Project: Center for Integrated Health Care
Organization: Thresholds
Chicago, IL
Written by Susan Braun

Julie's Dream
“I had a dream a few days ago that I saw my guardian angel and he said I was going to die,” says Julie, stopping nurse practitioner Diane in the hallway of the Thresholds Psychiatric Rehabilitation day program.  “I’m just so scared, what can I do?” 

Julie is a survivor and bears the scars to prove it.  She survived a childhood of abuse and years of self-injury or cutting, as a way to ease the pain inside her.  She has been diagnosed with schizophrenia and now battles voices inside her head, sometimes loud and overwhelming.  She has beaten bulimia, however now struggles with diabetes and weight control.  She has been trying to quit smoking for quite some time.

Diane leads Julie into the Integrated Healthcare Clinic, a primary care clinic run by a team of registered nurses and nurse practitioners from the University of Illinois at Chicago, College of Nursing.  Because it is based inside the day program, members like Julie can access health care on short notice.  Julie sits in an exam room today, anxious and afraid.  “I’m not ready to die—I don’t want to go yet.  I’m so freaked out—I had this dream, and then yesterday when my blood pressure dropped, I just got so scared.”  

The IHC nursing team has learned to take seriously the symptoms experienced by the patients and helps them sort out the cause, be it physical or psychological, or both.  Diane checks Julie’s blood pressure and blood sugar, reassuring her that the medication that caused the drop in blood pressure has worn off and she will be just fine.  Diane teaches Julie how to check her pulse so she can see if it is racing too fast, giving her yet another tool to help control her anxiety.  She is visibly more relaxed as she heads out of the door to her group session.

Justin, a Thresholds case manager, says “IHC nurses know how to differentiate between a members’ psychosomatic complaints and their physical problems.  And they manage the members’ chronic and acute health problems with sensitivity.”  IHC staff understands the side effects of various psychiatric medications and that often cognitive changes and deficits occur after years of a mental illness. The nurses are sure to spend the extra time needed to ensure the members understand what is happening and are reassured they can manage it.   

Julie has also found support and help in a special Thresholds group home for people with both diabetes and mental illness.  At the group home, the staff teach the members about diabetes-what it is, how to take care of yourself when you have diabetes, what to eat, what the medications are for and how to take them properly.

“When you have schizophrenia, you can get so confused sometimes, and it’s hard to remember things,” says Joseph, another house member.  “The staff drills us, over and over about how to take care of ourselves, so we remember.  When I first came to the house, I had relapsed pretty bad, and I remember saying to the group, ‘I’m here to learn about diabetes and how to take care of myself.’  That was my turning point; I haven’t missed any medication or relapsed since then.”

Both Joseph and Julie agree that the house and the IHC clinic staff “really push you to be independent,” to learn to plan the menus, to exercise, to take your meds regularly.  Julie comments, “I am emotionally so much stronger now—I have a lot more support here, both the staff and other house members.  We are all learning together to take care of our diabetes.”

Julie knocks on the clinic door after her group, and peeks her head in.  Diane greets her warmly and asks what she can do for her.  Julie says, “I am just really glad that you are here when I have issues and you are always able to help me.” Then she grins and adds, “Just tell me I’m not going to die.” 

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