Day two of my second attempt at Effexor. Still getting pretty bad vertigo, mild nausea. But will just follow BabyPsychDoc's advice and push through until our appointment on Tuesday, to see whether it abates. Sometimes drugs just have some yucky side effects while your body adjusts, I guess. Unfortunately, vertigo is competing with my still slightly manic-y mood, and with dental pain mostly abated, I set about cleaning the house, if somewhat staggeredly (yup, I making up words, just like Shakespeare). So the house is in perfect order, which is always nice to come back to after you go away for a few days. I also cleaned lil sis's room, just tidied stuff away, vacuumed, made her bed and did her laundry. Obviously, I stayed out of her drawers etc because I wouldn't like someone invading my space like that... I hope she doesn't mind, and is just happy to have a tidy room to come home to too. I just can't help myself at the moment. Everything has to be done. And it has to be done NOW,
Anyways, leaving early in the morning for hometown, not sure how much internet access I will have over the next few days. Mum (who is a registered nurse) wants to take me up to the hospital she works at to get my blood pressure checked. Just to see if that is what really is causing the vertigo...you know mums! But should be able to get in and out pretty quick, small country hospital, very slow and of course a dash of nepotism chucked in. Not sure I'll be up to the races though. Probably just spend a bit of time hanging with my gran, she has been pretty down lately. Am also excited to be able to grab some cuttings for my newly established gardens.
As for all the stuff from yesterdays blog, well, have decided to just let it go, and worry about it only if it becomes a more frequent occurance. Am looking forward to a break away, and have enjoyed the min break from therapy thus far....but also feels quite odd...like I am in therapy withdrawal or something!
Happy Easter to All
Showing posts with label Physiotherapy. Show all posts
Showing posts with label Physiotherapy. Show all posts
Friday, April 2, 2010
Wednesday, March 17, 2010
What if
What would the world be like if I woke up tomorrow and just told the truth? The whole, unblemished, sometimes dark and twisty, truth? Not on the obvious stuff...like does my butt look fat in this? Some little white lies are necessary for the world to continue on harmoniously. But what if I was to tell my mother exactly what went on under her roof when I was a child? The ways that I was used, broken and messed about. What if I told her about the anger I harbor, that she didn't protect me, she didn't love me enough to notice, that I was so inconsequential to her. What if I told my grandparents that their expectations suffocate me to the point where I feel like I will never breathe freely again? That I am less concerned with completing my degree than with completing the lattice work of self harm scars tatooing my thighs? What if I told my older sister that, in fact, what happened to you in our childhood was not the worst, and although I don't know it for sure, I am pretty sure it is I, who retain the most scars, despite your aptitude at being the victim in the family? What if I told my little sister, that it is not my job to continue to protect her, I have sacrificed myself for her, but I am not her keeper? What if I could ask them to be foundations for me, when the gremlins seem determined to drag me under. What if I told my therapist how attached I have become to her, and how very angry and scared that makes me, because, she is, and all she ever can be is a therapist, who by very description will leave. That I am angry that she can not be available to me at the times when the gremlins are worse? That she doesn't have any magic answers? What if I told her the depths of depravity I have been a party to and she turns away? What if once I get angry, once I feel the pain...really feel it...I can't stop it.
Through the counsel of another, and some self reflection today, I realised I am not doing as good a job as I thought keeping this under wraps. Everybody knows I am not being entirely truthful. Would the truth actually be better for them, then the worry of guessing. Does the truth really set us free?
Through the counsel of another, and some self reflection today, I realised I am not doing as good a job as I thought keeping this under wraps. Everybody knows I am not being entirely truthful. Would the truth actually be better for them, then the worry of guessing. Does the truth really set us free?
Tuesday, February 16, 2010
On the ward and out of my mind- Therapeutic or Babysitting?
Continuing on from here, here and here
One cannot expect to go into a mental health ward (at least in the public system) and experience any real therapy. There are several reasons. The focus on providing treatment in the least restrictive environment (and lets face it, also the lack of financial resources to have enough bed space) mean that all but the most severe cases of psychosis or the forensic cases are discharged in quite a short amount of time. In my experience, most people are there between 2-14 days at most. The emphasis is quite heavily on containment whilst the worst of psychotic symptoms/ suicidal ideations pass and medication adjustments.
I was first admitted to Ward B in 2006. My first admission was quite a lengthy one, in part due to the additional medical issues I experienced as a result of my overdose. I was in hospital for about 2 and a half months. Over the next two years, I was admitted on four other occasions, for periods ranging from 5 days to two weeks. Whilst in hospital there were a number of people I could theoretically talk to, in order to process what I was going through and experiencing.
