Oh The Places You’ll Go

“I’m sorry to say so, but, sadly it’s true that Bang-ups and Hang-ups can happen to you.” ~ Dr. Seuss

I’ll be the first to tell you — psychiatric nursing never appealed to me. Not one bit. Just . . . . UGH!

Perhaps it was the instructor I had — a lesbian who resembled George Washington and happily acclaimed that she was a registered sex therapist. (Not quite sure how unbiased she could be.)

Perhaps it was the lack of instruction on the why behind the psychiatric diagnosis – more time was spent on “therapeutic listening” aka “just sit there in absolute silence which is as uncomfortable as hell just waiting for someone to say something.”

Maybe it was the limited amount of time we had in clinicals with, again, no clear definition of what different disorders were but an emphasis on care plans and DSM numbers.

My reaction to psych nursing was a gritting of my teeth, with the mumbling of “I HATE psych nursing.” Whether it started as a dispatch on an EMS call or working in the ER as a nurse, the response was the same. I readily admit it, I’m no saint. But then something happened that started to change my perspective.

I was randomly assigned to the “psych hall” at work — and I hated every moment of it. One day, though, my reactions towards my patients began to change. I recognized them for what they were. People, with mental illness, having a bad day — that’s all. The majority of our patients are PEOPLE, having a BAD day. We don’t delineate between people with cancer having a bad day, or people with pancreatitis having a bad day, or even people with hypochondria having a bad day — but when it is people with a mental illness having a bad day, the dynamic changes.

Some of our patients are homeless. Some are not. Some are on medications, some have been on medications but cannot afford them and turn to street drugs to try to alleve the suffering they feel. No one chooses to be tortured by their own mind. Many times the medications they are on need to be changed or adjusted — it’s not a one-and-done field of medicine.

Regardless of the complaint, we all have basic needs: Food. Drink. Safety. Sleep. I get on a level with my patient – I have a conversation. I don’t do it in a clinical fashion, just sitting and talking. I make eye contact and offer hugs. I offer food and drink. I build a rapport and a feeling of safety, acceptance and non-judgement. I tell them I’m glad they’re there. And then, they sleep. Sometimes for the first 24 hours or more. If they’ve been on the streets or manic at home, they may not have slept for days. I judiciously ask for medication to help quiet any auditory hallucinations they may be having.

I demonstrated this to a co-worker yesterday. I had her sit in a chair. At first I sat beside her, legs crossed in a similar fashion to how she was sitting, making conversation about why she was there and what I could do to help. I asked about her past history and medications, when she’d last slept or eaten. I segued into feelings of suicide or wanting to hurt herself. It was all very laid-back and easy going. I then stood in front of her while she sat, clipboard in hand, writing down answers and checking boxes while asking all the same questions. Afterwards, she said she immediately felt attacked when I stood in front of her, forcing her to look up at me. The act of writing things down seemed very clinical and non-caring to her. This is a co-worker who had teased me that I “babied” my patients — she quickly gained an understanding of how a simple stance can either put someone at ease or intimidate them.

Touch and eye contact are huge — these are people whom society has deemed “odd” or “weird” or “unacceptable” because they are often seen to have bizarre behavior by talking to themselves or moving as if having an argument. Making eye contact accompanied by a smile causes uncertainty many times, but when it continues aided by a simple touch on their hand or their arm, or a hug if wanted, the barriers start to come down and they begin to open up more.

Anticipating needs – warm blankets, socks on their feet, for the females — feminine products — if they come from a place where those are not readily available when needed it can save them embarrassment and discomfort. Funny thing is, these are all the same things I offer my non-psychiatric patients, and no one ever comments that I’m “spoiling” them. It makes me sad that offering simple comforts to psychiatric patients is considered “spoiling” as if they don’t deserve to have compassion offered to them.

Years ago I promised God I would go wherever He wanted me to go and do whatever work He wanted me to do. Working with the mentally ill has uncovered my selfish sense of superiority as well as my discomfort with people who are different from myself. I often think of Mother Teresa, though I would never dream of comparing myself to her. I think of her commitment and compassion for the poor and dying. Would that I had a heart as big as Saint Teresa!

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