Seclusion and Restraints: Observations from the other side

Here’s what my friend Josephine knows about what happened in October, having been my designated “contact person”:

 

According to Jo, I was admitted on Wednesday around noon. Apparently the nursing staff called her, as well as Lynnie, as my emergency medical sheet instructs.

 

She comes up to see me that evening, bringing with her some clothing and toiletry items etc. and while she is there she makes it clear to the staff that she is my “caretaker” and is to be told everything so that she can contact my family, when the need arises…(This seems to work, as it turns out, as she will be kept in the loop, thank god.) Anyhow, I am doing relatively fine, though the nurses say I refuse to take the medication the doctor prescribed, which concerns them. Apparently there are plans already being made for a hearing to force me to do so.

 

Before I fast forward to the weekend, when Josephine next sees me. I want to interlace here what I do recall, which is one conversation with the doctor, in his office, during which he tells me that he wants me to take Zyprexa.  “Have you heard of that drug before?” But then memory gets fuzzy, because I am back in bed,  in a bedroom I think is a double, though I am not sure, because I know that for most of my stay it is a single right off the nurses station where they can keep an eye on me, and just as he leaves, I raise up on one arm and scream, “I will NOT take Zyprexa, you F—ing bastard!” Dr Z stops in his tracks, looks back at me, and says, rather mildly, “That’s not very nice.” I finish off with, “Fu– you!” He has heard this before, clearly, turns on his heel and leaves.

 

The next memory I have must occur also before Josephine returns. I am sitting in a room with Dr Z  and someone I think is a judge or a hearing officer. A woman sits on my left, perhaps a patient advocate or a nurse, I do not know.  I recall specifically that Dr Z (whose name I only learn after I am discharged) seems to have spoken to the folks down at N hospital where Dr O practiced because he quotes what I recognize is their Axis II diagnosis, word for word.  This was created specifically for me by Dr O. in addition to paranoid schizophrenia and always struck me as  malarky but was a sore point too, and cruel as it seemed to blame my illness on me. (I had many words with her about it, and I challenged her  to prove it was true. She agreed it did not hold water, since it was only “true” in hospital, and so was just a convenience to satisfy  staff unhappy with my uncontrollable behavior — yes, there too, and equally unremembered!)

 

Nevertheless, it was written in my chart at N hospital and so now it is repeated as if gospel. In addition, the doc decides that he has seen, in two or threee days and five to ten minute interviews with me, “absolutely no evidence of narcolepsy, and no reason to treat for it.” He believes that my sister’s attempts to influence my treatment,  giving him my history of medication responses etc. constitutes improper interference and should not be permitted under any circumstances.

 

After that, I lose all interest in the discussion, knowing it is not going to go in any direction that will be in my interest, that I am being treated by someone who neither knows me nor cares to learn enough to treat me properly. Furthermore, having been taken off all the medications I have come in on (except oddly enough for my Lyme disease antibiotics) as having been “ineffective, by definition, otherwise you would not be here,” I am already feeling drowsy and distant, at a remove from the proceedings and not quite caring what happens. The proceedings come to an end when the hearing officer, or whoever he is rules in favor of the doctor, who wants to force me to take, not Zyprexa but Trilafon, 8 mg BID (twice a day) or Haldol by injection if I refuse. I may object and say I will not do so and will only take the damned Haldol kicking and screaming. Or perhaps I say nothing.  I don’t really know.  I may  only think this, but it is a prescient remark, or thought, in any event.

 

Memory becomes a series of refrigerator-dim flashes. I vaguely recall one incident: literally kicking and screaming while being held down for an injection by any number of security personnel…But even this memory constitutes no more than just an impulse of light on the confrontation, as if I am looking down on my body as I struggle with the guards, no more. Then just blankness.

 

What Joesphine tells me next is that she returns on Saturday, bringing my poetry book. She is appalled at the change in me and asks the nurses, “What happened to Pam?!” I am not merely irascible, she says, but explosive. I am mean and I am violent to the point that I will not let anyone  come near me. If they attempt to I lash out, not just verbally but physically as well, any number of times actually slapping, smacking or in some fashion hitting the nurse of aide trying to take my vital signs or give me medication. She tells me that even when I appear to be deep in thought, sleepy or sedated, I can in an instant rouse myself to fury and explode, launching into a tirade of invective and even physical abuse.

