By Angela

Re-Evaluation 2008

Dr. Knutman, SERS Psychiatrist

(Note: Events are real, names have been changed, and photos
are not real professionals described in the story.)

After Angela’s appointment with Dr. Jakov, Estelle picked up for Angela and took her to the office to make more efficient use of time for the next appointment. SERS had scheduled another re-evaluation by the psychiatrist later that afternoon. To give Angela some time to rest between appointments, she slept on a couch in one of the empty offices.

Time passed quickly and it was time to leave. Estelle brought along the same information that Dr. Jakov had so quickly dismissed. She and Angela wondered how he would approach Estelle this year. Last year when Angela said she wanted her advocate to be present during her exam, he said that she could sit in the room but not say anything.

Dr. Knutman escorted Angela and Estelle back to his office. This time he was very friendly towards Estelle. As he offered his hand, he said pleasantly, “Hello. Good to see you again. I’m sorry, I’ve forgotten your name and the agency you work for.” This was interesting, Angela thought to herself.

As the psychiatrist settled back in his chair, he asked, “Well, how are things going for you now?” In his report last year, he commented that he expected Angela’s problems would be resolved once her law suit was over.

“About the same,” Angela replied.

He picked up a folder on his desk and looked through some papers. “I see Dr. Pemberton still has you on the same dosage of Effexor,” he said.

Angela thought she sensed disapproval on his part, as she had from the year before when he made the same comment. “Yes, I think it might be because I take a lot of medicine for migraines. I heard you have to be careful when you take anti-depressants and migraine medication,” replied Angela. Her father had told her about an article he read in the newspaper about Serotonin Syndrome, a rare but serious condition caused when the body gets too much serotonin.

“You have migraines? How often?” he asked.

“Yes, sometimes 3 to 5 times each week.” Why didn’t he know this? She had given him the long list of medications she’s been on each time she’s seen Dr. Knutman.

Knutman continued the interview, asking about various aspects of Angela’s life. “Tell me about your social life. What kinds of activities do you do with your friends?”

Angela talked about how her relationships with her friends had changed. Many simply drifted away. Some friends she would communicate with periodically either by phone or email. Very rarely did she go out with friends. There might be an occasional person who would come to her house or pick her up and take her to their home where they might have lunch or sometimes watch a rented movie. Movies at the theater were too overwhelming. So were restaurants. She had gone out to a restaurant a few times with a friend – usually during off hours when there wasn’t quite as much noise and confusion. This usually wasn’t very enjoyable for Angela since she had more difficulty listening to and understanding their conversation because there was too much going on in the environment.

“What time do you get up? What kinds of things do you?” he continued.

“I usually get up around 6:30 or 7:00,” Angela replied. She explained how her cats were the first to start pouncing on her to wake up and feed them. Then the birds were the next to start singing or squawking, followed by the dogs howling whenever the birds’ singing hit a high note. “When it reaches that point, there is no more sleeping or staying in bed. I have to get up.”

In terms of activities, she used to enjoy gardening but that was too difficult. So she explained to him how she put some containers close to her back door to grow flowers which attracted hummingbirds and butterflies. She told him how she had started receiving OT and PT services again to help her get better and be safer in her home. How she now had a power chair which not only helped her be safer around her home, she was now able to enjoy “walks” around her neighborhood with her dogs and say ‘Hi’ to her neighbors.

Angela described how, when the weather got warmer, she had to stay indoors since her tremors got worse and she was more likely to collapse. During this time of the year, she would wait to go to the store around 6 or 7 at night when the weather had cooled down a bit. Sometimes she did sewing or crafts; these weren’t activities she could do all the time, since they caused more irritation to her neck and arms.

He asked about whether she could drive. “Yes, as long as it is close by, isn’t on the highway, or at night or when it’s raining or snowing. I usually take a nap before I go out so I have enough energy, and use a motorized cart in a large store or my walker in a smaller store,” she explained. “I don’t like asking people for help. I try to do what I can and ask for help with the big things.”

“What does that include?” asked the psychiatrist.

“Like cutting the grass, or cleaning up the flower beds and putting down mulch, or doing some home maintenance stuff,” answered Angela.

Estelle added that her agency helped Angela get to appointments or places that were farther from her home or required highway driving. “Ideally, she should avoid driving, but she doesn’t have the finances to get the help she really needs,” explained Estelle. “In fact, we did some problem-solving about how Angela might receive some of the help she needs. She now has a person living with her as a caregiver providing some assistance in exchange for a room. Her name is Melinda and she is in the waiting room right now, since I have to leave for a meeting in a few minutes and she is here to take Angela home.”

Dr. Knutman told Estelle she could have Melinda come join him and Angela when she left. Right before she left, he said that he notice Angela had been a patient of Dr. Jane’s while in a psychiatric unit of a local hospital. “What was that all about?” he inquired.

“That was right after the trial,” explained Angela. “I was pretty depressed and didn’t feel safe being alone. I didn’t know how I was going to cope and just wanted to die.”

Estelle added, “Though Angela won the case, the jury didn’t award enough to cover the lawyer’s costs, let alone Angela’s medical bills. She didn’t receive anything and was feeling pretty hopeless about her future and how she would get the help she needs. We all thought it was a good idea for her not to be alone just then and supported her in her decision to go to the hospital.”

Getting up to leave, Estelle handed some papers to Dr. Knutman. “This is information from the doctors’ depositions who were treating Angela, explaining her condition regarding the damage done to her artery going to her brain,” she said. Knutman accepted the papers saying that he would look over the information.

Melinda joined Angela, and Dr. Knutman questioned her regarding how long she had been residing with her and the kinds of things she helped with. She told him about how they had morning meetings every day where she helped Angela prioritize what she needed or wanted to accomplish, helping her break down overwhelming tasks into smaller pieces, assisting with household chores and other various things.

Soon it was time to leave. Angela’s head was throbbing; she took her medication for her migraine. She wasn’t sure what to make of Dr. Knutman today. He was nicer than the last time and seemed receptive to the information they had given him. But he had been nice once before – the first time she had spoken to him. He had been nice during the first part of his questioning, but then turned sarcastic towards the end saying, “So how can you have a brain injury? You didn’t hit your head or lose consciousness!” She didn’t trust doctors anymore.

© Angela Cramer, 2008-2009


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