. If you’re a social worker and reading this, I don’t mean to sound unsympathetic, as I’m aware you’re dealing with finite budgets, but I don’t care about you, I care about the bi-polar caregiver who’s having murder dreams.

I’ll return to this theme in a later post, but if you want to get anywhere with a social worker, the best way is to never speak with them. If you speak to a social worker,on behalf of your bi-polar parent it’s game over however, assuming it’s not too late because some sort of process has begun, here’s what you may wish to do.

If you’re on a phone call with a social worker, and you get the feeling you’re being told that you’re getting nothing, stiffen your spine and actually ask direct questions to obtain unambiguous yes or no replies. Police are skilled into getting people to incriminate themselves by asking questions that result in practical confessions; similarly, social workers are very well practiced in saying ‘Tough luck, you’re on your own’ when making it sound like they’re doing you a favour and getting you to thank them for it. Ask questions like:

• ‘I’m sorry, I don’t understand: can you tell me in 12 words or fewer the purpose of this call?’
• ‘So, you’re telling me that you have a geriatric bipolar person who has mobility issues, and has had falls and you are choosing to risk incurring greater expense to the system, rather than provide a walker? Do I have that right? Can you give this to me in writing, please?’
• ‘You’re suggesting I quit my job and go on social assistance to become a full time unpaid geriatric psychiatric nurse and abandon my children. Okay, please explain why I would do that?’
• ‘We’ve established that this is a geriatric patient with diagnosis of bi-polar disorder, kidney failure and an undiagnosed palsy and I live an hour away. Your suggestion for her getting to medical appointments is that I take off five days of work per month forever. In practical terms, you’re asking for me to get fired, is this correct?’

Once you’ve shone a light on what they’ve said — that you’re being hung out to dry — ask them specifically what you can do to get on the other side of the decision line. I know I’m knocking the valuable and important work that social workers probably do, and I promise to make up for it in another post but my practical advice is to never assume that social workers will help you and certainly not immediately or with speed. (UPDATE – – Topic revisited in a follow-up post.)

As a side effect, sometimes due to a medical event, a hospital will call and say to pick this person up but stay with her the next 24/48/72 hours. When will they call? Friday afternoon. I’ll probably return to this subject in a later post but the ‘no’ word can work wonders here too. Remember, they’re past masters at getting you to agree to this sort of thing. (UPDATE – – Topic revisited in a follow-up post.)

5. Get the person into a supervised environment.

Should family members live together? Maybe, but don’t be guilt-tripped into it. Your life isn’t a Norman Rockwell painting so don’t pretend it is for the benefit of others. And certainly since you probably the last one left to deal with your bi-polar relation, it’s suspicious how few of your relatives seem to be jumping at the chance, eh?

Okay, now people have different levels of income and I cannot know what your financial situation is, dear reader, but there has to be some sort of environment where the bi-polar person can live, or live near. The reason is the worst thing that can happen is medication compliance issues. Getting the person into a location where meds are supervised is key. The latent assumption here is that your parent’s spouse is now deceased and that you’re the only one left talking to your bi-polar, geriatric parent.

Your own life matters and as I told a social worker: ‘If she moved in with me I’d move out.’ Like it or not, your long term goal: to get this person into a good environment with people her own age, and programs, and busses and social activities. If you don’t have the financial wherewithal to make it happen immediately, make this your long term goal; it may take a while to get onto enough waiting lists to get this to happen which is why documentation is so vital.

• Use the ‘No’ word when people insist the bi-polar person be moved in with you. If they think it’s such a hot idea, they can go first.
• Do not worry about what other people think.

6. Doughnuts and stamps

Seriously, bring sticky buns every once in a while — every three months for a senior’s home for example — in order to grease the wheels. Doubtless your bi-polar parent has been driving the staff  and management crazy. You’d be surprized how much a thing like this counts. They have hard jobs, showing sympathy and appreciation counts.

Once you convert a ‘tough luck, let us know how it works out’ to a ‘O, we did find some money under the seat cushions for that program,’ mail a thank you card to whoever got your mom or dad into that program. Seriously, no one does that any more. You’d be surprised how well that goes over. Moreover, call just to say ‘hi’ and two weeks after they’ve told you to fuck off. You never know what might get shaken loose the next time you call.

7. Never accept blackmail

People are generally reasonable but the universe looks very different to a mentally ill person. Basically, the world seems to operate on supernatural forces with no rules. So, the few things over which the bi-polar person have control, they tend to use like a stick. My mother refused for years to do a will as it was a club with which she could beat me. Finally, one night she rung me to say that she needed a soft drink and I should drive across town in rush hour because ‘I’m going to do my will soon.’

I replied: ‘Let me get this straight: you’re blackmailing me over club soda’ hung up, and didn’t return the next three dozen phone calls.

