I just reread my poem and the incredible comments i posted from “Rachel” –who knows who she really is, a loyal and wonderful reader of Wagblog and a terrific writer herself — and i thought it bore a reblog right here on my own blog. Rachels comments about the difficulties of nursing in this insane world are right on! Thank you.
GOMER: ER-speak for a troublesome, unwanted person in the emergency department, acronym for Get Out of My Emergency Room
So many times gurneyed in by ambulance and police escort
“dangerous to self or others,” and too psychotic
to cooperate or scribble consent, you suspect by now
you are just a GOMER to the snickering scrubs in the ER
who whisk you in back with the other disruptives
lying in beds, waiting for “beds.”
One time you dip paranoid into the inkwell of your purse
extracting a paring knife more amulet than effective protection,
they strip-search you, then, unblinking, eyeball you all night
through a bulletproof plexiglass window.
In the morning, 15-day-papered so you can’t leave,
they send you ominously upstairs.
Later, at home, the voices decree your left leg
should go up in flames to atone for the evil within, and you listen…
I continue to be assailed by the same demons as usual, of which i will not speak except to say that it is an effort more often than anyone knows not to walk out of here and away into the cold of night, that indeed i feel deeply (and am told by voices much more powerful than they should be) that i should disappear for the good of all. If I seem strong and resilient it is only my fear of death and a rage that so many want me to die nonetheless, but i feel a terrible resulting sadness that i can’t find it in me to comply completely…In fact, whatever life throws at you, one either survives or dies. But no one can possibly understand how much anguish such a conflict causes me daily, minutely, even by the second, even when I appear at my most cheerful.
I give you Rachel Platten’s lyrics, because I like the song, and sing along with it, though I do not in fact believe that I have any right to believe in them for myself.
On this day five years ago, I got the news that a recent lung biopsy showed that my lungs were inflicted with a severe form of graft versus host disease (GVHD) called bronchialitis obliteran syndrome (BOS). BOS, I came to find out, was a known but uncommon side-effect resulting from a bone marrow transplant (for leukemia) that I had had earlier in the year. And by severe I was told it meant the BOS was incurable, non-reversible, and, in most cases, aggressively fatal. I was also told — because I had asked and insisted on an answer — that, according to a National Institutes of Health (NIH) study of the time, BOS had only a 13%, five-year survival rate. In other words, there was an 87% chance that within five years I would be dead.
Well, it’s been five years and here I am – a newly…
After they had me trussed up in restraints…No, let me back up a bit, because it was not that easy…Hannette was the point person, shall we say, the person who had my head between her hands and was cradling it, “oh so gently” as she “oh so soothingly” commanded me to CALM DOWN RIGHT THIS MINUTE!” Again and again, she subjected me to these absurd demnds as if I could possibly do so upon her order. And as if I ever would do anything but attempt to writhe away from her clammy awful grip on my ears that nearly deafened me to her voice even so.
Finally the job was done and they had fastened a thick plate of velcro across my chest so I could not even sit up or do more than bend my neck a bit to see their handiwork, briefly, before i lost strength and had to lie back down. But I was emotionally overwrought with the situation, and what had happened in the space of only minutes.
WTF? How could this have happened when all I ever wanted was an Ativan to calm down and help me speak? And now what?
But they just trooped out, with Annette leaving last, saying, “You will tell us in WORDS when you are safe enough to be released, or you will remain in restraints.” She then departed too.
Although two monitors were posted silently in the adjoining room, I could not see them for my position, nor were they permitted to speak to me, as I knew from prior experience. I let out a scream that echoed through the empty chamber like a banshee howl but it made no difference. Yes, I could hear Chelsea from somewhere, — a sweet female staff member who remembered my Advance directive and the other times I had been restrained — saying, “Pam, take a deep breath, try to stay calm, I am here, you are not alone…” And I mentally thanked her. But as soon as I could remember that she was there, she was taken away, removed by someone who was told not to talk to me….and so it went. A Dr. Lasix came to me within the half hour and told me he wanted me to come out of the restraints as soon as possible but I would have to agree to talk with him. What did I have to say to that?
I could not respond with a shake of my head or a simple nod so I remained silent. He shrugged and left.
Several people attempted to engage me in conversation, but as no one phrased their comments as Yes or NO questions, I had to remain still. I was not unwilling to answer, simply unable to. But time and again they told me I was “unresponsive” or non-compliant, though I was calm and had been rewarded with the requisite assessment to possibly come out of restraints every fifteen minutes. But no one let me, because they would not let me answer their questions without speaking aloud.
The hours passed. First one then two then three. Finally the nurse Jennnifer decided to relent and allow as how I might answer the safety questions with a shake or nod of my head.
