Jim Ramoni’s entire professional career has been in the Santa Clara County (California) Social Services Agency, dating back to 1990 as an entry level social worker in child welfare. Since 2013 he has been the Director of the Department of Adult and Aging Services. He has a Master of Social Welfare from the University of California, Berkeley, a Bachelor of Arts in Molecular Biology and Psychology from San Jose State University, and is a Licensed Clinical Social Worker.
Jim: My caregiving experience really existed over the course of my relationship with my husband. He died in November of 2016. We’d been a couple for twenty eight years, since 1988. But within the first few years of us being together, Jon had a heart attack … that was in 1994. He had a quintuple bypass after that and recovered really well. I guess that’s when I started caring for him in the way of a caretaker.
Jon kept doing well throughout most of the 90s and into the early 2000s, but by 2007 he was having heart issues again. I mean, he was never without heart issues, but then they realized that things were getting bad again. So his doctors decided that he needed another bypass operation. That was in 2007.
He recovered well at first, but then he started to develop congestive heart failure. By 2016, as that worsened, he went in to have a procedure at Stanford Hospital. They put in an LVAD, or Left Ventricle Assistive Device … a pump that’s placed into the heart with a lead that comes out of the body. Then there are attachments battery packs that are to be worn during waking hours. At night, you take the batteries off and plug the unit into an electrical source near your bed. So really it’s a form of mobilized-life support. It allows people to lead a fairly normal life after their procedure.
I wish I could say that Jon recovered from his LVAD surgery and went on to live that “fairly normal” life. But he didn’t; he died four months later from a MRSA infection, among other complications. His heart had had enough. He just couldn’t go on.
When I reflect back on that time now, I realize that so much was happening then. A lot in the sense of caring for Jon, sure. But also just the emotions that arose from it all. What exactly was happening when it was … things I couldn’t see or understand during the thick of it. I powered through a lot of it, just put my head down and went on … I did what had to be done.
I’m a master’s level social worker. I started graduate school 30 years ago this month, as a matter of fact. I went to UC Berkeley to get my Master’s in Social Welfare in 1988 and graduated in 1990. I was actually studying to be a medical social worker. That was my field of interest and my focus. I couldn’t secure a hospital social work-position when I was coming out of graduate school and returning to San Jose, so I fell into a position in the county. At the time, I worked in the Department of Family Children Services in the Social Services Agency as a child welfare social worker. I worked with abused and neglected children for nearly five years before becoming a supervisor for social work staff.
Flash forward a few years and I’d gotten involved in management. From there, I worked in administration for a year, and then had an opportunity to manage in the Department of Aging and Adult Services, where I’ve been for 20 years. Now, I’m the Director. I have to say, this part of my career been the most rewarding aspect of my time in the field.
In my more personal experience with caregiving, with Jon, I was suddenly faced with the reality that I was going to be his primary caretaker when he was discharged. And because of the device that had been implanted, I actually had to be certified and trained to the extent that I had to take several tests to demonstrate my knowledge and skill. He was scheduled to be discharged the week before he died. And so in preparation for that discharge, there was medical supplies being delivered to the house … home health nursing services contacting me and trying to set things up. Of course none of that ever came to fruition because Jon didn’t come home. But what I’d begun to recognize then is that I was starting to be affected by all of this. I was getting stressed. All of a sudden, the caretaking was far ahead of anything I’d ever had to do before.
I realize now that the implications of Jon’s return home were much greater than I could’ve even imagined. I may have had to leave work. I may have had to resign or retire early. Simply recognizing the impact of these decisions with which I was faced … it was huge. I know lots of people who have had to deal with very difficult care for many years, and their lives are impacted in ways that I’ve never had to experience. It’s a reality not many know, including myself in a way. I’m very empathetic towards them.
I was the primary breadwinner for mine and Jon’s household, so I was still working when he got sick; when he died. I had to be sure that we were safe financially. I realize now that perhaps I was a little bit in denial. Not in a huge sense, but in a way that I understood that I just needed to do what I needed to do. There was no choice. It was what I’d always done as a social worker — whatever “it” took, I did. And in this case, this was all happening to the person I loved. I was going to do whatever necessary to take care of him.
Did caring for Jon impact your professional efforts?
Yes, of course. Caregiving has always been a part of what we do in the social services profession, but now a huge portion of our population is reaching a critical point in age such that we’re talking about it regularly. We’re finally acknowledging this population like never before. Everything has to be really focused on how we’re addressing these ongoing needs, needs that are so present in every professional aspect, whether it be a conference or a seminar or just a meeting of other entities where we’re trying to brainstorm and come up with service delivery. Caregiving is an aspect of all of that.
I actually just became a volunteer with Hospice of The Valley because I want to continue to give assistance to others with respect to care. This particular role is not that of a physical caretaker, but more of an emotional support for the patient and their family. And I can’t think of anything more profound right now, certainly due in part to my own experiences, than to work with people at the end stages of their life. It’s a powerful experience that’s difficult to put into words. It’s truly unlike any other.
You have to have a support network of some kind in place. I’m not saying it has to be vast, but you’ve got to be able to have at least somebody you can talk to, that you can lean on, that you can express your thoughts, feelings, and frustrations to, because caregiving will offer a complete gamut of emotions. I think it’s also important that we don’t forget to bask in the good moments. That way, you can express some of that happiness, too.
A significant social determinant of health is connection to other people. And if you don’t have that while you’re doing one of the most stressful things that you’re ever going to do, and you’re doing it all by yourself without an outlet for expression, you won’t be as effective in your role. Practice self care in this way. Everyone involved benefits.
Interviewed: 25 August 2018, by Rajiv Mehta; edited by Julia Rubano
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