Tag Archives: nurse

Abuse, Health, Seclusion and Restraints

Five Point Restraints At Vermont Psychiatric Care Hospital (cont)

6 Comments

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.

 

 

 

 

 

 

 

 

 

 

 

 

Health, Poetry

SISTERS OF NO MERCY

4 Comments

POEM IN WHICH I SPEAK FRANKLY, FORGIVE ME

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, and you do it, you do it:
the searing flare of cobalt actually crackles.
This time you tell no one, the char too deep for pain,
until fear of worse trumps your fear of being taken away.

This is not the story of your life.
It’s not the story of your life–
but every time a hulking goon squad clamps restraints
around your flailing wrists and ankles, threatening
to prosecute you for biting those hands that shackle you,
you wonder if there will be any other…

© Pamela Spiro Wagner. All rights reserved (Please note that I request that you do not reblog, reprint this poem or save this poem for anything but personal use. The rest of this blog post may be used if you credit Wagblog properly.)

________________________________________________________

A new reader, Rachel, has had training as a nurse, and is not reluctant to share her insights from the other side of the gurney, so to speak. Her comments have been enormously illuminating to me and contain so much helpful information that I have asked her if I might post them on Wagblog itself so others might have the opportunity to read them “first hand.” I have collected all of the ones here at Wagblog (there are others on my http://www.aboutschizophreni.blogspot.com site) and will try to provide some context for each one so they make sense, if they do not by themselves.

This first comment was in response to my post, AM I CRAZY…Nov 4, 2012 — when I doubted the veracity, of fact if not experientially, of what happened to me at the ED last summer.

Here is what Rachel wrote:

“OH….. Pam. I completely relate to this post…

Is anything more traumatizing than not being able to trust your own perceptions? I don’t think so.

I have so much swirling around in my head that I could say about all this, it’s hard for me to sort it all out, but I will try.

15 years ago I went through nursing school. One of the things that was greatly impressed upon us in our training was the fact that medical charts are Legal Documents – therefore, you must be ultra-careful about what you write in the charts! Also, there is so much charting and other paperwork required, to meet the legal demands of insurance, etc., that it is truly impossible to do the charts “right,” and still find time to do the actual job of patient care. So… just because important happenings are not recorded in your medical chart, that should by no means be taken as proof that it did not in fact happen, in some fashion.

As for that security guard…. sigh… I’ve led a strange life… about 20 years ago, for part of one year, I worked as a security guard in a bank. The security guard who trained me was one very scary dude. All he did was talk about his wonderful collection of guns, and his beloved hobby of shooting those guns, and bragging that he would have made a satisfying career out of being a hit man, if it weren’t for these pesky laws against being paid big money to commit murder! I became so alarmed by this fellow’s homicidal rants and ramblings that I told our boss all about it. The male boss, a retired U.S. Marine, dismissed my concerns out of hand. “People who talk about killing never do it,” he said.

A few months after I left that job, the hit man wannabe shot his fiancée. It was an accident, of course, he having so little experience with guns….

I am so sorry for this latest cruel trauma you have endured, Pam. Just being treated so roughly is enough to put any person at risk of losing touch with reality. As the late Viktor Frankl, MD, PhD, survivor of nearly 3 years in Nazi concentration camps, said in his life-changing book, Man’s Search for Meaning: “An abnormal reaction to an abnormal situation is normal behavior.”

I believe that is probably what happened with you this past July. You were thrust against your will into an abnormal, traumatizing, soul-annihilating situation, which undoubtedly unleashed multiple memories of similar traumatic indignities in the past. You were being treated, not with the kindness and compassion that you needed and deserved, but with palpable disdain. Harsh thoughts and hateful emotions are communicated, far more than with words, via body language, facial expressions, the eyes, the tone of voice, the “vibes” – even a so-called dumb animal instinctively knows when it is not safe, when the people in charge are not to be trusted.

A nurse, concentrating on giving injections in the proper way and in the proper amount, is not going to be paying any attention to what exactly a security guard is doing, or saying. Also, if she realizes after the fact that she gave an injection for which the order had already been cancelled, I am sorry to say that too many nurses, AND nurse instructors, are NOT going to admit that in the chart. I know this, for I’ve witnessed it firsthand. It’s sad, it’s illegal, immoral, and potentially deadly dangerous , yet it is true.

As for having a run-in with a security guard who has a homicidal attitude? I’m sorry to say that they are not at all uncommon, either.

