2.1.8: Case Study- Betty
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WCC HLTH 285
Case Study Bio
Betty is a 60 year old Caucasian woman referred for substance use disorder assessment by her primary care doctor because he is concerned about seemingly increased mania and diabetes which is not well managed when she becomes manic. In periods of mania the doctor reported Betty binge drinks, does not eat and does not check her blood glucose levels. She was recently hospitalized with a blood sugar of 782 and was almost unconscious. When she started to feel better and stabilize, she attempted to leave the hospital AMA (against medical advice) so the unit physician contacted the county designated mental health team to evaluate Betty for detainment, enacting the Involuntary Treatment Act. Evaluators did commit Betty for 72 hours but upon release from the hospital she was placed on a Least Restrictive Mental Health Court Order which expires in 90 days.
Betty is an only child born to married parents who have both recently passed. Betty was recently separated from her husband of 34 years, but not legally; they are living apart “only to give me time to get squared away again”. When asked why she has come for an assessment, Betty explained, “My recent hospitalization due to the diabetes and the doctor is worried about my drinking, apparently. When asked if she thinks she may have a problem with drinking or other substances, she replied, “I don’t think it is my drinking but really it is the Bipolar that is the problem. I just haven’t found the right doctor to treat me for that yet.” She went on to expand quite extensively about her medical history and many of her accomplishments in her life which she described as having come to “a screaming halt” when she gave birth to a stillborn daughter 15 years ago. She had tried to get pregnant for years and finally did only to lose the baby. She stated she was unable to have any more children due to her age. At this point during assessment Betty said she couldn’t continue with the assessment and asked if she could leave. This writer reminded her she is required by her LR court order to complete the assessment. She was offered a short break prior to continuing the assessment. Betty appeared very agitated during the assessment and often talked over this writer and interrupted. She presented somewhat manic although she stated, “I am better than I was before going into the hospital.”
Betty reported she was hospitalized once as a teen and once as a young adult. She admitted to attempting suicide on only two occasions. When asked how she tried to suicide, she reported she overdosed on her mother’s pain pills when she was a teen but as an adult she tried cutting her wrists. She reported she still sometimes thinks about suicide, especially around April 14th, because that is when her baby girl was born. Betty became very emotional when talking about her stillborn daughter. According to Betty, her daughter was a full term, healthy baby but in the last 30 minutes of delivery, the baby stressed and the cord was wrapped around her neck and she was not yet turned face down. She stated when the doctor tried to turn the baby manually, she further stressed and that is when the heartbeat stopped. She gave birth to her daughter but she could not be revived.
Betty graduated from Friday Harbor High School and went on to a four year college, Washington State University. She was studying nursing but was a year shy of her bachelor’s degree when she had to quit. When asked why, she reported she just had some personal problems and she did something “stupid and ended up in the hospital”. When asked what, Betty said she had a minor car accident. This writer then called Betty’s attention to the discharge paperwork from the hospital and mentioned it has most of her history in the document. This writer asked again, if it may have been when she tried to hurt herself. Betty then became quite defensive and agitated and yelled, “that’s none of your business and it has nothing to do with why I am here. “ This writer reassured Betty the information is very confidential and it is important to have all the information about her history in order to be of the most help possible. Betty calmed down and then said she was hospitalized because she slit her forearms open and was found unconscious. Betty stated the man she loved and wanted to marry cheated on her and she caught him.
Betty reported that she enjoys dancing and listening to music, sometimes swims at the local gym, and used to love hiking and bicycling, although she has not done these activities in a long time.