More Psychiatric Abuse in Mental Hospital and Emergency Room

Donnelly Building is #11. But we faced Maple Ave and couldn’t see the magnolia, or the oaks or copper beech that Olmstead planted…

Yes, this is hospital restraint and seclusion – it really happened like this at Middlesex Hospital in 2010 (I am just reprinting it here to reprise it for edification’s sake and because it is relevant.) In fact there were many more personnel and guards involved and more men…I just didn’t know how to draw a crowded scene at the time, so I made it simple!

I admit I was angry. I admit I was loud and irritable. I admit that I may have been perceived as “difficult.” But never once did I make a verbal or gestural threat or even so much as stand on the floor or approach anyone face to face. In fact, for three hours I did nothing but lie on a gurney, quietly, and try to sleep and remain calm, hoping to…But wait. You don’t know the half of it.

Well, if my energy holds out, let me start at the beginning. Except that I do not really recall the beginning, largely I suspect, due to our good friend, Ativan. However, this much I do know: my case manager came to my apartment five days ago after I called her in extremis, just wanting to talk. She offered to come over to see me, which she has done before and left me in better shape than I was when she came. I assented, though I had some doubts about it because she seemed a bit too concerned for my good. I knew I had a writer’s week planned up at Wisdom House again in the NW corner of the state starting this weekend and didn’t want her to push the panic button.

To make that part of the story shorter, push that bright purple button she and an associate did, once they came and found me in a mess, unable to assure them properly that I was not hearing voices telling me to burn myself. Now, my plans were in fact to burn myself somehow, depending on what the voices told me. They had already instructed me to burn my leg that evening. That was partly why I had called the case manager, because I knew I would follow through. I also knew that I could not keep it a secret if I did follow their instructions, which would have ended my vacation plans prontissimo.

But when that other LCSW went out into the hall to use her phone, I knew it was under false pretenses — she said she had to cancel an appointment of hers because she was visiting me but she was clearly lying, I just couldn’t do anything about it. Just as I suspected, she called 911 to summon the police and EMTs. When they came, I objected to going to the ER, but you know of course it was “Pamela, it’s the easy way or the hard way. You are going to the hospital no matter what…” Argh, the usual story.

Worst of all — since I still don’t know whether legally they really had a right to force me — once in the ambulance, when I stated quite clearly that I did not want to go to Hartford Hospital, and this was clearly and prominently stated in my Psychiatric Advance Directive (PAD) of which I had made sure they had a copy, they dispatched me there anyway.  When I screamed my objections from the back of the ambulance van they told me that the police had instructed that they could take away all of my rights with impunity. Oooh, I did not know what to do about this, but it put me in an evaporative fury. I simply had no power.  Disaster nearly followed, and new trauma most certainly did.

Once in the ER, I was taken directly to the so called “purple pod” — the psychiatric section, and shifted onto a gurney in a curtained-off cubicle, told to change into hospital garb, which I did under duress but before I was forcibly changed by the guards, as was the threat, and was told to lie down and be quiet. I did. I submitted to a physical by an APRN that took 15-30 seconds, after which she pronounced me physically sound, ready for a psychiatric interview. Then I waited. And waited. And waited. The room — the  purple pod — began to fill, and doctors and MSWs came and went and talked to people and passed by my cubicle, but none stopped or said a word. I remained silent, still hoping my semi-comatose behavior would bolster my case, earn me a ticket out of the ER without being hospitalized.

Then another woman, middle-edged, bent over from back pain, loudly asked to talk with a doctor, complaining, “I’m tired of waiting! My back hurts!” The response was that she would not get to see Dr So and So until she was sober and the alcohol was out of her system. She returned to her gurney for a time and then again was at the nurses’ station complaining of fatigue and wanting to have her interview so she could get on her way. Once again the same reply.

This jarred me out of my complacency. I grew irritated. Why were they making me wait? I had been there hours already and had not come in drunk or on drugs or anything like it. I had been quiet, submissive, and they just ignored me. Well, I dunno what happened next precisely, but I exploded (but in some sense in a controlled fashion, because I only got down off the gurney once, in order to use the restroom…) Some cropped-haired woman with an official look and a clipboard came by and I started rationally to ask her why I had not been seen yet, and she began an answer. Unfortunately I just barreled on about how I had been waiting hours and was not drunk and not high and, and, and…And well, it snowballed from there because of course nobody at the ER is professionally trained or for that matter paid well enough to care to learn or know how to calm an agitated person down without brutalizing them….This forever surprises me, since surely they must watch TV where such situations are frequently featured.