Consultant Psychiatrist
Generally, I saw this guy maybe once a week at most. Usually it would be him, a Student, my assigned nurse for the shift and I. Occasionally members from my medical team were invited to participate. Not quite like the horrible ward rounds that you guys in the UK have described. But still somewhat intimidating. The focus of these meetings was primarily to establish where I was at, mental health wise and to adjust medications. They usually only lasted five minutes or so, and there was generally no suggestion on how I might deal with some of the symptoms I was experiencing, other than to suggest I ask my nurse for a prn when needed. The consultant changed over the two years that I was in and out, but the one thing that did remain the same was that he was male, usually quite authoritarian and foriegn. I found myself getting quite upset when having to go through my history with these guys, as a) I wasn't really comfortable with men b) several things on Doctor said to me about my family made me feel quite judged (I think it was due to significant cultural differences in the ideas surrounding parents and respect) and finally, as English was not their first language, it was near impossible to talk in the idioms and metaphors, we would generally engage to soften the impact of telling a trauma. They simply did not understand. Language had to be clear cut and brutally to the point. Raw and stark. Being the passive personality I am, I usually just accepted it, but one occasion it got too much for me and I got up and stormed out of the treatment room. Unfortunately, anyone who has ever needed a walking stick before can tell you it is near on impossible to "storm off" and I ended up going arse up in front of the nurses station and all the patients. I then promptly burst into tears, which the nurses responded to quite quickly, as I am known to be a non-crier. Bundled off to my room, the nurse could do little more than pat my shoulder as I howled for the next 15 minutes. That's why I don't cry. Once I do, I can't stop. Anyways....
Nurses
As I mentioned, you got an assigned Nurse at the beginning of each shift, who was supposed to check in with you for that shift, and if you had any additional problems you were to find them. The one thing all the nurses had in common was that they were OVERWORKED. The bulk of their time by necessity had to be spent caring for the geriatric patients. They weren't normally sitting in the office ignoring us (it was a cramped, uncomfortable space anyway), they were working hard. That's where the similarities ended. Some nurses were so burnt out from the demands of "general nursing" on the ward that they had no energy left for mental health nursing. A brief "How are you today?" was sufficient to their requirements and if you did approach them with an issue, they would try to listen but you could see that harried look in their eye of someone who knows they have 1001 things to do before their shift ends. Some were burnt out by the demands, but made the effort anyway. Spent the time developing rapport with the patients. Back in the days before somking restrictions came into full force, they may sit in the courtyard and have a smoke with a group of patients, always observing, in a non-confrontational way that is so much better than "How are you today?". They may be too busy to deal with you straight away but they will tell you when they can see you, and they will keep their promise. They had the skills to turn subjects that we had in common into ways of exploring the patients issues. For instance one nurse, who was also a professional photographer, would always want to see what was new in my portfolio, and we would discuss how it was representative of the way I saw the world..... and finally there was the last kind of nurse....relatively rare, thankfully. The ones who hated mental health patients, thought we were all just lazy sods who were bunging it on for attention. Mind you, the community had its share of acopic personalities that made their way to Ward B, but no excuse for the nastiness these women exuded. If its not a field you want to work in, that interests you...then why the hell work there! I met some wonderful nurses in Ward B. As a gimpy, little long term patient, who wasn't violent or particularly demanding, I was out of the ordinary for them. Most patients were gone too quickly for them to develop rapport and the ones that remained (in Ward B at least) were pretty far gone to dementia. So, I guess in a way I became their little mascot. But for those majority of nurses who did the best they could in an under-resourced area, there were 3 or 4 nurses, whose callous actions or words remain with me today
Case Manager
I didn't get introduced to my first Case Manager until I was about a week away from discharge. Their focus is generally Ccmmunity Care. My first Case Manager (Y) was fantastic. She found away to relate to her clients, she made sure to make the meeting spaces somewhere comfortable, whether it be a park or a coffeespot, and she firmly believed in talking and doing.. in other words, by all means talk about what was going on, but at the same time go for a walk as part of my PT or go and check out a second hand book store. Anyways she was my Case Manager for most of the time I was in that area... and whilst I was in hospital she did check-in on me, she would drive me to and from my private psychiatrist appointments, when I had permission to leave the hospital. She was less of presence than out in the 'real world', I guess because she knew while I was in there I was relatively safe and contained.
Patients
Anyone who has spent time in a mental health facility will know that it is the patients that you spend the most time talking to. And often the ones you turn to, for advice or comfort. There are some inherent difficulties in this. You have to be concious of the fact that a) some of them will not be entirely truthful with you, and b) some of them will have issues that may end up impacting on your own mental health. This is particularly important to keep in mind if you decide to keep in contact outside of the ward. But the benefits are they are usually extremely judgmental, and even though no person has exactly the same experiences as you they do have a greater understanding than the average person. The other thing they bring to the table is some comraderie and humor in a dark time in your life. There is a suprising amount of laughter in a Mental Health Ward. The downside to this, is many of the 'acopic' patients, went from this comraderie and support back to their isolated and lonely existences, felt the void, and so would make a suicidal gesture just to be re-admitted for a few days to a world where they felt accepted.
Other hospital staff
Being a longer term patient, the housekeeping staff got to know me quite well, and would often stop for a quick chat. It was all very light, but it was always nice for them to compliment me on how well my walking was coming along, or as one old duck said to me "Some meat on your skin and those dark circles away from your eyes, you're starting to look quite bonny" :) In addition, (S) my physiotherapist was a fantastic support. She worked really hard to keep me goal focussed on the future, to give me hope, but on the few occasions I did fall apart, she was lovely too. I guess she didn't have to adhere to boundaries as strongly as the MH professionals do, and in those times when I was wondering if I was ever going to walk, read and talk properly again, she would take my hand and let me cry. She also provided me ample opportunites to get out the pent up anger inside me and direct it into my rehab sessions, knowing when to push my buttons to get me to push myself just that little bit further out of anger. She was a big reason why I recovered physically as well as I did, but I also believe she was a big reason why I made the steps forward with my mental health too.
