Sunday, November 14, 2010

Welcome to the nuthouse.

I am a psychiatric nurse.

Psych is my nursing specialty by choice.  I've been told several times, by people who are or are not in the health care field, that I am not a "real nurse".  It is true that my day doesn't consist of hanging IV antibiotics, doing wound care on stage four pressure ulcers, or participating in codes.  But mental health care is still health care, and it is an important part of maintaining a healthy body and mind.

My job is less physically tiring, but more mentally tiring than your average nursing job.  I spend my days talking to people who are at what may be the lowest point in their lives.  And I'm not just having conversations; I have to monitor everything I say in the name of therapeutic communication.

I believe that mental health care is underfunded and overlooked, and that the stigma attached to seeking mental health care prevents many people from getting the help they need.  I take my job seriously and am passionate about mental health care.

That being said, let me share with you some key points regarding psychiatric nursing.

Bad Ideas That Get You Hospitalized:

  • Showing up at your local Emergency Room and telling them that you took an overdose consisting of a bottle of Vicodin when you actually only took ten tablets of Motrin.  They will pump your stomach full of charcoal, start IV fluids, put you on a 72 hour hold, and send your ass to me.  The ER staff and I will see your toxicology results and know you lied.  And if you did this to get the attention of the boyfriend/girlfriend/spouse who just dumped you, you have only given them another reason to breathe a sigh of relief that they are now free from your dramatics.
  • In the same vein *HA*, superficially scratching yourself across the wrist with a dull dinner knife, showing up at the ED, and telling them you tried to kill yourself.  Once again, you will be graced with my bright and shiny face for 72 hours.  I have cat scratches on my arms RIGHT NOW that are more serious than your "injury".
  • Ingesting mind altering chemicals.  If you decide to go against my advice, then do not proceed to get nude/run onto the highway/hump police cars/think you're the messiah.  If you're lucky, you will sober up from your ordinary marijuana high or LSD trip in my company over the next 72 hours, learn a lesson, and go home.  If you're unlucky, the marijuana you smoked may have been laced with PCP or formaldehyde.  Welcome to your first psychotic break!  Your brain is now permanently altered and the rest of your life will consist of crippling audio and visual hallucinations, delusions, and the horrible side effects from the anti-psychotic drugs you will now have to take for the rest of your life.
  • Threatening anyone's life.  Do not tell a co-worker you want to kill your boss.  Do not hold a gun to your spouse's face.  Do not try to run over your brother-in-law.  Do not beat your stepchildren.  It will take much longer than 72 hours to convince staff that you're "all better".  And threatening staff upon arrival to the psych unit, which may be momentarily satisfying, might just get you a 90 Day Certification.  Up to 90 days of ME as your nurse, hooray!  

Bad Ideas Once You Are Hospitalized:

  • Refusing to remove your shoelaces, belt, and drawstrings, or refusing to allow staff to perform a body search.  Congratulations, you now are a 1:1, which means a staff member will ALWAYS be within an arm's length of you.  Good luck taking a satisfying shit with an audience!
  • Refusing to give up any weapons.  If you're lucky, staff will quickly take you down to the ground, I will give you a shot in the butt, and you will have a nice eight hour nap.  If you're unlucky, staff will call the police, the police will hit you with the Taser, and you will go to jail.  Either way, the weapon will be given up.
  • Threatening to hurt staff or other patients.  My staff just drank two Rockstars apiece and are looking forward to burning off some excess energy.  Once again, you will be taken to the ground, shot in the butt, eight hour nap.   Plus, this little show guarantees extra good behavior from your fellow patients, who just witnessed the event and saw me smile as I gave the injection.
  • Hurting yourself superficially on my watch.  Since you have very limited options in the carefully controlled environment of an acute psychiatric unit, you have probably scratched yourself with your own fingernails, on the toilet paper dispenser, or using the radio antenna.  If it was the first two, you will be instructed to talk to staff when you feel like hurting yourself, and then any other attention seeking behavior will be ignored.  If it was the radio antenna, your peers on the unit will make your life miserable when we remove the radio from the milieu due to your antics.
  • Hurting yourself seriously on my watch.  To the drug addicts who punch walls or slam hands in doors--was the permanent nerve damage really worth the Percocet?  To the suicidal with serious intent--please talk to staff.  I'm not being heartless when I take away your bedding, I'm keeping you safe.
  • Staff splitting.  If one staff member tells you "no", do not ask the same question to another staff member.  We will find out what you are doing and you will lose all privileges.  Say goodbye to your cigarettes and the telephone.
  • Forming romantic relationships with other patients.  This turns out badly in so many ways.  And please don't try to have sex on the unit.  We will find you during the act.  You will be moved to another unit.  The only other unit available is for the actively psychotic and it is scary.  And good luck with your newly acquired Hep C.
  • Trying to manipulate me, your nurse, into giving you extra pain medication or benzos.  I'm talking to you, detoxing addict who doesn't want help.  We call this "med-seeking behavior" and I am charting it on your record right now.  I understand that as soon as you are discharged, you will go back to your Oxy/Perc/Xanax/Klonopin abusing ways, but I will never be your drug dealer.