Did your terrified, traumatized mind fill in the blanks with words he did not actually say, as a way to make some kind of sense from what he had done to you? Maybe. But the fact remains that your autonomy, your power, your rights as a human being, were taken away from you, and you were thrust into a terrifying, traumatizing, abnormal situation. For you to be put into such an extremely abnormal situation, particularly in light of all the old trauma memories it undoubtedly evoked in your mind, an abnormal reaction on your part in such an abnormal situation is, really, truly, Normal Behavior.

Rachel

My response to her comment:

All I can say to these things, Rachel, is WOW! I may have to rethink my blog post. Maybe some of what I thought was not delusional but did in fact happen. For instance, I wrote so often that I got those 3 shots. Now I am thinking, maybe i did indeed get them, because why would I pass out so immediately from a mere 20mg of Geodon and 1 mg of Ativan. But with 5 mg of Haldol added it would make more sense.

As for the guard (I refuse to call them security guards as they provide NO security and are in my opinion out of control thugs) I think he may indeed have compressed my neck, if only by holding me down in such a way as to restrain me roughly. Whether or not he intended to strangle or kill me, I dunno. And I have no idea whether or not he said those words, only that they do echo precisely what those nurses said or I hallucinated they said over the hospital PA system about my phone call, which they claimed to have recorded and were also replaying over the same PA system…So if those were the same words, perhaps it was only a hallucination. But perhaps only the words, not the rest of it. Thank you SO very much for validating as much as you have. I truly appreciate your contribution to this site and hope you will continue to offer what you know and have experienced. It is so welcome!

Pam

Rachel’s next comment was in response to my two new artworks: first the Killer Nurse collage, and then the Monet “take-off” of Argenteuil boats at evening…:

…Killer Nurse, HAHAHAHA! When I was in nursing school, a group of my fellow students dubbed themselves (oh you are going to love this): “Sisters of No Mercy.”

They were, too! By the way, I was elected class president by my fellow nurse students, an honor I did not seek out. When I realized by the end of the first semester that I am not cut out to be a nurse, I thought I could not let down my much-younger classmates who had honored me so, by dropping out! Thus I kept slogging doggedly away, and made it through to the bitter end, making all A’s or 4.0s, I’ve forgotten now how we were graded. Then I took the final big test that determined one’s eligibility to get a license, shocked myself by scoring in the top 1% in the entire nation, gave the big Class President year-end speech at graduation, got my diploma, obtained my license, and…. I worked 3 or 4 days as a nurse, hoping to get my money’s worth out of my costly education, but I still wasn’t emotionally cut out to do the hard job of a nurse and I knew it, so I abruptly quit, and let my license expire.

If you have to be a “Sister of No Mercy” to make it in that profession, you can count me out!

Rachel

Then her latest comment is again in response to my blog entry titled AM I CRAZY? and  my response to her first comment.

You are most welcome, Pam, I’m so glad my words could help.

I just want to add this, though: most of the security guards I worked with so long ago were very good people. There was only a small percentage of guards who had that scary macho-swagger itching-for-trouble attitude. You find people like that in every segment of the population, as I’m sure you know. But it truly did seem to me that a higher-than-average percentage of such types are drawn to work that allows them to wear a uniform and carry a weapon and push people around. These types are more like children playing at cops-and-robbers, than adults doing a serious job.

On a typical day, standing around in a security guard’s uniform watching the world go by is the most boring job on the planet. When finally “something happens,” these “Make My Day” gung-ho types come alive, and in the worst way.

As for the job of nursing… that’s a very different thing. I worked for a couple of years as a nurse’s assistant, before I finally went to nursing school. Nursing is HARD. Really, it’s an almost impossible job. There are never enough nurses, meaning most hospitals and nursing homes are chronically understaffed, and therefore there is never enough time to get everything done that needs doing. The work is absolutely overwhelming at times. You can work your entire shift at a flat-out RUN and STILL not be able to do it all, and do it “right.” You need 6 hands, you need a stomach made of cast iron, you need a backbone made of steel, and you need feet that can take an unbelievable pounding.

A person can go into nursing with a heart of pure gold, caring and compassionate and empathetic to the max, and the day-in-day-out unrelenting MISERY you see all around you will either kill you, or make you harden your heart in self-defense. As a nurse in a busy hospital, a nursing home, and most especially in an emergency room, the world is one big gaping aching wound, a bottomless pit of sorrow and need, and nothing you do is ever nearly enough. You need to be in 10 places at once, doing 10 different things, and almost everyone demands and criticizes, if not the patients, then very often their family does the complaining.

Stay in nursing long enough, and it is almost impossible to hang on to both your sanity, and your heart. This is why I could not do it! I only worked one week in an emergency room, this was as part of my nurse’s training, and that one week of non-stop, often life and death emergencies, almost did me in!

