In working with clients within the realm of the Child Advocacy Law Clinic, I have encountered some previously unforeseen challenges in my capacity as the social worker, given that I am now on a team with law students. As we are working with families who have negative associations with social workers—understandably so, as Child Protective Service workers and Department of Human Service investigators are threatening their family’s integrity by removing their children and often moving for termination of their right to parent—it has been an interesting task to try and work around the wariness these clients have of yet another social worker intruding into their lives. If there is already stigma, misunderstanding and distrust of social workers among working class folks due to the negative associations with treatment for mental illness, for these families who have had their lives invaded, it is all the more understandable that they are reticent to speak with anyone on our legal team. Despite this recognition, it is occasionally frustrating and at times tedious to try and reach out to clients who are disinclined to interact with us already, and ask them to trust me enough to tell me what has been going on in their lives, even if it is to their legal advantage to work with all of us.
It can be very difficult not to automatically default to a sense that I as a worker know better than they do, and that I’m trying to make their lives better; this approach is exactly the same mentality that DHS too frequently takes with families such as our clients’, and in order to truly ally with our clients, it is imperative that the social workers in clinics such as ours not fall into that hubris trap. I, like many others doing social work, am coming from a desire to promote social justice and better working family systems; having client families who are potentially broken enough to have been reported to Child Protective Services offers a significant challenge to my desire to work with families holistically. Our wish is to always have families who are able to be repaired, but the alleged damage we encounter with severe neglect or child abuse cases conflicts with this desire, and we are tempted to choose sides, such that our legal team may be advocating the legal dissolution of the family system. I have needed to approach several of my clients with active humility, recognizing that they know their family situation, their lives, and their stories better than we ever will, in all its complexity. It is our jobs as their advocates to work hard to foster a trusting and working relationship with our clients, such that we may be in the best position to work with and for them, rather than assuming we know what is best for their lives, as too many of our professional colleagues do. This means accepting that it may be in the best interest of the most vulnerable members of the family to be court-removed from their birth families, even though I know from a developmental standpoint that any legal action, including continuing the status quo without intervention, will result in further trauma and pain for the family members.
I have had to set aside some significant initial prejudices in more than one case, because with a mentality that I somehow know “better”, I will never be able to align with a client in a way which is truly respectful or open to understanding the intricacies of their lives. There is always more to a human story than can be captured by a court report or allegations, and my goal as a social worker in a legal team is to look for the complexities in each case which have informed the actors’ decisions for good or ill, that I can work to humanize their story for a harsh system. This has required me, in the instance of one of our lawyers guardian ad litem cases, to set for myself the task of actively trying to find something likeable about a client mother who’s failure to protect, at least superficially, exposed her daughter to sexual abuse at the hands of her partner. Rather than make follow my initial assumptions based upon the court report, however, I have been working to reserve judgment on her inaction and the treatment of her daughter as it is portrayed on paper until I interact with her in person more, and try to better understand the circumstances of her life and the case. Only by doing this am I ever going to be an asset to a legal team working for clients in a family court system; if I allow my prejudices and initial impressions to overwhelm my ability to engage with clients in a way which provides a richer understanding of their world, then I have the potential to be as detrimental to their lives as the DHS workers who give them pause in interacting with social workers in the first place. Recognizing this, I have tried hard, despite intermittent frustrations, to continue to engage clients who are leery of working with me and our team, elicited stories regardless of my initial impressions to look for what my biases may have caused me to miss, and continue to seek avenues to get the most comprehensive understanding of my clients’ stories as I can. These steps are the best way, under less than optimal client conditions, that I know to overcome prejudices and serve my client well.
Thursday, April 1, 2010
Wednesday, January 6, 2010
the natural
I am Lord Love’s natural:
Happily I pledge myself
to his service. Worshiping,
I will cry out his praises-
Eager to make obeisance-
Please Master Mars and Lady
Venus’s lusty Son here.
Praying on my grateful knees.
