Denise on The Stemwinder: This is a Rebirth

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Author Interview: Part II


Denise discusses Irene, the centerpiece of The Stemwinder, establishing boundaries with clients, and how taking the leap to publish her story was a rebirth.





Irene’s story starts off with a near-fatal car accident. What was the initial prognosis after she came out of emergency surgery?

DV: No one expected her to survive. I mean, after all of the surgeries and an extended period of rehab, her recovery period was fragile. Here’s the crazy part–and to this day I think about this–Irene has Lewy Body Dementia, which is in my eyes is the worst kind of dementia you can have. How did that get by everybody? Perhaps they were more focused on the head injury. Perhaps they were more focused on the broken bones and her confusion from the accident. I’m not putting the finger of blame on anyone but I think because Irene didn’t really have that one perosn, whether it was a family member, friend, or neighbor that could be her advocate like I had become, they were triaging the injuries, they were triaging post-symptoms, and then major surgery–no one was really focused on her cognitive status.


The doctors who treated her didn’t factor that in?

DV: Didn’t take the time and as I said, it wasn’t their only focus. Also, she was only in her late 70s at the time. And then when I met her I thought, this is just a hunch but I don’t think this was just the car accident. Something was going on before that, which indeed caused the accident because of her confusion. And so there was a delay in treating her dementia. If the dementia had been treated sooner or diagnosed sooner, would it have made a difference in the cognitive decline? Probably not. Starting late on a particular medication for dementia really doesn’t serve much purpose but I could see what it did when we initially got the diagnosis right. And the geriatric psychiatrist proscribed the right meds. I could see the impact that these drugs had on her but not so much now. She’s still alive and well but does she need to be on these meds anymore? I don’t know.


As Irene’s care manager, when you’re introduced to her situation would you say it’s your responsibility to discern what others have missed or do you have to be on your toes with every aspect?

DV: Well, because I’m also her Power of Attorney that’s just one hat that I wear. Right now I’m all about healthcare. The finances are the easy part. It’s the health decisions that are challenging which was a big part of why I was intensely protective of her. So I wear the care manager hat most of the time. Then when it comes to decision-making I put the POA hat on. I think it’s important that I stay on top of “team Irene.” And all of the people on that team know my role so I’m always up to date on her decline or improvement. We recently just put her on hospice. She’s got this wound on her bottom and because of her systemic diabetes, she won’t heal like you or I would. So it just gives her more nursing care and more comfort care. I was on the phone with her sister the other day to let her know. It’s funny, she said I know you’re her power of attorney and you take care of her finances but she said I’m still her sister and Howard’s still her brother. I said, of course, that’s why I’m calling you. She said, almost in a sad tone, I know for many years we weren’t in touch with Irene but she’s still our sister. I get it. But I don’t tell her everything because I don’t’ have permission from Irene. I know what she wants them to know and what she doesn’t. I communicate what they need to know. It’s the first time I sensed a little bit of animosity. She’s always appreciative and sometimes I have to educate them on certain things. For example, a lot of people don’t understand healthcare. I almost got the sense that she would have preferred I call her before I decided to put Irene on hospice. But I don’t have to explain that or defend that.


That’s a great example because in the book’s intro you describe yourself as a surrogate family member. But it goes beyond that doesn’t it?

DV: For better or for worse, I’m the official decision maker, hence the surrogate. It is what it is. I’m involved in Irene’s care and treatment plan, and unlike most POAs I’m probably more involved. One, given the nature of what I do as a care manager and social worker. Two, given my personality and number three, given just who I am. It’s part of my ministry. And that’s okay. It all sort of meshes together.


I think that’s what readers will really appreciate because you acknowledge that not all professionals take those extra miles or are willing to do so.

DV: And I’m blessed to have those people in my life–the other care managers who I connect with. Not just professionally but they’re driven by something that I’m driven by. It’s a higher level that takes us there. I talk a lot about that in the book and getting into the muck. It doesn’t even feel like work even though it can be exhausting. It opens you up to be more exhausted because you open up your heart and mind a little bit more than most people would.


Another interesting aspect of your professional story is the unknown. You navigate from case to case not knowing what’s in store.  

DV: It’s interesting that you say that because when I think about my new clients in the last three or four months, it’s been less supportive work to the clients but more to the family and children. They’re trying to figure out what went wrong. How can I fix this relationship before they die? I find myself doing more ministry to the children than the actual client. So that’s been a little bit of a different twist in my caseload.


Do you find that enjoyable?

DV: Yeah. It makes me feel a little bit more vulnerable. I have to really be on my game. I have to be really clear about what those boundaries are. What to share and what not to share from my personal life.


You also said that you’ve gotten a little bit better with balance. Do you feel that after writing this book?

DV: Yes. Absolutely. I feel like it’s been a rebirth. Like most human beings, if only I knew 25 years ago, I could’ve stopped a lot of angst and pain for myself that’s human right? But I feel more… and I’ve been waiting to say this for many years–I feel more grounded. Having written this book and coming out looking at it through a different pair of lenses, and knowing that I’ve been able to establish borders and boundaries. And if I choose to cross some of them I know what’s coming at me. I know what to expect now. So it’s less risky. I never thought about that before but now it’s less risky, whatever that means. And I feel less stress. I feel more at peace. I feel renewed. And the other thing people say, tell me about the title. The Stemwinder, what’s that about? What a unique name. I love that its origin is tied directly to Irene.


What’s the one thing people would be most surprised to learn about care managers?

DV: I think people will be surprised about what a care manager actually does. We don’t sit at a desk at a computer all the time. We’re out, our sleeves are rolled up, we’re in it. So I think they’ll be surprised to learn all the things a care manager can or should do. How and why we do it. It really gives a good foundation and a solid groundwork for what our role is, if allowed. It does highlight the profession, and shows there are many Denises out there that are care managers. We each have our own brand, and our own style in how to do it. Whether you’re a social worker or a nurse or a therapist, there’s lots of us out there going beyond the call of duty. This will be a growing profession. It’s already growing. It is already something that people are becoming more aware of. Maybe there are states like Florida and New Jersey and Pennsylvania that have a higher percentage of elderly people living in those states. It really speaks to the job. I think it really does hone in on that. I would hope that one of the takeaways is that people would find their own strength to tell their own story. Everyone has a story. It’s scary but hopefully everyone can find that voice that wants to come out.


The Stemwinder is available on Amazon and our Book Reviews page



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