Nursing Voices

Wednesday, July 05, 2006

The Devil Doesn't Always Wear Prada

The movie marquee announced, "The Devil Wears Prada." My patient would disagree. He thinks the devil wears a hospital ID badge and works on a psych unit.

Alan glared at me from across the desk. “Oh wonderful,” I thought. “Another outstanding holiday weekend. ” The police brought Alan to our emergency room in handcuffs. His girlfriend had called the authorities after finding a stash of weapons under their bed. Alan told her he wanted to kill his parents because he wanted to rid the world of evil. It was Alan’s first psychotic break. I hoped Alan would stay calm during the admission process. As with every holiday, we were working short on the unit.

“You bitch,” Alan screamed. “You can’t keep me here against my will.” So much for staying calm,” I thought. I had asked Alan to sign his admission paperwork. “Alan, I’m your nurse and you are at the hospital. You are in a safe place,” I said. He balled up his fist and shook it in my face yelling, “Liar! I know who you really are.” I leaned back in my chair and pushed the panic button under the desk to summon security. I responded “Alan, if I’m not your nurse, who am I?” He scowled and said, “You are the devil and you are going to hell!”

People ask me what it’s like to work on a psychiatric unit. As the weekend charge nurse, I’m responsible for making sure that things run smoothly on my unit. While the Monday through Friday crew is out enjoying the weekend, I’m stuck working with a skeleton crew. And because I have little backup in case of an emergency, I keep a tight rein on the unit. If a drug addict starts threatening staff or the other patients because it’s not time for a dose of Methadone, I put them in the quiet room. If they become violent, I put them in restraints. No questions asked. If a patient’s visitor becomes disruptive and threatening, I have security escort them off the unit. And if all hell breaks loose, I’ve been known to call the police. My entire focus is on patient and unit safety.

I can’t remember all the names patients have called me throughout my long nursing career. Nurses take a lot of abuse. However, being called a devil is pretty common when you’re dealing with a paranoid patient with religious ideations. I felt sorry for Alan. He wasn’t a bad guy. He was a decent person living with a very bad disease. I knew that unless Alan stayed on medications, he would never get his life back. I was relieved when two security officers arrived to help me escort Alan to his room.

As Alan repeatedly screamed I was going to go to hell, I prepared to give him an injection of Haldol and Ativan. As I leaned over him with the filled syringe, I thought, “No Alan, no one is going to hell today. I can't leave the unit because we don’t have enough staff."


Anonymous may said...

when i was still a student, i thought it would be great to be a psychiatric that we have our occasional psych patients with medical issues, i totally do not know if i can handle it. you guys are mde of pretty strong stuff to work in a frustrating situation all the time.

7:00 PM  
Blogger Mother Jones RN said...

It's not bad all the time. There are some shifts that are a lot of fun. One night I got to meet a patient who thought he was Jesus Christ. He chased me around the unit all night trying to baptize me. He said he thought I was a "little heathen." If he only knew:-)

Thank you for the compliment, May.

10:12 PM  
Blogger kt said...

oh holy cow that was a funny line at the end. "no one is going to hell, we don't have enough staff." that was good.

anywho..since you asked - you are tagged. go to my site to see the list of "4things".

8:11 AM  
Anonymous Anonymous said...