I make my dear offerings,
Inside and out I am Yours.
I’ll perform as dictated.
This is happy consumption,
To make of my body such
Provision that my Love may
Use, and feast upon me ‘til
we are both full, and sated.
~Anna H.
Happily I pledge myself
to his service. Worshiping,
I will cry out his praises-
Eager to make obeisance-
Please Master Mars and Lady
Venus’s lusty Son here.
Praying on my grateful knees.
I make my dear offerings,
Inside and out I am Yours.
I’ll perform as dictated.
This is happy consumption,
To make of my body such
Provision that my Love may
Use, and feast upon me ‘til
we are both full, and sated.
~Anna H.
Book Review: First Person Narrative on Grief and Loss- My Own Country, a Doctor’s Story, by Abraham Verghese
Anna H
Sallie Foley
SW 617- Death, Loss and Grief
Property of the author; do not use or reproduce without express permission.
Abraham Verghese’s narrative on his time as an infectious disease internist treating AIDS patients in the rural, east Tennessee town of Johnson City provides a vivid and compelling depiction of the manifestations of grief and loss which can overwhelm medical and familial care givers in ministering to terminal patients. In reading it, we may find a compelling and deeply personal account of the experience of death, both anticipated and sudden, and the vast array of emotions expressed and felt by those who are required to cope with such losses, as those anticipating their death, and those who are left to care for them, and others to follow. During the first stages of the AIDS epidemic, starting in the summer of 1985 when little was known about the disease and all the stereotypes and stigmas attached to its being an illness of only the urban, gay male and drug-using populations still held largely true, Dr. Verghese begins his tale of slow-dawning but horrific comprehension of the impact AIDS has on patients and family alike. Despite his seemingly pristine country location, as Verghese develops a burgeoning caseload of patients, most of whom are gay men, he unfolds for his readers the rising feelings of panic and helplessness experienced by both the medical and general communities in the face of a disease which is even still considered by many to be a death sentence. Along with the devastation of an HIV/AIDS diagnosis, Verghese opens our eyes to the myriad of losses accumulates through lifetimes of hardship for nearly all of his patients as members of these already pariah groups: familial rejection for sexual orientation, enormous struggles for daily survival in poor and rural areas, and wide-spread social dismissal combine to compound the grief expressed in this book. As he describes sometimes poignant and stirring, other times graphic and disturbing vignettes of living and dying with AIDS, we relive through Verghese’s memoir the acute pain of immediate threat to livelihood that the disease became to his patients. Through his personal struggles to provide care to this much-feared population, we experience again and again the wash of sadness and loss as one after another of his patients becomes a real person in his, and by extension our eyes, only to waste away in pain and die.
Patients are often aghast, even devastated by the news that he must give them, and the range of emotion his patients, and by extension he, feel in anticipation of their death runs the spectrum from nonchalance, denial, rage, courage, depression, and grief to empowerment and a sense of purpose. Family members’ reactions frequently extend as far, but the grief Dr. Verghese and his patients feel is at times compounded when family members react as much of the broader community does: with fear, prejudice, and condemnation for a lifestyle they do not understand or on which they look down. Deaths are often met with the same mixture of feelings from patients and Verghese, some are ready and it is a mercy to see their physical pain ended, others are a frightening indictment of a community’s lack of compassion, or grief- and anger-filled accounts of the seeming futility of trying to help those with this “virus from hell”. Similarly, these patients all cope with their grief in different ways, and in doing so, give Verghese an outlet to express both his and their mixture of emotions. Several patients, such as Fred, who renews his commitment to gay activism in leading the TAP support group for other patients like himself coming to terms with their diagnosis of AIDS, offer the readers bright spots of hope and comfort in the otherwise seemingly bleak remainder of their existence. Some, like the patient Luther, rage at their predicament and give outlet for Verghese’s own bitterness at being able to do little to save anyone he treats. Still others, such as Gordon, gently come to terms with their illness by first grieving, then integrating their loss of future, and often past missed opportunities with loved ones, into a calm and peace which touches us and begins to sooth his and our pain in their death even as it blossoms.