Private Psychiatrist
By this stage I had been seeing Dr B for a little over a year. As soon as I was allowed out on leave, I began to go to my appointments with her twice a week, first on escorted leave with either my mum or Case Manager, and then by myself. I found it quite surreal that I was signing out of a psychiatric hospital to get psychiatric help, but the reality was, in order to get the containment I needed to go outside of the Public System.
There were some differences and some similarities at Big City Hospital.
Consultant Psychiatrist
Usually there was just you, him and the junior doc. Not quite as confronting as at Ward B, but also it meant that there was no nurse to explain things to you when you left. I often found it hard to absorb what was being said. The consultations were the same length, about 5 minutes, but seemed to be more regular than on Ward B. Every 2-3 days. He is also the guy who heads the team the Junior Doctor and Case Manager assigned to me in community care are apart of. This means he is kept more regulalry apprised of what is going on with me, and is generally consulted in CM thinks I might need an admission. So there is a lot less repeating myself. And quite often they will do a direct admit rather than make you endure a horrible A&E admit.
Nurses
Now this is one that I do get quite cranky about. I understand that we live in a world of paperwork, back-up paper work and back up, backup paperwork, but the amount of time the nurses spent even out of the office, let alone actually engaged with patients was abysmal. They did not have the same geriatric workload as Ward B nurses. WHAT ARE THEY DOING?? I believe a small part of it can be attributed to the system of medication hand outs. In Ward B, three times a day you lined up outside a window for your medication, this took two nurses about an hour to do. Of course, they had to track down the odd non-compliant patient, but it worked pretty well. Assigned nurses gave out any prns or the odd medication that fell outside these times. In BCH, each assigned nurse, prepares the meds for each of their patients and then runs around the ward like a headless chook with a dixie cup of pills and another of water, trying to find their patient. As there is a bunch of nurse all trying to do this at the same time, the tiny meds room gets quite jammed up, which slows the process further. I've watched an individual nurse take two hours to get through all her meds. It seems to be a waste of time that could be better spent with patients. In BCH, I quite often went an entire shift without talking to my assigned nurse, or even knowing who is was until they came to give me meds. A common phrase was "Ive been measning to come and see you. Just let me finish these meds". And then you never see them again... I am not a squeaky wheel in hospital, so I am easy to overlook. Additionally, I have had a nurse tell my private psychologist who rang, that I was doing very well, and that she has spoken with me that morning....and she had not even seen me! Most of them are good nurses I think, but there is a culture of inefficiency and a tendency to migrate to the nurses station where its comfy. The nurses station in addition, is nowhere near the middle of the ward, so they had no idea what was actually going on (i.e patients smoking dope in the corner (I witnessed this!), there was gossip about patients getting it on in the laundry (not sure if that's true) If you did need to see your nurse, it would take a lot of banging on the door just to get anybody to respond. Massive Fails in my opinion.
Case Manager
Unlike in Ward B, my Case Manager in BCH was housed in a separate location from the hospital. I think she only came to the hospital once, when I was first admitted to introduce herself. However she does always make sure to let them know if I am coming etc and checks on me when I am discharged.
Other staff
Consumer Advocate (K) came and saw me twice during my lastincarceration admit. She also arranged for her counterpart to check in on me on my birthday, which was sweet.
Patients
Similar to Ward B, but have had a few bad experiences this time round. One of the girls I befriended in there ended up taking me on a bit of a roller coaster ride outside of the hospital. But I will always be grateful for the few months of friendship we did have. And I truly hope she manages to work through her issues. Unfortunately, I had to distance myself to preserve my own mental health.
Private Psychologist
I began seeing (D) about two months before I landed in BCH the first time, over the next 6 months I had two subsequent admissions. I cannot emphasize how much of a support she has been when i have been hospitalised, and I really need to remember that at times like now, when I am pissed off at her. I was really reluctant to go in my first admission. I had stayed out of hospital for nearly two years, I didn't want to go back to that. I didn't want to admit to how far things had gotten out of control. She did not push hospital, in fact she is in many ways anti-hospital, but eventually we both had to admit we were out of options. The first admit, she sat in the ER with me for hours, waiting for admittance. She also did a lot of the talking (background history stuff) that I was unable to do. I don't think I would have stayed and waited if she hadn't have been there. She also rang me pretty much everyday to check how I was going. At the end of the admission, the Consultant Psych told me, that if I was admitted again, (which I think he suspected I would be, with D-day anniversary coming up) that I was to go to my bi-weekly session with her, for continuity. So on the subsequent stays, I was faced with the surreal prospect of leaving a mental health ward on leave, to go and get mental health help. Seems ludicrous! But it helped.
Ultimately, I can see that Public Mental Health Facilities are not meant to be therapeutic communities, I can see the arguements for least restrictive environments etc BUT if the patients are going to be in the hospital anyway, you would think that there should be some attempts to provide an environment more conducive to processing whatever emotions etc they are feeling. I don't know exactly what the answer is, but I suspect a big part of it, particularly in BCH is getting the nurses off their arses, out of the nursing station and into the messy melee that is a psych ward. That's what they signed up for after all.
