Seeking wholeness…determined to soar

Editor’s Note: In recognition of May as National Mental Health Awareness Month, Rebecca Swift, LCSW, shares a story about her work as a behavioral health consultant to Siloam’s medical staff as they seek to provide whole-person care for our patients.  Rebecca writes…

I wish I could introduce you to “Samir,” a refugee I met recently. He is a newly arrived refugee to the U.S. – alone – without any family. When I entered the exam room, Samir looked at me with tearful eyes and softly said, “I have no hope to live anymore.” I sat down as he continued saying that he was not sleeping well, was crying every day, and that he didn’t think he would ever amount to anything. We talked for quite a while about his experiences and the normal process of adjustment. By allowing him the chance to share his story and feel heard, I believe we made progress that day.

I attempted to offer some hope for him by arranging for on-going counseling services at one of our local mental health partner agencies. Knowing that he would be coming back to Siloam for another visit in two days, I gave him an assignment which I hoped would be therapeutic for his mind and his heart.

Samir is an artist, so I said to him, “I want you to paint a picture that answers the question, ‘Who am I?’” He stared strangely at me for a moment and then suddenly looked me straight in the eye and said, “I can do that. I can definitely do that!” He left the clinic with a smile on his face and determination to complete his “assignment.”

Two days later, Samir returned to Siloam glowing and sounding like a different person. He brought his sketch pad and a huge bag of other art projects. He sat for thirty minutes with me going over all of his art, showing me all the drawings he had completed from his memory, and then he pulled out the “assignment.”Dove in cage by refugee - 5-2013

I was amazed – what a beautiful picture he had painted! Samir had painted himself as a dove in a cage in his former homeland with evil, danger, and fear surrounding the cage. Then, when he stayed in another country for a brief time, he again felt like a dove in a cage but with less danger, although still imprisoned. Finally, he pointed at the top of the painting. There was a third dove, standing a little taller, with light coming from behind him, and with much more beautiful surroundings. Smiling at me he said, “This is me in the U.S. – I am still in a cage, but I know that good things are coming.”

Samir has been to Siloam a few times since our meeting and each time he is smiling and brings more of his paintings to show us. He is participating in counseling services that were arranged for him after his first visit, and I believe that with time, he will make a new life for himself that is full of hope and wholeness.

He will have many barriers to overcome in order to find wholeness, but the first step is being willing to acknowledge there is a problem and then accept help. One day I expect to see him paint a soaring dove free from any cage.

Siloam Scenario: Getting “Armed” for Whole Person Care (Part 1 of 3)

Dr. Morgan Wills writes…

Just last week staff nurse practitioner Jina Hawk Lotze encountered a 35 y.o. female patient with an unusual pain in her right arm (see photo).

For many of us, the natural tendency is to jump straight to diagnosis.  Some of our volunteers who saw the patient did just that: “Roundworm,” said one. “Hickeys?!” wondered another.  Interesting possibilities for sure, but a systematic approach was needed.

Now, despite our modern infatuation with laboratory tests and radiologic studies, the key to a medical diagnosis almost always lies in taking a careful history.  However, one of the major exceptions to this dictum is the field of dermatology.  In Derm, at least as many of us were taught, the first rule in making a diagnosis is to describe the appearance of the finding. 

So, what do you see? 

The questions we should ask about a rash are actually pretty straightforward.  Such as:

 – Are there discrete lesions?

– What shape?

– What size?

– What color?

– Are they flat or raised? (hint to the digital audience: these are flat)

– Any other noteworthy characteristics?

Based on these observations, the clinician can build what we call a differential diagnosis—a short list of possible diagnoses.  What kinds of skin problems would be on your “differential dx” for this patient? 

We’ll give you a few days to ponder it before offering the answer.  In the meantime, though, we’ll give you a hint: the patient did not seem very concerned about the rash…