Good Ideas:

  • Out-Patient: If you're feeling depressed, go see someone.  If you're feeling suicidal, GET HELP.  If you're embarrassed, get over it!  There is no shame in getting therapy and/or taking medication.  Listen to your therapist/psychiatrist and do what they say, no matter how stupid or silly you think it is.
  • In-Patient: Play an active role in your treatment.  Do our packets and questionnaires.  Write in the journal we give to you.  Participate actively in groups.  Talk openly with staff.  We know that this is a hard time in your life, and we are here to help you.  But we cannot do the work for you; we can only give you the tools to help yourself. 

I have only scratched the surface on the topic of psych nursing, but I am going to spend the rest of my day off NOT thinking about work.  

And to the public--stay crazy, I need the job security.

Monday, November 8, 2010

Snoring is stupid.

Before I get to the main topic, snoring, I want to share a conversation I just had with my spouse.

Me: *flopping down on the bed*  "I was going to blog something but I'm just not in the zone."
Zac: "You better get in the zone, or you're just going to peter out and never write again..."
Me: "Whatever!  I tried, and I have ideas, but I just can't do it."
Zac: "Go blog about how I was snoring earlier."
Me: "What, that you were snoring earlier?  That would be one sentence.  You were snoring earlier."
Zac: *relates previous snoring incidents I could write about*
Me: *getting off bed* "Fine, I'm going to go blog about you snoring."
Zac: "Don't force it or you won't be funny."  *as I'm walking out of the room*

Zac's verbal and nonverbal messages to me are always this super consistent. 

Anyway, Zac snores SUPER LOUD. 

When I am tired or when I have to be up the next morning, this makes me angry.  Not just somewhat ho-hum irritated, but red faced, clench-fisted, hypertensively angry.  So I shake him, wake him up, and tell him to stop snoring.  After this happens several times, we yell at each other, say we're sorry, and then Zac goes to sleep in the extra bedroom.  I used to think that it was bad or unhealthy for married people to sleep apart if they were in the same house, but I think the extra bedroom has saved Zac more than once from being suffocated in his sleep by my favorite pillow that I got at Walmart that is the OPPOSITE of memory foam of which I detest and may be the topic of a later blog post. 

One time, when Zac was snoring super loud and I didn't have to be up early the next morning and therefore wasn't in a red rage, I decided to record him with my cell phone.  Zac doesn't understand the volume, intensity, and lack of rhythm to his snoring and it was going to be awesome to have proof.  So I recorded it and then played it for my own enjoyment.  The recording came out so loud and perfect it surprised me and was super funny and I couldn't stop laughing and my laughing woke Zac up so I played the recording and he said "that's not me you made that up" and went back to sleep.

Sometimes the snoring will wake me up, but most of the time I am never asleep by the time the snoring starts.  This is because Zac falls asleep five seconds after he closes his eyes.  I need at least 30 minutes to flop around in bed, tell my brain to shut up, try to distract myself with thoughts of kittens and cake and cookies and nachos...and then I need a snack so I go downstairs, bring my loot back upstairs to eat, forget a drink so I have to go back down then up my fud, finish watching whatever TV show I put on to watch while I ate, lay back down, think about all the mistakes I made at work that day or all the socially awkward things I said to acquaintances, beat myself up, tell my brain to shut up, and so on and so on...until I eventually tire myself out enough to pass out from mental exhaustion...either that, or the Lunesta finally kicks in.  So we tried to have me fall asleep first, but it rarely works. 

Also, sometimes, I will hold cat fur or blanket lint under Zac's nostrils and see if he will suck it in.  I'll try and get a video of that next time.