This is the first time I've read your blog. I come from a family that has a long history of both diagnosed and undiagnosed mental illness- though it is never openly discussed.
In fact, I thought my depression starting at age ten (just about the time my parent's horrid 6 year divorce saga began) was just me. First I threw all my energy into being the perfect tomboy. I taped my emerging breasts down and dedicated myself to beating the boys at soccer on recess (no matter the bodily cost) to prove the worth of a female who didn't want to play with dolls or dress in pretty clothes. Then in junior high I became super student. I was terrible at home but at school I spoke up in class, did all my work PLUS did extra on almost every project I did, I formed a club, I was president of two clubs and on the staff of the school magazine etc... and I was very unhappy every moment I wasn't completely busy.
Nothing came to light until my brother starting having problems. About the time he became about my height we had finally been pulled out of a horrid daycare facility (I was 12 and going to sunrise preschool). The catch was I had to watch him, and we had to keep order. If anything went wrong, BOTH of us were back to sunrise preschool. I didn't want another afternoon supervising toddlers since I was the oldest child in the place and they had *no* age appropriate activities for me,... I was dedicated to keeping my brother out of trouble. This was fine, but sometime before I turned 13 my brother became rebellious. He didn't listen to me, would go outside to play and leave the area he was allowed to play in, and consequently we would fight. All were able to be resolved without my mom knowing until one day he came up behind me, wrapped my long hair around his fist multiple times, and proceeded to slam my head in the door of the microwave- and when I fell, on the tile floor. I escaped to my mother's bedroom, locked the door (he was beating on it) and called her at work. She came home, and we went back to daycare.
My brother also began to have horrid tantrums that would include acts of self harm. We went to counseling, but the counselor was terrible and caused more harm than good.
At 14 he managed to sneak outside with a friend during a sleepover and smoke a laced cigarette. He attacked me in my sleep.
At 14 he was mad that he was asked to rinse off his plate so he slammed the glass in his hand down on the counter as hard as possible- glass lodged in his wrist and blood spurted everywhere with the beating of his heart. He nicked an artery and severed several nerves.. "just a temper"..
he is now 22. So far we have been through three suicide attempts with one near success, a period of time when he thought he was hearing voices (self diagnosed himself and schizo, went to the counselor once, and pronounced himself cured), two failed attempts at college (pure laziness, not money or bad grades), cutting, he's stabbed himself in the leg twice when one of his online girlfriends broke up with him (hes never had a face to face relationship with a girl), the inability to hold a job, smoking despite severe asthma and lack of health insurance since he won't a) stay employed or b) go to school, drug use, alcoholism, and he never tells us the truth about anything- even the most minor things.
I've since found out both of my Uncles on my mother's side had/have mental issues, my father's father was an alcoholic, one of my grandfather's brothers was an alcoholic, and etc etc.
Everyone still keeps it hish hush, even my brothers current condition and past problems are not openly discussed. My mother is very aware of his problem, and constantly bugs him about counseling (i don't think she approaches it the right way), my father recognizes that there is a problem but doens't believe in psychiatry, and I'm the older sister that acts as the go-between for most of the communication about and sometimes even to my brother.
My brother is in denial of his problem. He refuses to see a counselor, and the one time his psychological problems were very obvious to him he saw a counselor once (after my mom put much time and effort into getting him into a state-run counseling program) and pronounced himself cured.. once, after a suicide attempt when he was 17, he was (finally) admitted by hospital staff into the psych unit. From day one in the unit he denied that he tried to kill himself-despite the fact that a suicide note was found along with texts to friends and a girl pronouncing his intent. His story was that he took a whole bottle pf painkillers to be "cool" and that he drank a whole bottle of vodka (that he bought from someone at school) because he was an alcoholic.
After two weeks the doctors gave up and sent him home- with instructions to take him to AA... my mom did until his fits about not wanting to go posed possible bodily harm to her or any other that tried to convince him.
I found out later that was one of the first times he had touched alcohol.
I am now 25 and my brother 22, and I feel like I am more responsible for him than ever even though I live a state down from him. It is distracting me from my graduate work, has caused me to have significant anxiety problems (which I am being treated for). Sometimes I can't help but feel guilty that I feel I am being pulled down with him. I liken it to the advice about not diving in after a drowning swimmer-they'll only pull you down with them. People I tell about this say I need to let him sink- he'll either drown or learn to swim.
I have one brother, one living grandparent, and a family so torn asunder I feel I don't really know anyone in it other than my mother and one aunt. My brother is precious to me. to get back to my example, I feel that even if I don't jump in after him, if he does drown, I might still go down with him.

I admire you for continuing to see these people as people, for having the compassion and the firmness to do your job. It can be very hard and very emotional to deal with people that are slaves to their mental state.
As a family member of someone who has walked through those doors as a patient... I applaud your service. You may be a devil to your patients, but you're an angel to me.

1:18 AM  
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9:23 AM  

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