On the ward and out of my mind- You are what you eat....

So, I started bloggin about my experiences in Mental Health wards here yesterday.

It continues...

Body image was never much of an issue to me (not until the last 6 months or so), but weight has always been an issue. When depressed, I restrict, not to lose weight, but because eating seems like too much effort and too life affirming. When I was first admitted to hospital in 2006, I was 38kg (about 84 pounds for those across the pond), which is about 10kg under my optimal weight. I found out later that a Doctor in the ICU told my mother that I must have either anorexia or bulimia to be this weight. Sigh. This suspicion was not helped by the fact that when I started to be offered solid foods, I rejected a lot of them because I truly had no appetite, and well... the food is just gross. They didn't really push it, but I was subsisting on icecream, soup and toast.

Shortly before I went down to the MH ward, my mother shared what the doctor had told her. To her suprise, I laughed. I explained that I didn't have the discipline for anorexia and I couldn't stand throwing up, so no, I had neither of these conditions. I knew I was too thin, I just didn't care. But obviously, the doctors did. So, it was time to watch myself.

Ward B had a dining room with a small kitchenette attached. Breakfast was continental style, with one or two nurses in charge of toasting bread in the kitchenette. Lunch and Dinner were ordered at Morning meeting. If you missed morning meeting then you got what ever the Rec Officer chose for you. At lunch and dinner time a big trolley was pushed through by one of the Hospital Auxilaries, and then you lined up and had your name marked off and your tray handed to you. There was another nurse who served soup. Of course, there was only plastic crockery, and the nurses monitered the dump tray, to make sure you returned your cutlery. Armed with the knowledge that I was probably being monitered for an ED, I dutifully attended all meals for the first week or two and then ate whatever slop they put in front of me. I made sure to stay in a common area and avoid the bathroom for a while after eating to avoid any unfounded suspician. Eventually, they were satisfied it was not an ED, but for some reason still could not wrap their heads around the fact I jsut didn't eat becuase I couldn't be arsed. I was subsequently tested for all manner of diseases and disorders that can cause significant weight loss, and all tests came back clear. Once the spotlight was shifted somewhat from my eating habits.I began to order sandwiches for lunch and dinner, as these were generally palatable, as was the soup. In addition, due to the brain injury, I developed quite a bad tremor, and found eating with cutlery quite difficult, so I was forced to on a couple of occasions have a staff member feed me. I was quite keen to avoid this humilitation. The staff did get frustrated with my rather restricted eating, and referred me to a nutritionist, but nobody really forced the issue. After more than two and a half months of nothing but sandwiches, I began to really hate them!!

The first thing I noticed walking into the dining room that first day, was the high portion of elderly patients. I mean patients with severe dementia, who could not mobilise, feed, shower or dress themselves. All the nurses who were not performing other dinner tasks, were sitting feeding one or two of these patients. I would come to find out, that with no dedicated geriatric ward, Ward B became a dumping ground for all elderly people for whom an appropriate nursing home placement could not be found. They were often sent in as "Violent and aggressive" and a few of them were, due to the dementia, but most of them were as close as you could get to being vegetative. According to the nurses, and patients who caused Nursing Homes too much work, or resisted in anyway, were, often inappropriately shunted off to Ward B.

Years later, when I was admitted to Big City Hospital, there was of course a small population of elderly patients, but none who needed the kind of intensive care, that more than 50% of Ward B's patients did. These nurses were run off their feet, doing geriatric nursing, instead of the Mental Health Nursing they were trained to do. They resented it. And the other patients on their load suffered from the inordinate amount of time that needed to be dedicated to this one patient population.


In Big City Hospital, the dining room set up was in many ways similar. But instead of ordering meals from the kitchen, you lined up at a dedicated kitchen in the dining hall, where one of the kitchen staff would allow you to choose from two options of pre-cooked meals, in a servery or sandwiches and soup. The nursing staff had little responsibility other than to moniter the dining hall, much like a school yard moniter. The one patient I saw who required such attention.. help with feeding, mobility, showering etc, was regarded with much resentment from the staff (He was a cantankerous old bastard who seemed to enjoy winding them up) I remember thinking. You only have one of him, and you share him as a patient. Nurses in Ward B would often have two or three such patients on their  individual shift load, as well as a couple of the more standard patients. Funnily enough, despite being more overworked, as a whole I would say nurses on Ward B spent a lot more time with their patients, despite this heavy workload, than staff at BCH did, despite the fact they essentially had more time. But more on that in another post.

At BCH I was never on an ITO, so was mostly free to (with permission) walk across to the shopping centre across the road to get the food I liked, if I felt like it. There was also a number of vending machines on the ward (Got's to have my diet coke), as well as snacks put out quite regularly. A lot of patients seemed to do nothing but eat all day long. If you didn't show up to a meal, you weren't questioned, unlike in Ward B, where you would be basically manhadled out into the dining room if necessary. On a few occasions at BCH I missed breakfast, and once dinner because nobody came to tell me it was on, and I was to distracted with internal stuff, to be aware of time.

The one arsey thing I saw quite regulalry on BCH was younger patients getting hungry after ridiculously early dinner and ordering a pizza, which the nurses would generally allow in. It was always amusing to watch the expression on the poor pizza delivery guys face.

Next time, I might talk about OT... the patroning schmucks....