From Dr. Verghese’s point of view, the most difficult aspects of facing death by AIDS is the fear of further loss of self—either in the community, with family, or in one’s autonomy—before one has actually died, coupled with the immense and overwhelming loss of being able to do little, if anything to stave off that eventual loss of self. AIDS is not a quick death, nor is it painless, and it causes much frustration, fear, and grief in his patient’s anticipation of their decline, as well as with regard to Verghese’s sense of self as a doctor and the expected power to heal. As privy to Verghese’s personal experience, we come to realize the toll this cycle of connection with and loss of patients takes on him when he becomes the only doctor trained in AIDS or even willing to provide primary care for his part of Tennessee. Through his treatment of, attachment to, and loss of these patients, we feel the deepening sorrow and sense of despair Verghese has as the death toll rises among these people he can only nominally help, and we grieve with him for all the suffering, caused by both an unrelenting disease, a fearful, too-often hateful community, and the visible deterioration of autonomy held dear by all of these people. They grieve, for the loss of futures they no longer can experience, for the disconnect they often have experienced with their families and that the little time they have left with, for the pain of being shunned and the pain of having to depend on those who are willing to care for them as they physically fall apart.
Thankfully, Verghese learns over the course of the book that, in part with his help, there is much that can and does improve in the quality of this end of life care, so much so that the death sentence AIDS starts out as in 1985 commutes to a gradual decline of maybe years by 1989. With him we discover the profound importance of palliative care and personal connections as he focuses more and more on quality, as well as quantity of life, referring patients to the TAP support group as frequently as he prescribes antibiotics for opportunistic infections, and making personal connections which heal his patients’ souls in a community with only marginal tolerance for the “gay disease” and those who still live with it. His acceptance and even embracing of his patients offers him what his medical degree cannot: the chance to be accepted and cared for as fellow human beings. It is this, more than any other medical approach described in the book, which does the most good in alleviating or at least tempering the grief they all feel. Verghese feels kinship with his displaced patients as an un-rooted, Ethiopian-born Indian working in America; the displacement from community, disconnect from family and ascribed tainted quality that leaves AIDS patients with an untouchable feeling is echoed in the doctor’s own personal life, and, despite ultimately developing compassion fatigue which forces him to detach from this community at the end of the memoir, throughout it we feel the strength of the bonds he develops. These acts of care are the balm—both he as their caring and compassionate doctor, and from those family members and friends giving loving support—which enable many of Verghese’s patients to live out their days in relative peace. Regardless of poverty, which is pervasive in rural east Tennessee, or sexual orientation, the cause of much fear and hate in the community, Verghese is able to form bonds which help diffuse grief, aiding to shift the model from the stigmatization of dying from AIDS to finishing life as much on one’s own terms as possible.
The DeSpelder and Strickland quote that “death is inseparable from the whole human experience; the study of death touches on the past, present, and future” is very much true in the account My Own Country provides of people living with an AIDS diagnosis. For some it is an erasure of any possible future, for many, as Verghese describes and maps out, it is the culmination of a progression of past events for those gay men in rural America who began with a desire to leave home to find a life which fits who they are, and which cannot be obtained in their home communities, but who ultimately return home to their families to integrate past and present, to make up for a lack of future, and to die. By the memoir’s end, Verghese observes that AIDS has gone from an isolating killer of a small, shunned few to providing the surprisingly reassuring possibility of community and support which encompasses both the anticipation of death and the living of the rest of one’s life. This emissary of death has offered a way of living, coping, and loving to those who share its sentence, and rather than be the fugue of mourning for lost futures, AIDS provides the surprising victory march by which his clients come to embrace life more than they had before. Certainly, grief and fear of death are a strain in all the moments thereafter- there is no escaping that the disease is killing them. However, as Verghese comes to realize, the community formed to grieve and cope with the loss of such a diagnosis, which extends to include those family members affected and grieving themselves, becomes one which also makes room for his patients to have a sense of self again, and in doing so, they find reason to celebrate as well. Grief at the loss of community, of past displacement which sent them seeking lives away from their birth home, gives way to the growth of a new community home of their own, in which they may be welcome.
