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.