Boy what a dilemma, this guy is his own biggest health risk on top of it all considering he already has a weak immune system. I'm taking it he is not a licensed caterer? I know counties can vary in whether of not the health department regulates owner occupied homes. If he is not an owner can something be said to the manager or owner of the dwelling? Would educating him on the mouse droppings and roach hazzards to others health help?

Pal,
You were there and saw the situation with your own eyes. You also have your patient's best interest in mind. I would think that you need to bring up the household cleanliness issue with the client. No need to mention anything about your partner's observations, capacity as cleaner, cook, etc. Just express your concerns as a clinician, the risks associated with mouse and roach droppings, the special risks for immune- compromised individuals, and so forth. I'm also wondering if your patient has had a recent eye exam. Could this person be failing to see that the dishes aren't clean, for example? (Please forgive any typos. I'm in migraine hell, but because I have been around many immune compromised people in various capacities, this is very important to me, so I wanted to weigh in.)

Interestingly, he USED to be a licensed caterer and worked with a firm in the cooking end of things, but not the cleaning or maintenance part of things.

Now, he is in a different business and this cooking thing, similar to my situation, is a result of "knows somebody who knows somebody who as well as X also does Y". So technically this is a private arrangement, not a catering contract.

What's interesting though (and I suppose this trait affects all of us in some regard):

My partner became known as someone who will clean in extreme situations because one client will tell someone else who has had problems keeping a cleaner and so on.

The cleaning client who told this guy about my partner is a near classic hoarder who, while not at all neat, at least keeps a clean bathroom and washes her dishes adequately.

*SHE has very little insight into why she couldnt' keep anybody to clean, and HE said, when talking to us about my partner cleaning for him "well I am not nearly as bad as HER, so you should be able to handle it."

So HE has no insight, because he is MUCH dirtier, my partner reports, but he is not a hoarder. He, like her, thinks his former cleaning service just got lazy.

This post was edited by palimpsest on Sat, Dec 8, 12 at 18:02

Well, unless the customers are a disadvantaged or simple group who must be protected and can not be expect to have observe and think, I don't think I'd try protect your client's customers.

Are the customers in the same building as your client? If so, then they already know.

But you might have a special duty to your client himself because although you are working with him as a designer right now, you have been his medical helper in the past. This is probably not your style at all, but upon spotting a mouse turd on the floor in the kitchen, I'd point it out with the toe of my shoe and say "EEEWWW, you have mousies! Do you know what can happen to you if you inhale the these?" in a kind of clownish way.

I'm suspicious of our food source, and I don't necessarily think that what comes out of your client's kitchen is worse that what comes out of the kitchen of the local restuarant.

jamies, I hadn't really thought of his customers from That particular standpoint, although the two people he does cooking for are more along the lines of Miranda from "Devil Wears Prada": they are the types who have assistants to do everything. He hand delivers prepared, prepacked, calorie-labeled portions to their --mansions--several times a week. They don't see his kitchen and would have absolutely no interest in seeing it.

(He didn't even meet one of the clients in person immediately, he met the client's main personal assistant, who wanted to know if he could be hired to be on call should the client get home at 4 am and feel like eating something. This is the situation)

I was thinking more along the lines of just saying something to Him. But I don't know which hat I would be putting on to do so.

I was talking with my partner and I feel a good approach would be for my partner to say "Listen, as someone who is trained as a chef, and has dug a bit into the conditions of your kitchen and such, you *really* ought to consider using your dishwasher because of X, Y, and Z, and from a house cleanser's standpoint also consider_____"(Whatever else is necessary to keep the house at a minimal standard between housecleaning visits. But my partner is very sensitive about hurting people's feelings.

{{!gwi}}

This post was edited by palimpsest on Sat, Dec 8, 12 at 18:20

Wow. This is tough-- and yet I do think it's critical that you do something--not just for him but for the others he is feeding.. and frankly for you and your partner. It's got to be causing you some stress and concern.

I was going recommend finding someone to give him some guidance on food prep but since your latest post said he had a history in catering, I don't know. Is this a paid gig or volunteer? Maybe there's someone you or your partner knows who could just offer to help and oversee cleanliness?

