Experiencing Integrated Care

June 26, 2020

Welcome to the Team

In this story, Ricky Caliendo, LMHC, provides a narrative that describes the experience of integrated care from a patient’s perspective. The names of the patient and doctor are fictitious.

“Another night of lost sleep,” I think to myself as the screeches of a toddler travel into my bedroom. There he is. At the foot of my bed, with that look only a mother could read. It’s time for breakfast. My stream of consciousness continues as I move through the morning routine.

“Breakfast, pack a daycare bag, project for the office, take your medication…what am I missing?…ugh, doctor’s appointment today!”

Attempts at applying eye liner and mascara at a red light should mask the lack of sleep. I adjust the rearview mirror to find my three-year-old son’s face showing intense curiosity.

“You look like a clown, mommy,” he comments through his giggles.

Children are brutally honest and, despite my exhaustion, my mouth cracks a small grin when we lock eyes through the rearview mirror. It’s time for him to go to daycare and for me to push forward.

“Coffee, doctor’s appointment, work, kid, bills, dinner, call with lawyer…” I recite to myself on the way to the doctor’s office.

As I enter my primary doctor’s office, I begin to script my conversation with him.

“Sleep, aches, lack of focus, tightness in chest, diarrhea…ugh, he is just going to think that I’m crazy.”

After checking in and nestling into the waiting area, all of a sudden I am acutely aware of the weight of my recently applied mascara that now feels like it weighs ten pounds. In the exhausting fight to keep my eyes open, I notice a new poster in the waiting room.

We have a new member of the team! Carly Johnson, LCSW, is our new behavioral health clinician and works diligently alongside our doctors to serve your whole-person health needs!

“Okay, Carly, welcome to the team,” I say sarcastically in my head. With just a moment to be still, I feel the weight of my eyes again, and began to nod off to sleep.

“PAMELA? Is there a Pamela here?” exclaims a staff member.

Waking up, embarrassingly, I pull my head up to see Carly’s picture staring at me and I gather myself for the appointment.

Blood pressure. Temperature. Medication list. Paperwork. Hold on, I know this routine. But what is this new paperwork? My medical doctor is asking me about my sleep, mood, motivation, and whether I enjoy things anymore? I complete the questionnaire and interestingly the score does seem higher rather than lower. I am curious about what the score means.

Dr. Haffner enters the exam room in his white coat and I think to myself, “How do they always keep those coats so white? I can barely keep my boy’s church clothes clean.”

Lost in my preoccupation about his coat, I look up and recognize that Dr. Haffner is awaiting an answer to a question that was completely lost in my daydreaming.

“I’m sorry Doc, but I’ve been feeling a little out of it lately,” I say in response to the unknown question. It turns out he asked the fairly typical doctor question about what has brought me in today.

I recite the symptoms list as gracefully as it has been in my head. “I did it!” I silently reassure myself.

Dr. Haffner validates my feelings about my symptoms and discusses some of the paperwork that was completed prior to him coming into the exam room. He indicates that he is concerned about my lack of sleep, low motivation, high levels of stress, and complaints about stomach aches. He reassures me that he will order some blood tests. But, while we’re waiting on those results, he wants me to meet a new member of the team. I instantly find myself nervous and excited at the same time.

A woman in her 40s, dressed in business casual attire, enters the exam room offering a big, warm smile. She introduces herself to me…although I acknowledge her name before she’s able to get it out…Carly.

Dr. Haffner and Carly explain the clinic’s approach to whole-person care, describing the connection between a patient’s medical, social-emotional and spiritual experiences, and their health. With my permission, Carly excuses Dr. Haffner and I find myself, again, sitting across from Carly feeling the weight of my eyes. This time, she is not on a poster.

Carly’s approach is a harmony of kindness, professionalism, and compassion. We have a frank conversation about my experiences being a single parent, my recent financial and workplace stress, and how my life goals that historically excited me, now felt deflated.

“It simply feels like everything I was working toward just passed me by,” I explain. “Now, here I am looking at it as if it is a distant mirage.”

Carly provides a sense of understanding and normalizes my stress. She talks about the importance of self-care, building motivation, and breaking down goals into small steps.

For the first time in a long time, I begin to see myself again…even if it’s at a distance. I used to think that I was so strong and independent, that I had to be for my boy. I thought my needs should come last. But Carly’s intervention really helps me understand the importance of taking care of myself.

I quickly realize that Carly — once just a stranger on a poster in the waiting room — is now a part of my healthcare team. She has provided me with a source of comfort and motivation. She has normalized much of my experience and encouraged me to revitalize old coping skills, such as painting, nature walks, and meditation. She has provided resources so I can explore some new strategies, as well.

After setting my follow-up appointment for two weeks, and walking out of the office, I truly feel cared for.

Thinking about past medical appointments, and how stress has impacted my day-to-day life, I think I was always looking for help from my doctor, but speaking in a code at times. It was a code that I did not know how to break. But Carly opened up a conversation that I did not necessarily think about going into the appointment, and I am so glad she did. I was beginning to crack the code. My happiness and health are intertwined and partially dependent on my self-care.

Welcome to the team, Carly.

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