Thursday, October 23, 2008

Mental Health

Thanks to my dreadful schedule, it has been quite a while since I posted. While it is still manageable, I have less of a life than I did last semester. Here’s what I figure – you’ve got the first two out of four years taking pre-reqs, right? Those aren’t too bad; you get to set your own schedule. Then comes the second two years that are the actual nursing program. The first semester is pretty stressful, because you’re getting used to this strange thing called “being a nursing student.” But by the end of the semester, you’re like “Hey! This is a piece of cake. Bring it.” The second semester, the one I’m in now, takes quite a bit more of your life away – and a large part of it is with what I’d like to call busy work and other crap you have to do on your own time. The lack of actual classroom time fools you early into the semester into thinking this will be easier than before. Wrong! And from what I understand about the last two semesters, you essentially have no life. Every minute of your free time is now Nursing School Time. Every ounce of dignity you had left is sacrificed to the Holy University in hopes of gaining enough knowledge to pass the Blessed NCLEX. (Oh, and passing grades so that you get the opportunity to even take the NCLEX.)

Needless to say, many of my fellow students (as well as myself) have been ridiculously stressed out at the idea that, as the senior students whispered so eloquently when they thought I wasn’t listening, “If only they knew. It only gets worse from here!” I have heard stories of girls sobbing randomly while driving or eating dinner, or even tearing up in school after a test (“My god, I think I failed! My life is over! They’ll kick me out of the program!”). I have even seen two male students blow up at each other during class because one of them randomly yelled “Shut up” at the other. Madness and book, chair, and door slamming ensued.

Lucky for me, I had a great conversation with my mom and have done my best to be realistic about all of this, as any outsider may consider to be the easy solution. Don’t worry! There are only two more semesters, you can do this, you’re smart, you’ve got this far, take it easy. Easier said than done, but I’m working on it. I am so grateful that for some reason I’m handling this way better than I did last semester. A few weeks ago, I even thought I was becoming depressed again, because I stopped caring and I felt so overwhelmed. That brings me to the main point I wanted to make in this entry.

The people on the psych floor, and the days I’ve spent with them, have changed my life. I have no idea what it’s done for other students, but for me, it’s been huge. Listening to the suggestions made by therapists in group meetings have been helpful things that I can apply to my own life and my own inner thoughts (Step 1: Stop telling yourself you’re stupid, ugly, useless.). Hearing from patients’ mouths how they got over disturbing and horrifying abuses have helped me rethink some of the things I’ve gone through in my life and some of the pent up hatred I have – how you have to either forgive the person, or just literally let it go and not think about it any more. Denial is my preferred coping mechanism, but perhaps I can learn to think like they do.

The patients – they are so strong, and they don’t even know it. They are so brave and beautiful yet feel scared and hopeless. They buoy up everyone else, praising their peers’ efforts with words and hugs, but shredding themselves to ribbons with their own thoughts. The worst part is the guilt and shame most of them feel for being in a psych facility – they, like most of our society, think that the ward is filled with homicidal sociopaths and scab picking schizophrenics. That is the farthest thing from the truth. But to convince the patients that society is wrong, it’s okay to be here, you are so brave and strong for coming here for help – that is practically impossible.

If I could teach ANYthing to any of the people that might come across this blog and read something, it would be about the mentally ill. There is no reason for mental illness to be taboo – really consider it for a moment. Your skin, your lungs, your heart, they are allowed to get sick, but your brain is not? Why should all the other organs be allowed to get diseases and deserve treatment but the brain does not? A person with asthma deserves their inhaler, and the pharmacist won’t look twice at them when they order it. But the shame someone feels when picking up their Prozac – can you imagine how that might impact someone’s treatment and recovery when the pharmacy tech gives them the side eye and lifts their eyebrow in disdain?

My point to the world is this – there is NO SHAME is seeking treatment for mental illness, whether it is inpatient, outpatient, or seeing a therapist. There is NO SHAME in taking medication for your mental illness, even if it is for the rest of your life. It is medicine that keeps you alive, the same as insulin keeps a diabetic alive. Mental illness is no different than any other physical illness, except the unlucky people with mental illness have no physical proof of their pain. Please consider this the next time you come across someone with a mental illness, and do your best to not judge them – they have probably been through hell, and someday you or someone you love could also become a victim of mental illness. Keep in mind – the lifetime likelihood that a person will get a mental illness is thought to be over 50%.

Saturday, October 4, 2008


My patient, Miss Smith (not her real name), is sleeping once again, as she has been most of the day. For the third time, she forgot where she was and what day or year it is. For breakfast I had to feed her slowly, bite by bite, and she was very proud of how much she ate - the most expressive she was all day. "Will you tell my daughter how good I did?" she croaked hoarsely. After she ate, I gave her a bath, careful of her paper-like skin, and noticed just how frail she was under all her blankets. Her thighs were only a little larger than my upper arms, and she was so dehydrated that her skin was dry and flaking over most of her body. Prior to today, I was nervous about bathing patients and giving them "complete care," but this woman was child-like in her confusion and for some reason it wasn't awkward - it just seemed like something that needed to be done - the care she deserved.

All day long I wished for a smile from her, something to let me know that she understands I'm here to help her. Occasionally when she opens her eyes I see a recognition in her face, but her cloudy eyes blink and its gone. I checked on her nearly every twenty minutes on my 12 hour shift - one, because she was my primary patient for the day, and two, because no one else on the floor seemed to care.

An hour after she ate, I found her sleeping once again, covered in yellow vomit full of all the food I had so carefully fed her and she had so painstakingly eaten. I made sure she was not any more confused or unconscious, and then internally freaked out. I found the charge nurse and she kindly helped me clean her up and change the linens. Miss Smith was still confused and disoriented, but luckily no worse than before, and there were no signs she aspirated the vomit into her lungs. I was sorely disappointed that she got sick - especially because she had just taken her pills for the day and was malnourished enough already. I gave her another bath, but she was bewildered and only asked "Can I go back to sleep now?" in just about the saddest way possible, like it was the only thing she wanted.

Later in the day her IV became infiltrated, and I berated myself for not noticing it sooner. Her painfully thin arm had a swelled lump the size of a grapefruit near hear inner elbow, and in a way to make it up to her I continued heating a wet washcloth to help it go down, checking on her every few minutes. At lunchtime, they brought her greasy ground beef and noodles and green beans, and I tried to pick them out for her. She refused them and turned her head after two bites, and I was kind of glad - the sound of her grinding dentures made me nauseous. It sounded like dying, like a desperate attempt to make old jaws process forced food when the body just wants to give up.

She left me thinking about death all day, and now still. Not so much death itself, but this act of dying so slowly and with such little dignity. This wonderful 97 year old woman left me wondering what she was like when she was younger. I wished I could talk to her, and kept willing her medicine to start working so she'd really wake up. Regardless of the effectiveness of the medicine, her Alzheimer's would've undoubtedly prevented us from having a meaningful conversation. I wondered what growing up as a young black woman in the early part of the last century was like for her, and what effect living through the wars and Great Depression had, and whether some mistreated part of her from long ago made her frightened of me. Mostly, I wondered what I would do if I went into her room and she wasn't breathing. I asked my instructor at the end of the day, and she was chipper and made a joke. The other students in my clinical made a joke about a student giving CPR chest compressions to a patient in the ER last week, how maybe it was him that killed her. I was the only one who didn't laugh. I wonder if it's because I'm an atheist, that maybe I have a different outlook on death and dying, because it's so final - there is nothing else after. Or maybe I'm the only one that hasn't turned myself off and become numb to caring for a dying human being. All I know is that I don't want to become numb.