Memorial Day weekend was BIPOLAR week! Not only was 50% of the unit energized and manic, but hyper-sexual as all get out.  For those of you that have never been on a psych ward, sex is not permitted. Peoples judgement is just a tad off, so having sex with another mentally ill person is not a great idea.  Sure, it ensures job security for those of us in the field, but we've already got the ED stacked up with 20 patients waiting to get in...I'm pretty sure I'll have a job for the next few years.
This past week was "stinky person" week.  I HATE stinky person week! One of my fellow nurses was walking around the unit with a can of Glade! I have a weak sense of smell (which is quite handy for a nurse), but we had 2 guys that bowled me over gagging. This is when the no holes barred bargaining begins.  I mean we can't put someone in restraints just to wash them, not allowed to withhold food and fluids (in spite of the fact that no one else can eat within 10 feet of them), but there is always something they want, so let the negotiations begin! And this is key...when you finally get them in the shower in exchange for...maybe a status change or their Walkman....there has to be 1). running water 2). soap 3). more soap, and 4). a stealth move to grab their clothes and throw them in the washer X6 while they are naked in the running water with the soap. This step is imperative. Otherwise they will put the wretched clothes back on and the gagging will commence again.
For me, I'll take hyper-sexual over stinky every time, even though it involves 3 hours more paperwork if those hot and horny ones do hook up.
22 days off now! Yipeeeeeeeeeeee!

Katie Clifford, the author of the blog Replikate http://replikate.blogspot.com/ posted a song by Melanie. Folk singer and songwriter of the late 60's and 70's. Woke up a memory for me.

I'm lovin it!

Dreams Come True

I just finished reading a friends blog.....she wrote about a work experience, where a kid came in, got his 1st national team uniform for the Pan Am games in Houston. He was SSOOO excited! He tried everything on, he wanted pix to show everyone. He grinned like a little kid on Christmas morning. It was a "dream come true" for this young man, and Kate got to share it with him.  I felt jealous.
The only time on a psych unit that I get to see people dance with joy is when we admit a Bipolar patient in the midst of an acute manic episode. It's slightly amusing, but not always pretty.
So I had to stop and think....did I witness any joy, did I see a dream come true?  Well, no. But (always seeking the silver lining) I hope I did see a dream start. Or at least a step in the right direction....and it will be a long walk with millions of steps. I'll call her....Tiffany. She was admitted to us after her 2nd serious suicide attempt in less than 8 weeks. Although she is only in her 20's, she has spent just under 1/2 of her life in institutions. Her history is a series of traumas and one disaster after another. She of course, has Borderline Personality Disorder, along with a mood disorder, PTSD, substance abuse...
The change I saw was that we went from angry despair and hopelessness to cracking the door of hope open, just a tiny bit. Yes, I used the word "we", because the path is a joint journey. 1st I dragged her, then I could get beside her, and finally I could nudge her from behind, towards the door. She was the only one who could decide to turn the knob and find a glimmer of hope.
"Hope is a waking dream" : Aristotle
 Of completed suicides; 20% had a mood disorder, 15% had a personality disorder; 10% had substance abuse disorders. I am not naive. I do not have the power to make someone decide to live.
Maybe it's my dream. My hope at work is always the same. If I can help one person to choose life over suicide I have succeeded, if I can help one person out of that profound darkness, I have succeeded.
So this week, my dream came true. I can't speak for tomorrow, but I will celebrate today!

Oh those Older Folk!

I'm on my stretch off, but saw a Face Book post by a co-worker. A gay co-worker.  As in more feminine than I am.  Wondering if I'll get to meet this 97 (yep, NINETY SEVEN!) year old gem.

Mark's Post:

" Interesting verbal abuse from a geriatric patient. "you're a whoremaster! All you care about is women and booze! " I had stop and ask her to repeat it to be sure I heard correctly."

