Disclaimer: All persons, places and things in this document are imaginary; any resemblance to actual persons, places or things is purely coincidental.
In response to my "commenter", (thanks for your comment, by the way), it's not so easy. The problems at this hospital are just an expression of our current social attitudes and priorities. State budgets got tighter and tighter, and we all (in our collective identity as "the state") cared about these people less and less. Used to be flowers and landscaped lawns here; now the patients can go for weeks (this winter on one unit), without hot water in the showers. And the problem isn't only with this hospital. Here's another story for you:
There's a patient that we know well. The patient's been in and out a lot over the last few years and has a serious psychotic illness. When the patient is psychotic there are various ritualistic behaviors...like walking in a particular pattern, or spitting on the floor....
"pft! pft!" ,the patient spits.
"Hey, don't spit" we'll say.
"Oh, sorry", the patient will say...but needs to do it...chasing away bad spirits, blessing the good ones, I don't really know...
The patient might also kneel down in the hallway or the dayroom and pray...in spite of our injuctions that this behavior would be frowned upon in public here in America....and will come over and kneel down and kiss your feet if you're not careful. Since none of us are actually sharers of the patients culture or particularly familiar with it, the significance of some of the religious expressions are lost on us, but we know from long experience, that when psychotic, the patient will do these things; when we get stability, the behaviors stop. We like this patient; ... a nice person that can get really really sick.
So we discharged this person a while ago, after they got stabilized again. About a month later, the patient's back. Seems that after leaving us, the patient stopped taking meds (where was the out patient case manager?) and, becoming psychotic, kissed the feet of a woman on a city bus. The patient was promptly arrested and jailed, charged with a sex offense. The court appointed attorney arranged a plea bargain for in which the patient would plead guilty and agree to register as a sex offender, and they'd discharge the prisoner to the hospital.
Here the person is, young...speaking a foreign language, living in a foreign culture, has shizophrenia; now saddled with a sex offender label, and has to register. This patient will be extremely unlikely ever to find an out-patient placement...and, although this person is, perhaps, crazy as a bedbug, he/she is NOT a sex offender, in our experience...and by now we'd probably know.
This is apparently unfixable.... a public defender allowing a psychotic person to plead guilty to a sex offense in order to get out of jail, is apparently unassailable...
Here the problem isn't just this institution, it's several...it's inadequate out-pt case management, it's inadequate legal representation, it's an attitude in the society about crazy people, sex offenders, immigrants, the poor. The result is a life locked up in a place that is poorly maintained, haphazardly staffed...even when this patient is stabilized and not in need of hospitalization, he'll be stuck here...what a life, eh?
Is this the best we can do? And what does it do to us to do this to others? What kind of society do all of us want to live in? Who do we want to be? Yikes.
Tuesday, January 31, 2006
Monday, January 30, 2006
The Assaultive Unit
Disclaimer: All persons, places and things in this document are imaginary; any resemblance to actual persons, places or things is purely coincidental.
An evening with the boys.
I nearly always enjoy working on this team. For one thing, all of the patients are men, and I like men. For another, many of them are in here for years and years and over time they become old friends. The pace is slow and laid back - all of these guys are taking massive doses of various drugs - we watch a lot of TV and play cards. Staff stay alert to brewing conflicts. Safety first is the rule here, since all these guys are here for some agressive behavior other, and are mostly not averse to physical confrontation. Two or three have head injuries. I've always felt disturbed by this inasmuch as this is a hospital for the mentally ill - brain injuries are a different kettle of fish altogether, and we have no particular expertise in treating them. But here they are and staff make the best of it.
One brain injured patient is missing tonight - he's at the medical hospital. Had a massive heart attack. Is expected, I gather, to recover, although he's had significant heart damage. This is a remarkable patient. He has no short term memory. He can remember things that happened to him before his big accident, but can't remember 10 minutes ago. Since the big accidnet was at least 25 years ago, he is continually surprised at what year this is, how old he is, how long he's been here. Each and every time you tell him the current price of cigarettes, or cars, he's absoutely astonished. You can do this all day long with him...tell him something about the present and watch his amazement. He has chronic pain in his back. He, more than anything in the world, just wants to go home and go back to work. Used to work construction, used to belong to the union, remembers the phone number of the local, is desperately unahppy at being confined here with nothing to do, nowhere to go, no memory, no future, just pain interrupted by smoking every other hour. His is a really awful fate and it's really awful to watch sometimes...here's this guy who has to live each day without the benefit of short term memory, with chronic pain, with no hope of ever getting better....ever...he's been with us six or seven or so years now (he's astonished when you tell him).
Everyone who's worked with him has heard him say, "Can't you just kill me?"