If you give in to black mail, the person won’t respect you. In my case, the mentally ill person was using the power of denial — a long time favourite tactic — to control. Any time she had a decision to make, she use that power to fuck things up for others ‘just because’. Well, don’t accept it. Call the bluff and hang up.

Your self-respect and sanity is not worth it. 

Pro tip: Blackmail regarding the mentally ill may not come directly from the person in question. Other relations may use it because they don’t want the, um, pleasure of the mentally ill person’s company.

8. Become a yes man

Agree with everything the bi-polar person says and then go ahead with what you were planning anyway. This was suggested by a friend who is a parent and, while it can be disrespectful and autonomy reducing, I guess it’s what dads and moms do sometimes. Not being a parent myself, I assume everyone with whom I am dealing is a rational agent. Wading through the sudden shifts in contradictory demands, I assume there’s a logical thread and what’s frustrating is that there is none. Of course, it’s maddening to me that there is none, and after several decades of this, you’d think I’d eventually learn but in my defence, I guess my instincts for logic are overly muscular.

Say yes, and move on and hope the bi-polar person moves on. Key to doing this, however, is to reduce the amount of contact so you don’t have to wade through a firehose spray of demands and end-of-the-world needs.

Say yes and move on. If asked why, say ‘soon’ or throw out an obfuscating delay like the pressures of work or your car sprained its differential or that your computer needs a new oscillation over thruster.

Summary

You actually have cards to play.

Why Emerg. Physicians can be such Cunts

This post is dedicated to Dr. HC, whom I met at on a late weeknight

As the caregiver of a bipolar person, you’re probably well-used to dealing with physicians, shrinks, nurses, social workers and medical clerks.

Very little of what you know applies to physicians in emergency departments at night.

People during daylight hours, on regular shifts, are generally civil but as the person for whom you are caring ages, in addition to all of the other joys of being a bipolar care giver, you’ll have to deal with geriatric falls, broken toes as things get dropped, kitchen accidents and unnamed tremors and arthritis-related accidents. The times that these occur can often lead to nighttime visits to the fibreglass chairs of your local hospital.

This can be a real shock if you’re dealing with regular GPs, specialists, or sports doctors, to suddenly be bullied by some asshole at two o’clock in the morning because you made the mistake of mis-using medical term. I suspect it’s because if I was dealing with a largely obese and illiterate public, and forced to wear a polyester jacket and a name tag past the Witching Hour, I’d be a little miffed too, particularly when I have to deal with a public that didn’t get past basic math and gets its science education from police shows.

1.Never speak in declaratives

Make every sentence a question, even if you know the answer and are merely seeking confirmation.

Doctors earn a few hundred grand a year and have weak egos as a consequence. Begin by telling what a poor idiot you are and how wonderful their poop must smell. ‘Look, I didn’t go to medical school, I do [INSERT YOUR JOB] and I’m sure you’re sick of having to explain what seems obvious to you but..’

Let’s say you mistake one technical term for another, and the doctor jumps down your throat over it. You may get an exchange like this:

‘Why would you want that?’ This may come quickly and aggressively as the physician tries to assert dominance. ‘You said [WRONG TERM], and I want to know why that’s your recommendation.’ The doctor is choosing to hear your question as a statement, and therefore a challenge to her or his authority. Take a deep breath and ensure what is heard is a question. I may be wrong here and am willing to be corrected, but I’d bet this happens generally when a mid-career doctor is in front of a younger doctor. (Opinions, anyone?)

To summarize: slow down the conversation. It’s great if you’re next to one of those ‘No verbal violence in the workplace’ posters that are all over hospitals.

2. Act like a moron

Explain that as a member of the public, you’re clearly an imbecile, and get the conversion back on track.

• Try to be funny: ‘I suffer from medical condition called moronitis. So, if we could just go over that again…’ You may not be up to it in a sleep-deprived state bit it usually makes it difficult for your interlocutor to be aggressive in response.
• Be blunt, but a blunt moron: Say you asked a question, and ‘If it was the wrong question, so be it, tell me what the right question is, after all, I didn’t do seven years of post grad in medicine’   You’ve appealed the doctor’s status, and apologized for breathing.
• If cuntishness continues: Say ‘I realize this is time consuming…’ then insert the doctor’s name as you read it off the name tag. That last bit can backfire if you lack confidence.

Again, I suspect that cuntishness comes from impatience and the inconvenience from the doctor’s point of view, because of the inherently unstructured accident and casualty environment when nuanced decisions need to be made quickly and they are dealing with a public educated in medical matters from soap operas and prime time dramas.  What do I know: I’m  a technocrat. Look, you will never have to see this villain again. Your job as the burned out caregiver of a bipolar parent is to get the info you need and get you and your bipolar parent back to sleep.

Post Scriptum:

I can attest from personal experience that ‘Don’t get angry with me, I’m not the one who chose to work here’ doesn’t work as an answer. Or it didn’t with Dr HC.