Writing as patient care

I remember a rough day, one of my last days in the hospital. I had a patient immobilized from the waist down and fresh out of surgery who could. Not. Stop. Peeing. In her amnesiac withdrawal from anesthesia, she was rapidly cycling through refusing to use a bedpan and demanding a bedpan. It was madness. An hour of back-wrenching linen changes and getting yelled at.

I can not tell you now how much I miss even those days. As a complete digression, I am made crazy by the challenges faced by nurses (and all clinicians) on the hospital floor, how it is everything but the patients that drives us mad. How many of us are forced to choose between the career we worked to hard for, our calling, and our own health and family. The American Journal of Nursing addresses the concern.

But hospital or no, I observe and I care and I’ll never not be a nurse.

Today I spent a minute in the Sylvia Plath exhibit at the National Portrait Gallery. Visiting with my son for a family event I just happened to pass the small room of framed letters and photos. I dragged him in, promised a treat if he’d chill for just 5 minutes, and let him tap sounds out of the installation of bell jars while I read.

In her letter, pinned just below a smiling photograph of Plath taken 6 months prior with her two very young children, I saw the lines that made it clear why a week from that day she would be dead by suicide.

She was getting over a terrible flu. After much distress, she had left her husband with babies in tow. Fled the comfort of their country home to a flat in London. It was the first week of godforsaken February. The longest, darkest, depressionest month.

February 4, 1963
“Everything has blown and bubbled and warped and split—accentuated by the light and heat suddenly going off for hours at unannounced intervals, frozen pipes, people getting drinking water in buckets and such stuff–that I am in a limbo between the old world and the very uncertain and rather grim new.”

So here is where writing can be patient care. Always be assessing, always be educating. You can do it with a dead mid-century poet if it makes a piece of writing.

Plath is in a volatile state, the responsibilities of motherhood on her shoulders, just separated from the comfort and support of friends and familiar places. The pipe freezing signals her loss of control. Her limbo between old and uncertain and grim? An expression of hopelessness.

It’s no revelation that Sylvia Plath was depressed a few days before her suicide. But by seeing her as not an hysterical artist inclined to shuffle off this mortal coil at a moment’s notice, and instead as a person, mother, a sufferer of a common condition, she is a

I recognize her words as if they were my own read back to me. Because they were my own, not long ago. The remark “I long to have somebody really play with and love the babies…They are so beautiful and dear and will in effect have no father.” This kind of loneliness, where you seek for someone to share love for your precious child, is crushing. And in the worst of depression: losing the ability to play with you babies, lacking energy, lacking interest. Having failed to mother, life’s most important task, why keep fighting? For me, someone noticed. And they got me help.

Hearing words like those of Sylvia Plath in her last days come from the mouths of friends and family should spur action. Recognize a mental health crisis. Help us take care of each other better. Be there at the bedside.

And as a writer, considering anyone who reads this my beloved patient, now you know. I’ve told a story that educates you. Listen for that tenor of in the speech of the people you care about. And to recognize it in yourself. Like a good nurse, assess, then act.

Also, why isn’t February Mental Health Awareness month? It is rough out there, folks. Take care of each other.

St. Elizabeths Asylum, Washington, DC.

Lo, I did write thee a splendid piece on my visit to the National Building Museum exhibit on Washington, DC’s great Asylum hospital, St. Elizabeths (no apostrophe). But ay I did it waiting for a surgery to close, needing something to do something with my nervous energy. The patient, when asked the standard pre-surgical question “Why are you here with us today?” (assesses orientation, assures that the patient is informed, confirms procedure), answered “I am dying.” Always believe the patient who says they are dying.

Crash cart at my side, fellow nurse and I finished planning our I-hope-this-doesn’t-turn-into-a-code, I typed out a gem. And upon finishing, ran off to do a thing and lost it.

Instead, here is an excerpt of a letter written by Dr. Charles Nichols, superintendent, to Dorthea Dix (nurse, hero) the greatest advocate for mental health that ever lived whose actions led to the establishment of the hospital, on the selection of a site.

The moral treatment of the insane, with reference to their cure, consists mainly in eliciting an exercise of the attention with things rational, agreeable, and foreign to the subject of delusion; and the more constant and absorbing is such exercise, the more rapid and effectual will be the recovery; but many unbroken hours must elapse each day, during which it is on every account impracticable to make any direct active effort to engage and occupy the patients’ minds. Now, nothing gratifies the taste, and spontaneously enlists the attention, of so large a class of persons, as combinations of beautiful natural scenery, varied and enriched by the hand of man; and it may be asserted with much confidence, that the expenditure of a thousand dollars each year, directed to the single object of promoting the healthy mental occupation of one hundred insane persons, with either amusements or labor, would not be so effectual in recalling reason to its throne, as will the grand panorama of nature and of art, which the peculiar position of the site chosen happily commands. The shifting incidents of the navigation of the Potomac, the flight of railroad cars to and from the city, the operations at the Navy Yard, &c., will continually renew and vary the interest of the scene.

