A Care home Visit Today

Today I made a trip to visit my elderly Aunt Millie* who had been transferred from her group home to a nursing home.  She is no longer able to mobilize, and finally, after a fall at the home - was moved out to the "new place".

My mother was worried that Aunt Millie, her sister, might not adjust to the change.

Aunt Millie had never married, and she relies on the rest of the family - her brother and sisters -  to deal with the arrangements of her care.

She is a real sweetheart - a simple soul.

Arriving unannounced,  as soon as I walked through the door, she knew who I was and called out my name.  

A big hug and a kiss later, I guided her wheelchair back up to her room so we could have some private time to visit.

The nursing home is an older home in an established neighborhood.  Nice big yard.  Meals are provided. My aunt's Canadian pension covers everything -  with a little left over for essentials and the occasional splurge.  My husband looked at the photos of the home and told me he wished his brother had a nice place like that to stay in his final days.

Nurse that I am, I snooped around the place a bit. 

The bathrooms are spacious and very clean.  No "hospital" smells about.  It just seems like a regular home - except it isn't.  

I peeked in a few rooms - they all seem to be about the same, with two single "hospital style" beds in each room.  You know, the old kind that I haven't seen since the '70s with the handles at the foot of the bed that you have to crank the head or foot up or down.

Aunt Millie can't walk anymore, so I wheeled her around.  I tried to get her to stand, at least - to see how she manages.  Very unsteady. 

My aunt in the hallway

I realized she won't be using her walker anymore, but she still asked where it was. 

I went through some exercises she could do while sitting in her wheelchair.  Then she asked me:

" Am I going to get worse?"

What could I say?  It didn't look good.  I doubt that they have any aggressive physio programs at this place.  Even if they did - there is only so much muscle tone she will regain. 

After all, she is over 80 years old.  But - her father did live to 100.

All I could do is sit there and try and hide the tear trickling down my cheek.  

She didn't seem to notice.

Her Psalter Hymn book was lying on her bedside table and I picked it up.   Together we sang some of her old favorite hymns - some I hadn't sang for decades.  The sound of Her warbling voice singing those songs of old with such a conviction seared my heart.  It was all I could do to get to the end of the chorus.

I admire this lady.  She has struggled with schizophrenia for the last 55 years.

She was committed to  Riverview - at that time a horrible institution.  She said she hated it there because she said the food made her sick.  Matter-of-factly she told of the insulin administered to put her into seizures** - the current treatment back then.    Multiple ECTs followed.  

I remember my Mom telling me that she had almost died once.

Then all the medications, the extrapyramidal side effects from her antipsychotics.  The psychotic episodes when the medications didn't work.  The torment of having schizophrenia.

Through it all, she kept her faith. 

She never did have those outrageous religious ideations that some get with the psychotic episodes.

She still has her worries.  Her heartaches.  She still misses her mom and pop - although they have been gone for 25 and 18 years respectively.

As I left her at the door, I gave her another hug and kiss.

"I pray for you every night " she whispered in my ear.

I am humbled.

************************************

*Millie = not her real name

**Recent articles about insulin coma treatment have attempted to explain why it was given such uncritical acceptance. In the United States Deborah Doroshow writes that insulin coma therapy secured its foothold in psychiatry not because of scientific evidence or knowledge of any mechanism of therapeutic action, but due to the impressions it made on the minds of the medical practitioners within the local world in which it was administered and the dramatic recoveries they saw in some patients. Today, she writes, those who were involved are often ashamed, recalling it as unscientific and inhumane. Administering insulin coma therapy made psychiatry seem a more legitimately medical field. Harold Bourne, who questioned the treatment at the time, is quoted: "It meant that psychiatrists had something to do. It made them feel like real doctors instead of just institutional attendants".  wikipedia excerpt per link

Social Networks & Personality & Behaviors

Can't remember where I found this. 

I thought this was a great way to illustrate the Social networks out there and link them to the various behaviors....

I do Facebook and that's about it. Looking at the chart.....I think I am more of a "stalker" than anything....

I like to keep track of my many nieces and nephews without them having to go to the "bother" of contacting me specifically with updates.  It's a great way to keep on top of events and milestones.

It has also proven to be a great way for my cousins and sundry to keep in touch since we live in all four corners of this continent.


I just don't understand the need to twitter.  I guess that is my age showing.  But really, on Facebook, I do get annoyed when every. last. little. move. is. recorded.    I don't want to know ABSOLUTELY EVERYTHING.

If you were to stumble upon my Facebook page (highly unlikely due to my security level settings) you wouldn't know that I was an RN.....as there is absolutely nothing on it that indicates that in any way. 

I keep my work very seperate from my social life, and except for the occasional phonecall from rellies that want to know what such-and-such a symptom means....... I keep a low profile.

Oh.  Except for the occasional comment on how *nice* someone's veins are.......

Psych Nursing

I did work Psychiatry for a couple years.

 This is my blog from April 13th  - check it out.

 I am putting the original blog entries in their proper place - when they were first written  - and creating a link from these new entries. 

You certainly can see how things have changed.....

Psych and Me

I suppose I wanted a change from Surgical after a couple of years of nursing...SO....

I transferred to the Psychiatric Unit. There couldn't have been a more radical switch than this. I had really liked my Psych rotation as a student so thought that perhaps this might be a good change.