 

At the same time, I am ataxic ( one nurse gives me red  slipper sock to warn staff that I constitute a “risk of falling” but these are soon lost and not replaced) and while I can be wild and have the strength of a rabid animal, at times I have trouble simply getting myself out of a chair. Once, a big security guard, seeing Josephine struggle to help pull me up from the recesses of a deep armchair, comes over to help and I go berserk. Suddenly violent, I take a swing at him, swearing  and screaming at him as if he were the one to have attacked me, rather than the other way around.

 

Once Josephine looked into my bedroom before she was shooed into the day area with me, where all visiting was supposed to take place, she saw that restraints — big leather cuffs — had been placed on my bed. According to her, they were used as frequently as every time I got medication or even every night in order to keep me from — well, I do not know what! But I can only imagine, given how she tells me I behaved. I do know that restraints are only supposed to be used in cases when violence is imminent or uncontrollable by any other means. Now she does assure me that they were, so far as she could see, only two-point restraints, the wrist ones, but that they were actually placed on my regular bed horrifies me, since it implies that they were to be at the ready and expected to be used, i.e. they were not simply an emergency appliance to be acquired from a rarely used, locked cabinet unopened for months at a time.

 

As an aside, I discovered when I arrived home, many just healing scars on my left leg that were not there before I was hospitalized. Yet I also remembered telling a nurse at the hospital that of all the places I had been, their unit was definitely the most safe, the most secure. I felt that it would be most difficult indeed to hurt myself there, as there were very few opportunities and almost no chances were taken…So how can I square that with these scars? I cannot remember when or how I acquired them. I only know that the summaries of my chart mention that I did injure myself, early on, which resulted in four-point restraints at least once (another being the slip-knot episode already described). But with what, and why I have no idea. Probably because of command hallucinations, and self-hatred. But that is only my surmise.

 

I “came to,” I rose to the surface of my insanity only once or twice that I recall, once to see my father sitting by my bed (why was he allowed  to visit in my room?) and Josephine standing there while I screamed something. I remember she abruptly left. After that, the darkness closed over me again.

 

The only other time I surfaced was when they dropped me on the seclusion room linoleum…about which I have written in some detail. But even then, I cannot really remember if it was one whole incident, or two or three amalgamated by a trick of the brain’s confabulatory instinct, and  the passage of time into a single coherent tale.

 

Then there is my journal , which tells a story that in its own way corroborates this one. Usually when I am hospitalized at least in recent years I  keep a detained record of everything going on around me for reasons of paranoia if nothing else. Because of this, I can read back afterwards and understand what I was thinking or doing. This has not always been true, and during some hospitalizations, further back, I was unable to do so,  and thus do not have such a record, but I am glad when I do because it helps me piece together what happened during times that I otherwise experienced later as blanks.

 

However, during the two and half weeks and longer during which I was  literally out of my mind this past October (Josephine insists that I wasn’t “right” even when I got home, and that it took a good two weeks before I was truly myself again)  there is no written record, not in my journal. I wrote a little during the first few days,  going from a self-loathing that speaks of a desire to burn my face (“deface my face and face up to my sins”) mingled with psychotic ramblings to utter confusion. This is almost indecipherable and devolves suddenly on Thursday to nothing at all, represented vividly if accidentally by two blank pages. It is only on briefly on Saturday and then on Sunday, October 18th and Monday the 19th (which may have been only a continuation on Sunday, as I was still confused as to the date and time), which I firmly believe all day is “Monday the 20th,”  that I apparently find the strength and clarity to “steal” a felt marker from OT and then a memo pencil to write with. All writing utensils but crayons have been denied me previous to this, I remember that much, though I also have not been able to, have not wanted to write either or I would have done so even with a crayon.