I take it back, or partly back. They claim to be professionals. They also, get this, several staff members of the ER claimed to have read my PAD, front to back, all 17 pages of it. They volunteered this information. Yet when push came to shove, when I became agitated, which has a PAD page all its own, what happened? Abuse par excellence. First they ganged up on me, a real no-no. Then they screamed back at me. Then they threatened me. One security guard (?nurse or ?aide) actually threatened to “4-point me” just for disturbing his purple pod.  As if doing so would quiet me!

“Oh, you dare put me in restraints,” I threatened, “and I will have your ass so fast you won’t know what hit you. Middlesex Hospital tried that and now they are facing JCAHO and the DOJ so just you watch your step!!!!!” He said nothing more about four-point restraints, I can tell you that. BUT, BUT, BUT… they had other retaliatory measures in store for me, because soon thereafter a whole panoply of guards and nurses came barreling into my cubicle and rolled my gurney headlong into a secure room (soundproof and with a door that locked, a guard assured me). There while a female nurse attempted to inject my upper left arm with three drugs, two of which were on my PAD’s “forbidden drugs” list, and others restrained me, two guards viciously compressed my neck. They squeezed down hard especially on the right side, cutting off the blood supply to my jugular and carotid arteries. I knew this, I felt my eyes pop, felt blackness in my head approach. I tried to alert the nurse injecting me, could barely burble through hard-compressed lips, “I can’t breathe!” which was the only thing at the time I could think of that she would pay attention to.  That they were choking me was a concept that simply didn’t form in my brain…Tough luck. She just ignored them and me and said, “You’re all right…”

I jerked away from her then, trying to get free from the guards. The nurse yelled at me because I dislodged her needle and started bleeding. But the guards only squeezed down harder, tightening their strangulation grip. I felt certain they really were going to kill me. Then the guard closest to my right ear said something along the lines of, “That will teach you about suing a hospital and getting JCAHO involved…” I feel like I have his words verbatim, but maybe I only recall the gist of them. Whatever he actually said,  he clearly harbored enormous resentment about my complaint against Middlesex Hospital and the involvement of the Joint Commission and possibly the DOJ.

When they were through brutalizing me, the guard finally unclenched his fingers from my neck and despite my accusations, they all rushed out of the room, closing the door behind them so no one could hear me. I lay back, stunned, understanding then just how people die during restraint episodes. How close I came to being one of those statistics I can’t venture to guess. “Unfortunate ‘accidents’ happen and nobody is to blame, really, it just happens…” I imagined them saying to my family and friends. At the time it felt like an extremely close call. I knew one thing: what those guards intended, and they intended to hurt me. Perhaps in their angry zeal they would have killed me. They were thugs. They were coarse, vulgar men who had likely been judged unfit for the police academy but still wanted to wear a uniform, have authority and to carry weapons and beat people up. Understanding this and understanding just how much danger I was in was extraordinarily frightening. I do not recall anything else. I must have fallen asleep despite my terror, subdued by the cocktail of drugs I had been given.

The next thing I knew,  they were wheeling me onto a psych floor at the Institute of Living, the psychiatric hospital associated with Hartford Hospital. This Once World-Renowned Retreat for the Rich and Famous closed its doors years ago,  re-opening with the same name but as part of the city hospital. It now caters largely to Medicare and Medicaid patients like me, which is a 180° reversal. Clearly the staff, at least on the floor where they placed me, care about as much about their patients as their meager salaries/wages pay them to. Which from my fairly minimal (I have been there three times, for brief and uniformly miserable stays) but horrendous experience on Donnelly 3 South at any rate tells me cannot be more than a pittance. Either they are paid too little to give a damn about their jobs, or they are mostly all of them jaded, burned out, control freaks. At a minimum it seems they just want a cushy job and a quiet unit with untroubling patients, drugged to the hilt so they will have no problems to deal with, nothing that a seclusion room and IM meds in the butt cannot handle.

They were not prepared for me, not prepared for someone who had nearly been killed in the ER, one, and two, who really did not want to be in the hospital, let alone in their hospital. I was ornery, bitchy, and, to the maximum possible, was not ready to obey their pissant commands. No I was not. I was a human being, a very intelligent human being whatever else was going on, and they were not treating me with dignity or respect, so I would treat them much the same, or worse…Well, that won me a lot of friends, I can tell you, NOT.

They hated me at Donnelly 3 South, they really did. They despised me and made these feelings very clear, very clear indeed, retaliating and punishing me at every opportunity. It would have been, might could have been funny to watch these so-called professional nurses and psychiatric staff behaving so badly, so much like children run-amuck, they were that out-of-control, had I not been so vulnerable and so very much in their power.