Interestingly enough, I loved it. For 2 years.

At first, I worked some day shifts and participated in some group therapy, but mostly I just passed out the chemical restraints/mood elevators, did one-on-one therapy - and SOAP charting galore.

What I discovered in those two years, was that the same patients rotated through the place - Revolving Door Syndrome. Drug induced psychosis. Depression. Paranoid Schizophrenia. Bipolar Disorder. Each one with Labels that we apply to a patient from the rapidly expanding DSM.

Did anyone ever get better?

I refused to learn to play pool with my patients because the cue looked too much like a weapon to me. (take note of phone assault story below)

On occasion we were assigned to patients that may have been a potential threat. I can remember taking an agitated paranoid schizophrenic male on a walk once – by myself. Looking back on it later, I shook my head, and promised myself, never again.

I am quite familiar and comfortable with schizophrenia having three relatives with that diagnosis. But a PARANOID schizophrenic is a whole "other ball of wax" (which btw is being dropped as a subtype along with others from the next edition of the DSM).

It was one of these types of patient that was the “person of interest” in a murder that occurred shortly after his release from our unit...his landlord/manager was shot. When he was caught - he admitted to the killing and also voiced delusional justification for his actions.

It was also a diagnosed Paranoid schizophrenic - and former psychiatric patient - that murdered my friend’s brother at a young age – plus 6 others. He is still locked up in a forensic psychiatric institute forty years later.

I am not trying to suggest that all psychiatric patients are dangerous. There is the mundane. And -yes - you can find these types of patients in all areas of the hospital – heaven knows I had more than a few in L&D.

It is just that the emotional/mental status is the main area of concern and the focus of treatment on a psych unit - and what you are dealing with isn’t something that is tangible and is definitely unpredictable.

My girlfriend that I worked with at the time told me about how she lost all of her upper front teeth due a patient grabbing a phone and whacking her across her face with it a few years back. There was no remorse. There was no recourse or accountability put on the patient – even in the court of law. "Nursing is your job - and this is one of the hazards of your occupation" is what the judge told her.

Our Psych Unit was fairly isolated at the time - and this was concerning especially at night when there was only one nurse on shift. There was a rehab unit through 2 sets of double doors – soundproof, unfortunately, due to a lack of foresight - just in case you had to yell for help - no one could hear. 

These doors were unlocked, so basically the care that our manager took to lock up our own knives under double lock on the Psych Unit was rendered moot. Not only could a psych patient sneak through those Rehab doors, but he could also slip unnoticed past the nursing station and into the Rehab kitchen where there was a big open drawer with a great assortment of very sharp carvers.

I switched to permanent nights and - when working on the unit by myself one night as per policy back then - an agitated patient rang. He was a young guy and had a history of making physical threats and he was upset that he couldn’t get back to sleep.

I tried to calm him - giving suggestions for relaxation - but he was too agitated to settle easily so I thought that maybe the chemical restraint approach might help him out a little - and offered a repeat prn sedative to him.

The medication room was a very small double locked cubicle, a room within a room, but situated away from the nursing station and the phone. No such thing as cell phones or even cordless phones back then.

When pouring meds, one had to stand back to the patient in an open doorway – no wiggle room.

Fairly unsafe, now I think about it – but that was the layout of the old unit. This particular patient soundlessly crept up behind me and smashed his fist in the glass in the door just inches above my head. I screamed, of course.

But – thanks to the soundproof unit - No one came running to help. No one could hear me. Lucky for me, this time, he didn't have one of Rehab’s knives.....

Shortly after that incident, they determined that one nurse was not adequate staffing and expanded to two nurses on nights. Thankfully it didn’t take a more serious incident to prompt the increase.

Sometimes the patients ran off, and we had to notify the local police of their departure so they could find them and return them. This happened more than once. After all, we were an "Unlocked Unit".

I can remember one young police officer who returned custody of one of our out-of-control patients kicking and screaming. This particular enormous patient had the tendency to strike out - and there was no way any of us could stop him if he felt the urge to run.

The officer stood in the doorway....and said...."you could try and stop these people at least...." to which I replied, "easy for YOU to say – standing there filling up the doorway with a gun on your hip...."

We would find the weirdest items in our patients' belongings when we did our "admissions search". One of the strangest - or maybe not so strange come to think of it - was a portable vagina...hair and all. I just couldn't bring myself to handle that one.

I think it was shortly after this that I pulled the plug and switched back to Surgical.
Wait a minute. No it wasn't.

It was during a one-on-one session with a very depressed young woman who just sat around doing NOTHING to help herself, brushing aside all suggestions - all the while complaining about everything going wrong in her life – I told her - "One of these days you are going to snap out of your depression and realize you are an old woman and will have done NOTHING in your life....."

Yes. That is when I realized I needed to get out of there. I don't think I was being therapeutic any longer.

I had put in 2 years and I was fine with moving on......

* picture of brain thanks to this site!

Posted by A NURSE at 11:22 AM

[comments were salvaged as below]

2 comments:
newnurseinthehood said...
Loved this. It really sums up the simultaneous frustration and fear and heartbreak that comes with working with these patients. I really wanted to work psych, but now that I've actually dealt with some of it, I know I'm not strong enough but I really admire anyone who can, even just for a little while.