 

Now, to my pleasure this marker and then the pencil is not  taken from me as too dangerous for me to have in my possession.d I begin to write. I write all day, literally. I write and write, 41 pages in one or two days. I write down everything that happens, and I write as if I know what has been happening, but really without the slightest inkling. It is clear that I have no idea what I have been through, nor what I have been like. I write of a nurse, one I clearly like, telling me I am “doing great” and my consternation at this, because I do not understand why she is telling me how I feel rather than asking me…

 

I write of my impending discharge, and I believe I write about how I don’t remember the last two weeks, but it doesn’t seem to bother me much. What does bother me is why no one on staff will talk to me, why people seem to avoid me, and why one male nurse seems bent on being nasty to me “for no reason.” (I may have made a point of hurting him during my weeks of insanity, that is all I can surmise as a reason for his animosity…).  I am paranoid — at one point I interpret the constant opening and closing of the weekend Dr H’s door, which I can hear from my room near the nursing station, as deliberate torture, intended to “get back at me.” When I finally get a glimpse of Dr H, I scream at him “You think I don’t know what you are doing, but I do, I do!”  He gives me a truly bemused look. I am thrown into confusion, not sure how to read it.  I  remain fairly certain, however, that he is “doing a number on me.”

 

(End of Part 1. I want to reread the rest of what I wrote during my last three days on the unit before discharge — then I will continue with Part 2.)

Pam W – Various photos

This is Pam W. in the spring of 2009. I am standing in front of the Inn on the Broad St Green in Old Wethersfield.

This is the famous and faithful old green recliner (Command Central) in which I do everything but Artwork and Jewelry making..I even sleep here at night.

In April 2007 I interviewed my best friend Joe for StoryCorps. This is the photo they shot of Joe, Me and Karen in front of the StoryCorps Airstream which houses the mobile soundbooth and recording studio. During the interview, which was aired on WNPR the following Friday morning, I had also to translate for Joe, who was losing his voice to ALS, amyotrophic lateral sclerosis, or Lou Gehrig’s disease. By then Karen and I were the only two who could still understand him.

My official author picture, in color rather than the B & W version on the book flap. I do not like it as much as the one being used for publicity, which has been cropped from my photo in front of the inn.

My cat Eemie, about whom this poem has been written:

TOOTH AND CLAW

With silk sufficiency the cat,

that pedigreed aristocrat,

stalks her prey, the Rattus rat

amid the sun-dazed blades of green

where grackles feed on haute cuisine,

of kibble that was meant for Eem,

my scrappy feline, who’d prefer

the tang of rodent blood and fur

while June bugs rasp and locusts chirr.

With one sure leap of grand design,

she hooks his nape and snaps his spine

‘mid cabbage rose and columbine

then daintily she sniffs the gore

and drops her tribute at my door

as if I’m her conspirator.

Seclusion and Restraints: How it feels

I remember, I remember, well, I remember very little, except in flashes of dim light, like a candle held up by which to read the fading pages of an ancient diary. I remember a sign with my name on it, taped to the door of a room, and how hard it was to find my way back, no matter how many times I made the trip. I remember a nurse with blond hair named “Patty,” whose real name, Lil, I learned only the second to last day I was there. I think I liked her, or that she treated me with kindness, and another nurse named Mary Ellen, who was kinder still, but not always there to save me.

I remember too, but again in uncertain flashes that tell me only that something happened but not exactly what: Being carried by arms and legs into a cold, empty room lined with linoleum, dropped onto my back on the floor, dressed in just two hospital johnnies and pajama pants and locked in there alone. I remember begging for a mattress, then screaming in outrage when I was refused.

This is how it goes: There is nothing in the room but me and air conditioning turned on full bore, though it is October and in the 50s outside. Why do I need johnnies or the huge pajama pants that are falling off me without ties to hold them up? Alone in that room, I take them all off, then squat to pee and take a dump. Good, that feels better. Blankness. Cold, cold. Again I scream for a blanket. Of course, nobody answers. I try to push the johnnies under me to cushion my bones so I can sleep, but the shivers prevent me from relaxing. I have to do something.