As Good As It Gets

I just finished working a whopping 4 day stretch that included Labor day. I try to follow the same patients, as continuity of care is really important to me. Somehow this week I got the OCD folks. If you have ever seen the movie "As Good As It Gets" you have a hint of hat these folks suffer through daily.
One of my patients has "pole vaulting pins". He checks EVERYTHING for pins. I didn't ask him what kind of pins ie: straight pins, ATM pins, surgical pins, lapel pins, push pins, steel pins, copper pins etc.  I do know they were NOT safety pins, cause the checking process lasted more than 10 mins, and exhausted this poor man.
So as I went to give him meds (OMG, 4 times a day), I gave him an empty water cup that he tapped upside down on the palm of his hand.  To get the pins out.  Just in case. After he had tapped this enough, he said "water" at which point I could fill the cup with water, and hand it back to him, so he could take his meds. PROVIDED I did not cross the cup over his med cup full of pills. Because some PINS may have jumped (aka pole vaulted) into the cup. His parents brought him in a metal detector. Really???
I also took care of a 31 year old woman (she looks like she's 15), who had the more typical germ thing going on.  Her hands are raw over the knuckles from cleaning.  Lord help us, it took 2 hours to have her shower/bath on Saturday. It would have been much shorter, but fool that I am, I agreed to supervise her so she could shave her legs and arm pits!!!!!  She had to clean the tub after each area shaved. She is also, a recovering heroin addict. She has been clean for 1 year now.  HOW THE HELL DID SHE SHOOT A NEEDLE INTO HER BODY??????????  They are always shared.  I would put on a Kevlar suit before I picked up a junkies needle.  To top it off, she has some psychotic thoughts! "Are these meds poison?". me= "No they are totally safe.  I will never give you anything that might hurt you".   I don't care how crazy you are, you deserve to feel good about yourself.....or how good you look.
She and Mr. Pin Man would frequently be at the med room door at the same time.  He would get nasty, she would get more paranoid. 
So I will take germs over pins any-day.

Treatment Failure; The Thin Man update

The Thin Man.

I am terribly sad about this....I learned at work a few weeks back that the medical examiners office (from a state about 12 hours drive from us) called one of our social workers, then spoke with the MD.  My wonderful, brilliant, humorous and handsome patient is dead.  I try really hard not to cry at work, but when I got in my car, I cried. 
In my line of work, what happened to him is referred to as  "Folie a deux", and it's pretty rare. In other words, he and his wife shared their insanity.  To illustrate: she ONLY came to see him on day of discharge to pick him up, and even then brought a VERY well know PhD and friend with her. She was afraid we would lock her up, she didn't know "the rules" of what you must say to get admitted to a psych hospital. He had prevented her admission to our hospital years before, with a convincing argument with the ER doc.
But, here's the word on the unit about it......she drove him to a hospital. She went into the ER and said her husband was in the car, and not well. No doubt the ER nurses and techs ran out to the car....and found a very dead man. In fact the ME reports he had probably been dead between 8-12 hours. Probably from starvation and dehydration.  This is a very painful way to die. There was no need for this to happen. This is what we call "total treatment failure". In psych, we don't normally have a lot of deaths. Yes, an occasional suicide, or sometimes even natural causes. But this????  It breaks my heart.
His siblings from around the globe actually called us, when they couldn't get him on the phone. Not the police, not his internist, and of course they had already spoken with his wife....who wouldn't ever put him on the phone. His social worker did call the police, who did do a "safety check".  That means they forced his wife to have him to come to the door so they could see he was there and alive.
His wife failed him.
His sisters and brothers failed him.
His friends failed him.
Our society failed him.
His world failed him.
I failed him.
I have always thought we should have a mechanism in place to "follow up" with our patients. I always write our phone number on the discharge instructions and say "please call if you have any questions, ask for me, I'll try to address your concerns, because it's so much easier than an ER visit".  Many patients have indeed called. I think we should make that phone call. But I have never pushed for this to happen.
Say a prayer tonight for "The Thin Man".
While your at it, say one for me. 

New Payment Plan

This has been one brutal winter. It's freezing in Northern Mexico, the Northeast has had record snows. Somehow, I still believe we are damaging our planet enough, and global warming is real.
But let's talk about the real problem. Weather forecasting.  CNN, The Weather Channel, NOAA, Fox News, weather.org...pick your poison.  These people are guessing. I'm sure they all went to college, got a PhD in weather sciences, but let's be honest. Their last semester they were given "the secret". A dartboard. Yep, no different than you will find in any fine honky tonk or bar across our great nation.
So I am proposing some changes. I want these people paid on commission.
A). the forecast is 100% accurate (yeah, that'll happen)= $10,000.
B). the forecast is so far off we all brought our umbrellas to work....to keep out of the sun? Oh I think not! minimum wage for 8 hours that day.Yes, Jim Cantore, this is how the other half lives.
Exceptions:
hurricanes. These storms can actually turn on a dime. However, should a forecaster get the location of landfall exactly right (after all, this would allow people to prepare and evacuate) $1,000,000. Yep, just like hitting the lotto.
Should a forecaster not make mention of an oncoming 100 mph breeze, no monetary penalty, BUT, the weather person and their immediate family (nothing like a little incentive from the home front) must live for 1 year (365 days and nights) on Ridge A. This homey spot is located within the Antarctic Plateau.  The average winter temp is MINUS 94 F.  Bring a coat.
http://www.telegraph.co.uk/news/worldnews/antarctica/6121866/Scientists-identify-coldest-place-on-earth.html
Shall we take a vote????