But when it came time to force me into a “side room” and try to keep me from leaving it, you better believe they didn’t have an easy target in me. After my experiences in Middlesex and Manchester Hospitals, I have schooled myself on my rights, all my rights vis a vis restraints and seclusion.  And you know that I let them know in no uncertain terms what the Connecticut statutes are, how seclusion is defined and when a restraint is taking place. How they hated me for this, and hated, oh, they –you know, I really have no word strong enough for the look of razorblades in their eyes when I pointed out that they were not following the most recent Standards of Nursing Care, or worse, how Natchaug Hospital nurses do things better, or how they were using seclusion and restraint when they had no “statutory right” to do so. I think the words “statutory right” both meant nothing – “what the heck is a statute anyway?” I could feel some thinking — and everything to them, and was impressive and frightening because of this. In any event, that look of utter negativity went right through me, as if they wanted to stab my eyeballs with an ice-pick.

Needless to say, however, they managed to use seclusion and restraint on me despite my protests. When I got too noisy for them instead of trying de-escalation techniques of any sort, they proceeded first to lead me into and then to push me back to a so-called “side-room.” When I got out, they forced me bodily pushed me back inside, and closed the door against my protests and verbal preferences, vocalized clearly,  to go to the “least restrictive environment” of my bedroom to calm down. That constituted a restraint, and when they would not let me leave that room, it became, as many of my readers will know, by definition a seclusion. Then, when they forcibly held me down for an injection of the three drugs that interact badly in me, and which I had requested specifically not be given to me (alternatives were suggested in my PAD), they abrogated every right I asserted. That in itself constituted a restraint without legal justification, especially since I was nearly sleeping by the time they managed to get the injection ready and no longer even agitated. They had to physically attack me in order to RE-agitate me, to justify giving me a stat dose at all. They kept me in that “side room” guarded by someone all night.

As I freely admit, I was horrible to them, a witch, a bitch, a harridan, but they never once behaved with any professionalism, or tried any of the calming, de-escalation strategies that I suggested in my Psychiatric Advance Directive. Oh, they had a wonderful comfort room, pretty much perfect, but for the lack of a padded floor and muralled wall. But I myself had to ask to use it; it isn’t as if they offered the use of it or suggested that I return to it when agitated. In fact, they seemed pretty cagey about it, acted as if I might possibly want to “over use it” and said I could stay for a “little while.” And when the radio broke down, who gave a damn enough to find one that worked when I returned the broken one, or to get me a weighted blanket when I wanted one. I sat in the comfort room’s therapy chair — arranged backwards so you couldn’t use it to rock yourself by pressing your feet against the wall the way it is supposed to be used! Because it was cold in there (yeah, the other big problem) I asked for a blanket, the aide/tech who found me one walked partially into the room and then threw it at me! Not casually for me to catch, mind you, but at me. As if I weren’t worth the time, trouble, or effort for him to hand it to me. I don’t know what he was thinking, or not thinking, but it seemed clear that at least at that moment he didn’t give a damn about his job. Or perhaps he was sending me a message about personal dislike, which would have been incredibly unprofessional, but what can I say? It has happened before…What a soulless bastard.

If anyone out there reading this is a psych tech or nurse or employee at a psych unit or institution, you should know or must learn that matters like the blanket business, however puny they seem, do matter, they matter a lot. Never at Natchaug Hospital would anyone, tech or nurse or even attentive housekeeper dream of throwing a blanket at a patient, not in bed or in a chair or a therapy chair. No one would throw anything at a patient, not even a tissue, and most certainly not in anger or a fit of pique. Not even in momentary thoughtlessness. No, if a patient needed or wanted a blanket at Natchaug Hospital, it would be gotten, often warm from the drier, opened up and carefully draped just so over the patient’s body.

This has a huge effect and makes a massive difference largely because it is indicative of the fact that Natchaug actually has a philosophy they work with and behave according to, not one of words they just push through their teeth and get lipstick stains on. Almost always at Natchaug the staff member would cover the patient and only leave the room after making sure that same patient was comfortable. The blanket-bringer would know or have been carefully tutored that the job description included an attitude of wanting patients to be happy and to get well because Natchaug believes a troubled person can only get well when well taken care of.

You’d think, and certainly would want each and every psychiatric hospital to operate on such humane and compassionate principles, wouldn’t you? Alas, at least in Connecticut, Natchaug Hospital in Willimantic is definitely the Hope Diamond exception to what remains very much a charcoal rule. Hartford Hospital’s Institute of Living? I wouldn’t rate it much above coal dust.

To be continued…