A Day in the Life of…

*Names have been changed to protect the guilty. And the innocent.**

**I feel really weird about posting this one cause it is something that happened but memory is a fickle thing. I have no idea how much I’ve exaggerated things in my mind over the nearly two years between these events and the original time of writing.

***I added a little to the ending that I couldn’t originally fit in the space limits so if the tone changes, please forgive me.

**** Yes, I still work at the same place, at least part-time since I’m currently in an accelerated BSN program.

 

“Where are you heading to?” one of the corridor deputies asked as I passed by him.

“Dog,” I responded. The metal tray full of medicine cups shifted slightly as I moved to the other side of the long hallway to let some inmates pass by. They had smiles on their faces and the pink slips in their hands that indicated they were on their way to release. I liked when people got released, especially on the second floor. Three fewer guys to yell and curse as me because I didn’t have a medication record for them or couldn’t give them something to help with their headaches or withdrawals.

“Are you sure? They’ve flooded three times today,” he commented to me then to the radio mic and speaker on his shoulder, “two CP to two Dog, you’ve got the nurse. Outer two Dog, please.”

“Thanks for the head’s up. Maybe they’ll chill out after they’ve gotten their medications,” I commented then turned left to face the green, heavy metal and hurricane glass door. It slid open, releasing a whoosh of fetid, humid air. Shit, piss, and a faint odor of burnt paper assaulted my senses, causing me to cough and my eyes to start watering.

“Amber! Great timing, we just finished cleaning up the last flood. The entire 200 side has their water turned off,” Turner, a young, tall, dark haired deputy hollered over the noise of people banging their cups on the windows and doors of their cells. I passed two shop vacs, three squeegee mops, and a broken broom on my way to the desk in the middle of a Y-junction.

“They broke a broom?” I asked loudly, as I noted that there was at least two feet of wood missing from the handle.

“Yeah, Smith, Thomas, and Gallegos used them to keep their door flaps open. Peters is stomping out the fires. Luckily they soaked the carpets enough that they’re only smoldering.”

“Wait, actual fire?” I looked to the right where Peters, a towering, heavy man was kicking at some blackened paper on the carpet just in front of the cells. “Holy shit, you weren’t kidding, there’s actually fucking fire!” I watched another flaming ball of paper fall from the second tier and roll in front of Peters. It puttered out just in front of him.

“Let’s start over on the 100 side. They’ve actually been good today. I’ll probably have Peters go to the 200 side. I’ve been antagonizing them all day,” he said with a sardonic smile.

“Okay, sounds good.” He clicked the mouse on his computer a few times and opened the slider between the desk and the 100 side of the pod then put on some gloves. We’d worked together multiple times and had the routine down. I told him who I had next on the tray and he opened the 18 inch by 4 inch flaps of each patient’s cell, or told me if they had moved within or out of the pod. By the time we had passed medications to nearly every one of the twenty four patient’s on that side Peters was back behind the desk.

“I’ll meet you up there,” he told me when I was in the small loft between the two sides of the pod. Turner went back the way we came to take over control of the doors and monitoring everyone on the cameras. The door to the 200 side popped open, the banging and yelling was overwhelming. Peters, easily six foot two, held the door open for me then allowed it to slam shut behind me and I got my first look at the mess that was the second tier walk way. There was at least a quarter inch of dirty water on most of it with things, I refused to actually acknowledge what they were, up against the railing. Three flaps were stuck open and the inmates in those cells were throwing out burning paper and fabric. I took a deep breath then turned to Peters, “Okay, let’s do this.” He opened the first flap.

“Mr. Taylor, what’s your birthday?”

“Why do you need my fucking birthday, just give me my pills you fucking whore bitch.”

“Come on man, is that the way you talk to a woman? She’s just verifying that she’s got the right person.”

“Fucking bitch, you don’t need to know that, just give me my damn Seroquel.”

“I’m sorry sir, but I cannot give you medication without verifying your birthday. Using a second patient identifier is standard nursing practice.” The response was rote, I wasn’t even aware that I was saying it until the end.

“Fuck you bitch,” he yelled before spitting at me. Angry guy next to me, fire in front, and I decided at that moment that I wasn’t going to deal with this shit.