Say "Yes to the Dress"

Most nurses cringe when they are assigned to work with a borderline personality disordered patient.  I know this will make me sound as sick as my patients, but I LOVE THEM!! My sarcastic humor is built in DBT!
Nina was in this week...actually she has been in for several weeks. She was admitted with suicidal ideation just 3 days after getting engaged. This does not bode well for a 50th anniversary party, but none the less, she likes the idea that someone wants to marry her. Problem is they met in our cozy home a few years back. Only she doesn't remember him. She was in the middle of a course of ECT, which doesn't always cause memory loss, but I guess it did that time around. Maybe that should have been his 1st hint-but he missed it. They met up again a year or so later, and he told her how they met, and he's been carrying a torch ever since.
Nina likes to cut or burn her body. I'm OK with that. Unfortunately she keeps trying to bait me into some argument how I should be all upset about this. Nope, sorry, ain't going there. I just say "hey, when your doing well, and ya look down at your arms, your gonna constantly be reminded of all that pain. Sorta stops ya from moving on eh?".  Then she shows me a tattoo she got on her wrist where she had a nice burn scar-exactly, like I was saying. Now, the future mother in law wants to plan her big day...almost every detail, including maybe....wearing her wedding gown?? (Nina's mom passed away....we talked a lot about that, she carved the word "Mom" on her hand, but it kept healing and fading away..."sorta like grief is supposed to do?"). Problem is future MIL wants to have a summer wedding. "Most people do get married in the summer" I remind her. The question is why did it take me FOUR days to put 2+2 together? But when I finally had my "ah ha" moment, I nearly peed my pants I laughed so hard. Nina laughed with me. Future mother in laws dress has short sleeves for the beautiful summer day!!!!  It's too bad I didn't have a copy of a pix from my wedding day, with sheer long sleeves.
Hey, for me, it was just the right dress.

The Thin Man

It's rare after so many years of doing the same thing to stumble upon something new....well, not new, but a new version.
What do you do with a 50 something year old man, who is quite tall, maybe 6'3".....and weighs........128 lbs????  Not kiddin you! And that was with his clothes on...so maybe closer to the 124 mark.  He does not have anorexia, which is usually the only time you see someone this cachectic in psych. As a matter of fact, in moments of "awakening" he is a delightful man, funny, warm, brilliant.....and starving to death.  How it got this far is almost beyond me. But not quite, you see his wife will not come visit him, nor will she call the staff to see how he's doing. She's apparently afraid we'll keep her, obviously unaware of our "one family member at a time" policy. 
During his moments of lucid thought (he had one entire day over the weekend) he has tried to eat whatever is not nailed down. I had to stop him. Re-feeding a starving body has its own unique set of complications.

We do get calls from his siblings around the globe telling us what to do and not to do. I didn't have the heart, even after the 25th phone call to tell sis, 1). We are not new at this. 2). Have you SEEN your brother lately?  He wouldn't let me take a picture, but let me tell you, some of the survivors of Dachau looked healthier! I think the "standing by and watching someone die" was already covered by his wife, so we've crossed that treatment approach off our to do list.

I have twice had the pleasure of  bathing the Thin Man, so I've seen his body up close and personal. 2 amazing things. 1). His skin is (so far) intact. Kinda odd considering his nutritional status in not "up to par", and his bones stick out way farther than any other tissue. 2).  You could easily teach an anatomy class with this guy as a living example/skeleton. You can count each bone all 206 of them.

