I always had a soft spot for Anna and knew her for the past three years. She came off and on for BP check and diet counseling. The last time I saw her was over a year ago for a BP check before Covid started. She looked very happy to see me!
"Everything is GREAT!"
"Dr. Annie! How are you?"
"Great! It is so nice to see you today! You are looking spiffy today! Typical New Yorker!
We laughed as we went into the exam room.
"Anna do you need to pee or do you need a drink of water before we start?"
"No, I am good Dr. Annie!"
"OK. You are here for a BP check today aren't you? I see that Dr. Sue Kin had a telephone visit with you two weeks ago and wanted you to come in to check your BP."
"How is everything?"
"Great! Just great!"
We proceeded with the visit and everything was going smoothly.
The Phone Call - "What Do I DO?"
As I got ready to print her after visit summary with her next appointment, her phone rang. I nodded my head as I typed as she looked at me as phone calls during visits were strictly discouraged.
She took the call and her face blanched as she listened. She stood up shaking, looking very upset, wiping her brow and sweaty hands.
"Anna, what's the matter? You look upset!"
"This is not good! This is not good!"
"Anna, talk to me!"
She kept wringing her hands muttering, "What do I do? What do I do?"
I am sure her BP had shot up and her PTSD was kicking in. She was sitting on the examination chair rocking herself.
"Anna calm down! May I have your phone please? Who are you speaking to anyway?"
"It's my aunt Sarah!". She gave me the phone.
I put it on speaker.
Aunt Sarah's Story of Abuse
"Hi Aunt Sarah! How are you? This is Nurse Annie. Anna looks upset. What's going on?"
Aunt Sarah launched into a long story. The short version was that there was a woman, Red, staying in Anna's section 8, government housing apartment that Anna's ex- boyfriend coerced her into staying with her. Red in turn now had been giving copies of the apartment keys to others who came in and out of the apartment at all odd hours. Red made Anna move out from her bedroom and sleep on the couch while Red took over her bedroom. Earlier in the day, Red walked in at 3am with a strange man and a baby. When aunt Sarah, who lived one floor up, confronted her an hour ago, Red slammed the door on her, almost slicing her hand off! Aunt Sarah called the cops who shrugged and told her that since this apartment was in Anna's name, she would have to make the complaint. That's when she called the patient. Anna was visibly shaking and wringing her hands. In addition to depression, PTSD, head trauma and abuse, she also had an intellectual disability and was socially inept.
Nurse in Action
"Are you her health care Proxy, Sarah?"
"No, I don't have any papers. I took Anna's care once my sister, Anna's mom, was put in a Nursing home for dementia as Anna cannot safely take care of her and I have to work most days."
"OK. We have to get you some kind of paper or the police won't listen to you as she is an adult. Let me call you back!"
I hung up and got Anna some water to drink.
"Sit tight! I'll be back."
Anna nodded quietly as I walked out of the exam room. I went to her primary care doc, Dr. Sue Kin, who was in another room catching up with her notes. I briefly explained what was going on.
"Sue, I think if we give her a letter stating that she has these medical conditions and that her aunt is assisting her based on her needs, the police will take them more seriously. She needs to file a police report and aunt needs to advocate for her."
"I agree, Annie." Sue quickly typed up a form letter with her medical conditions, stating that her aunt was assisting her. She printed it, signed it and gave it to me.
I made 2 copies and gave it to Anna. We called the aunt again from the room and I spoke to her. She planned to take the letter to the police station and both of them were going to file a police report against Red.
I gave Anna an appointment for one month for a follow up for BP check and she left.
I huddled with her provider and the administrator as I wanted to discuss the possibility of adult abuse at home. The team agreed of the possibility and I ended up talking to the social work manager offsite who agreed. I called Adult Protective services and they gave me a case number and asked me to call the next day to find out if the case was accepted. I did and was told that her case was accepted. I ended up talking to the case worker and her manager there and she received a home visit within two days. They helped her get Red evicted and continued to monitor for a whole month.
Last week Anna came back for her BP check, which was normal and told me that the police case and order of protection against Red was still in effect. She heard that Red had got arrested for something else and was in jail. She had also gone to family court with her aunt. The judge ordered the landlord to change all locks of the apartment and the front door so that Red or her cronies would not have access to the building.
Anna looked happier and continues to see a therapist who helps her with her issues. Her mother is fully demented and in a nursing home. Anna's aunt watches over her and helps her with her appointments, groceries and any help that she needs. Anna loves to come to our clinic and says we are her family and we are nice!
There are many young and older adults like Anna that are taken advantage of and my antenna is always on high alert when I see them. I always feel grateful to be in a position to help the Anna's of the world as in their case it truly takes a village to raise them and keep them safe!
What is Intellectual Disability?
Traumatic Brain Injury and Concussion