I make a long rope of the silky acetate pants then form a slip-knot and put the O over my head with the knot to one side. I pull tight, figuring it won’t take long. I sit to one side of the little window in the door, so no one sees me immediately. Finally they come running. But they don’t understand it is a slip-knot and that pulling at it only tightens it  more. I am struggling for air. A nurse yells for scissors, bandage scissors the only ones available and they cut the pants free. Still, I am in big trouble. I would tell them I only wanted to get their attention, that I just wanted a mattress and a blanket, but what good would that do? Still, do they really think their act of violence, which will follow, will solve anything? Blankness. I have been thrown onto a bed in another seclusion room. As staff and goon squad wrestle my wrists and ankles into padded cuffs, I kick and bite in protest, all of which will be written up as my being “assaultive.” In the end, it is no use.  I scream and scream until the usual injections – 5 mg Haldol and 2 mg Ativan – take the scream out of me and I finally fall asleep.

That should have been the end of it. “Wake up calm and they take you out of restraints.” That’s the name of the game. But this time, I wake and I am still in full 4-points. I ask the nurse why. “Doctor’s orders,” he says. “But that’s punishment!” I answer, shocked. “No,” he says, “restraints are therapeutic. We never use them as punishment.” “Bullshit! Dr Z is punishing me because he doesn’t like me and you know it. He is a sadist.” The nurse doesn’t answer immediately and when he does, he just says, “Go to sleep.”

I remember how they kept me in restraints for 12 hours that time. The chart summary tells me more, that I spent a good part of 5-7 days in seclusion and/or restraints, so there is a lot I do not remember. Am I better off for not knowing? That’s what some people tell me. How would you feel? Would you want to know, or not to know?

————————————————————————————

I realize that the above is simply a restatement of an earlier more detailed post, so it must be obvious that I am still very troubled by what happened. Indeed I am. I am even more troubled by my lack of memory the rest of the three weeks there…which fact was noted even in the summary of my stay, which Dr B (Li) got from the hospital the other day (in lieu of what he requested, which was my entire chart.) Memory loss has dogged me for many many years. Only now can I acknowledge it, and only because Lynnie and others witnessed it. But for so many years I felt desperately  troubled and, well, desperate to hide it, afraid lest anyone know how little I could remember of what happened from day to day. This was especially extreme when I was in hospital but even afterwards it was troubling to me; sometimes I felt I was missing half my life! People — that is to say,  doctors. nurses,aides — expected me to remember ordinary happenings, because they obviously  thought that I was responsible for what I did from one day to the next, which you are not, not in the same way, if your memory is impaired. This expectation was so stringent that I dared not admit how little I did remember of events after they passed. I thought the scant trace they left would somehow prove my evil, prove that I was a shameful deficient person. So  I desperately took cues from others about what they wanted me to “remember,” tried to “pick their brains” about whatever it was that had happened, or that I had presumably done, whatever it was that they expected me to recall. Sometimes a concrete clue might help me piece things together – say for instance if I had scars or wounds that hinted at recent self-injurious behaviors or if there were scribbling on the walls that suggested another sort…But if there were no cues, it was much harder to ferret out what was wrong. Sometimes I might have to come right out and ask, “And you are referring to…?” But I didn’t dare do that often or it would have given my lack of memory away, something I didn’t dare permit…

Now here is the other side of the story, which I find hard to square with my experience in October: one  psychiatric nurse’s account of how situations involving restraints can look to staff.

 

Wonderful Poem at the Merton Institute

Check out the  http://mertoninstitute.org for the source of this, but in the meantime, I think it is not illegal to reprint it here, a marvelous poem, chosen by our friend and hero, Billy Collins, for the 2008 Merton Prize for the Poetry of the Sacred. As I wrote in a letter to a friend about it: I have this secret fondness for formal poems that hide their form beneath enjambments and nonchalance and (perhaps this may sound weird) humility, as I sense this poem does…I really liked it, found it sort of Frost-like, without its insisting on the likeness. Could not find out anything more about the poet, nor any more of his works, except the single sentence that he has indeed published before…Wonder where and what.

The Orb Web
by David Culwell of Columbus, Ohio

One night I stood inside
And, through the fan-shaped window in
The front door, watched a spider spin
A web to snare, in its tried

Way, some of the mesmerized
Moths fluttering in the porch light’s glow
Like bits of paper people throw
At parties or pint-sized

Satellites. The wheel
Of a web hung beneath the right
Corner of the frame, not quite
But nearly setting a seal

Against my going out
Or someone’s coming in. Indeed
A friend was coming soon to read
My hard-spun lines about

Beauty’s fading bloom.
I need to get the broom, I thought.
But I just stood there gazing, caught
By the eight-legged loom:

An inch or so, with gray-
Brown hairs and legs with bands of brown
and yellow, it hung upside down
Laying a sticky ray.