So exactly what is the matter with this man, you may ask? Here's my 25 cent diagnosis: he has a major depression, with psychotic features.  He has delusions (here we go again) vs. hallucinations. He chose not to (or could not) get help or have his depression treated, so typical of men! It progressed along it's merry way and invited some psychotic thinking to join in.  Fortunately his last healthy neuropathway was lonely and picked up the phone to schedule a check up with his internist (who, btw has called 3 times a week to see how he's doing), who booted his butt (gently, hence the still intact skin) into an ambulance and off to the hospital.

I like this guy. I wish I could tell you more about him....he has had a fascinating life so far.....but seriously, all that HIPPA stuff is real, and was around YEARS before the stupid HIPPA laws, which really have nothing to do with privacy BTW.  That's another soapbox story.

Dementia is a THRIFTY state of being!

So my significant other came home last night. I had arranged a trip to Colorado for him to help out our 24 year old son.  Tiling, spackling...a brake job. I stayed home to care for HIS Mom. I was way too pissed off to hear/see him.  Red wine does that to me. I am Holy Hell on wheels if I've had red wine.  He had NOT done the 2-3 things I had implored him to do, with repercussions.
So here is my current threat.  I will find an apartment in the spring and move out.  I can hardly kick the 92 year old MIL to the curb.  His siblings are 1000% worthless!  They want financial information.  Shit, we didn't get that when she was 1 day from being totally un-cared for. Guess I could have called Dept of Elderly Services and reported her abandoned.  I just thought that would be... like....unethical!  HELLO!!?? Do you leave a 92 year old alone just to get some cha-ching?  Gag me!

The good news is that she will read the same magazine 4-5 times in a single day.  So dementia is a thrifty state of being.  There is NO such thing as leftovers, it's totally new every night!!

People are treacherous creatures!

One of my patients is back.  Not unusual at all. I don't know why, but I get along pretty well with this fellow. Most of my coworkers see him as cold and bitter, but for some reason he cracks me up.  He worked as a psych tech in his previous healthy life, so he's been in "the business" so to speak.  Well the last time he was in I asked him to make some sort of a list...maybe the pro's and con's of having a disabling illness (yes kids, there are pro's, but that's another post entirely), maybe his strengths and weakness's....neither of us could remember.   What I do remember was that the 1st thing on the list was his view of humankind, "people are treacherous creatures".  That was the moment we connected as 2 people vs nurse/patient.  Don't get me wrong, I don't agree with him, and I don't normally laugh "at" my patients, but this slammed my funny bone!  I laughed so hard I had tears streaming down my face, and I couldn't stop. So why was that a "moment"? Because he started laughing with me. It took him a bit, but we all know what it's like to be sitting with someone who is busting a gut laughing!  You either storm out of the room (looking back I'm surprised he didn't) or you join in...and he joined me.  So he has joined the ranks of "my favorite patients", and it's not a very long list.
This stay?? We have something new to add to our list of secret laughs. He was telling me why he couldn't return to his current residence. Gangs, cops and his internist.  They are all in it together. I LOVE THIS!!! So he's going through this long convoluted story and I say to him "geez, you have a fixed delusional system"!  It was an "ah ha" moment for me.  He didn't like the idea (can't say as I would either). In fact he got a little defensive...duh! The next morning when I brought him his meds, as I was leaving the room he said, "and I do NOT have fixed delusions". I said "oh yes you do" and dashed out of the room before he tried to explain why he didn't. I didn't have time.  See that's the thing about fixed delusions. They are FIXED!!! There is no convincing him otherwise.  The good news is that the ECT he was having did not effect his short term memory.  What would I do if it did?? He would forget that "people are treacherous creatures" and that his world is a fixed delusion. And then what would we laugh about?

This is TOO much work

So, I'm reading my nieces' blog "Like Doogie Howser" and I try to leave a simple comment.  OH, hell no they say!! Must have a Google account.  Well, I have about 3, none of which I can recall the password.  Several trys later I give up, and post "anonymously".  Then I have to try to decipher those wacky words they now enjoy torturing the Baby Boomers with.  Then they text me a "validation code" which apparently must be used in under 15 seconds, or they send you another. Are these people kidding?? I have to at least FIND my cell.  Then find my glasses, then "accept cookies" (I'm sorry, do I look like I don't accept cookies??)
So, THIS TIME I really am gonna try to keep this blog going. I'm not gonna tell ya where I live or where I work.  Too much really funny shit happens at work, and it's all HIPPA protected.
I will tell you this much:

I make Mildred Ratched look soft.

I've been a psychiatric nurse for 32 years.  I could NOT make this shit up if they paid me.