I’ve worked the last several evenings on a unit for high risk psychiatric patients. This is not to say that they are necessarily violent, though they might be, but rather that they are higher risk for hurting themselves or others, need to be watched for sexual behavior, or just have greater medical needs. They could be depressed, delusional, paranoid, borderline, psychotic, schizophrenic, any number of things really.
Besides my actual name, here’s what I’ve been called by patients on this unit:
doctor nurse a puppet yes man demon rapist nice man patient (the adjective, not the noun) motherfucker cocksucker dick The Spanish Inquisition toilet water a good guy nerd
Most of the patients are polite and appreciative, or they just stare blankly at me when I address them. The majority of the negative terms for me came from one person in particular. Today when she called me a nerd, I almost laughed. “Geez lady,” I thought, “that’s so tame compared to all the other things you’ve called me. It’s practically a compliment.”
What do I do to earn her scorn? Oh just things like: checking on her every 15 minutes as required by policy, asking her to keep her voice down when she’s shouting in the dayroom, telling her that it’s inappropriate for her to leer at another patient and say, “I’m licking this chocolate pudding like I want to lick your body.” I know, I’m such an asshole. Oh yeah, she called me that too. Well, she mouthed it. Could have been mouthing “Ice gnoll.”
A couple weeks back I had containment training. It is sometimes colloquially known as takedown training, but I really do have too much respect for it to call it that any more. The program we use at our facility is called SAMA (Satori Alternatives to Managing Aggression) and was developed by this zen-calm guy who developed the old method used by the Texas Department of Mental Health and Mental Retardation. I strongly suspect he's a badass in a Tai Chi kind of way. And as my friend Carole will tell you (and maybe show you too), Tai Chi has awesomely-named moves like Repulse Monkeys. How cool is that?!
Anyway, SAMA begins with verbal interaction; trying to de-escalate the situation before it becomed physical by conversing with the aggressive patient and guiding them to productive thoughts and actions. The practice exercises were pretty hokey, but I've already used the technique twice with good results. I can absolutely see the applicability anywhere, not just in a psych/medical setting.
If that's not working, we might have to move on to protection and containment. I feel fairly confident that I could prevent myself from being strangled, extricate myself from a grip, and/or retrieve an object, say a board with a nail through it (shoutout to Kang and Kodos!), if need be. A couple Sundays ago I put Joolie down on the floor in my excitement when I really shouldn't have. Sorry Joolie! You were such a sport to fake strangle me, and then look what I did. Thankfully I didn't go full out and "guide" you down the hall to a seclusion room (straight-jackets and padded rooms are soooo passé).
I was politely informed by the instructor that since I am a guy and didn't flabbily perform the maneuvers like some of my fellow trainees, I would surely be recruited to the on-call security team which responds to Code Grays (abusive/assaultive behavior). Good thing I'm already going to the gym. Sure I've been told my short hair, goatee, and forehead wrinkles can be interpreted as menacing, I'd like some shoulders to go along with the deadeye stare. I've already seen two situtations where an aggressive patient completely backed down at just the sight of the security team down the hall.
And so I issue a guarded invitation to my friends to behave aggressively next time we meet so I can practice.
A) I’m working full-time all over the schedule. Bouncing around from days (7 AM – 3 PM), to evenings (3 PM – 11 PM), to graveyard (11 PM – 7 AM), while throwing in a few 12-hour shifts really screws up my sleep schedule.
B) I was unsure how to write about the psych facility and the patients there. I feel very protective of the patient’s privacy and recognize the unjustified stigma that mental illness bears in our culture. Unlike the ER last summer, there just aren’t many patients culpable in their illness and the environment doesn’t lend itself to shaking my head while thinking, “These crazy people.” You know, cause the place is actually for crazy people. Not that we use that word.