The second thing I have become aware of in retrospect, is how lucky I have been to have other people, (private practitioners, physiotherapist, auxilary staff ect) step into to fill the void left by the lack of involvement of behalf of the nurses.
One cannot expect to go into a mental health ward (at least in the public system) and experience any real therapy. There are several reasons. The focus on providing treatment in the least restrictive environment (and lets face it, also the lack of financial resources to have enough bed space) mean that all but the most severe cases of psychosis or the forensic cases are discharged in quite a short amount of time. In my experience, most people are there between 2-14 days at most. The emphasis is quite heavily on containment whilst the worst of psychotic symptoms/ suicidal ideations pass and medication adjustments.
I was first admitted to Ward B in 2006. My first admission was quite a lengthy one, in part due to the additional medical issues I experienced as a result of my overdose. I was in hospital for about 2 and a half months. Over the next two years, I was admitted on four other occasions, for periods ranging from 5 days to two weeks. Whilst in hospital there were a number of people I could theoretically talk to, in order to process what I was going through and experiencing.
Consultant Psychiatrist
Generally, I saw this guy maybe once a week at most. Usually it would be him, a Student, my assigned nurse for the shift and I. Occasionally members from my medical team were invited to participate. Not quite like the horrible ward rounds that you guys in the UK have described. But still somewhat intimidating. The focus of these meetings was primarily to establish where I was at, mental health wise and to adjust medications. They usually only lasted five minutes or so, and there was generally no suggestion on how I might deal with some of the symptoms I was experiencing, other than to suggest I ask my nurse for a prn when needed. The consultant changed over the two years that I was in and out, but the one thing that did remain the same was that he was male, usually quite authoritarian and foriegn. I found myself getting quite upset when having to go through my history with these guys, as a) I wasn't really comfortable with men b) several things on Doctor said to me about my family made me feel quite judged (I think it was due to significant cultural differences in the ideas surrounding parents and respect) and finally, as English was not their first language, it was near impossible to talk in the idioms and metaphors, we would generally engage to soften the impact of telling a trauma. They simply did not understand. Language had to be clear cut and brutally to the point. Raw and stark. Being the passive personality I am, I usually just accepted it, but one occasion it got too much for me and I got up and stormed out of the treatment room. Unfortunately, anyone who has ever needed a walking stick before can tell you it is near on impossible to "storm off" and I ended up going arse up in front of the nurses station and all the patients. I then promptly burst into tears, which the nurses responded to quite quickly, as I am known to be a non-crier. Bundled off to my room, the nurse could do little more than pat my shoulder as I howled for the next 15 minutes. That's why I don't cry. Once I do, I can't stop. Anyways....
Nurses
As I mentioned, you got an assigned Nurse at the beginning of each shift, who was supposed to check in with you for that shift, and if you had any additional problems you were to find them. The one thing all the nurses had in common was that they were OVERWORKED. The bulk of their time by necessity had to be spent caring for the geriatric patients. They weren't normally sitting in the office ignoring us (it was a cramped, uncomfortable space anyway), they were working hard. That's where the similarities ended. Some nurses were so burnt out from the demands of "general nursing" on the ward that they had no energy left for mental health nursing. A brief "How are you today?" was sufficient to their requirements and if you did approach them with an issue, they would try to listen but you could see that harried look in their eye of someone who knows they have 1001 things to do before their shift ends. Some were burnt out by the demands, but made the effort anyway. Spent the time developing rapport with the patients. Back in the days before somking restrictions came into full force, they may sit in the courtyard and have a smoke with a group of patients, always observing, in a non-confrontational way that is so much better than "How are you today?". They may be too busy to deal with you straight away but they will tell you when they can see you, and they will keep their promise. They had the skills to turn subjects that we had in common into ways of exploring the patients issues. For instance one nurse, who was also a professional photographer, would always want to see what was new in my portfolio, and we would discuss how it was representative of the way I saw the world..... and finally there was the last kind of nurse....relatively rare, thankfully. The ones who hated mental health patients, thought we were all just lazy sods who were bunging it on for attention. Mind you, the community had its share of acopic personalities that made their way to Ward B, but no excuse for the nastiness these women exuded. If its not a field you want to work in, that interests you...then why the hell work there! I met some wonderful nurses in Ward B. As a gimpy, little long term patient, who wasn't violent or particularly demanding, I was out of the ordinary for them. Most patients were gone too quickly for them to develop rapport and the ones that remained (in Ward B at least) were pretty far gone to dementia. So, I guess in a way I became their little mascot. But for those majority of nurses who did the best they could in an under-resourced area, there were 3 or 4 nurses, whose callous actions or words remain with me today
Case Manager
I didn't get introduced to my first Case Manager until I was about a week away from discharge. Their focus is generally Ccmmunity Care. My first Case Manager (Y) was fantastic. She found away to relate to her clients, she made sure to make the meeting spaces somewhere comfortable, whether it be a park or a coffeespot, and she firmly believed in talking and doing.. in other words, by all means talk about what was going on, but at the same time go for a walk as part of my PT or go and check out a second hand book store. Anyways she was my Case Manager for most of the time I was in that area... and whilst I was in hospital she did check-in on me, she would drive me to and from my private psychiatrist appointments, when I had permission to leave the hospital. She was less of presence than out in the 'real world', I guess because she knew while I was in there I was relatively safe and contained.
