LANSING, Mich. — When it comes to treating patients in Geropsychiatric Evaluation and Management Services (GEMS) at McLaren Orthopedic Hospital, Dr. Blake Casher likens himself to a detective, as well as a chef. But those who have watched him work with patients have been known to compare him to a magician.
Shannon Kienitz, patient care manager of the GEMS unit before becoming director of patient care services at the Orthopedic Hospital, recalled a time when a woman in her 90s from northern Michigan was in a combative state of dementia when she was brought in. She was hitting and kicking those around her, as well as eating very little. Dr. Casher diligently worked with her to see if adjustments to her medication would improve her condition.
“The turnaround was incredible,” Kienitz said. “She was up walking, and talking, and eating. She was calling her sister on the phone. She was here for 45 days and the improvement she made from the time she came to that 45th day was almost like a miracle.”
Figuring out why patients are acting the way they are is the “detective” part of his job, according to Dr. Casher, medical director of the GEMS unit. Once he has done that, or thinks he has a good idea about what is going on, figuring out what combination of medications can improve their mental state is the “chef” part.
“I sometimes feel like a cook where I put a little dash of this and a little pinch of that when it comes to their medications,” he said. “I feel like I am really good at taking small doses of different things and having them all work together so the patient can get better.”
Getting better can take different forms when it comes to the patients Dr. Casher works with, most often for two to three weeks.
If one is suffering from dementia and is acting out in ways they cannot control, his goal is to calm them down so they are not psychotic or agitated, but not so sedated they cannot walk, function, or stay awake.
If they’re depressed, the goal is to help them become less down about their life, or not depressed at all. If they’re psychotic, and hearing or seeing things, or hallucinating, the goal is to eliminate those symptoms so they are less fearful or anxious.
While Dr. Casher and the staff in the GEMS unit are intent on improving the mental well-being of their patients, educating families of patients about what is going on, and what the future could hold, is also important.
Polly LeTourneau, the social work/case manager in the GEMS unit, is involved in the education process in many ways, including serving as a counselor for families who have a loved one undergoing treatment, informing them about the type of care resources available to them, and explaining how Medicaid works and what services are eligible for reimbursement.
Dementia can be difficult to talk about for it is a disease with no cure. It usually occurs when the formation of proteins in certain areas of the brain short-circuit electrical impulses that enable the organ to act as the body’s command center. There is currently no way of removing these proteins once they have formed and they eventually inhibit the brain’s ability to function.
Rose Babcock, retired patient care manager in the GEMS unit, said there were times when a patient’s family member would admit their loved one and then ask her, “When am I going to get my grandma back?”
She would tell them the grandmother they were going to “get back” was not going to be the same person they knew two years ago, or possibly even two months ago. That is not to say working in the GEMS unit does not include heart-warming moments.
Babcock recalled a mom who was brought in by her son who she no longer recognized. She always thought he was her late husband. But just before she left the unit, there was a brief period when she recognized him as her son, and he was so thankful for it.
“He said, ‘I had my mom back for five minutes,’ “ Babcock said. “That meant the world to him.”
Judy Jenson, a registered nurse in the GEMS unit since 2001, loves to see people get better after receiving treatment. She admits working with dementia patients can be difficult because it’s a degenerative disease, but it’s “gratifying to see them better off when they leave here than when they came in.”
When it comes to working with elderly people suffering from depression not related to dementia, she takes great satisfaction when someone who entered the unit in a state of extreme anxiousness or sadness leaves it with a vastly improved state of mind.
Jenson has particularly enjoyed those moments when she has run into a former GEMS patient outside of work and the person has given her a big hug and thanked her for helping them get better.
The GEMS unit, which first opened in 1989 when it was part of Lansing General Hospital, has received several grants from the McLaren Greater Lansing Foundation. The most recent grant will fund the purchase of 17 dementia clocks that help ease the anxiety patients suffering from Alzheimer’s disease or dementia feel when they can no longer make sense of a standard watch, clock, or calendar.
For his part, Dr. Casher will continue to take satisfaction in bettering the lives of as many patients, and their family members, as he can.
“I want them to go back to their families or their facility in a lot better condition than when they came in,” he said. “I want their loved ones to say, ‘Oh. He’s doing a lot better. I’m really glad we did that.’ “