As I read your vivid, beautifully written description of what you endured last July, I could SEE it in my mind. In the eyes of the nurses, you were not a suffering human being with worth and dignity and rights no less important than their own, you were merely an unwelcome interruption, a problem to be dealt with, quickly and firmly and with a minimum of fuss and paperwork. This was not YOUR fault, it was the fault of the system, for want of a better word.

But knowing how HARD nursing is, does not in any way excuse the harsh, hateful, disrespectful attitude you were shown.. yet it does, in my mind at least, explain it. I have seen and experienced it myself, from BOTH sides of the medical charts, this harsh, disdainful attitude.

I have witnessed this, both as a nurse-in-training, and as a patient. When you’ve been called from the bedside of a child whose body was crushed less than an hour ago in an automobile accident, and his mother is dead, his father is hanging by a thread, and if the child survives, he will most likely never walk again… and here is a patient who has nothing visible wrong with her, only she is “inexplicably” freaking out – the disdainful, put-upon attitude from the medical personnel who simply do not “get” the first thing about the very real horror of psychological distress, is very real. It’s not your imagination, and it’s not your fault, either. It’s just that they don’t get it, and they are overworked and exhausted and stressed and overwhelmed with the horrors of life in the trenches.

I hope you know what I am trying to say here? To you, in your time of extreme duress and suffering, the snappy bitchiness and cold-heartedness of the medical personnel, coupled with the terrifying physical roughness of the guard, must have felt so very personal. But YOU were not the real target, in my opinion. The nurse was probably (inexcusably!) bitchy because she was already behind in her duties when you were brought in with your immediate pressing needs, and the guard was probably an overgrown boy playing macho-cop-wannabe, who finally got to see some adrenalin-pumping ACTION.

Someday, if they live long enough, that guard, and the nurses, will become old and infirm, and they will most likely experience, in some fashion, what it is like to be the one who is disempowered, hurting, fearful, and in need of compassionate help, while being treated like they are nothing more than an unwelcome interruption, a pain in the ass, an unimportant, non-person. Someday, I believe, it all comes back around. At least, that’s my hope!

Rachel

Finally, the following comment concerns my post “Open Letter to Dr Deborah Weidner (Sept. 9, 2012)”

The memories this post brings back…. I was shaking inside as I read it. It was hard enough going through this kind of mistreatment as a powerless teenage girl in a state mental institution, I can’t imagine going through this now, at the age of almost-60. I’m so sorry you were put through this. Until I read this just now, I thought your emergency room mistreatment of last July was the worst you had gone through recently. But this…. I don’t know how you came through it. I think if this had been done to me, I would have permanently checked out of reality.

Your feistiness is what’s keeping you alive. The very thing in you that the “wardens” of the mentally ill want to drug and shame and torture out of you, that undying spirit of yours is why you are still here, still breathing, still functioning, and still able to coherently tell your story. You are amazing.

Rachel

Art, Health, Uncategorized

Art: Killer Nurse and Placid Seascape

7 Comments
We all know what happened next…8.5 by 11″ © Pamela Spiro Wagner All rights reserved.
Boats at Evening, after Monet, 11 by 14″ © Pamela Spiro Wagner All rights reserved.

I do not have a lot to say tonight after yesterday’s marathon writing session, but I wanted simply to share my latest artwork. The first one, the collage, is going to be part of a talk I give to a group in December…I won’t say to whom or where just yet. All I will say is that this is how most psychiatric nurses deal with patients: “You do what I say, or else…”

The seascape on the other hand was simply a doodle I did one day while looking through an art book. I saw this Monet of boats at Argenteuil and thought I would sort of copy it, though not really. I just didn’t have any boats or water nearby to paint, so I figured I would use his painting as a model, a close one, though I clearly did my own thing with it…(And I am no Monet!).

Art and artwork, Book, Drawing, Medication, Mental Health, Mental Illness, Schizophrenia, Uncategorized, Writing

From Memoir Sequel — A Little Bit to Entice?

1 Comment
Maybe not my book, but hands holding her favorite book!

You should know that what follows is just a tiny scribble of what I have written, and it might not even make the final cut once I finish writing the book. But I put it here as a little enticement for readers, a tempting snack to “grow the appetite for more” when it comes out. That said, I must warn that in addition to alerting you that the passage below might end up on the cutting floor, if it does not, it still may not start the book. But here I am hemming and hawing and making excuses. Nothing wrong with posting what I have for now, for the nonce, even though I may remove it later on. Comments on subtitle would be greatly appreciated. If you have suggestions for improving it — the subtitle, i mean — so much the better.