Sallie Foley
SW 617- Death, Loss and Grief
Property of the author; do not use or reproduce without express permission.
Abraham Verghese’s narrative on his time as an infectious disease internist treating AIDS patients in the rural, east Tennessee town of Johnson City provides a vivid and compelling depiction of the manifestations of grief and loss which can overwhelm medical and familial care givers in ministering to terminal patients. In reading it, we may find a compelling and deeply personal account of the experience of death, both anticipated and sudden, and the vast array of emotions expressed and felt by those who are required to cope with such losses, as those anticipating their death, and those who are left to care for them, and others to follow. During the first stages of the AIDS epidemic, starting in the summer of 1985 when little was known about the disease and all the stereotypes and stigmas attached to its being an illness of only the urban, gay male and drug-using populations still held largely true, Dr. Verghese begins his tale of slow-dawning but horrific comprehension of the impact AIDS has on patients and family alike. Despite his seemingly pristine country location, as Verghese develops a burgeoning caseload of patients, most of whom are gay men, he unfolds for his readers the rising feelings of panic and helplessness experienced by both the medical and general communities in the face of a disease which is even still considered by many to be a death sentence. Along with the devastation of an HIV/AIDS diagnosis, Verghese opens our eyes to the myriad of losses accumulates through lifetimes of hardship for nearly all of his patients as members of these already pariah groups: familial rejection for sexual orientation, enormous struggles for daily survival in poor and rural areas, and wide-spread social dismissal combine to compound the grief expressed in this book. As he describes sometimes poignant and stirring, other times graphic and disturbing vignettes of living and dying with AIDS, we relive through Verghese’s memoir the acute pain of immediate threat to livelihood that the disease became to his patients. Through his personal struggles to provide care to this much-feared population, we experience again and again the wash of sadness and loss as one after another of his patients becomes a real person in his, and by extension our eyes, only to waste away in pain and die.
Patients are often aghast, even devastated by the news that he must give them, and the range of emotion his patients, and by extension he, feel in anticipation of their death runs the spectrum from nonchalance, denial, rage, courage, depression, and grief to empowerment and a sense of purpose. Family members’ reactions frequently extend as far, but the grief Dr. Verghese and his patients feel is at times compounded when family members react as much of the broader community does: with fear, prejudice, and condemnation for a lifestyle they do not understand or on which they look down. Deaths are often met with the same mixture of feelings from patients and Verghese, some are ready and it is a mercy to see their physical pain ended, others are a frightening indictment of a community’s lack of compassion, or grief- and anger-filled accounts of the seeming futility of trying to help those with this “virus from hell”. Similarly, these patients all cope with their grief in different ways, and in doing so, give Verghese an outlet to express both his and their mixture of emotions. Several patients, such as Fred, who renews his commitment to gay activism in leading the TAP support group for other patients like himself coming to terms with their diagnosis of AIDS, offer the readers bright spots of hope and comfort in the otherwise seemingly bleak remainder of their existence. Some, like the patient Luther, rage at their predicament and give outlet for Verghese’s own bitterness at being able to do little to save anyone he treats. Still others, such as Gordon, gently come to terms with their illness by first grieving, then integrating their loss of future, and often past missed opportunities with loved ones, into a calm and peace which touches us and begins to sooth his and our pain in their death even as it blossoms.
