Tuesday, September 22, 2009

True Story Tuesday-Not Just a Fish Story

At night, if I left my window open, I could hear the howls and cries of the disturbed. It was eerie. Across a narrow drive, just yards from my nursing dorm, hundreds of troubled souls tried to find rest, just as I did. But by the sounds echoing off the walls of my small darkened room, it seemed that instead of respite, night brought terror and torment to many. Getting out of my bed and peering through the window, I couldn’t distinguish where the sounds were originating, I could just see scattered lights through the trees and frosted glass of the medical center’s psychiatric hospital.

The noises seemed to permeate my dorm room more than usual that night, a reminder that the next day I would have to face some of my deepest fears. I tossed and turned thinking of that what lurked inside of that dreaded building, only a stones throw. It would be the site of my next clinical rotation-Psychiatric Nursing.

A few short hours later, tired from a fitful nights sleep and full of apprehension, I found myself at the entrance of the psych hospital.

“Walk in, just put one foot in front of the other and go in,” I cajoled myself.

A dozen of my classmates had already entered the building, but I hesitated for a moment. Just the thought of going onto the locked wards was overwhelming. My experience with the mentally ill was very limited. Aside from seeing a few homeless people talking to themselves on the street, I had no idea what mental illness was all about. I was about to come face to face with the outcasts of society, the deeply psychotic, paranoid, delusional, and I found myself feeling powerless and afraid.

“Okay, when we enter the ward,” my instructor was saying as I caught up with my class, “I want each of you to find a patient to sit down with and talk to.”

A loud buzzing sound signaled the opening of the secure doors to the psych ward. My instructor left us, just inside the entrance, and headed to find the charge nurse. We stood there wide eyed and filled with anxiety about being left alone. A moment later the charge nurse joined us and gave a brief orientation. We wouldn’t find the patients in traditional hospital rooms, she informed us, as the patients were only allowed in their sleeping quarters at night. She then directed us to the dayroom. The dreary, grey-green dayroom was quiet when we entered. A couple of dozen patients, in their own clothing, sat expressionless on worn vinyl sofas. They were all in close proximity to each other, yet each seemed to be in his or her own world.

Over the week or so leading up to my time on the psych ward, my class was briefed in the basics of psychiatric nursing. The limited knowledge that was imparted to me seemed to only leave me feeling more vulnerable. I realized that simply conversing with the patients would not be enough. We had begun training in a behavioral medicine skill called therapeutic communication. This special technique would help us to connect with our patients in a more effective way and we were expected to apply it.

Reluctantly entering the dayroom, I noticed an empty spot on a couch next to a woman with a white towel draped over her head, looking like she had just stepped out of the shower. Timidly, I approached and sat down. Looking at the band around her wrist, I could see her name: Rachel Earl. Remembering that I needed to make eye contact, I positioned myself so that I could peer under her towel.

“Good morning Mrs. Earl,” I said softly, “My name is Julie. I’m a student nurse, how are you this morning?”

“Oh dear,” she replied, “I don’t feel so well.”

“So, you’re not feeling well,” I said, deliberately reflected her words back to her in an awkward attempt at therapeutic communication.

“I see you have a towel on your head,” I said, self consciously expressing my observation.

“Well, I don’t want my gills to dry out!” she said responded somewhat impatiently.

Oh no, what do I say to that?

“You don’t want your gills to dry out?” I clarified.

“Yes, I need to be back in water. I can hardly breathe like this.”

“Go on…” I led.

“The towels do help. They do keep my gills moist,” she informed me.

Be therapeutic, I must be therapeutic.

“Mrs. Earl, you don’t have gills,” I said gently, presenting reality, “You are a person, a human being.”

“No, I am a fish, you just don’t understand!”

“Would you please excuse me,” I said as calmly as possible, seeing I was clearly not equipped to deal with her, “I’ll be right back.”

Finding my instructor, I told her that my patient seemed to think she was a fish. She encouraged me to go and speak with one of the ward nurses.

“Oh yes, Mrs. Earl,” the nurse said, responding to my inquiry “the fire department was called to her home yesterday. A neighbor reported water flowing out of her front door. She had plugged up all of the drains in her home and turned on all of the faucets, trying to fill her house with water. Indeed, she thinks she is a fish.”

Returning to her side, I tried to think of therapeutic communication techniques that I could use to help her return to reality.

Self disclosure? No, I’ve never thought of myself as a fish, or any other animal or object.

Humor? Not unless, I wanted to be slapped with a fin.

Validation? It just didn’t seem appropriate.

No, as a first day psych student nurse who wanted to do no harm, I used my best therapeutic communication tool yet…I just sat with her silently. Calmly present, but silent.