I don't know.. while the thought kind of turns my stomach and gives me health concerns for all those affected(and I am not a clean freak by any means), my bigger concern is the perception issues-- not unlike someone battling an eating disorder having a damaged perception of their body image, it seems like your client has a flawed perception of his own lifestyle. I get it to some degree. I know when I was battling some depression after some major life changes, I just kind of let things go.. my house, my own health, my yard. I found no joy in caring for me or the things around me anymore. This is (definitely) way more personal than I wanted to be when I set out to write this post but I can look back and see how screwed up my vision was.. figuratively and literally. It's not an uncommon reaction to loss and/or depression. Sometimes we throw on blinders and build these walls of denial to protect ourselves. I had NEVER employed denial as a coping mechanism in the past.. but as I dealt with my depression (also something I wasnt accustomed to), it did become part of the package that kept me trudging along. Could this be part of what's going on with your client-- is this a new behavior or situation? Has he experienced loss or is he depressed with his own health and HIV status?

Honestly, I don't know how to best help someone in this situation--me? I just kind of woke up out of the fog. However, I wasn't living in unsanitary conditions (dusty and disorganized, yes).. and I wasn't feeding others. I think there is some urgency to the situation you describe .. and yet I'd want to handle it very carefully. I wouldnt want to send your client into a tailspin.. but rather to help awaken him before he or someone else experiences the grave consequences. He clearly doesnt want to cause harm.. and yet i fear he is.

Good luck, Pal.. it's not an easy problem and I don't think there's an easy solution.

Then there is also the secondary, but unlikely, situation of liability.

If Ms Miranda gets ill, and somehow it is traced back to consumption of food from that kitchen...will the cook take the liability, or try to pass it to the person who cleaned the kitchen, putting your partner into a potential unwanted situation?

It is one thing to clean a residence, it is another to clean a "commercial kitchen" to code.

I don't have any advice to offer, but just wanted to add this consideration to the analysis.

Since you went there as his decorator, but have also had contact with him in some sort of health-related field, I think you could speak to him wearing both hats actually. "When I was in your home the other day, ...and as someone involved in the health field also, I feel that I need to mention..."

Are you sure he really cooks for those people? Seems a little odd that they would not have someone on staff to do that or buy from an established business/restaurant/caterer. His food must taste good, though, or they wouldn't keep ordering it if it is true. Just sounds like a very strange situation to me.

It also seems bizarre that someone with such cleanliness issues would invite a decorator into his home. Doesn't sound as though he is thinking clearly or focused on the right priorities.

" cleanliness issues would invite a decorator into his home"

This just shows the complexity of the human personae I guess.

The woman who referred my partner to him IS an interior designer, that's how my partner knows her. She has a lot decent furniture and beautiful art BURIED under clothes, papers, and other litter. No one who ever saw her apartment would hire her, but at her job, contract furniture layout and sales, she is apparently successful.

I don't understand the arrangement he has cooking for this Miranda-type guy. The guy does have staff at his house and did want to hire my acquaintance full time in some capacity, but it sounds as if this Miranda type person has lots of good "ideas" that come and go and Miranda-type can afford to pay for it.

Could it be as simple (other than the dishes) as finding him a good exterminator? State it just as you would a design problem. You have "A" issue and here is "B" solution.

Although rodents and other vermin are common problems where we live a big part of it is the human(s) living in the house.

The hoarder decorator used to be our neighbor. She had MAJOR problems with mice, while we, in the ten years we lived above her, and shared plumbing and HVAC stacks and runs, did not.

She has trapped as many as eight in two days. We had ONE in ten years and I think it wandered upstairs while we were doing some construction, didn't find anything and left. We have never found any droppings. We literally saw this mouse come up through the floor and go back in. She has crumbs everywhere, we didn't. Almost as simple as that.

The current tenants in my house have a mouse problem. It was not a problem before they moved in. It Has to be them.

So an exterminator can exterminate away, but if the food source is there it hardly matters, they will be back.

----
But, I think the dishwashing issue is the big one, and keeping the food processor and blender clean.
----

It's interesting that you bring up the design problem approach: these are actually the only types of projects I have done for him. No interior design in terms of decorating. It has all been problem-focused storage planning, figuring out ventilation issues in the kitchen, and window coverings, which are extremely important in the densely populated neighborhood he lives in.