From Dr. Verghese’s point of view, the most difficult aspects of facing death by AIDS is the fear of further loss of self—either in the community, with family, or in one’s autonomy—before one has actually died, coupled with the immense and overwhelming loss of being able to do little, if anything to stave off that eventual loss of self. AIDS is not a quick death, nor is it painless, and it causes much frustration, fear, and grief in his patient’s anticipation of their decline, as well as with regard to Verghese’s sense of self as a doctor and the expected power to heal. As privy to Verghese’s personal experience, we come to realize the toll this cycle of connection with and loss of patients takes on him when he becomes the only doctor trained in AIDS or even willing to provide primary care for his part of Tennessee. Through his treatment of, attachment to, and loss of these patients, we feel the deepening sorrow and sense of despair Verghese has as the death toll rises among these people he can only nominally help, and we grieve with him for all the suffering, caused by both an unrelenting disease, a fearful, too-often hateful community, and the visible deterioration of autonomy held dear by all of these people. They grieve, for the loss of futures they no longer can experience, for the disconnect they often have experienced with their families and that the little time they have left with, for the pain of being shunned and the pain of having to depend on those who are willing to care for them as they physically fall apart.
Thankfully, Verghese learns over the course of the book that, in part with his help, there is much that can and does improve in the quality of this end of life care, so much so that the death sentence AIDS starts out as in 1985 commutes to a gradual decline of maybe years by 1989. With him we discover the profound importance of palliative care and personal connections as he focuses more and more on quality, as well as quantity of life, referring patients to the TAP support group as frequently as he prescribes antibiotics for opportunistic infections, and making personal connections which heal his patients’ souls in a community with only marginal tolerance for the “gay disease” and those who still live with it. His acceptance and even embracing of his patients offers him what his medical degree cannot: the chance to be accepted and cared for as fellow human beings. It is this, more than any other medical approach described in the book, which does the most good in alleviating or at least tempering the grief they all feel. Verghese feels kinship with his displaced patients as an un-rooted, Ethiopian-born Indian working in America; the displacement from community, disconnect from family and ascribed tainted quality that leaves AIDS patients with an untouchable feeling is echoed in the doctor’s own personal life, and, despite ultimately developing compassion fatigue which forces him to detach from this community at the end of the memoir, throughout it we feel the strength of the bonds he develops. These acts of care are the balm—both he as their caring and compassionate doctor, and from those family members and friends giving loving support—which enable many of Verghese’s patients to live out their days in relative peace. Regardless of poverty, which is pervasive in rural east Tennessee, or sexual orientation, the cause of much fear and hate in the community, Verghese is able to form bonds which help diffuse grief, aiding to shift the model from the stigmatization of dying from AIDS to finishing life as much on one’s own terms as possible.
The DeSpelder and Strickland quote that “death is inseparable from the whole human experience; the study of death touches on the past, present, and future” is very much true in the account My Own Country provides of people living with an AIDS diagnosis. For some it is an erasure of any possible future, for many, as Verghese describes and maps out, it is the culmination of a progression of past events for those gay men in rural America who began with a desire to leave home to find a life which fits who they are, and which cannot be obtained in their home communities, but who ultimately return home to their families to integrate past and present, to make up for a lack of future, and to die. By the memoir’s end, Verghese observes that AIDS has gone from an isolating killer of a small, shunned few to providing the surprisingly reassuring possibility of community and support which encompasses both the anticipation of death and the living of the rest of one’s life. This emissary of death has offered a way of living, coping, and loving to those who share its sentence, and rather than be the fugue of mourning for lost futures, AIDS provides the surprising victory march by which his clients come to embrace life more than they had before. Certainly, grief and fear of death are a strain in all the moments thereafter- there is no escaping that the disease is killing them. However, as Verghese comes to realize, the community formed to grieve and cope with the loss of such a diagnosis, which extends to include those family members affected and grieving themselves, becomes one which also makes room for his patients to have a sense of self again, and in doing so, they find reason to celebrate as well. Grief at the loss of community, of past displacement which sent them seeking lives away from their birth home, gives way to the growth of a new community home of their own, in which they may be welcome.
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