“Nope, I’m out,” I turned and banged on the door to the loft. It felt like an eternity before it popped open, though was probably less than a few seconds. Enough time for raving man in the cell to make another go at spitting on me, but not enough for him to do much else.

“What happened?” Turner asked, genuine concern in his voice.

“Fucker spit at her, that’s what.” Peters commented.

“So… no meds tonight, got it.” The door back to the 100 side popped and Peters escorted me across the walkway, down the stairs, and back to the officer’s desk. It gave me enough time to shake off my surprise and for my anger and frustration to take over. “You want to press charges?”

“Huh, what?” I thought for a moment before shaking my head, “I don’t think so? He just got the corner of my top.” I looked across the way to the guys standing on the bottom tier at their cell windows, cups in hands. “I’ll come back for everyone else here after I’ve finished the rest of the floor. Can you let them know?” I asked, pointing to the ones at their windows.

“You sure?” Turner and Peters asked in stereo.

“Yeah, it’s not their fault the dumbasses up there decided to be worse than usual tonight,” I shrugged, “and, it’s, y’know, my job or something.”

“If you’re sure,” I nodded, “we’ll see you later then.”

“Try not to have too much fun!” I waved bye as the slider opened back to the hallway.

A Bird in Hand is Worth Two in the Bush. Sometimes.

When I first read this prompt I couldn’t help but think, “man, I hate trying to remember this sort of stuff.” As it turns out, it took only a few extra moments of thought for me to realize that I was highly focused on those “two birds” more so than the “one bird” for months.

There was a time, not so long ago, a year ago actually, where I was desperately looking for something else. That something else was a job that could pay me enough that I wouldn’t feel that I needed to work two jobs in order to be more or less financial stable and not have to rely on my husband so much. I was stressed at my main job and really not all that interested or happy in my second job. I had little time to spend with family or friends and was pretty much just constantly tired. It got to the point that before I found that mystical different job I quit my second job. I still needed the change in employment. I really needed the higher pay.

So I continued to pretend that I was doing alright in my only job while daydreaming about something different, something inpatient or in a hospital or even in a completely different sort of outpatient clinic. I was thinking of all the things I could do with my magical new income. I was despairing that after 6 months of searching and turning in applications nothing was happening. No call-backs. No emails. No letters saying “sorry, too much inexperience, come back in a few years.” I was getting desperate. Work was harder to focus on, I was missing important things and my boss was unhappy with me.

The story actually has a happy ending. When I finally stopped constantly thinking about a change and jut tried to go with the flow, I got a call-back. I got an interview. A month later (a very long month later mind you) I got an offer. Huzzah! Sometimes, looking at those two in the bush can be very motivating and give you the extra drive needed to do change circumstances so you can let go of the one in your hand and “catch” the two in the bush. It’s not impossible. Yeah, it’s risky, but there are many things that are worth a risk and a leap of faith.

New experiences at work

Hello there. I have left this blog inactive for too long. This is probably not the greatest topic to start up again with, but I have to vent somewhere.

I started working at a locked psychiatric acute treatment unit a few months ago. I’ve been working in psych for years. Five years I think. I’ve been in some pretty funky situations with people threatening all sorts of things, people out of control, and people acting out against others. However, I’ve never really been in a situation with someone who is not just actively planning suicide, but acting out on it.

Well, tonight that changed. I was just getting ready to leave work. Grabbing my purse and going out to grab my jacket and all that good jazz when one of the room call lights goes off. Since there were only two other staff in the facility and one wasn’t in the office I went out to see if they needed some help. Turns out the counselor found one of our patients in her room trying to hang herself with a part of her blanket that she tore apart and was trying to loop around the door handle. She had tried to block the door from opening with her body (why the doors open into the rooms and not both ways is still beyond me) but luckily it’s hard to block a door with your body if you’re not propped against something.

I think the thing that stands out to me the most is that she had written a suicide note and had it right there on the desk. This wasn’t a call for help, this was an outright attempt. A pretty good one too. I’ve had patients threaten to hurt themselves and declare they were actively looking for ways to do it, but they never actually managed to do so. This gal, she planned it well. She waited until right after a check (every 15 minutes due to risk) and tore the blanket, tied it, and arranged everything. Lucky for us, the counselor went to talk to her earlier than the patient had expected.