Patients
Anyone who has spent time in a mental health facility will know that it is the patients that you spend the most time talking to. And often the ones you turn to, for advice or comfort. There are some inherent difficulties in this. You have to be concious of the fact that a) some of them will not be entirely truthful with you, and b) some of them will have issues that may end up impacting on your own mental health. This is particularly important to keep in mind if you decide to keep in contact outside of the ward. But the benefits are they are usually extremely judgmental, and even though no person has exactly the same experiences as you they do have a greater understanding than the average person. The other thing they bring to the table is some comraderie and humor in a dark time in your life. There is a suprising amount of laughter in a Mental Health Ward. The downside to this, is many of the 'acopic' patients, went from this comraderie and support back to their isolated and lonely existences, felt the void, and so would make a suicidal gesture just to be re-admitted for a few days to a world where they felt accepted.
Other hospital staff
Being a longer term patient, the housekeeping staff got to know me quite well, and would often stop for a quick chat. It was all very light, but it was always nice for them to compliment me on how well my walking was coming along, or as one old duck said to me "Some meat on your skin and those dark circles away from your eyes, you're starting to look quite bonny" :) In addition, (S) my physiotherapist was a fantastic support. She worked really hard to keep me goal focussed on the future, to give me hope, but on the few occasions I did fall apart, she was lovely too. I guess she didn't have to adhere to boundaries as strongly as the MH professionals do, and in those times when I was wondering if I was ever going to walk, read and talk properly again, she would take my hand and let me cry. She also provided me ample opportunites to get out the pent up anger inside me and direct it into my rehab sessions, knowing when to push my buttons to get me to push myself just that little bit further out of anger. She was a big reason why I recovered physically as well as I did, but I also believe she was a big reason why I made the steps forward with my mental health too.
Private Psychiatrist
By this stage I had been seeing Dr B for a little over a year. As soon as I was allowed out on leave, I began to go to my appointments with her twice a week, first on escorted leave with either my mum or Case Manager, and then by myself. I found it quite surreal that I was signing out of a psychiatric hospital to get psychiatric help, but the reality was, in order to get the containment I needed to go outside of the Public System.
There were some differences and some similarities at Big City Hospital.
Consultant Psychiatrist
Usually there was just you, him and the junior doc. Not quite as confronting as at Ward B, but also it meant that there was no nurse to explain things to you when you left. I often found it hard to absorb what was being said. The consultations were the same length, about 5 minutes, but seemed to be more regular than on Ward B. Every 2-3 days. He is also the guy who heads the team the Junior Doctor and Case Manager assigned to me in community care are apart of. This means he is kept more regulalry apprised of what is going on with me, and is generally consulted in CM thinks I might need an admission. So there is a lot less repeating myself. And quite often they will do a direct admit rather than make you endure a horrible A&E admit.
Nurses
Now this is one that I do get quite cranky about. I understand that we live in a world of paperwork, back-up paper work and back up, backup paperwork, but the amount of time the nurses spent even out of the office, let alone actually engaged with patients was abysmal. They did not have the same geriatric workload as Ward B nurses. WHAT ARE THEY DOING?? I believe a small part of it can be attributed to the system of medication hand outs. In Ward B, three times a day you lined up outside a window for your medication, this took two nurses about an hour to do. Of course, they had to track down the odd non-compliant patient, but it worked pretty well. Assigned nurses gave out any prns or the odd medication that fell outside these times. In BCH, each assigned nurse, prepares the meds for each of their patients and then runs around the ward like a headless chook with a dixie cup of pills and another of water, trying to find their patient. As there is a bunch of nurse all trying to do this at the same time, the tiny meds room gets quite jammed up, which slows the process further. I've watched an individual nurse take two hours to get through all her meds. It seems to be a waste of time that could be better spent with patients. In BCH, I quite often went an entire shift without talking to my assigned nurse, or even knowing who is was until they came to give me meds. A common phrase was "Ive been measning to come and see you. Just let me finish these meds". And then you never see them again... I am not a squeaky wheel in hospital, so I am easy to overlook. Additionally, I have had a nurse tell my private psychologist who rang, that I was doing very well, and that she has spoken with me that morning....and she had not even seen me! Most of them are good nurses I think, but there is a culture of inefficiency and a tendency to migrate to the nurses station where its comfy. The nurses station in addition, is nowhere near the middle of the ward, so they had no idea what was actually going on (i.e patients smoking dope in the corner (I witnessed this!), there was gossip about patients getting it on in the laundry (not sure if that's true) If you did need to see your nurse, it would take a lot of banging on the door just to get anybody to respond. Massive Fails in my opinion.
Case Manager
Unlike in Ward B, my Case Manager in BCH was housed in a separate location from the hospital. I think she only came to the hospital once, when I was first admitted to introduce herself. However she does always make sure to let them know if I am coming etc and checks on me when I am discharged.
Other staff
Consumer Advocate (K) came and saw me twice during my last
Patients
Similar to Ward B, but have had a few bad experiences this time round. One of the girls I befriended in there ended up taking me on a bit of a roller coaster ride outside of the hospital. But I will always be grateful for the few months of friendship we did have. And I truly hope she manages to work through her issues. Unfortunately, I had to distance myself to preserve my own mental health.
