Dementia praecox et Cocoa Brown

Would it come as a surprise to anyone if newFNP disclosed that Cocoa Brown had serious mental illness?  It pains newFNP to see her suffer.  

Cocoa Brown has schizophrenia and boy does she ever struggle.  When she feels like she needs a break from the world, she goes into the emergency room and tells them that she is suicidal.  She has attempted suicide in the past, she is marginally compliant with her anti-psychotic because she frequently runs out before she makes it to the pharmacy for a refill, she has a history of drug abuse, she is precariously housed and, frankly, if she wasn't in psychiatric care, she would likely be actively suicidal again.  

Cocoa Brown has also developed urinary incontinence, perhaps as a result of her anti-psychotic, perhaps her weight, perhaps a combination of the two.  

Do.  Your.  Kegels.  

During Cocoa's most recent inpatient mental health stay, she fell asleep in the day room and had an accident.  To hear her tell it, a nurse kicked her chair and gave her a bit of shaming about the accident.  Cocoa Brown described the conversation that subsequently ensued.

Cocoa Brown replied, "What the fuck are you waking me up for to tell me that.  Everybody knows I can't control that!"

(NewFNP imagines that the nurse pauses at this point, wondering what her next move should be.  Cocoa Brown, however, is undeterred.)

"You don't wake me up for that!  You wake me up when it's fucking time to eat or take meds, but you don't fucking kick my chair and wake me up for that!"

(Amen to not missing a meal.  On a roll now, newFNP imagine Cocoa Brown pointing an index finger at the nurse.)

"The next time you wake me up for something like that, I am going to knock you the fuck down!"

Lest anyone think that she is not serious, may newFNP remind you that Ms. Cocoa Brown previously attacked an ex-partner with an exposed-nail ridden board.

NewFNP could have given her a lesson about behaving properly.  Instead she simply said, "Cocoa, I hope to never hear those words directed at me."  To which Cocoa replied, "Aw, newFNP, you know I'd never say that to you."  

Whew!

However, the scenario does bring to mind several salient points:

- unlike Cocoa Brown, newFNP would like to be awakened if she is dozing off in a puddle of her own urine.

- mental illness causes people to behave in unpredictable, non-normative ways.

- mental illness has a devastating effect on people's lives.

Cocoa Brown will never have a normal life.  Her schizophrenia will likely continue to affect her life in negative ways.  She is poor, she is socially marginalized, she has not benefited from vocational therapy or social rehabilitation.  The internal and external worlds in which she lives are very different from most people's. 

But newFNP loves taking care of her -- as much as she can.  Pill refilling, blood pressure monitoring, syphilis treating, and in offering a friendly and peaceful exam room where Cocoa can just be Cocoa.