The good thing is that we worked well as a team. The RN took lead and the counselor and I were able to act on directions calmly and without tripping over each other. The other patients remained safe and most didn’t seem to even realize something funky was going on. I don’t know if that speaks to our handling of the situation or to how low functioning this particular group is.

I hung around until our program manager could come in since I have to be back in at 6 am and didn’t really get much of a debrief. I guess this is probably it for now. I don’t feel that I need it as much as the counselor does (did?) as she was the one who found this patient and interrupted her. I can only imagine the emotions associated with that, the number of questions, “what if…” that would come to mind. I’m sure she’ll get the debriefing she needs – our program manager made sure to ask how she was doing during their first phone conversation.

Regardless, I’m bringing some chocolate in for both of them and my manager. They deserve it for how well everything was handled and for remaining calm and collected while still at work. I already have my chocolate so it’s only fair that I make sure they get theirs too.

Surprising Revelations at Work

There are always people who surprise me by their belief systems or tolerance for others. The more educated an individual is, the more they are capable of surprising me. Recently, I have been not just surprised, but astounded by comments from one of my co-workers, a psychiatrist to be more specific. Some of the people who read this may actually know her, but just in case I will not name any names. Also, I hope this does not color negatively any opinions toward her. She’s still a wonderful psychiatrist and I still like working with her.

What is it that she surprised me with? Apparently she has a pretty significant misconception and negative bias toward GLBT persons and is much more conservative in her beliefs than I expected. She has done a very good job of keeping her personal beliefs from interfering with her job, I have to give her credit for that. I didn’t even know she had a bias against people who can be identified in the GLBT, sexually diverse/different, or pro-abortion, etc. groups until very recently. It does however make some of her comments throughout the last few years make more sense. For example, she was very surprised when a patient told her that she (the patient) had asked for the doctor who was the most tolerant of sexual deviancy and the front desk set her up with this particular psychiatrist. it probably had something to do with who had openings as well, but still, it was something that shocked the psychiatrist enough that she wanted to share her surprise with me (and another nurse) soon after the appointment was done with.

About 6 weeks later she shared with me her experiences at a conference she went to. It took place in southern California and there were many more GLBT professionals than she has ever interacted with. During the course of the three day conference she discovered that she could relate to just about everything the gay/lesbian men and women were sharing and even the way they shared their own stories. It was probably the absolute best conference for this revelation to occur at since the entire point was to discover how to actually hear patients and other people, basically let them share their stories without interruption. The participants could only speak one at a time and the ones who weren’t speaking could only listen, they could not comment except to the entire group after each exercise.

Mind you, the reason why this truly astounded me was because her nurse (the one for her outpatient caseload) is a gay man. It took me all of 5 minutes interacting with him to determine two things – he was gay and was an INTP in the Meyers-Briggs personality system. The second was just a nice thing to know, the first was just another thing to know so I could know how better to relate to him. However, this psychiatrist has worked with him for nearly two years and hasn’t a clue. When I mentioned my surprise to the other nurse he just shrugged it off as something he has seen before. People who don’t want to accept GLBT individuals are unaware of the vast number of people that are GLBT.

I do have to admit that while I’m surprised and honestly a bit disappointed to know that someone I highly respect has such a bias, I do have to respect how well she is able to separate her personal beliefs from how she treats and interacts with her patients. As far as I’m aware, she has never demonstrated any sort of negative, derogatory or unthinking behaviors towards her patients or in front of our other co-workers, especially when we are discussing patients. I don’t know how much our other co-workers interact with her regarding more personal matters, so I’m not sure if I’m either late to the party or someone she feels comfortable with and is willing to share such belief systems that are contrary to the norm within the agency we work for. Well, at least as far as I can tell that is. I could very likely be surprised by other people that I work with. In the same way though, I don’t believe it would decrease my respect for them for the same reasons. As far as I can tell they do not let their personal beliefs interfere with how they interact with our patients. That’s something to be proud of really. And they should give themselves a 4 on the diversity and tolerance/acceptance part of our self-assessment thingy. 😉

I do wish that everyone believed as I do – that as long as no one is harmed that any way of being and living and loving is okay – but I know that the chances of that happening in my lifetime are slim. However, I do hope that as we all learn more about each other, the more tolerant (accepting even?) we can all be towards others regardless of whether we agree with them or not. I think it would go a long way toward the world being that much better of a place to live in. When it comes down to it, that’s really what I want. I don’t want people to all agree with me, but I do want the world to be a better and more tolerant, and maybe even accepting, place. I also don’t think it’s too much to ask. Do you?

