Cane

    M A R Y   E.   G A R R I S O N

I came to social work after a journey of working with people but never finding my true calling. Ultimately, it was on my interview day at a community mental health center that I met a man who changed my life. He displayed symptoms of schizophrenia and we spoke for a short while but I knew after connecting with him I wanted to be a social worker in mental health. I was committed to meet my goal as I wanted to do all I could to help others and advocate on their behalf. I received my MSW (University of Illinois at Urbana-Champaign) and became a licensed clinical social worker and worked in direct practice for 12 years. My career path took me to academia where I am now an Associate Professor of Social Work at Millikin University. I have the distinct honor of working with students educating them about the social work profession and specific areas including community mental health, poverty and ethics. My journey has been life changing allowing me to understand how essential it is to advocate for social justice, provide services to individuals that will honor one’s dignity and worth as a person and value the importance of their human relationships. I strive for integrity in all I do.

I chose this Cane because …

… It belonged to Arthur, a 54 year old man with a diagnosis of schizophrenia who had been in treatment for more than 20 years. His treatment included medication, case management, residential and community support. Arthur had poor hygiene and grooming and poor communication skills, all of which led to a life of stigma and marginalization.

The story of this cane unfolds as Arthur arrives home after a day in a rehabilitation program. He is displaying signs of confusion and imbalance. He was unable to articulate anything that was helpful in deciding in what to do. Arthur has had a history of needing the regular removal of a build-up of ear wax which often times has led to these same symptoms – confusion and imbalance. With that knowledge, I took Arthur to his doctor the next morning, but a check revealed no clogging. Arthur was silent as we sat in the exam room with the nurse. Given his symptoms weren’t related to wax build-up, I advocated for a thorough physical exam. However, instead, the doctor gave Arthur this cane to help with his imbalance and told me to call back in a few days if things were no better.

We made it back to the group home where almost immediately Arthur lost control of both bladder and bowel. He was unaware of what had happened and staff cleaned him. He continued to show signs of confusion and imbalance and after an hour or so I decided we needed to go to the emergency room.

With cane in hand to assist him with his balance, we were off to the emergency room. We waited several hours and when the doctor came in, he spoke directly to me without acknowledging Arthur. I introduced Arthur and asked him to share with the doctor what he was experiencing and filled in the blanks as I could. The doctor felt it must be an issue with his psychiatric medications. Because I knew Arthur so well, I was confident that these were not an issue and something else was going on; this was something new. The doctor refused my request to run blood tests and a CT scan. I told the doctor that Arthur needed to be examined thoroughly and I wouldn’t allow him back in our group home until we knew more about what the problem was and how best to plan Arthur’s care. After a long standoff, the doctor agreed to some blood tests and upon receiving the results saw immediate cause for concern and agreed to admit Arthur for the night. As Arthur got settled in, I waited and assisted him as I could with the cane at our side at all times. Arthur held the cane even when in bed, almost as a support beyond his balance. Arthur had some tests run over the next few hours and when I left him he was resting. I told him I would return the next morning.

When I arrived the next morning, Arthur was lying in bed. A team of doctors walked in quickly and looked at me and Arthur. Looking directly at me one of the doctors told me that Arthur had cancer that had matastized throughout his entire body. I turned to Arthur and asked if he heard what the doctor said and if he knew what that meant. Arthur shook his head yes. I asked the doctor about treatment and what his prognosis was – how long would he have to live. The doctors said that he only had a few weeks and they would refer him to a hospice. They looked at Arthur and said “if you want to get up, be sure to use your cane,” and then left the room.

Arthur could barely get out of bed, let alone walk with a cane. He smiled and said Ok, in his quiet voice. The doctors left and I sat with Arthur. I brought along a large Hershey candy bar (his favourite thing ever!) and as I handed it to Arthur, he said, “Thank you. I would like you to please leave because I do not want you to see me in so much pain.” Arthur had the most understandable speech I had heard in ten years – completely clear and deliberate in what he was saying. Yet it was hard for me to hear Arthur say he was in pain as, from what I could tell, he had never been able to feel pain before– there had been times where he had burned his hands on coffee or fell and hurt himself but never expressed pain from it when we asked. Now it was different. The cancer had ravaged his body and he was on morphine to help the pain. He was going to die soon and there was nothing that could be done, so the doctors said. I respectfully left Arthur, saying I’d be back in the morning. I noted that he had his hand on his cane.

I received a call that evening that Arthur had died. Arthur had no family (we at the group home were his family), so I collected his belongings – his clothes, glasses and wallet. And there lay the cane.

I have kept the cane ever since. It is a constant reminder of how important it is to advocate for individuals who have no voice. We will never know if there would have been a way to know Arthur was so ill with cancer earlier, but I believe that if over the years a doctor had taken the time to look at Arthur as a whole person, he might have lived longer.

Research tells us that individuals who experience serious mental illness die 25 years earlier than those who do not experience serious mental illness – why is this? There are many reasons including the lack of treatment for those suffering due to stigma and problems with coordinated care to treat the whole person – mentally, physically and spiritually. This cane represents a gentleman who was a victim of exactly that stigma and lack of integrated care for his whole person.