It lifts my iron anchor of a heart to read about this period in time, the asylum movement. Started by Quakers and somehow collecting political support for the mission to create a place, tranquil and serene, to house and heal vulnerable, imprisoned, and cast away persons suffering from mental illness. Public funding! Our government and the people it represents setting aside money to better provide for its poorliest members. Acknowledgement that all people have dignity and value.

**I know you’re thinking asylum? You mean those places where people are locked up and tortured and experimented on? Yes, terrible. But I’ll refer you to the many, many atrocities committed against those walking free: people of colorindigent people seeking care at public hospitals. Medical ethics has an awful lot to answer for. It’s my speculation that we pin it all so easily on asylums, place all our unquiet ghosts there, because of the fear and stigma bound to mental illness. Chew on that. I digress.

Asylums were conceived in goodness. Every pure-hearted reformer may know exactly where the road paved with their good intentions will end up, but I’m glad that they’re trying. We keep trying. We should always be trying.

PS- As Dr. Nichols states, I’m in favor of doing anything that “recalls reason to it’s throne.” Especially in this nuthouse town.

Obama’s Op-ed

 If the criminal justice system is the largest provider of mental health services in the US, then I think Obama’s executive action on solitary confinement is relevant health policy. Give the op-ed a read. I’m enjoying so very much the final lap of his presidency as I see, to quote him quoting every lapsed Catholic’s favorite pope, “every human person is endowed with inalienable dignity” written all over his moves.

A father’s scars: For Va.’s Creigh Deeds, tragedy brings unending questions – The Washington Post

A father’s scars: For Va.’s Creigh Deeds, tragedy brings unending questions – The Washington Post.

I’ve been sitting on this for several days trying to think of what to say. Ultimately, what comes across in the beautifully written article is how completely, tragically unresolved it all is. Personally for Deeds. By extension for everyone else that has felt the isolation and suffering of loving someone with mental illness.

A few months before I began nursing school I was working for a non-profit doing case management for young adults. My co-worker and I split up the less desirable community functions, so that week he took the career fair at the local high school and I took the meeting with the director of the locality’s CSB (community service board) at the social services office.

Virgnia’s CSBs are tasked with providing a locality (usually a few counties) all legally mandated mental health, intellectual disability, and drug and alcohol recovery resources. They evolved in response to the deinstitutionalization movement that took place between the late 1950s and the 1980s (that is a doctoral thesis in itself, but check pg 1 of this report for a quick overview). Among many other functions, CSBs are the people that you must go through to have an person evaluated for commitment to a pysch facility against their will. They are legally responsible for providing a wide array of services to a vast and growing population, and they are so so desperately underfunded. At Rockbridge Area Community Services psych staff includes an RN, LPN, case manager, 2 psychiatrists, and 2 “telepsychiatrists.” Although not listed on their site, in my experience the professional staff are often part-time and more or less donating their services in addition to maintaining practices of their own. This skeleton crew is required to cover heartbreakingly vulnerable people 24/7. What about private providers? I’m a rural county, and so is Bath. Here at home we have zero mental health providers. In our neighboring country there are 2. There is no financial incentive to practice here.

Back to my story. On time for once, I sat in a small conference room with 10 or so social workers, free clinic volunteers, non-profit people, a few teachers. The standard frumpy, knitted brow people that give their lives to others for peanuts and are a little peeved about it. The CSB directer started his PowerPoint. People. Kept. Coming. More chairs were pulled in and the corners filled up with awkward standers. The PowerPoint went off the rails. It was 150 degrees in there. Voices were raised. “The wait list is 6 months long! I can’t let my erratic off-her-meds client be the caregiver to small children. What am I supposed to do!” His advice: go to the ER with a credible suicide threat and we can bump her to the top of the list. She’ll get seen in a week. The sheriff added, “Several times a week all my deputies are stuck in the ER for hours with a person who has threatened themselves or someone else. You come to the hospital and give us the order to detain them (Emergency Custody Order) and we spend hours driving the person to the closest in-patient psych unit if a bed can be found at all. I can’t afford that!” The “ECO” is time limited. For Gus Deeds time ran out before a facility could be located.

The meeting was an hour over time. The CSB director was pulling out his few remaining hairs. When all was said and done every single person in that room had a story about themselves or a loved one failing to get access to mental health services. I went home and ate a refrigerator of feelings.

How can we all have such intimate experience with the burden of mental illness and feel so ashamed to bring it up publicly? Schizoaffective disorder affects 1 in 100 people in the US. Bipolar is more than twice that. Let’s run some 5ks for goodness sake.