On the way home tonight, I finally worked out how I was going to write about work and was keen to get home and start typing. That’ll have to be in the next post though because as I turned onto my street, my headlights swept across a man lying facedown in the gutter. “Oh shit. This is not good. Okay, he’s probably passed out drunk, but what if he’s not, or he’s got alcohol poisoning?” I debated getting out of the car to check his pulse and breathing for about three seconds before deciding that it was better to call EMS first, then run back to him.
It was only a few hundred feet to my house, so I drove home and rushed to my phone to call 911. There’s an EMS station less than a minute away and I surmised that they’d likely arrive on scene before I returned. Still, I was eager to get back to him just in case. Nothing doing, the 911 dispatchers have questions to ask. I understood, so I made myself breathe slower and just get through it. No I don’t know his condition, didn’t even see if he was breathing. I’d say early 30s. Blue jeans and a grey t-shirt. After summoning EMS, the dispatcher patched me in to the police and they took down my name and what I was wearing (stop it pervs, it was so they could identify me at the scene if necessary).
I hung up and ran back to him. I called out to him, then shouted. Concluding that he really was unconscious, I felt for a pulse and watched his back for breathing. Thankfully, his pulse was RRR (regular rate and rhythm) and breaths were deep and regular. Just then, the fire truck showed up. I’m fairly certain that all firepersons in Austin are EMT-certified and they are regularly summoned to medical emergencies, probably because their response time is exemplary. True in this case at least as they arrived before the paramedics even though the fire station is twice as far as the EMS station.
After reporting my assessment to one of them, they rolled him over, concluded he was drunk and waited in a circle for the paramedics. They police showed up and shined flashlights at Drunk Guy for around 90 seconds until EMS arrived, loaded him on a gurney, and trucked him off to the hospital. Police said I wasn’t needed for a report, so I walked back to me house. Whew. When it was first happening, I was thinking of that nursing instructor at our school who was on her way home from work when she drove by a man lying on the ground, stopped to render aid, and had to start CPR. Thankfully it wasn’t necessary in this case, but you better believe I was running through chest compressions and all that as I trotted down the street to Drunk Guy.
Just to head off some friends, yes, if I had a cell phone I could have stayed with him and assessed his condition while on the phone with 911. That is a very good reason to have a cell phone. Good enough to cave in and get one? Meh.
Lastly, it’s been noted by others before me, but dang Austin has hot firemen. Sure the whole hero thing helps, but handsomeness was in plentiful supply tonight. The cops were pretty smokin’ too. EMS not so much.
Late December back in '63... Um, sorry. Got a little carried away there.
I got home a little while ago from my first evening shift at the psych facility. I'll just say this, I'm glad that I'm getting defensive and patient take-down training on Wednesday and Thursday. Could have used it during the events of this evening, but things worked out all right.
It's a good thing that I'm confident and not easily riled by patient behavior, cause there was button-pushing tonight! Insert lyrics to The Facts of Life theme song here. Wait, here's the actual song. Hmm, now that I've listened to it, only the first stanza makes sense in this context. Oh well, "C'est La Vie".
A few years ago, I was invited to a pig roast by my friend. Said friend's brother is a Park Ranger in some Southwestern state and had occasion to shoot a wild pig that was menacing the park. Figuring it would be a shame for it to go to waste and thinking ahead to when his brother would be visiting, he froze it solid and had it waiting as a present. My friend was delighted by not only the present, but also the creative-thinking that would required in getting the pig carcass back home to Austin.
They decided the direct route was best and so they double wrapped it in game bags, then put it in a sturdy canvas duffel. At the airport, my friend checked it as luggage. He half-expected security to take him aside when the pig skeleton showed up on the x-ray machine, but he and the pig arrived in Austin unhampered.
He quickly let all his friends know that there would be a roasting the next weekend. Then the question of how to thaw the thing came up. If just left out, the outside of it would surely begin to warm to unsafe temperatures while the core was still frozen. So he and his wife emptied their refrigerator of everything, including shelves, and bungie-corded the pig into it. The door barely closed.