Gratitude and Work

I was surprised earlier today by the emotional reaction I had while discussing a case with a therapist at work. The most surprising thing about it was that the emotions I was feeling were a combination of surprise, relief, and the acknowledgement of the truth of her words on top of everything else I have felt related to the patient we were discussing.

The patient we were discussing is a particular difficult case. We’ll call the patient Susan. Susan has been a patient of mine for the last year. She has been in the hospital or a residential treatment facility for something like 8 out of the last 12 months, if not more. Most of the breaks between were no more than 1-2 weeks, if that long. She would be in outpatient treatment and after some time without the support of staff 24/7 she would have an episode of high depression and hopelessness and helplessness and attempt to kill herself, usually through overdosing on her medications. After a few weeks in an inpatient setting she would step down to the residential house I work with and be there for months. It was not only hard on Susan, but also hard on all the people who have worked with her the last year, myself included. I have felt so many different emotions regarding her and her case that I do not know that I could name them all or describe them all.

The thing about all of this is that her therapist, someone that I hadn’t met before because she is new to the center, and I met to briefly speak about Susan. Recently Susan had an episode where she felt hopeless and helpless again but managed to reach out to her therapist and myself. Her therapist took the opportunity to reminded Susan about all the people that care about her. Susan’s mother and son were not the only people she was reminded about, but also her psychiatrist and myself as well as all the clinicians at the residential house because her therapist was aware of just how much Susan meant to us and how much we wanted her to succeed.

She told Susan about all the people who care for her and Susan was able to recognize it and even helped her therapist compose an email to the some of her treatment team and her mother. I received that email and thought it was a great step for Susan, but hadn’t fully comprehended exactly why it was so important for Susan to compose it herself to some of the people who are currently helping her.

What made me realize just how much we had impacted Susan’s life was when her therapist told me today that se had recognized how much the people who had been treating Susan truly cared about her wellbeing and that Susan was able to see it too. That was why it was so important for Susan to write that email, why Susan was taking more steps forward in her treatment, why her therapist was working so well with the psychiatrist and myself; They knew that we cared and that we weren’t just going through the motions.

That was when I teared up and felt so many emotions that I could not process them all. I wasn’t expecting it at all. I am usually able to pull back and keep that professional barrier up, but it is rare to get that acknowledgement from someone who isn’t on the residential teams I normally work with. It brought up all the emotions I have had regarding Susan, plus some ones just regarding my work in general all at the same time. Most of all though was gratitude. Because I know that Susan is with a good therapist who can hear more than what is said, which I have found to be a rare talent even within the mental health field.

It was a very unique experience and I hope that I am able to learn from it. Just writing this here has helped me a bit, but I anticipate several more writing/blogging/journaling episodes will come around before I feel like I have processed through everything. I hope I will be able to tell Susan how much she has helped me to grow as a mental health nurse and that she will take that knowledge with her through her life and remember that she can make a positive impact whether she is the one being helped or the one helping. 🙂

How do you love?

Do you love many things, many people?

Or are you more restrained, cautious and careful and pensive in your expression of love?

I love many things, many people. It is just a part of me. It’s part of the extremes I use to describe everything in my life. I tend to “love” more things that “hate” or “despise” because they are so very painful and thus something to be avoided (in most instances) but there are so many levels between the love I feel for my husband which is the most… well, the most everything that I feel, and the despair or loathing that I feel for those that intentionally hurt anyone else for their own amusement or pleasure.

The point of this being that I long to know what it is that you love. I long to know how others experience love. I want to experience their love and they experience mine and we can both grow in our own understanding of others and expand how we can love ourselves and others.

I know that the love I feel for the different people in my life is as different as the individuals. There is the sweet, gentle, amusing love that I feel toward a certain 9 month old. She doesn’t melt my heart – her smiles are too infectious to allow such things. Then there is the cautious and protected and slightly painful love I feel toward my father. And the safe and protected and understood love for my mother. The exasperated, eyes-rolling, smiling love I feel toward my brother.

