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Wow, so apparently this was a ridiculously busy quarter. It's now June 5th. I finished all my hundreds of practicum hours just yesterday. So naturally, now I have some time to update.
"Psychiatric Emergency, this is Jane,"
This is how I answer the phone down in the psych ED at Harborview Medical Center. It feels like we're in a basement with no windows (for safety), and it's kinda dreary with nothing on the walls; no eclectic hospital art or any color at all really (for safety in reference to the lack of art, but color?) But I love it. I love psychiatric patients. I love the team of providers and staff. It has been, by far, my most rewarding clinical experience in nursing school. I had chosen "Psych" for my senior practicum placement because I studied psych nursing in Thailand, and wanted to see what the American system was like. Now I have an idea. It's horrendous. Psychiatric illness and care carries an intense stigma in our culture, and it is one of the least resourced sectors of our healthcare system. In fact, the majority of our population suffering from psychiatric illness is homeless and the biggest provider of psychiatric "care" is our prison system.
This may very well be one of the main reasons why I feel so drawn to this patient population, it is one of the most vulnerable and disadvantaged communities in our country. For me, as a pseudo-provider, this means that often a small gesture can go a long way for an individual in crisis. I can do small gestures, I can make very small differences, and this helps because there is an infinite amount that I cannot do for this population...
Enough political advocacy for now, here are some of my favorite stories from the past 10 weeks.
A patient watches me give medications to another patient in the hallway. He comes up to afterward and says, "Hey, I take Topomax, and I haven't had it yet today..." and I replied, "Oh, I'm sorry, but you're here because you overdosed on Topomax." The patient starts laughing, "oh yeah, I forgot. I'm probably good for a few days."
My preceptor says to staffing on the phone: "We're great, we have three nurses" and I say, well maybe 2.5. He says again, "Oh no Jane, When we get a float nurse from the main ED, then we have 2.5. We count you as a whole nurse here."
Wow, a whole nurse!
Once we did get a float nurse from the main ED (see previous post: A Montage regarding the Harborview Emergency Department from August 2008-a serious ED that has amazing nurses, but they are not psych nurses..) She asks the group of us, or maybe no one in particular, "So what are you guys doing these days for folks with mental problems.. er, uh, mental issues or whatever it is you call it now?"
The Emergency overhead pager goes off: A voice crackles over our heads "51 year old male whose been involved in a scuffle with a gun-" is immediately interrupted by another, more snarky voice chiming in with "Ok Lexi, as soon as there's a gun involved, it's no longer a 'scuffle', new criteria have been met"
One new admit on the psych emergency unit demands "How can you detain Jesus?" RN answers: "Immaculate detention?" Later, same patient profoundly inquires "How can you inject Jesus?" RN suggests "Omnipotent injection?" Patient states matter-of-factly during an initial assessment on the unit, "Yes, I am Jesus... but I can't walk on water." Religious preoccupation was one of my favorite manifestations of an illness presentation.
And on a heavier note:
I became inducted into the team officially as a psychosis doula. I went to the admission room to collect a new patient. He was sitting at the processing desk with a ball point pen aimed at his jugular. The receptionist says "What are you doing with that pen, can I have it back?" I ask him to give me the pen, and I will take him back. He responds and mentions "I am supposed to do it, today is the day.." We enter the lock-down unit and he pauses in the doorway, "I don't know if I can go in here, they say it's not a good idea," We settle into his room and begin to talk. I leave to retrieve some water and a urine specimen cup for him to pee in. When I return to his room he is crouched on the floor lifting the head of the gurney and looking underneath. He turns to me when I distract him and says "I am supposed to lift this, and put my head here, and then pull it down, hard." We talk more. We discuss safety, and self-control. He asks to be placed in restraints, he doesn't feel that he can be in control. After doing so, he reacts to the physical restraint by yelling, and jerking his body on the gurney, which is now chained to the wall in this tiny fear-inducing room. I sit with him, with my hand on his shoulder, and all of a sudden doula voice sets in. It's ok, you are safe now. This is a safe place. When you feel anxious about not being able to move freely, take a deep breath--like this, with me--and tell yourself you are safe, you are safe. The patient breathes with me, deeply, like we have been transported to a beautiful sunny yuppie yoga studio. He repeats "I'm safe, I'm safe, it's ok, I'm safe" over and over until he actually falls asleep.
My preceptor walked by and observed this for a moment. She pulled me aside and said "I'd heard you were a doula... well done."
This is when I fell in love with schizophrenia, for anyone remotely interested please read this incredible story: The Day The Voices Stopped by Ken Steele.
After many more experiences on this unit I became twitter-pated with Autism, Asberger's, Borderline Personality Disorder, Delirium Tremens, methamphetamine-induced psychosis, hallucinations in general, mania, malingering and more. My love for them relates to a strong desire to learn everything about these conditions and how they effect a person, and how society in turn treats them. There is a lot to learn.
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