"Well," we say, "no, actually they won't let us do that". "Can't you just give me the electric chair?" he says. And he means it. He doesn't understand the fix he's in; over and over and over he says, "I just want to go back home." Of course, he has no home...the home he's remembering was sold years ago, his parents are dead, his siblings are not interested in him. He has a court appointed guardian who brings him a candy bar twice a year. He always think some other guy is wearing his shirt and if we're not on top of it, he'll beat the shit out of him. He gets a cigarrette every other hour, and an extra one when he puts on his diaper at bedtime...he's incontinent now because whatever's going on in his back results in a lack of sensation to urinate...we can remind him during the day, but at night he needs a diaper. This is humiliating each and every bedtime, and staff has learned to bribe him into it with an extra smoke.
Anyhow, this guy had a massive heart attack....and come to find out....no one....not his social worker of many years, not his court appointed guardian...no one...has gotten him to sign a DNR form.
The poor guy gets a chance to exit, and we've got our foot in the door. We save him.
Now he's even more disabled...and still gets to come back here...although it'll all be new to him when he returns.
I confess, this gives me the urge to intervene somehow; if the system had a face, I'd slap it.
An evening with the boys.
I nearly always enjoy working on this team. For one thing, all of the patients are men, and I like men. For another, many of them are in here for years and years and over time they become old friends. The pace is slow and laid back - all of these guys are taking massive doses of various drugs - we watch a lot of TV and play cards. Staff stay alert to brewing conflicts. Safety first is the rule here, since all these guys are here for some agressive behavior other, and are mostly not averse to physical confrontation. Two or three have head injuries. I've always felt disturbed by this inasmuch as this is a hospital for the mentally ill - brain injuries are a different kettle of fish altogether, and we have no particular expertise in treating them. But here they are and staff make the best of it.
One brain injured patient is missing tonight - he's at the medical hospital. Had a massive heart attack. Is expected, I gather, to recover, although he's had significant heart damage. This is a remarkable patient. He has no short term memory. He can remember things that happened to him before his big accident, but can't remember 10 minutes ago. Since the big accidnet was at least 25 years ago, he is continually surprised at what year this is, how old he is, how long he's been here. Each and every time you tell him the current price of cigarettes, or cars, he's absoutely astonished. You can do this all day long with him...tell him something about the present and watch his amazement. He has chronic pain in his back. He, more than anything in the world, just wants to go home and go back to work. Used to work construction, used to belong to the union, remembers the phone number of the local, is desperately unahppy at being confined here with nothing to do, nowhere to go, no memory, no future, just pain interrupted by smoking every other hour. His is a really awful fate and it's really awful to watch sometimes...here's this guy who has to live each day without the benefit of short term memory, with chronic pain, with no hope of ever getting better....ever...he's been with us six or seven or so years now (he's astonished when you tell him).
Everyone who's worked with him has heard him say, "Can't you just kill me?"
"Well," we say, "no, actually they won't let us do that". "Can't you just give me the electric chair?" he says. And he means it. He doesn't understand the fix he's in; over and over and over he says, "I just want to go back home." Of course, he has no home...the home he's remembering was sold years ago, his parents are dead, his siblings are not interested in him. He has a court appointed guardian who brings him a candy bar twice a year. He always think some other guy is wearing his shirt and if we're not on top of it, he'll beat the shit out of him. He gets a cigarrette every other hour, and an extra one when he puts on his diaper at bedtime...he's incontinent now because whatever's going on in his back results in a lack of sensation to urinate...we can remind him during the day, but at night he needs a diaper. This is humiliating each and every bedtime, and staff has learned to bribe him into it with an extra smoke.
Anyhow, this guy had a massive heart attack....and come to find out....no one....not his social worker of many years, not his court appointed guardian...no one...has gotten him to sign a DNR form.
The poor guy gets a chance to exit, and we've got our foot in the door. We save him.
Now he's even more disabled...and still gets to come back here...although it'll all be new to him when he returns.
I confess, this gives me the urge to intervene somehow; if the system had a face, I'd slap it.
Sunday, January 29, 2006
Let's Open the Door!
Disclaimer: All persons, places and things in this document are imaginary; any resemblance to actual persons, places or things is purely coincidental.
The Madhouse needs a little fresh air, so I'm opening the door!
I work at the State Madhouse and have just been "counseled" for the second time about going outside the system when trying to help patients. This time, the "counseling" was very stern...and contained a warning that if I kept up this unacceptable behavior, I might even be terminated. My stupidvisor insisted that I must tell her everything if I experience any further impulses to help patients. And, in the interests of cooperation, and hoping against hope to avoid termination, I figured I'd write down all such impulses here and make them available. This way, not only my supervisor, but also my co workers, her co-workers, the families of patients, the funding authorities, the regulatory agencies, President Bush...everyone...will be advised if I should have an impulse to help a patient in an "outside the system" way. Complete transparency, that's my goal. Absolute cooperation with the powers that be. Fresh Air for All!!
