On the ward and out of my mind

OK. It's nearly 2am and I need some distraction. Twice today I have heard/read about somebody elses experience with Mental Health wards. One, was through a phone call I had with friend (C) in another state, who just spent a few days in what sounds like the MH ward from hell. And then I read MadSadGirl's latest installment in her "Tackling the Mental Health Minefield" series. So I thought I would write a little about some of my experiences.

As my regular readers would know, I hail from the other side of the equator. Here in Australia, we run off what I guess would be called a two-tiered health system. Pretty comprehensive universal hospital cover in the public system (but with pretty long waiting periods for non-emergent stuff, and overworked, underfunded hospitals). And for those who opt into Private Health Insurance or are prepared to pay out of pocket, a number of private hospitals. I acquired private health insurance, when I was diagnosed with epilespy, because if I had to go to hospital for any length of time, then I wanted it to be somewhere my Private Neurologist had treating rights. I haven't needed to use it for that. Its also a good idea to get Private Health Cover here before you turn 30, otherwise you lose out on the tax-rebate. So pretty much, I just used it for covering basic dental, optometry etc. 

The first time I was admitted to a MH ward, was back in 06, post OD. It was a public hospital in large regional hospital. I spent some time in the ICU while I was at my worst. After a few days (its hazy... a week at most) they attempted to move me down to a MH ward. But I was still actively hallucinating as a result of the medication I had taken, my heart rate and blood pressure went through the roof, and after about 12 hours (and my mum pleading with them to get me onto a medical floor) they decided I was to medically unstable and transferred me back up stairs. As, they had begun to notice some of the effect of the brain injury I had acquired, I went up to the Rehab ward, so once I was stabilised my Physiotherapy, Speech therapy and Occupational therapy could commence. Once up there, they also realised I had developed Aspiric Pneumonia from being extubated, so they got started on treating that as well. I was place on 1:1, which basically meant as they didn't have me in the 'safe' confines of the ward, and I had (apparently) at some point verbalised that I had every intention of finishing what I started as soon as they all left me the hell alone, I had to have a Mental Nurse, who had me in sight all the time, as well as the regular floor nurse who looked after me medically. For the first two days, this was probably somewhat unnecessary, as I drifted in and out of consciousness, and was not able to walk or even get out of bed by myself anyway, due to the brain injury. But after that, as necessary as I see the 1:1 was now, it was a pain in the ass. I could not talk to friends or family without a stranger listening in, I could not take the time to process what had happened, as I had someone taking nots on my every move. And, although for the first week or so, I could not mobilise to the shower or toilet by myself, once in there, I was afforded no privacy, as they could not leave the room. Necessary, yes. Consquence of my own actions, yes. Pain in the ass, yes yes yes! For the most part of the, oh, two weeks, that I was on the Rehab floor, my 1:1 nurse had a pretty easy shift. Once I was not actively hallucinating, I was pretty quiet. And I was resigned to the fact that I wouldn't be able to do anything in hospital anyway. Plus my mum was there everyday, helping to feed and shower me (grimace) And all the medical stuff, obs, meds etc was done by the floor nurse. So pretty much they just sat there reading Women's Day. A few, given that 1:1 time with a patient, a luxury they did not normally get, did try to talk to me about what was going on with me, what had led up to the OD, where my mind was at now. But I wasn't really in a place where I was willing to talk yet. One tried to convert me to accept Jesus Christ as my Saviour. The whole Let Go, Let God shite... which was very unprofessional. But for the most part they were ok. I began my rehab with my wonderful physio (S) and her lovely assistent (lilS). Got taught how to transition from bed to chair, and then later down the track from chair to walking stick or zimmer-frame. By the time I left to go down to the ward two weeks later, I was mostly using frame or stick, with the wheel chair only when I left hospital on day leave with my mum or when the nurses had to escort me back up to rehab floor for my sessions (otherwise would have taken me half an hour to get there) So once my medical issues had somewhat resolved, they made the decsion to move me back down to the MH floor. Was probably still a bit too soon, medically, but is very expensive to have to dedicate nurse to one person, or else they just take them off the ward floor, and it becomes understaffed.

One nurse, explained the MH wards to me, one night shift. She explained I was going to Ward B, which was a lower security ward, than Ward A, where they put the floridly psychotic and forensic patients. I was still on an Involuntary Treatment Order, which meant I could not leave ward without supervision, but the ward was only locked at night. So, I could try to leave if I wanted, but security and police would be called to bring me back, and then I would be transferred to Ward A. She also told me I could smoke in the courtyard in Ward B... that was enough for me after three weeks without a cigarette. I was brought down and shown to my room. The ward was laid out in a T shape. The Dining room/ Kitchenette/Common Room were in the middle, with small nurses station running along side it. From there, there was three corridors, to the left and right were "adult" beds, and down the centre a partition opened up what used to be the adolescent ward, to allow for more bed space still. At the very end of the corridor on the left (males), was another small tv room, with the requisite MH ward piano. I was taken down the right (females) corridor to a private room. There were 8 private rooms down one side of the corridor, with every two rooms sharing a bathroom. And four dorm rooms down the other side, with four patients sharing a room. I was happy to be given a private room, which I was later told was because I still had complex medical needs. They left me to settle in the room a minute, while they went to grab my paperwork. I took the opportunity to hobble my way to the bathroom to enjoy a bit of privacy for the first time in two weeks. Bliss. Once I got the hang of the weird bathrrom locks, that had to lock both the door from mine and the adjacent bedrooms access into the bathroom.