Like a second hand
It circled, moving inward; soon
the web, which seemed a gauzy moon,
Was done, with every strand

Laid necessarily.
The web itself was like designs
On Persian rugs; I read its lines
As living poetry.

A moth flew into it
At three. It fought, wings flickering,
To free itself, but couldn’t spring
Away from the gripping knit.

The spider scuttled there
And nimbly spun the moth in silk
While another of its ilk
Flew into the snare.

The spider hardly knew,
Of course, that something like a gust
Would sweep away its work like dust
And leave no strand in view.

I looked at my watch: the time
Was near. I didn’t lift my gaze,
But walked away, trying to raise
The mettle for the crime.

Academy of Medicine – Poetry Reading for a Bunch of Shrinks?

Wowee zowee, who’da thunk it could go so well? I was more worried than usual and I had this profound dread that — I dunno — somehow disapproval and dislike and even hatred of me would reign overall. Worse, that all those shrinks would find my poetry either cold and incredible (but who are they to say?) or somehow incomprehensible at least in part….This is not just self-loathing baring its usual fangs, but my deep fear that a repeat of my encounter with Dr Z in the Hospital in October would occur, writ large, or with so many others over these past 35 years. Truth is, I am terribly frightened of most doctors, of all sorts, and this despite the fact that I am all too aware, intimately so, of how human, how terribly flawed they can be and how despicably they can sometimes behave. Even so I am aware that I “give” them — give most people — way too much power over me (I have never understood that “give” but it must be true, though it feels like they take it, forcibly), power to dominate and judge and make me feel like shit. Moreover, I am so afraid of them and their power, that I become completely paranoid about — well, any doctor, really any health care professional, from technician to nurse to doctor, I need to see these days! and my mind conjures up scenarios about how they intend to harm me, complete with delusions and hallucinations that  corroborate every such feeling.

Just this past week, for instance, when my migraine, along with vomiting up what looked like coffee grounds, put me at the emergency room again, paranoia completely took over. I still believe that they knew everything I felt and perceived, indeed were doing precisely what I “knew” they were doing …. Why I even call it paranoia I do not know, when I believe it was real. Why? Because, because, because…I have to hope and pray it was paranoia. Otherwise life would be unbearable…unbearable! I would at this point much rather be told, reassured, that nothing happened there, at the ER, and that it was “only” my paranoia, than to find out that indeed I was right all along! No, I hope to god I was wrong! And if I need to be labeled paranoid in order to be wrong, then fine, so be it. Better than to be right and find out that what I was so terrified by really was happening there all along…

But where was I? I was speaking of Wednesday night’s reading. I started out — well, the problem began — I was fine up until that point mind you! — when we entered the building because unlike the hotel, it was vast and echoing which produced an immediate physical disorientation on my part, I felt off balance and dizzied, as if under attack and anxious…I wanted to get out from under those echoes and that vastness…So I was scared simply upon entering the building and wanted to get away from it…This did not abate, and being scared almost to muteness beforehand, it only got worse, esp when Mary left me alone in a big room just off the hall where the reception was taking place. I felt then as if I were going to disappear, to implode, to die, to be killed, if she didn’t come back quickly…I didn’t know how to escape and I knew that I would have to, that I would not survive otherwise and immediately. I slunk to the wall near the door, carrying all my things, my coat and bag and my poetry. Adrenalin shot into my chest and poured down my arms and legs, preparing me for flight, when suddenly Mary returned.

I think she realized what a state I was in then, and felt bad. Which only made me feel worse, and I couldn’t talk for a few minutes.  But I made myself pull myself together and I did calm down, and made it clear that to enter the room where the reading would take plaee once full would be much harder than to do so when it was still in the process of filling. So we went in, Mary going first and fending people off (so I felt) and when I finally had a chair beneath me, I could breathe again. Just knowing I could keep my head down and stop anyone from talking to me, even if they recognized me allowed me to relax, which was what I  needed.

