How would you behave?

A multiple choice question:

You want me to pay attention to you. How would go about it?

A) Ostentaciously clear your throat
B) Broadly gesticulate
C) Say, "Excuse me. Might I have a moment of your time?"
D) Break the plastic cover of a ceiling-mounted fluorescent light, then hold a piece of it to your neck

If you answered D, than you are very much like a patient I took care of recently. I admit the question was vague, what I should have asked is:

I've spent the day mostly looking after just you. It's getting close to bedtime and you are resisting the fact that the communal dayroom closes at night. After a sequence of pleading, bargaining, and threats from you, I conclude that this behavior is attention-seeking and inappropriate. I tell you, "You don't have to go to sleep, but you need to go to your room and be respectful of the other patients trying to get to bed." Then I disengage and walk away. How will you get me to pay attention to you?

Put that way, what other answer could it possibly be but D? Such is the logic of the troubled I guess.

Fun with Spanish

Yesterday in my Spanish for Healthcare Workers class I cracked myself up by composing this sentence:

El bebe el bebé.

Translates as "He drinks the baby." From the perspective of today I realize that I'm stoopid, but dang it was funny yesterday.

Alpha male alert

A little while ago I encountered a new kind of patient. I've seen the incredibly depressed and disheveled, the haunted schizophrenic, the mile-a-minute manic, but this was my first bipolar young turk. The testosterone coming off this guy could stun a rhino (and Barry Bonds). Shirtless push-ups in the dayroom? Sure, why not. Hitting on every female under the age of 50? Of course. Ostentaciously adjusting his package? All in a day's work. Yeesh. I had to have the "it's not appropriate to discuss your sexual conquests here" conversation with him twice.

The kicker was he's tremendously hot. Seriously, best-looking psych patient I've ever seen. How annoying is that? At least he wasn't hot and even-tempered without a trace of grandiose delusions.

Odd psych drug ads

Thanks to BoingBoing, I stared in head-shaking wonder at this collection of Japanese psychiatric drug ads. Some of my favorites:

Serenace® (haloperidol)


"Do you hallucinate that a giant bird-of-prey is after you? Serenace® can help." This and the rest of the Serenace ads are not what I would call soothing.

Rivotril® (clonazepam)


It's not uncommon for me to ask patients where I work if they're feeling anxious. Now I know that my follow-up question should be, "Would you rather feel like a naked child sitting in a field of flowers while a large umbrella protects you from the metaphorical storm? Great, let's see if you've got clonazepam prescribed."

Doral® (quazepam)


I don't know about you, but if just the ad is soothing my insomnia imagine how well the drug works. Ridiculously adorable.

These ads reminded me of a previous posting, this collection of American psychiatric drug ads. Faves:



Not sure how a child slumped over on a swing represents a Stabilized Epileptic, but then I never studied advertising in school aside from a brief analysis of its ever-refined means of manipulating people.



"See? You can poke her in the eye and she doesn't even flinch. Sweet!"



Mom: Umm, I'm a little concerned that Timmy's pupils are freaking huge.
Nurse: Don't worry, Nembutal is the "gentle" barbituate. If he stops breathing, call us.

The hits keep coming

I added a site meter to the blog awhile ago. Every once in a while I'll check the referrals to see how people found me. Mostly it's Google searches where the searcher never even came to the blog. People search for some weird things. Weird ungrammatical things. I'm the 8th return on Google for "picture of opening ladies urethra." 4th for "boy nipple sting dermatology."

Doesn't "boy nipple sting dermatology" kinda maybe sound like a Belle & Sebastian song that was written while drunk and never recorded?

Sounds of the psych unit at night

A/C
snoring
ring binders of med charts snapping open and closed
muttering
jangling keys of the staff
shuffling feet of the patients

I came up with the title of a mongraph, but I don't want to write it. I just like the title: On decreased muscle tone in the lower extremities of psychiatric patients, or Why the mentally ill shuffle when they walk

Reading material...Part II

I went with Douglas Adams, specifically Dirk Gently's Holistic Detective Agency. It's odd that I hadn't read it before being a fan of Adams. It was great. I love comic time machine stories, Connie Willis' To Say Nothing of the Dog is a big favorite of mine. After I finished Dirk Gently's, I polished off that memoir of a guy in a psych ward that I started last week on a graveyard, Nervous System by Jan Lars Jensen. It wasn't great, but interesting and provides good insight on the thought process of psychotics.

Around 6 AM I started in on Michael Azerrad's Our Band Could By Your Life. I'm not much of a fan of Black Flag, Big Black, Mission of Burma, and several of the other bands it profiles. Azerrad's such a compelling writer though that I enjoy just learning more of the history of these bands and the American underground scene of the '80s. Thanks go out to Choo for selling this at Dan's garage sale last year.

Thanks also to jlowe for the Vonnegut suggestions. I've been eyeing Player Piano lately. I'll bring it along tonight, though I'll be reading the Dirk Gently sequel The Long Dark Tea-time of the Soul first.