“Will you remain safe and not hurt anyone?” she asked me, standing above me.
I nodded my head.
“Will you remain safe and not attempt to harm y0urself?”
I nodded again.
Will you get up go back to the unit to and to your room and continue to behave safely if we let you out of restraints?”
Nod nod nod.
Jennifer seemed happy with my responses but also at a loss as to what to do with them. She paused. “Okay, thank you Pam. I have to go back and confer with Hannette and see if she will agree to take you out of restraints now that you have agreed to be safe.”
She left, turning her back, promising to be back within a few minutes.
Instead, it took a good half hour, and when she did, both she and Hannette arrived with a plan. “We have decided that we want to free up one hand and you will write a safety plan with the free hand. Then we will approve it and if it is adequate we will see about taking you out of restraints.”
I frowned. Even as she spoke, Hannette had moved to the end of the gurney where my stocking feet lay exposed. Her belly squished against my toes and soles of my feet, and I felt an immeidiate disgust and worse. I felt instant revulsion, as if I were being deliberately molested by someone who knew I was helpless to resist. So I kicked at her mightily. If I could have spoken in words I would have yelled something too, like “You effing …something or other…!” but alas, I could say nothing in protest, only scream, and kick. This did have the effect I wanted of getting her to stop and move away. Someone told her to move past me at the head of the bed next time and she did…
But the safety plan writing thing was their way of upping the ante abominably. How dare they? They had already illegally kept me restrained in FIVE points for far longer than necessary, just because they wanted to prove a point and force me to speak. without even offering me Ativan to calm down let alone to promote speech. Now this??? I flat out refused. And so somewhat triumphantly they trooped out, leaving me alone again, still in restraints at 6:00 o’oclock in the morning.
I knew I had to remain as still as possible to earn yet another assessment within the next fifteen minutes. But my muscles and veins hurt becuase I had remainedstill for so many hours, and no one had done any range of motion exercises on me, actively or passively. I was becoming afraid that I would develop a blood clot if I did not move my limbs on my own, and no matter what they interpreted it as, I began a methodical program of movement. I carefully circled each leg ten times in each direction, the restraints clanking as I did do. Then I bent each knee up and down, up and down. Ditto with my arms, until I was satified that I had exercised them at least a minimum and could relax into the required absolute stillness for the next fifteen minutes so I could earn an assessment.
Finally, Jennifer returned a final time. But this time it was only to tell me that they were leaving for the night. “First shift will have to take you out of the restraints. It is too let for is now.”
when end I herd this, I let out a bnshee scream of exhaustion and utter frustration, but it was too no avail. Only when first shift finally came on and found me still in restraints at 7:00 am did they relent and give me Ativan and take me out by 7:30.
I admit i had been slamming the doors at 2 o’clock in the morning but this never triggered anything before from the unbelievably patient and forbearing staff at Vermont’s Psychiatric Care Hospital, Unit D, except some bemused bewilderment at what had set me off and offers of PRNs to help calm me. After all, with only two other patients on the floor and those two either stll awake or dead to the world, it really did not matter if I raised a ruckus. But this time, because Hannette was the nurse on duty, my nemesis, it mattered a great deal more than it ought to have.
Instead of letting me slam my door a few times and cool off, as i had so often before. or if not, then opening the safety door so when I slammed it it closed only on air, thwarting my attempts to make noise….instead of any of these non-personal interventions, Hannette decided to take another route no one else had ever done. She came right into my personal space and inner sanctum almost no one ever violated without asking me first. Not only did she enter my bed room, but she came right to the door way of my bathroom where I had pulled my mattress and situated my small bedroom stall inside there underneath the shower head.
I stood on the mattress, by the toilet, higher by a couple of inches, boosted by the mattress. But Hannette pushed up close and yelled at me, “You will not slam any more doors tonight, do you understand?! You WILL CALM YOURSELF right this instant!”
That was like yelling at me, BE spontaneous! Yeah, right. I had gone to the med window at this state hospital I had been committed to weeks before, asking for a second tiny dose of Ativan for severe anxiety and because I had been unable to speak for a few days. The next day the people from my recovery residence were coming and I needed to be able to sleep to meet with them in good form and i had to have a voice to speak with them…
for years catatonia and mutism have intermittently plagued me, and it was only in 2003 that we discovered how effective Ativan was for catatonia…later on, when mutism was the bigger problem, Dr C decided to try it, seeing it as as a feature of catatonia, with good results.
However, here at VPCH the on-call doctor,Lasix, knew nothing about my relapsing mutism, nor my need for Ativan. He only knew about my complaints of sleeplessness and anxiety. So called around 1:30 AM he refused me a second .5mg dose and ordered me to try to relax on my own and sleep for another hour, before he would consider a second dose.