This may sound OT, but do you/partner cook at home? I remember you posting once about a chicken, and that you would never ever have a chicken carcass in your house because you eat out mostly (or so I recall)
I cook everyday and while I'm not pristinely clean, the very element of cooking -and storing a huge variety of foods- would attract mice. Crumbs happen when cooking, and they might not get cleaned up to the degree that a commercial kitchen would.
Anyway, give them a little slack if that's the case.
All this seems to tie in with the fact that we here occasionally have a roach problem- but I know I am quite clean and never leave dishes out overnight or food open and overall without moving into heavy ocd territory, am doing all that I can.

But back to your original question, personally, I would myob, but that's my usual approach to such things.
Who knows exactly what happens in food carts across America, yet people survive.

A lot of cooking gets done in our house, but yes the bar for food prep hygiene is unusually high here. I realize that.

On the other hand we both eat out fairly regularly: both having worked in kitchens and knowing full well what goes on in them, and have never sent food back or lodged a complaint even if we found something in our food--because we both understand how these things happen. I am not at all squeamish. As a matter of fact, I think it is better to Not be too fastidious when it comes to immune system challenges, and would Never buy antimicrobial wipes or pens or that type of thing for home use. A bit of dirt is good for you. I have never understood the restaurant patron who goes ballistic and demands a full comp. over a hair. I don't want to get into that discussion here, though.

But this guy had plates and utensils in his cabinets that were stuck to each other because they had been put away as "clean" and they weren't clean enough obviously. On top of this he always seems to have a bit of non specific congestion (which I relate to mouse droppings and dander, and roaches as well as dust) and vague GI complaints (which I think might be a low level of food poisoning -- on the level of mild staph)--but I don't know for sure.

Our natural inclination would be to MOOB, but I feel that I have two related pieces of information that might be helpful.

Sitting this guy down for an honest and candid talk, linking his ailments to the cleanliness of his house is the first step. If I were in your shoes, I would feel obligated to convey that message.

Have you ruled out medical issues that could be causing this? Cataracts or other eye disease combined with some form of cognitive decline come to mind. Do HIV drugs tend to cause fuzzy brain?

I would first have an exterminator come in. Then maybe he can find someone that can help him clean up after himself when he cooks. Maybe an intern (of some sort)or a maid for a couple of hours. Organization is key to keeping things cleaner which has already been adressed. Whatever, you must say/do something.

If he does have a staph infection he could have a condition named PANS which is staph that has not been killed in the body and the autoimmune system sends a message to attack parts of the body and, in particular, the brain. Many with ocd have been found to have this and it can be treated.
For me I would simply say "I'm having a personal ethical battle because I don't want to hurt your feelings but I feel others may be at risk for health issues regarding the food you prepare"

I think you need to put on your health care hat, and talk candidly with him. You know what you & your partner have seen in his home, and rather than trying to find an explanation for his behavior, you just need to present the facts to him.

Offering to help him solve it would be very nice, but ultimately it's up to him, and then you can decide the relationship you want with him in the future.

This may sound cut & dried, but really, isn't it?? So put on your big boy pants, and tell him the truth and your concerns.

Yes you do need to talk to him and somehow explain the risks. You are a very diplomatic person so this should come somewhat natural to you. However, I do think you will need some sort of back-up plan. On some level he does know something is not right about his cleanliness. If he is comparing his situation to the hoarder gal but claiming he is not as bad he knows something is up (although he might not get what it is). So, you will have to begin knowing he might shift the focus onto something other than his hazardous food preparedness and work area. It's even possible he may become a bit off or hostile toward you as though it's your fault. Maybe he won't but it's best to be prepared.

Yes you do need to talk to him and somehow explain the risks. You are a very diplomatic person so this should come somewhat natural to you. However, I do think you will need some sort of back-up plan. On some level he does know something is not right about his cleanliness. If he is comparing his situation to the hoarder gal but claiming he is not as bad he knows something is up (although he might not get what it is). So, you will have to begin knowing he might shift the focus onto something other than his hazardous food preparedness and work area. It's even possible he may become a bit off or hostile toward you as though it's your fault. Maybe he won't but it's best to be prepared.

Yayagal, the PANS thing may actually be the way to bring this up for discussion.

While healthy for many years for the most part, he has been exhibiting memory problems and that type of thing that have been progressive, and they have not gotten to the root of. This may be it.

I think the memory/distraction thing has been clouded somewhat by the fact that he is also a classic ADHD and I do not throw that term around loosely.