Allright.
So my plan is to write up a little synopsis of each shift I work there, being very careful to protect all identies and thus to conform absolutely to the fabulous new, helpful HPPA law. Here's the first shift since my "counseling".
Childrens Unit: Evenings, Saturday.
I haven't been on this unit since the big freeze when the pipes in the ceiling burst, flooding the entire unit, I'm told, with several inches of water, about six weeks ago. When I open the door to the unit's kitchen, I smell mold....the cupboards are open, empty, torn up, piled up...this is clearly not where the children's food is kept any longer. Team staff tell me they're making do with the staff fridge. The carpet has not been taken up since the flooding. I'm told that at the time an unpleasant goo dripped from the vents. Apparently years ago when the building was treated for its asbestos, the cure was to pour glue onto the asbestos in the ceiling, which would keep it from blowing around, etc....and this now dripping goo was the disolved glue, asbestos combo according to gossip, underwritten by somebody in the construction trades who asserted that, yes, indeed, if you soaked glued asbestos with water, it would dissolve as described.
So now we have, perhaps, an unfortunate mixture of mold, asbestos and children. A state supported combination. Facilities Management has apparently assured everyone that it's completely safe.
One employee, at least, has a doctors order to avoid the unit for health reasons.
The children, as ususal, are a pleasure. One tiny little girl plays the drums at the resource center with complete abandon, stretching her legs to reach the peddle on the big drum, pounding the symbols, making wonderful noise; I play pool with an 8 year old, just my speed. Then we walk back to the unit for dinner...and therapy...
We'll teach them how to cope with their mental illnesses...I hope to god we're not giving them some physical ones while we do it. I confess to an impulse to call OSHA or the health department.
Tomorrow: the Assaultive, Dangerous Unit!
Best regards,
Gaddefly
The Madhouse needs a little fresh air, so I'm opening the door!
I work at the State Madhouse and have just been "counseled" for the second time about going outside the system when trying to help patients. This time, the "counseling" was very stern...and contained a warning that if I kept up this unacceptable behavior, I might even be terminated. My stupidvisor insisted that I must tell her everything if I experience any further impulses to help patients. And, in the interests of cooperation, and hoping against hope to avoid termination, I figured I'd write down all such impulses here and make them available. This way, not only my supervisor, but also my co workers, her co-workers, the families of patients, the funding authorities, the regulatory agencies, President Bush...everyone...will be advised if I should have an impulse to help a patient in an "outside the system" way. Complete transparency, that's my goal. Absolute cooperation with the powers that be. Fresh Air for All!!
Allright.
So my plan is to write up a little synopsis of each shift I work there, being very careful to protect all identies and thus to conform absolutely to the fabulous new, helpful HPPA law. Here's the first shift since my "counseling".
Childrens Unit: Evenings, Saturday.
I haven't been on this unit since the big freeze when the pipes in the ceiling burst, flooding the entire unit, I'm told, with several inches of water, about six weeks ago. When I open the door to the unit's kitchen, I smell mold....the cupboards are open, empty, torn up, piled up...this is clearly not where the children's food is kept any longer. Team staff tell me they're making do with the staff fridge. The carpet has not been taken up since the flooding. I'm told that at the time an unpleasant goo dripped from the vents. Apparently years ago when the building was treated for its asbestos, the cure was to pour glue onto the asbestos in the ceiling, which would keep it from blowing around, etc....and this now dripping goo was the disolved glue, asbestos combo according to gossip, underwritten by somebody in the construction trades who asserted that, yes, indeed, if you soaked glued asbestos with water, it would dissolve as described.
So now we have, perhaps, an unfortunate mixture of mold, asbestos and children. A state supported combination. Facilities Management has apparently assured everyone that it's completely safe.
One employee, at least, has a doctors order to avoid the unit for health reasons.
The children, as ususal, are a pleasure. One tiny little girl plays the drums at the resource center with complete abandon, stretching her legs to reach the peddle on the big drum, pounding the symbols, making wonderful noise; I play pool with an 8 year old, just my speed. Then we walk back to the unit for dinner...and therapy...
We'll teach them how to cope with their mental illnesses...I hope to god we're not giving them some physical ones while we do it. I confess to an impulse to call OSHA or the health department.
Tomorrow: the Assaultive, Dangerous Unit!
Best regards,
Gaddefly
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