Then there’s the love that dwarfs the others. It’s nearly painful, in an odd sort of way. It’s a sudden swelling over of everything that my heart, both physical and metaphorical, is capable of holding twice over. It’s my brain forgetting to tell my lungs to expand or relax for moments at a time. It’s a rush of energy through my veins, a tingling along every nerve, an expansion of my mind and spirit outside of where I define the boundary between myself and the rest of the world. It’s a desire to feel the soul that can cause all these sensations and experiences to cascade through my entire being. And the relief at that touching? Enough to make me cry when I really allow myself to think about it. And all that is before he says or does something that makes me laugh or smile or shake my head in disbelief that there is someone in this world as absurd and dorky and sweet and wonderful as this man I have tied my life to.

Honestly, it’s quite unbelievable to me that I even have the capacity to feel all that. I was pretty certain I was broken. I had closed myself off to the chance of feeling anything more than the relieved, protecting, gentle happy-sad sort of love that I feel for my cats. See the song Hallelujah for a relatively accurate portrayal of how I felt I would always be stuck at. “Love is not a victory march, it’s a cold and it’s a broken Hallelujah…” Rufus Wainwright has one of the best versions of this in my humble opinion, but that is a very mild tangent.

The point here being that I am curious. I want to know how and what it is that other people love. Or hate. Or fear. Or rejoice. Or any number of other emotions. What do these things mean to other people. What do they all mean to me? How are they the same, how are they different? What do I have to do in order to be given the opportunity to understand or know this? Is that even an option? How will my perception of the world change? So many questions, but no way that I’m aware of to find the answers. At least not in this lifetime, not in this world or using my current understanding of reality.

Maybe I can find a way in my dreams? That would be nice. And a very nice change of pace from what I have been experiencing. On to something new and different? Yes, please.

There Should be a Rant Here

There should be a rant here. Really there ought to be. I have a lot of anger directed toward “the system” right now that has very little opportunity for outlet. Outlet being anything more than a rant or raging against something which is beyond me, but which I am also a part of.

The system I am referring to is the publicly funded mental health system within the state of Colorado. There are so many issues with it, so many times where I and my co-workers are stuck between a rock and a hard place, between being ethical and recognizing that the bottom line still is, and always will be about funding. The safety of the consumers is taken so much more seriously than the safety of the staff, except where the risk of bad publicity or press is possible in which case much is swept under the rug. If someone doesn’t have insurance but truly has a need for services, we may be able to find some time, some funding, some help. But if someone else has insurance but no motivation or drive or desire to get better we keep throwing more and more services at them because god dammit, we can make up for their lack of anything if resources are thrown at them. Except it doesn’t work that way. And we all know it. But because they can get the services, it’s not right to hold them back for someone who maybe can’t afford them but would actually possibly benefit from them.

Oh is it so very broken.

And I feel dirty sometimes for being a part of it. For perpetuating it. Despite the fact that I dig in my heels and advocate for what is most ethical, at least as far as actual treatment and therapy is concerned. But I am very low on the totem-pole and my opinions only matter if I can convince the psychiatrist who is having the medical director breathing down her back as well as the board members and other such peoples that best ethical practice is not always best practice. And dammit she doesn’t have enough power to go against it either.

And the worst thing is that I can’t even blame them. If they weren’t so pushy about what they want from the programs I work with, the programs would no longer exist. Funding would have dried up years ago and the services wouldn’t exist for anyone. At least nothing that stayed around long enough to actually be of any use to the people who need them. But it doesn’t make it any easier to think about either.

Despite what it appears up above, you still haven’t seen my rant. You’ve seen the tale end of it, where I am on my hands and knees, spent and crying and begging for some brilliant solution to make itself known to me or the people around me. This is the spent and wrung out and just plain tired part of me begging for something to change.

In the meantime, I’m going to snuggle with my fiance and try to forget that when I wake up in the morning and get ready to go to work that despite all my best efforts, it’s never going to be enough to help everyone that needs it and that I’m part of a system that I cannot stand. Because there are some days or weeks where I have to forget it if I’m going to be able to do anything of what I can do for the poor souls caught up in the system. I know that I have been able to help people. I know that I have helped to turn around peoples’ lives and that they are better off for me having been their nurse. But on days like today, it’s so very difficult to remember that.

I have to try though.

Peace