I was still sitting there 10 minutes later, when, let's call her Nicole, came back in to check on me. She knew I was dying for a cigarette, so she took me out to the courtyard, handed me my cigarettes, introduced me to a few of the younger patients, and told me she would be back in a few minutes to go through my paper work with me. I smiled hesitantly at the other patients, and then sidled away (as much as one can sidle with a walking stick) to sit on a bench and chain smoke seriously. I hate to admit it, (I think this is the case of a lot of people on their first admit) my immediate thought was.... I can't talk to them, they're crazy! Never mind out of all of them I was the one who just came off 1:1 and was still on an ITO. It was then it began to dawn on me what I had done, or more to the point, where I had landed myself.

Nicole came back out and took me around to a table on the other side of the courtyard, out of ear shot. She asked if I wanted to do this in my room, but I wanted to continue smoking, so I said outside was fine. Still she took care to speak softly, to protect my privacy. "This" turned out to be a patient intake form and a the first of what would be one of the many risk assessments forms I had done over the next four years and various inpatient stays. Mood leading up to the OD?... very low. Sleep?...had been bad for months but am told I didn't sleep at all for four days before OD. Have no memory of this week at all, although I was later told I did go to work for the first two days (Mon, Tues....OD on Sun), but I didn't have this info yet. Just one big missing chunk of time. Self Harm? No point denying, they had seen my scars and cuts. Eating? I was 38kg at 161cm at the time, so obviously not great. Current level of suicidality? Hmm...hesitant to answer that. Did I think I could come talk to a nurse if suicidal or self harm urges got to much? What am I going to do about it if they do...I'm in a MH Ward, I'm guessing they don't leave blades lying around. Did I have a plan? Like I'm going to tell you. Then she spoke about my life before OD. Professional Care? Yes, Psychiatrist for two years. Diagnosis? PTSD. History of sexual, physical, verbal abuse? Yes, yes and yes. Drug and Alchohol abuse? No. Psychosis? Apart from the OD induced hallucinations, no. Family support? Well.......... Housing? Not sure. Currently rent by myself, but mother insisting I come and live with her.

Nicole stopped and gathered up the paper work. And then suprised me, by pulling a packet of cigarettes from her pocket and lighting one up. She looked at me and said "I bet you are just feeling pretty shit about the way things have gone, huh?". I nod, dumbly. She went on to say "This place really isn't so bad... just think of it as a chance to take a break and focus on yourself" I say nothing. She smiles sympathetically (or is it empathetically) She goes onto explain the rules. Meals in the dining room at 7.30am, 12.30pm and 5.30pm. Meal selection is done at Morning meeting, which everyone is expected to attend in Common room at 8.30am. Courtyard open at 6am, closed at 9pm. No smoking inside. Permission (and for me supervision) required to leave the ward. Checks every hour (15 minutes for me, for the time being)

She walks me back inside pointing out things as she goes. Kitchenette is for staff to serve only. Coffee/Tea and snacks available for Morning Tea and Supper at 10.30am and 7pm, respectively. She points out the patient board. My first name has been written up there, next to my room number, and my dedicated nurse, which for this shift is Nicole. I am to find her if I need anything. We head back to my room. We both shiver as we walk in. I am to find out, my room is inexplicably colder than the rest of the ward, even the nurses say so. I will have to use four blankets at nights. My room contains a single bed, a laundry hamper and a built-in unit with a cupboard, shelves and a desk. There is barely enough room to get my zimmer frame in, so I will have to become more proficient with my stick. My bags have arrived. Friend (Miss G) has packed what she thought I would need, as mother is not ready to face apartment yet. She has included my Journals, thinking that I wouldn't want then left at home where prying eyes could see. I don't want them here either, content could keep me locked up for a lot longer than I was planning on staying. (I later give them to Miss G to keep at her house until I get out) Nicole goes through my bags, looking for contraband.... she finds it, disguised in ways that even I don't see the potential danger until she points them out and starts giving me ideas. Perfume (glass bottle, alcohol) Razor (obviously) Phone Cord (OK...hang on what???) Belt (I guess...) Shoe laces (Just take the shoes, I'll wear my thongs) ad infinitum. Lighter (Apparently I can probably get this back later) She eyes the journals curiously, but just gives them a cursory shake. She wraps a patient ID sticker around the back of my phone to cover the camera lens...for privacy reasons.

Any Questions? When do I get to go home??? Sigh. "That's for the doctors to decide, but it will probably be a little while, you're not well, physically or emotionally". She goes on to explain that they normally don't get patients with complex needs like mine. Most people either take a non-lethal OD, and are well enough to come down from A&E or CCU within a day or two. Or else they take the lethal dose, and well, they don't end up here. She said that (S) would be coming down for a meeting with the rest of my "team" and I, later on that day, to discuss my rehabilitation and the Psych Doc would come up with a plan for putting me back on meds... I hadn't had any since the OD, apart from my epilepsy meds, because they wanted to give my system time to recover.

She pats my shoulder and gets up to leave. At the doorway she turns and smiles. "You just have a bit of relax" Lunch is in 10 minutes, I will come and get you. If you need anything come and find me. If you start to feel dizzy, hit the call button" I notice the red button nestled next to the bed head. She turns and leaves shutting the door softly behind her. I lean back, clasping my childhood comfort object to my chest, and look around. And I think "What the hell have I gotten myself into?"

To be continued at some point.....