In this room, which had some sort of insulation that baffled the echo in the halls and open space downstairs, the disorientation passed almost at once, and the adrenalin seeped away, until it was only at the level of keeping me alert, not so much alarmed and ready to flee. I no longer felt dizzied or on the verge of hyperventilation or even, as I had, such imbalance as to the possiblity of falling. It was weird  to the max but as soon as I left that room after the event was over, I had trouble immediately, having to negotiate the space with great care, using the banister to take the stairs and even so, feeling my feet and legs uncertainly take the steps downward and feeling the alarmed feeling build up and up the longer we remained. I felt even so that I could not hear properly, though all had left and there were scarcely more than 5 or 6 of us left in the building. I was so glad when we finally got outside I barely registered that noisiness by comparison!

But I am ahead of myself! First the “event” took place.

Barbara from the Foundation that sponsors and indeed is the originator of these humanism and medicine events did a brief introduction about the  Foundation itself, then my publisher got up in her striking bright red coat, and spoke, wildly enthusiastic, about my book. In bombastic terms she praised me endlessly, until I cringed and felt no one, least of J herself could possibly believe such drivel….. I can only hope she tones it down tonight as it was way over the top…upsetting me because I felt certain she was lying to herself and making everyone laugh at me as well. Finally, she was through and gave me the signal to do my thing. Luckily I had more than cut my teeth on public speaking with our book tour for Divided Minds, so I was fine, once I got started. Of course beginning with, How to Read a Poem: Beginner’s Manual, and a few words of explanation, put most people at ease. So you better believe I start with that almost without fail. What else?  And after that my spiel and that poem, I had them…as they say — in my hand. But really, they had me! You see, I was no longer terrified, nor intimidated. Instead I was having fun and wanted only to please.

The rest of the reading went swimmingly, with Mary providing a short intro to each chronological section of the book, and me reading about 3 poems from each, That way, I could let her do some of the organizing of the reading and taking some of the pressure off me, and it eased my tension a bit, even though I guess I could have done it myself, seeing as I had done so at Mystic (though I admit, there I had also started weeping near the end, thinking about Joe as I read a poem about him. In fact, it was probably my crying during that poem there that led Marjorie to suggest I stop at the so-called forgiveness poem, rather than continue through till four o’clock as I was scheduled to.)

In fact, I do not mind crying, it is mostly others who seek to save me from my own tears who mind…They are the ones who cannot take it, who think they have to save me from embarrassing myself, them, and the world. when in fact I don’t mind crying in public, any more than I could care less where I sleep! (I have slept in some pretty weird places, including right in the middle of a labyrinth in a public garden….Could simply not walk a foot farther but collapsed into a heap and slept for a couple of hours, oblivious to the fact of people staring or otherwise wondering what I was doing there, and my family having in disgust moved on…) But at the Academy, I was prevented from crying or at least it never became an issue which at moment, is a source of relief though I do not believe it would ever truly have proved a problem to me.

The following night, I was less articulate, possibly more tired, though I hadn’t felt so, just more tongue-tied, and less quick to think or respond…Nevertheless , the audience was very kind and laughed right on cue, which is more than I can say for the shrinks, kind though they were. and which this audience was not made of particularly. They even responded better, in terms of audible laughter to In Memoriam Memoriae. Laughing at the ending, and esp at the pauses where laughter was most welcome.

Oh, I am such a ham…But in truth this is only on stage, and nowhere else. And only in terms of the truth, not as a true actor, which I cannot be for beans…I dunno how to “act act” and wouldn’t want to. What I think I like to do is be myself, but be a goofy me, or a funny me, which others call, Play acting, but is really just being goofy, and me too. Can I not be goofy sometimes, or might i not achieve that state of innocence where one can play and be irresponsible occasionally? Why must one be staid and unimaginative and awkward and nothing always…

Well, I fear I must stop here, finished or no, as my face is coming off and I simply cannot stay awake longer. I have to go to bed because I am fading and losing touch with whatever i am writing.. When the fingers threaten to fall asleep on the keyboard and the keyboard becomes invisible because you are closing your eyes against your will, you know it’s time to sleep…And so I will, myself, take this body off to bed. Sleep well and good night.