Private Psychologist
I began seeing (D) about two months before I landed in BCH the first time, over the next 6 months I had two subsequent admissions. I cannot emphasize how much of a support she has been when i have been hospitalised, and I really need to remember that at times like now, when I am pissed off at her. I was really reluctant to go in my first admission. I had stayed out of hospital for nearly two years, I didn't want to go back to that. I didn't want to admit to how far things had gotten out of control. She did not push hospital, in fact she is in many ways anti-hospital, but eventually we both had to admit we were out of options. The first admit, she sat in the ER with me for hours, waiting for admittance. She also did a lot of the talking (background history stuff) that I was unable to do. I don't think I would have stayed and waited if she hadn't have been there. She also rang me pretty much everyday to check how I was going. At the end of the admission, the Consultant Psych told me, that if I was admitted again, (which I think he suspected I would be, with D-day anniversary coming up) that I was to go to my bi-weekly session with her, for continuity. So on the subsequent stays, I was faced with the surreal prospect of leaving a mental health ward on leave, to go and get mental health help. Seems ludicrous! But it helped.
Ultimately, I can see that Public Mental Health Facilities are not meant to be therapeutic communities, I can see the arguements for least restrictive environments etc BUT if the patients are going to be in the hospital anyway, you would think that there should be some attempts to provide an environment more conducive to processing whatever emotions etc they are feeling. I don't know exactly what the answer is, but I suspect a big part of it, particularly in BCH is getting the nurses off their arses, out of the nursing station and into the messy melee that is a psych ward. That's what they signed up for after all.
The second thing I have become aware of in retrospect, is how lucky I have been to have other people, (private practitioners, physiotherapist, auxilary staff ect) step into to fill the void left by the lack of involvement of behalf of the nurses.
Monday, February 15, 2010
On the ward and out of my mind- I'm Bored!!!!!
Ok.. well it appears I won't be sleeping any time soon, so I might as well continue with these posts. See part one here and part two here.
Once you are confined to a MH ward there is not a lot to do, other than sit and think. And the last thing they want you doing is thinking! So they have a little schedule they run through each day to keep the crazies happy. Ward B "OT" time was not run by a qualified OT, rather two Recreation Officers, ( read nurse who got sick of nursing and decided to spend the rest of her career beading and sum dood with no neck who liked to take the male patients down to the gym to bond and got sulky if a female patient, say, thought she might like to go for a run on the treadmill.)
Morning meetings started at 8.30am every morning. The R.O. would first take meal orders, introduce new patients, and take care of housekeeping. It was also an opportunity for patients air minor grievances. The R.O. would then write the schedule for the day, and take names for excursions and banking, as well as the Centrelink lady who came in once a week to help clients sort their benefits out. We would then do the Petal Puzzle from the paper (word puzzle) together and then scatter back out to the courtyard to smoke. Some people were very vocal in these meetings, a great deal of us were pretty quiet. The only time I really spoke was during the Petal Puzzle, the only real form of intellectual stimulation I was getting.
Some activities were regular. Gentle exercise on Monday and Thursdays, which I had to attend because my lovely Physio (S) came down to run it, and she thought it would be good for my physical rehab. Of course, to rub in the humiliation of being the only one under 50 doing it (the younger patients pissed off outside for a smoke, and spent the whole hour staring through the glass and laughing) I also had to wear the belt. The belt is a thick canvas thing that velcro's and buckles around your waist with handles on the side or at the back. Its used in Rehab for patients who are learning to balance and walk again, so the physios have something solid and strong to grab if you start to fall. On Wednesday lunch they took the bus to a local Mental Health Clubhouse that hosted a wednesday lunch for $2. The idea was to introduce patients to other service users and the facility, so that when they were discharged they had community support. I think its a great concept, just not for me.. I found it kind of creepy and depressing.
Other activities during the morning might include escorts to the gym, morning sing along (yeah... I said it...sing along!) Volleyball tournaments against Ward A. In the afternoon while male RO did shopping/banking for patients female RO did art, sewing, beading, trivia games. I must admit I actually did enjoy beading, not elaborate stuff, the precisness of it just appealed to my slightly OCD side.
This schedule was repeated week in, week out . Which was great if like most people on Ward B you were there for a short stay. (2 days average for an OD, 4-7 days for most other stuff) The only long termers like me were the geriatrics and one woman who I never found out what was wrong with. She was in her 30's but literally would not move or look at anyone. She just stayed where she was put and stared off into whatever world she was in. She was pretty, her husband came to visit her regulalry and I always felt quite sorry for him....and her too, of course. The point is Ward B was a temporary stop for most people, the long termers ended up on Ward A. But somehow, I, as a long termer, ended up on Ward B. And there is only so much beading one can do!
Occasionally, the week would be shaken up by an exciting once off activity. BBQ in the park, bus trip to local national park and dam (they drove us through mcdonalds drive through and got us soft serve cones on the way back...giggle...) Other times we would head over to Ward A for social time and a bbq
Interspersed with 'activities' were workshops. Patients were 'strongly encouraged' to attend ones that the nurse or doctor thought relevant to their current issue. I got shoulder tapped for the anxiety one. I also got bullied into the relaxation class, which I walked out of after a few minutes. I find a lot of relaxation strategies to actually be quite triggering and make me quite agitated. The workshops were all very short, language aimed at the lowest common denominator and of course had a very heavy CBT bent. Out of boredom, I believe I probably attended all of the workshops over the course of the two months (they cycled through on a two week rotation) including ones that were clearly not apllicable to me at times. the staff tolerated this as I sat quietly and they didn't really know what else to do with me.