___________________________________________________

BLACKLIGHT:  a memoir of one woman’s fight to recover from schizophrenia

Blacksoup,  tarstew, coffeecombs – submerged in the darkness of things I cannot face by light, inky, skeletal, reaching-out things that pinch and grasp and touch, I fight to swim away, even though away means into a blinding headache. I am sucked down again and then again, until through pounding surf, someone calls my name, almost too faint to hear. Desperate, I thrash upward, cracking the surface of the day and open my eyes. It’s well after dawn yet all the lamps in the room burn brightly.

“Pam, wake up. Unlock the door. I’m here,” someone shouts. The door thunders on.

What time is it? What day is it? I must have plunged into sleep the night before without awareness, for all I know is that I break into daylight like a common mole nosing into what feels like leaf litter and detritus, the remains of an old picnic. Popcorn is strewn across my lap and chair in a white rash.  Resting on its side halfway off the night table, a cup of coffee, now empty, its contents on the carpet. I hoist myself off the recliner with a groan, trying to shake off my shoulders the gargoyles of nightmare. I sleep in my clothes but I never go barefoot –too liable to be bitten by the inanimate fang of a tack or discarded fork– so it takes me a minute before I can home in on my flip-flops.

“Sorry, sorry, sorry,” Wrenching the deadbolt, I yank the door open. “I didn’t hear you. You’re early today.”

“It’s 8:30. No earlier than usual.” Elissa, her dark hair pulled back from her face, carries her big nursing bag and tablet computer. She wears slim, tight jeans and a ruched tee shirt that make her look thirty-five at most, not the forty-something she rarely admits to. She assesses me quickly before coming in and asking, “How did you sleep? And did you eat last night?”

Almost every morning begins this way, not with the bleep, blurt or blare of an alarm, on which I can mash the snooze button. Not even with the sweet sun-rising tones of my favorites song on iTunes, no, my morning begins with this won’t-take-no-for-an-answer Thor at the door. It’s not Elissa’s fault. Sometimes I leave my door unlocked before I cliff-fall into sleep so she can come in on her own the next morning and gently wake me. But not always, and then what can she do but hammer at the doorway of Oneiros, because nothing else will rouse me.

Elissa has been my primary visiting nurse for more than 10 years and she is the one who checks on me every morning, rain or shine, snow or hailstorm. She can read me by now the way a farmer reads the sky, and just one look or something in the tone of my voice tells her when things are copacetic and when they are not. She has seen me well and she’s seen me precariously ill and she’s the first to recognize when I’m somewhere in-between, headed in the wrong direction. Her main job is to keep track of and make sure I take my medications, but when paranoid, I have yelled at her or been snappy and high strung and irritable. She has never taken it personally. I no doubt have driven her nearly to distraction but she flicks all away as no big deal. I must say though that even though I wouldn’t admit it at the time, she has in more than one instance saved my life.

She keeps returning with a smile nevertheless and now instead of telling her how glad I am to see her, I turn away, mumbling that I had a lousy night. It’s true, but I feel like a lout for saying so. Or at least for saying so first thing.

_______________________________________________________

Argh, now all I can see are the faults, but I will leave it as is, and not panic or take it down at once. I have learned that there is no terrible tragedy is letting people see rough drafts or the work-in-progress, though it be only that, a rough draft, not the polished version. If nothing else, it proves that I too am  a human being who must write and make mistakes before editing and rewriting my copy. In fact, I rewrite a zillion times before I am happy with what I have written. Each poem takes at least 20 rewrites, at a minimum, and most take at least 50 while some over 100. As for prose, well, I cannot even begin to estimate how often I rewrite or revise each passage. but needless to say it is well over 50-100!

Not only is there no shame in revision, I take great pride in how much rewriting and revision I do. It is a point of honor with me that I take this much time with my writing and do not hurry it — ever.  People who believe that the first words that come out of their pen or mouth or computer are sacrosanct are likely to not be real writers, only dilettantes who play at writing, but never take it seriously. Who want to write, but who never really do so, except for in the pages of a journal or doggerel between friends and family.

Do not get me wrong, I do not disparage this sort of writing. In a sense ALL writing counts as writing. And all writing is good for a person. But not all writing is publishable or suitable for the public consumption, and that is what I mean by writing done by a “real writer.” Someone for whom writing is what life is all about. Someone for whom life would not be worth while if she could not continue to write. Someone who knows the value of editing and revising and rewriting and who knows that a good editor can a writer’s best friend.