This is what occasioned, at 2:00 AM my panicked outburst of door slamming. But I did not start the melee that ensued. Properly the trigger was Hanette’s grabbing my wrists. She restrained me in such a fashion for some reason, but now I dunno why exactly. Maybe she saw my mute shaking my fists at her as threatening. Even so, she ought to have just backed away from me, having cornered me in the bathroom, where I felt threatened by her!
As it was, however, she approached closer and grabbed my wrists, another mental health specialist nearby saying at the same time, “we dont want to go hands on here at VPCH.”
“Then don’t grab my wrists!” I screamed silently. But reflexively and in terror, I bent to nip her fingers with my teeth in order to get her to release me.
Well, that of course was where all hell broke loose… and much more to say but the library hours end now so I have to leave this for tomorrow when I can spend more time at the hospital computer.
So, what happened next you can guess. She yelled for help and help arrived in seconds in the form of staff prepared to go “hands on” not only to stop me from biting her but to actually restrain me completely.
As they bodily hoisted me off the floor, screaming wordlessly, one man asked, “What now? And HAnnette answered promptly, “Seclude her!”
This horrified me. Not again, not a third time in weeks. not in Vermont where they were trying so they assured me everywhere to reduce these events to zero…This was ridiculous.
But Hannette had had it in for me ever since the episodes early on in my stay — when there had been forced medication, something my Advanced Directive had explicitly advised against for good reason, and which the “good doctor ” had for some reason seen fit to decide to go for anyway…with predictable consequences. So for several days as a result I had been a version of the Exorcist’s Linda Blair over that first week or two and that is only a small exaggeration. The foul language spewing from my mouth in hourlong torrents was utterly uncharacteristic of me, both in kind and sheer amount.
But it was now nearly week three and after I had filed a grievance, the forced meds had been stopped and so too my involuntary Linda Blair imitations. Only Hannette it seemed still held those horrors against me. Everyone else had been both forbearing during those horrendous days and extremely forgiving afterwards. What is more, during my outbursts, even when I tossed chairs and overturned tables, no one had over reacted or punished me for the extreme and extremely disruptive behaviors i had exhibited at the time, no one.
Only once, when I became apparently dangerous, did the charge nurse put me briefly in five point restraints. and that was when I literally splashed urine all over him and other nurses and urinated on the rug in public and then hit him and two other people…But at no other time did they even come close to suggesting involuntary procedure such as meds or seclusion or restraints. Or at least not that I knew of.
Now here i was being dumped in seclusion largely because Hannette had grabbed my wrists, standing too close to me in my own bathroom!
Worse was to come. After the panoply of staff dashed from the room, I ran after them in anger but they closed the door and locked it, locking me in alone.
Hopeless, I sat back down on the mattress dazed and sad but not moving. I heard them talking but scarcely listened, trying to calm myself and wondering how long they planned to keep me in this god forsaken room. Then I heard someone say, “She has her glasses and watch. We have to get them!”
Soon they piled in again, all of them on top of me at once, peeling off my two pairs of glasses and watch and my medical band. And then they searched me for pockets of which I had none. All this time I was screaming, wihout verbalizing a word…and fighting them in protest at the intense violation of my person. Then as they tried to dash off I followed closely and almost escaped the room with them. This time they did not succeed in closing or locking the door, no, because I was wedged in-between. So someone said. “Back inside!” and we all moved as one back towards the mattress.
I thought they were going to use the maneuver Scott , that charge nurse. had used the other time, to twist my arms and legs in such a way as to make it difficutl for me to untangle myself and give them time to get out before I could follow. Not pleasant for me but not painful either and rather clever nonetheless.
But no, instead, to my dismay I heard Hannette call, “Get the Bed.” The BED??? For what? What had I done to deserve The Bed????
But the bed was gotten and within minutes I was trussed up in FIVE POINT RESTRAINTS for nothing more dangerous that holding up my fists at Annette and nipping at her fingers when she herself had grabbed my wrists!!!!
The worst is yet to be related alas. much worse. But I do not have enough time tonight in the library to explain it all and I need to post it tonight or it will be lost. I go home to MRR on Monday , which may be news to many who have been wondering where I am or have been.
It has been a long long journey and it is not over yet. More tomorrow on this story and perhaps I can also catch you up on other parts of it as well. In the meantime know that VPCH is by and large a good place all told, just not a place to call home, not if you have any life of your own left to live.
“In India when we meet and part we Often say, ‘Namaste’, which means: I honor the place in you where the entire universe resides; I honor the place in you of love, of light, of truth, of peace. I honor the place within you where if you are in that place in you and I am in that place in me, there is only one of us." ~~Ram Dass~~