I guess my hesitancy in all of this has come from the convoluted source of the information coupled with the fact that I am neither his primary care physician or his infectious diseases physician, I am a dentist who sees patients in these categories. However there have been a few patients in whom I have been the actual diagnostician of something that could not be sorted out by their physician and this might be one of those cases.

The approach should come from the person doing the cleaning and organizing, as part of the work. If it were me, I would tell him that, he may not have noticed, but he appears to have developed a mice problem! Such phrasing saves him from embarrassment since ostensibly he could be unaware or it could be a new problem. I would then recommend an exterminator (it will at least give him a clean slate and perhaps plug entry areas) and, if you want to go the extra mile, make sure the exterminator leaves instructions on prevention (which I think most have). You can almost spin it like, gee, as a cleaning person, this problem is bigger than my expertise. Like it was your failing!

You do risk offending, but I would look at it as a good deed. It isn't good for him or his clients, and could cost him jobs, health, as well as embarrassement if unchecked.

I worked with someone once who was an incredibly suave, handsome gentleman. Impeccable. He was also the quintessential high powered Wall Streeter. But I will always remember him for this gesture. In and around NYC, Wall street firms use black cars extensively to get clients and their bankers to meetings, the airport, etc. A very common problem is that black car drivers are immigrants, often coming from cultures that do not use deodorant. It was a standing joke. I am talking bad enough that you wanted to roll down the windows. Anyway, one day on such a trip, after we all got out of the car and signed the bill, my colleague went over and spoke privately to the driver for a few minutes.

When asked, he said that he very politely told the driver that standards of hygiene in our country are may be different than others, but that here it was considered very important to control body odor. He urged him to bathe more frequently and use deodorant, because his business required close contact.

I don't know how other might view this, but I thought this was a good deed. All the rest of us had really dehumanized these people and joked about it, I'm ashamed to say. He took the time to give advice, knowing full well he might make the driver angry.

I would be guided by the same impulse here. Risk angering this person in order to help him.

Was typing while you posted mtnrdredux, pretty much the same thought...

Every once in a while when winter hits a mouse gets into our house and makes its way to what we call the food closet (it functions as a pantry but is a closet). The mouse does not make itself at home on the counters where crumbs from dh's bagel have been left. It goes where it is dark and food has not been stored properly, like a box of crackers on the shelf, a new bag of chocolate chips left on shelf etc. The only way to combat it is get rid of the mouse and store food in plastic or glass.

If your partner is still organizing and cleaning for him could he present kitchen/pantry cleaning and organization as just another service he offers? Depending how they communicate, an email could work (or even print a brochure). "Here is my list of services and the charges. Would that be acceptable to you?" If the response is no, then at that point would he will feel comfortable diplomatically telling him about the issues he noticed?

If your treatments come under HIPAA you can't mention anything you know about the patient's medical condition except in certain covered instances anyway. You could not mention to a chef that s/he should follow scrupulous food safety guidelines because you knew that one of his or her clients was ill or immunosuppressed, for example, without obtaining a written consent to do so. It can be a conundrum when it would be helpful to a patient to pass along information but the privacy laws prevent it.

The only person I would be saying anything TO, is the patient/client. I know he is HIV positive, He knows he is HIV positive, actually anyone who wants to read his Blog knows he is HIV positive. I would not be revealing anything to anyone except that he should consider washing his dishes more carefully.

One of the effects of HIPAA is that it codifies that the nine bazillion people who work with electronic data and insurance companies all have access to everything about everybody while I am left wondering if I should say hello to a patient I recognize on the street if I am not by myself, because by saying hello, I am potentially revealing that patient's HIV status, since my friends know I treat HIV+ patients (and many immune-competent patients as well.) At the very least I am revealing they need to see a specialist.

We actually had someone question whether or not patients should be called from the waiting room by their names. We're not going to have them take numbers, and certainly they aren't going to be able to remember their chart numbers. It's almost ridiculous---by that logic we should provide stealth parking, because in a small town everyone can recognize their cars!

Perhaps the patients should all wear executioner's masks, lest they recognize each other in the waiting room?

That might strike the wrong note for a doctor's office :-)

You've been given good advice by several here to say something to him. I agree. It's all in the way you do it. I'd definitely mention to him the dirty dishes, a possible mouse problem, etc. Let him know you are doing it to help/protect him and hopefully he will understand and want to do something about it. After all, it is for his benefit as well as others.

tina