After a month or so it hit me, that no matter how lame the activity was, if i just grinned and beared it, it looked good in my notes and put me closer to discharge, so I threw myself in, barely concealing my disdain and trying not to ark up at the patronising undertones. Even (I'm ashamed to admit it) the sing alongs. I learnt that you had to play the game. Paint happy pictures, sing "You are my sunshine" and look damn well excited to be doing it.
Even with the reasonably full weekly activites, the weekends stretched on for ever, as there were no RO's on. I accumulated a plethora of art supplies (with sketch pads I didn't have to show anybody, I took up crocheting (also recommended as part of my "Fine Motor" rehab. I wore my MP3 player constantly. I spent weekends using a collection of Dr Seuss books that I had borrowed from the kids I used to nanny for, to try and prod my brain into remembering how to read again. I practiced writing with the sheets the OT from my rehab team supplied for me, as well as worksheets to improve my 'scanning' capabilities.
In addition to the activites on the ward, I was also doing a lot of rehab work. Aside from the stuff I mentioned above. I would have an individual session with (S) the Physio every day or two, as well as attending Balance and Movement group classes and Fine Motor Classed (mostly populated by patients who had suffered a stroke or had a hip replacement. I had speech and OT every few days. My designated nurse for each shift would also come and run through a series of exercise designed by (S) for 10 minutes or so each shift. They particularly liked the ones where they got to try and push me over (while sitting on a bed) so that I could practise using my core muscles. Some got a little over enthusiastic with this one! I think perhaps working out the frustration of their shift.
During my time in hospital and even as an outpatient (S) was my lifeline. She didn't take any bullshit. When I yelled at her, she yelled right on back. But she also seemed to know where my breaking point was, how hard to push me. She was honest about what she thought my recovery time would be (two years... she was pretty close, I last used my walking stick 22 months later) And she gave me something to focus on. I couldn't do anything to 'fix' my mind, but if I worked hard I could undo the damage I had done to my body. She was never judgemental, even when I complained, despite the fact I had done it to myself. I pretty devastated when a year into my physio she went off early on maternity leave. But I am eternally thankful for compassion and firmness she demonstrated in that first year. She was also a great advocate. When she found out that the room I was in had not been equipped with the necessary equipment she has requested she got it sorted straight away. Within 10 minutes I had the toilet chair, shower bench and transfer chair I needed in my room.
Ok. So moving onto Big City Hospital Program. I have been hospitalised there three times for periods from one week to two and a half weeks. And there activity program includes....erm... not a lot. They do have an RO, but she tends to set random activities up in the dining room, without letting people know she's doing it, so unless you happen to walk through you don't know its on. These activites are mainly arts and craft, beading, sewing and once cooking. So not a lot for the average male to do. But I'm a girl and I liked beading. I just managed to miss it most days. They also occasionally brought a Wii out to play. Other than that, no morning meetings, no real scheduled activities, no workshops, no trips. Just hours of sitting in a depressing, concrete courtyard chain smoking. Once again, my MP3 player was my friend. My own art supplies. And a stack of books. (Yes, I did get the hang of reading again). There aren't even any books or bookshelves in the ward, just hideously out of date, lame women's mags. I wanted to dontate some books, but there is no shelf.
Anyways. Next I will probably talk about MH professionals. When I have the energy to write it up.
Once you are confined to a MH ward there is not a lot to do, other than sit and think. And the last thing they want you doing is thinking! So they have a little schedule they run through each day to keep the crazies happy. Ward B "OT" time was not run by a qualified OT, rather two Recreation Officers, ( read nurse who got sick of nursing and decided to spend the rest of her career beading and sum dood with no neck who liked to take the male patients down to the gym to bond and got sulky if a female patient, say, thought she might like to go for a run on the treadmill.)
Morning meetings started at 8.30am every morning. The R.O. would first take meal orders, introduce new patients, and take care of housekeeping. It was also an opportunity for patients air minor grievances. The R.O. would then write the schedule for the day, and take names for excursions and banking, as well as the Centrelink lady who came in once a week to help clients sort their benefits out. We would then do the Petal Puzzle from the paper (word puzzle) together and then scatter back out to the courtyard to smoke. Some people were very vocal in these meetings, a great deal of us were pretty quiet. The only time I really spoke was during the Petal Puzzle, the only real form of intellectual stimulation I was getting.
Some activities were regular. Gentle exercise on Monday and Thursdays, which I had to attend because my lovely Physio (S) came down to run it, and she thought it would be good for my physical rehab. Of course, to rub in the humiliation of being the only one under 50 doing it (the younger patients pissed off outside for a smoke, and spent the whole hour staring through the glass and laughing) I also had to wear the belt. The belt is a thick canvas thing that velcro's and buckles around your waist with handles on the side or at the back. Its used in Rehab for patients who are learning to balance and walk again, so the physios have something solid and strong to grab if you start to fall. On Wednesday lunch they took the bus to a local Mental Health Clubhouse that hosted a wednesday lunch for $2. The idea was to introduce patients to other service users and the facility, so that when they were discharged they had community support. I think its a great concept, just not for me.. I found it kind of creepy and depressing.