Five or so days later, the pig was thawed, a fire pit was dug, a spit was erected, and everything was ready to go. An intrepid team of BBQ experts assembled at 6 AM to begin the roasting. When guests begin arriving around 11, the pig was still not cooked through. Never one to panic, my friend ran to a hardware store and purchased two sheets of corrugated metal which the roasting team then used to construct a lean-to over the fire pit. It worked magnificently and just a few hours later, the pig was done. It tasted okay. Sweet, though rather gamey.
I wish I had pictures. The process was much more fun than the result.
When I started writing tonight I turned on the TV just for some background noise. Turns out the 2006 Scripps National Spelling Bee was on live. I love spelling kids ever since I saw the glorious documentary Spellbound, so I watched the Bee out of the corner of my eye while typing. As it went on and more kids were eliminated, I watched it with increasing attention. When it was down to the final three (all girls), I was on tenterhooks [In a state of uneasiness, suspense, or anxiety].
Word after word went by, the majority of which I've never even heard of. Apparently, the way to do well is to not just obsessively study word lists, but learn the patterns of spelling in French, German, and Hawaiian. There were an awful lot of words of those origins. Here's some fun stuff from the final rounds:
poiesis - production, creation, formation. I actually knew this one because of nursing school. Hematopoiesis is the production of blood cells. Hooray, a word I actually know.
aubade - a poem or song greeting the dawn. It's of French origin and now that I know the word, I want to write one.
weltschmerz - mental depression or apathy caused by comparison of the actual state of the world with an ideal state; sentimental pessimism. Ha! I knew the word, a great example of the hilarious specificity in German compound words concerning mood, but "sentimental pessimism?" Genius!
The penultimate championship word:
kundalini - the yogic life force that is held to lie coiled at the base of the spine until it is aroused and sent to the head to trigger enlightenment. I'm more familiar with the sexual aspect of this word and was mildly surprised that the word came up. Shame on me I guess.
ursprache - language that is the recorded or hypothetical ancestor of another language or group of languages.
Congrats to 2006 Champion Katharine Close!
So, spelling bee yay! And then I kept the TV on as Diane Sawyer introduced a Primetime special, A Call to Action: Saving Our Children, about foster care children. One and a half minutes into it and I was already in tears. Sure it was mildly exploitative - giving a mother who's child was taken away from her because of neglect and sexual abuse a chance to "tell her story"? Blech - and yet, it was captivating. Diane Sawyer, you are good with kids, at least on camera.
And then the show closed with a bit about the kid who made me cry at the beginning. He was adopted by two dads and doing well. To which I say, "Right-wing nutballs? Fuck right off."
Today was my second day of work at my new job. I'm a Clinical Assistant at a psychiatric facility. If I was working at a hospital on, say a post-surgery floor, Clinical Assistant (CA) would mean I'd be taking samples of various bodily fluids, vital signs, and probably making beds. At the psychiatric facility, the work I'll do doesn't have much of a physical component. I take vital signs once a day, but other than that, most of the chart notes I'll make concern behavior and clients' adherence to the program and rules.
I'm not getting paid as much as my job last summer, but it is easier and I like that I have therapeutic contact with clients. I doubt I'll end up going into psych nursing, but it's always nice to get exposure to different aspects of nursing and I'll have a leg up on my fellow students when we have our mental health clinical in the Fall.
I was explaining the work to my roommate when I mentioned some of the items that I have to search clients' bags for as they aren't allowed, for instance shoe laces, aluminum cans, and aerosol containers. She looked at me quizzically and I explained they weren't allowed because:
Shoelaces - can be used to attempt suicide by hanging Aluminum cans - can be torn apart and used to cut themselves or others Aerosol cans - contents can be inhaled for a cheap high
She was horrified, which I absolutely understand. It all makes perfect sense if you consider it from the right perspective, but most people don't automatically think of the violent uses of everyday things. Which is precisely why some of the clients are in the psych facility in the first place.