The stench was horrid. Like rotting flesh. What was worse is that it was my flesh.
I had an infection along my C-section incision and the incision was oozing. Ironically, while doing a search online I found the OB who delivered my daughter and told him that I thought my incision was coming open. He seemed dumbfounded. It had been years since I had given birth to her – my youngest, but he insisted I get to the doctor right away. I called the doctor’s office and told them what I thought – my incision was coming open and it was oozing.
It was itchy.
It was painful.
And, it smelled awful.
They got me in right away. I was escorted to a room with not one, but two doctors. I suppose they thought I was going to be an interesting case. It turned out I wasn’t so interesting after all.
My incision was fine.
It wasn’t open.
It wasn’t oozing.
It did smell awful.
It was red.
It was itchy.
It was painful.
TREATED WITH KINDNESS
It’s because I hadn’t showered in days, maybe longer. I honestly can’t remember how long it had been, but I know it was summertime which made it worse because…sweat. I have what’s commonly referred to as an apron of skin – the fat that not-so-adoringly hangs down and makes my belly button droop. Technically, it’s called a panniculus or pannus. There, you learned something new today.
I had a fungal infection. And, it was bad. I was given ointment and strict instructions on how to take care of the infection – washing, keeping it dry, etc., but here’s the thing. There was no judgment. None. I was treated with kindness by both doctors – both male doctors. This was at the VA Medical Center in Lebanon, PA. They had access to all my records. They knew I had major depressive disorder. They knew I was a rape survivor. They obviously knew that just staying alive was a daily battle. I was having a difficult time with ADLs.
And, often, I still do.
Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) are often thought of when assessing our aging parents and grandparents and their abilities to take care of themselves, but they’re also very real obstacles in someone who has mental illness.
So, what are these ADLs and IADLs? First, they’re basic tasks that a person needs to be able to do to not only survive, but to thrive. Talk to someone in a major depressive episode, and I guarantee you that it’s hard enough to dig deep to find the will to survive, much less find something in your soul that shouts, “you will thrive!” No. No. Our souls are shouting, “Go back to bed. Go to sleep. Go to sleep, but don’t dream. Wake up when everything is better, and not a second before.”
ADLs AND IADLs
You’ll find many variations of ADLs and IADLs, but these are the basics…
- Personal hygiene – bathing and grooming, oral care
- Continence management – the ability to use the toilet properly and having control of bowels/bladder
- Dressing – the ability to select the wear properly clothing for the appropriate weather/occasion
- Feeding – the ability to prepare a meal and feed themselves
- Ambulating – the ability to walk independently and transfer from one position to another
- Managing finances – balancing checkbook, managing assets, and paying bills
- Transportation – driving themselves, using public transportation or finding other means of transport
- Managing household – housecleaning, laundry, and home maintenance
- Communicating with others – using the telephone, cell phone, email, or mail
- Managing medication – obtaining medication and taking as directed
- Shopping – shopping for meals, clothing, and other household essentials
You may think that these things are no-brainers, but truly they’re not, as evidenced by inability to keep myself clean and healthy. There were other things I wasn’t able to do though, too.
I wasn’t paying the bills.
Scott had to hand me my medication.
I couldn’t go shopping by myself.
I didn’t drive – as in, I didn’t have a driver’s license.
Clean clothes were a luxury.
I avoided phone calls.
I avoided people.
I wasn’t opening the mail.
I wasn’t cooking.
I slept all day.
Or I didn’t sleep at all.
Obviously, I wasn’t bathing.
I stayed in pajamas all day unless it couldn’t be avoided.
The school often called to remind me to pick up my daughter.
And I wasn’t brushing my teeth.
And, so many more things.
JUST LIKE ALICE
I was in deep. And, I was falling deeper. I was Alice – falling down the rabbit hole and watching everything as it passed me by. Except, my rabbit hole wasn’t fanciful, it was dark. The dong of the clock bellowed and echoed between my ears. The mirror reflected back to me an image I did not recognize, and yet it cried when I cried. It was angry when I was angry. Falling through the center of the earth was something I longed for. It was a way out without having to be the one responsible for the path.
Or just maybe, I was the Mad Hatter.
Things didn’t get easier. My infection cleared up, yes, but that was the highlight of my life. Even my children didn’t bring me joy. I distinctly remember telling my therapist that I wanted to want to be happy. I wanted to want to play with my children. I wanted to want to be me again. I wanted to want to feel something other than despair. Those aren't typos. I wanted to want.
Eventually, I would take a slew of personality tests and psychological inventories. And, the Global Assessment of Functioning (GAF) scale was used to assess my daily function – more than what the scoring system of ADLs and IADLs can do. The GAF scale is still used by clinicians, but it is no longer found in the Diagnostic and Statistical Manual of Mental Disorders (DSM). I scored a 35 on a scale of 0-100.
Now, the WHODAS 2.0 (World Health Organization Disability Assessment Schedule 2.0) is used with a score of 0 = no disability and a score of 100 = full disability. I don’t know what I’d score on WHODAS 2.0, but at a glance, I know I’d do better. Some months. Most months. Not all months.
Six months later, I would be awarded disability from the VA for Major Depressive Disorder (MDD), but not before inpatient hospital stays and a long trial and error of medications, but Social Security turned me down. The judge said he thought I was faking and thought my psychiatrist was lying. Yes, the judge said those things to my face. In fact, he asked me to prove that I never had a driver's license in any of the 50 states. He was later removed from the bench, but the damage was done. It was many many years before I was able to return to work. Many years before I could help support my family and even then it only lasted for a couple of years.
Now, some ADLs are goals…like getting a shower every day. Generally, I complete it more days than I don't, but I still have weeks here and there that Scott questions me…wondering if I'm slipping again. If I'm falling down that rabbit hole. Over the years he's learned the language to use. He knows what works. How to be firm, but gentle. You can learn, too.
If you know someone who is having difficulty with ADLs or IADLs, it may be time to intervene. We can’t do it alone. But do it without judgment. We want to want to get better. We just don’t always know how.