That night, as I lay in bed listening to the turbulence of the psych hospital across the way, I pictured a little old lady who thought she was a fish. It was clear to me that my prior impression of people with mental illness was way off base. My fear had been unfounded. Now, my trepidation had been replaced by sadness. A sorrow brought on by a deeper understanding of the devastation of mental illness.

Today I am joining Rachel and Mr.Daddy at Once Upon a Miracle for True Story Tuesday. Head on over to their blog and read some usually fun and often hilarious stories.


He & Me + 3 said...

Oh that is so sad...mental illness is so devastating and sad.

Heart2Heart said...

WOW! I am so lost in that story that all I can feel is such compassion for those lost souls that remain locked away within the confines of their very minds. I could only imagine that Jesus would come and restore them to their former selves and once more they could find hope and love again.

Love and Hugs ~ Kat

Tranquility said...

Oh the poor thing. I can't imagine the anxiety of thinking your not going to be able to breathe and not having anyone who can help you!

Rachel said...

After years of working with delusional patients at nursing homes, all I felt was a deep sorrow for ones that would experience uneccessary fear and anxiety.

It begged the question of if you'd rather lose your mind and not know it, but be happy... or - just be sane and fearful.

Always admired people who could seamlessly bring a smile to either kind.

Thanks for sharing.

Beth E. said...

Bless her heart...and bless yours, too! You have great compassion for others. :-)

Mighty M said...

What a story.... I would have been so scared (like you) to even enter the building. I hope I never have to suffer - or see a loved one suffer - from a debilitating mental illness.

Belle (from Life of a...) said...

I wonder what in the world triggered THAT!

Rachel said...

Oh you little stinker! I was wondering (but too afraid to ask) if you'd used my name as a "names have been changed to protect the innocent" ;)

And you went and did it.

I guess it's better to be fishy, than to be the guy who thought you'd shoot him, right??? :)

~*Michelle*~ said...

Wow....what a story. I was thinking along the lines of Rachel with losing my mind but being happy or being sane and fearful.

God bless you for reaching out to the Lost....you are showing the compassion of Christ.

Beth in NC said...

Oh wow, that is horrible. God bless those poor souls.

Girl, I would have been terrified in a psych ward too. I don't even like going to nursing homes. Though those are the places that need God's light!

Foursons said...

Yeah, that would not be the job for me. I have a BA in Psychology, but that still would NOT be the job for me.

Pam D said...

That truly is sad. In watching the decline of my father-in-law, who was once an aeronautics engineer, I am heart-torn at how the mind wears out along with the body. The loss of who he was is devastating for my husband. But to be like that while still able-bodied is incomprehensible; it seems like such a terrible waste. I know that God can work good through all circumstances, but it's hard to find ANYTHING good in a place like that. Well, other than you....

blueviolet said...

It's terribly, terribly sad. I find it so hard to swallow that there are some people who will never really be helped to the point where they're functioning members of society.

Helene said...

That is so sad. When I was working on my MA in psychology, I had to do an internship at a therapy clinic. I encountered a lot of people who were mentally ill. The sad thing is that they truly believe what they say. I cannot imagine what's going on in their minds.

Orah said...

I remember during my psych rotation, thinking - this would be an exciting specialty to get into. You never know who or what you will meet from one second to the next. It would surely not be boring to be a Psych nurse. Then I saw a "take down" and decided ..... uh, maybe not.

Krista said...

This is sad, and it's one of the things I myself am nervous about as I go through nursing school. I've spent a bit of time working in an Alzheimer's unit, and although it made me nervous at first, I found it quite rewarding. Even though the patients usually aren't aware of the surroundings, it's rewarding to know that you are helping them in some small way.

Mr. and Mrs. Nurse Boy said...

WOW! You are a very talented writer!

Mrs. Nurse Boy

Stacie, A Firefighter's Wife said...

Hi there, another firewife told me about your blog. It's great to meet another believer/firewife!

This story is very sad. Mental illness is completely devestating.

Mr. Daddy said...

I always thought there was something alittle fishy about my Rach....ROFL.....

Lesli said...

Mental Illness is very sad. Not to have control over your mind has to be so scary. Sometimes it takes working in the medical field to actually understand that. My husband is a PA and he worked several years in mental health, it became so depressing for him that he decided to work in another department. It takes a very special person to work with these patients. They definitely have my respect! Great post!

Semi-Slacker Mom said...

So what happened next? Did you ever have any other dealings with her?

Becca~TimeWellSpent said...

I think my experience with mental illness was about what yours was. It was scary to me as well. Poor woman. It is so sad!