Other activities during the morning might include escorts to the gym, morning sing along (yeah... I said it...sing along!) Volleyball tournaments against Ward A. In the afternoon while male RO did shopping/banking for patients female RO did art, sewing, beading, trivia games. I must admit I actually did enjoy beading, not elaborate stuff, the precisness of it just appealed to my slightly OCD side.
This schedule was repeated week in, week out . Which was great if like most people on Ward B you were there for a short stay. (2 days average for an OD, 4-7 days for most other stuff) The only long termers like me were the geriatrics and one woman who I never found out what was wrong with. She was in her 30's but literally would not move or look at anyone. She just stayed where she was put and stared off into whatever world she was in. She was pretty, her husband came to visit her regulalry and I always felt quite sorry for him....and her too, of course. The point is Ward B was a temporary stop for most people, the long termers ended up on Ward A. But somehow, I, as a long termer, ended up on Ward B. And there is only so much beading one can do!
Occasionally, the week would be shaken up by an exciting once off activity. BBQ in the park, bus trip to local national park and dam (they drove us through mcdonalds drive through and got us soft serve cones on the way back...giggle...) Other times we would head over to Ward A for social time and a bbq
Interspersed with 'activities' were workshops. Patients were 'strongly encouraged' to attend ones that the nurse or doctor thought relevant to their current issue. I got shoulder tapped for the anxiety one. I also got bullied into the relaxation class, which I walked out of after a few minutes. I find a lot of relaxation strategies to actually be quite triggering and make me quite agitated. The workshops were all very short, language aimed at the lowest common denominator and of course had a very heavy CBT bent. Out of boredom, I believe I probably attended all of the workshops over the course of the two months (they cycled through on a two week rotation) including ones that were clearly not apllicable to me at times. the staff tolerated this as I sat quietly and they didn't really know what else to do with me.
After a month or so it hit me, that no matter how lame the activity was, if i just grinned and beared it, it looked good in my notes and put me closer to discharge, so I threw myself in, barely concealing my disdain and trying not to ark up at the patronising undertones. Even (I'm ashamed to admit it) the sing alongs. I learnt that you had to play the game. Paint happy pictures, sing "You are my sunshine" and look damn well excited to be doing it.
Even with the reasonably full weekly activites, the weekends stretched on for ever, as there were no RO's on. I accumulated a plethora of art supplies (with sketch pads I didn't have to show anybody, I took up crocheting (also recommended as part of my "Fine Motor" rehab. I wore my MP3 player constantly. I spent weekends using a collection of Dr Seuss books that I had borrowed from the kids I used to nanny for, to try and prod my brain into remembering how to read again. I practiced writing with the sheets the OT from my rehab team supplied for me, as well as worksheets to improve my 'scanning' capabilities.
In addition to the activites on the ward, I was also doing a lot of rehab work. Aside from the stuff I mentioned above. I would have an individual session with (S) the Physio every day or two, as well as attending Balance and Movement group classes and Fine Motor Classed (mostly populated by patients who had suffered a stroke or had a hip replacement. I had speech and OT every few days. My designated nurse for each shift would also come and run through a series of exercise designed by (S) for 10 minutes or so each shift. They particularly liked the ones where they got to try and push me over (while sitting on a bed) so that I could practise using my core muscles. Some got a little over enthusiastic with this one! I think perhaps working out the frustration of their shift.
During my time in hospital and even as an outpatient (S) was my lifeline. She didn't take any bullshit. When I yelled at her, she yelled right on back. But she also seemed to know where my breaking point was, how hard to push me. She was honest about what she thought my recovery time would be (two years... she was pretty close, I last used my walking stick 22 months later) And she gave me something to focus on. I couldn't do anything to 'fix' my mind, but if I worked hard I could undo the damage I had done to my body. She was never judgemental, even when I complained, despite the fact I had done it to myself. I pretty devastated when a year into my physio she went off early on maternity leave. But I am eternally thankful for compassion and firmness she demonstrated in that first year. She was also a great advocate. When she found out that the room I was in had not been equipped with the necessary equipment she has requested she got it sorted straight away. Within 10 minutes I had the toilet chair, shower bench and transfer chair I needed in my room.
Ok. So moving onto Big City Hospital Program. I have been hospitalised there three times for periods from one week to two and a half weeks. And there activity program includes....erm... not a lot. They do have an RO, but she tends to set random activities up in the dining room, without letting people know she's doing it, so unless you happen to walk through you don't know its on. These activites are mainly arts and craft, beading, sewing and once cooking. So not a lot for the average male to do. But I'm a girl and I liked beading. I just managed to miss it most days. They also occasionally brought a Wii out to play. Other than that, no morning meetings, no real scheduled activities, no workshops, no trips. Just hours of sitting in a depressing, concrete courtyard chain smoking. Once again, my MP3 player was my friend. My own art supplies. And a stack of books. (Yes, I did get the hang of reading again). There aren't even any books or bookshelves in the ward, just hideously out of date, lame women's mags. I wanted to dontate some books, but there is no shelf.
Anyways. Next I will probably talk about MH professionals. When I have the energy to write it up.
Sunday, February 14, 2010
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.....
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.....
Subscribe to:
Posts (Atom)
Posts