Reading material for monitoring the suicidal

I worked another 16-hour shift last night/this morning. I wasn't scheduled for it, but when asked I thought, "Well I'm up already, it's good money, and I mostly have to just sit here, read, and make sure this guy who is sleeping doesn't try to kill himself. I'm in!" About 4 AM I was regretting it. Mostly because I was very tired (I'd been up since 7 AM the day before), but also because I was reading a crappy play called Bus Stop written by William Inge that was later turned into a movie starring Marilyn Monroe. Just cliche as all get out, though since it was produced in the '50s maybe Inge was the first to write them. Wait, is that better or worse?

By 5 AM I was slightly more alert and reading Arthur Miller's The Crucible which almost made me cry is was so good and relevant. I'm working graveyards for the next couple nights and I'm thinking of reading Douglas Adams or Kurt Vonnegut. Funny science fiction or rabidly satirical science fiction?

A proposition

Tonight a female patient told me I had pretty eyes and that we should have a baby together. I'd have been flattered, but she'd already tried that line on a male patient and a female staffer.

Dragged around on a rope all day

I was all set to write an amusing account of my day at the lake with friends last Saturday, and then I saw that Joolie beat me to it. Read it, it's funny. If I was talented, or even had the program, I would have photoshopped a picture of Joolie with fins and gills cause she was totally amphibious, if by amphibious you mean "able to get up on skis and wakeboard immediately despite not having practiced in many years."

My two best wipeouts of the day were off the tubes, no surprise if you read Joolie's account. One crash had me barrel-rolling off the side of the tube for two full revolutions. On the second, I ended up skidding backwards on my back so forcefully that I created my own wake at least a foot high and my swimtrunks were yanked below my ass.

Next time we go out, I'm going to record video of the tube wipeouts.

3 PM to 7 AM

My night and early morning was divided into 15 minute increments. Every quarter-hour I would leave the nurses station and walk the unit checking the patients on precautions. Suicide precautions, assault precautions, elopement, fall risk, self-injurious behavior, sexual behavior. Poking my head in to see the patients sleeping or more objectively, to see their eyes closed, respirations deep and slow. Poking my head in to make sure they weren't cutting themselves or going into other patients' rooms or trying to strangle themselves with an improvised ligature. Then I returned to the nurses station to make notes, add paperwork to charts, and resume reading a memoir about a writer who was hospitalized in a psych ward.

I worked 16 hours straight yesterday/today. I'm tired.

White plastic knives

These are plastic knives I had to remove from the meal trays of certain patients at the psych facility. Looking at them now makes me a little sad.

Sticks and stones may break my bones

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.”

I see that you are lunging at others with a sharpened chunk of plastic. Are you angry?

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.

An emergency

I haven’t posted in awhile for a couple reasons.

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.

Oh What a Night

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 pig roast

Inspired by Joolie's run-in with a roast pig, I decided to share a roast pig story of my own.

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.

TV makes me happy, then sad

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.

Championship word:

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."

My new job at a psych facility

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.

Orientation hell

Today I went to orientation for my new job, except not really. The orientation was for all new employees of the hospital system without being specific to anyone's job. I can see the advantage of covering general information that applies to everyone like benefits and safety. I could do without the extensive examination of the over-long mission statement. Plus there's the fact that I just went through the same orientation a year ago. I didn't sleep well the night before, so I was a little irritable when I arrived. Here are some notes I made:

It's only five minutes in and I'm already simultaneously bored out of my skull and preoccupied with violence. Hmm, not the best mindset for a healthcare job. Clearly I need to be fired immediately. Hee.

There are many awful jobs, cleaning pig pens or cold-call sales for instance, but high on the list must be leading weekly orientation sessions. Repeating the same information every time, answering the same insipid questions, forcing a smile every damn week when some self-amused joker cracks wise at the start of Q&A by asking, "When do we get paid?" Ha, ha, ha! Ha, ha, ha...ha. Sigh. Someone jam a pair of forceps in my brainstem and stir vigorously. That's what I'd say if I had the job.

As soon as I walked in this morning I said to myself as I scanned the room, "Don't sit at the all-guys table. It's nearest to you with several empty seats, but you know for a fact since you did this last year that forced camaderie and lame art projects are on the agenda. Guys generally aren't good at these things. Sit at the table with the sparkly-eyed women who glory in this crap and they will allow you to eschew enthusiastic participation with only mild looks of disapproval." Alas, I hesitated and was lost. The HR folks sent me to the guys table (wouldn't HR want to prevent such a concentration?). At least at this table nobody is going to nosily ask what I'm writing.

Sitting at an all-guys table has some distinct advantages, a minimum of forced conversation and the barest effort to complete lame, "team-building" exercises being the two that come to mind. The primary disadvantage is that no one wants to volunteer to be our table's speaker. Fortunately we have a go-getter dad at our table and it practically defaulted to him.

Orientation is over. Note to self, do not quit your job and then go back to the same hospital system for another job more than six months later cause then you'll have to sit through this again.