As I parked up my first morning, even above Slade’s Noddy Holder screaming “It’s Christmas”, I could hear screeching “I want my medication. I want my medication. Where’s my medication? I need my medication.” The poor neighbours either side of the building must have
been well p’d off. It was six forty-five, it was cold, pitch black outside and the street was eerily quiet other than the high pitched screeching coming from the Mental Health Rehab Unit.
Someone in the office by the front door pressed a button to let me in and I was greeted with this tiny little lady who grabbed both my hands and panted “Help me. Help me please. I need my medication. You’re new. Are you an Agency Nurse?” Will you help me.”
I spoke calmly but firmly “Listen to me, I can’t help you right now…” I was trying to calm her down enough so that she could hear me and take in what I was saying while trying to get her to take a breath as she was panicking and was as white as a sheet. I really felt for her.
“Please, please. I’m begging you” she continued to screech as I tried to disentangle myself from the tight grip she had on my wrists. The office door opened and a nurse yelled “Mandy, stop it, leave her alone. Mandy!” I’d now managed to get myself free but Mandy had grabbed the nurse and was pulling on her cardigan, all the while screeching “You’re a bitch. You’re a fucking bitch! Get my medication you fucking black bitch.” The nurse eventually pushed me into the office and she followed, turning to slam the door in Mandy’s face with a kiss of her teeth “Oh Lordy Lord. That Mandy. She will be the death of me. I am Ayo and who are you?”
I breathed a sigh of relief and introduced myself as the Student Nurse. “I don’t know. See how it is. I pray to God for her sins” she humphed. “Hmmm. Take a seat. Ah! Here comes the staff and I turned to see two females and one male puffing away outside, the ciggie smoke belching in the office window. “Tsk, I don’t know. Smokers heh!” said Ayo as she reached to slam the offending window shut. Seven o’clock on the dot the three members of staff traipsed in, throwing their coats on top of a filing cabinet. Lisa was first to introduce herself as the RMN, the shift coordinator and my supervisor then “That’s Lorna, she’s a qualified (RMN) and that’s Graham the NA (Nursing Assistant).”
“Okay.” started Ayo above Mandy’s screeching. “The lady herself. Mandy, she slept and now she has been shouting before six thirty. Lord help me! Everybody still in bed. Only Sasha, she awakes all night but she stay in her room. Somebody needs to clear her room. I saw the mouse there.” My feet moved on their own, up off the floor and I shuddered involuntarily as I looked around for the said mouse. Ayo continued and ended with “Moss needs to see a Doctor, his toenails need to be cut. It’s in the diary for this morning. Now I’m going home. Goodbye!” She pulled off her slippers and put them in her bag then huffed and puffed as she bent down to put her shoes on. She grabbed a large woollen blanket and shuffled out of the door.
Lisa went through the diary, handed out tasks to the other two and said she was doing medication and that I should shadow her. Lorna went off to wake up the other nine patients that lived in the ten bedded unit and Graham wandered off to the kitchen to prepare for breakfast.
With our coffee, Lisa and I went to the medication room, we were met with Mandy who was still gulping in great lumps of air, wringing her hands saying “Thank you Lisa.” and “Thank you nurse.” to me. I could get quite used to being called Nurse.
“Right Mandy. You know we start titrating down your Diazepam today.”
“No, please Lisa. Not today. I can’t cope. I can’t cope!” Mandy screamed.
“Nought point five milligrams Mandy. You won’t even notice it.” Lisa tutted and turned to me. “She’s been on thirty milligrams three times a day for years and you can see it doesn’t reduce her anxiety. So we’re going to try tapering down while she’s her in Rehab.” Mandy lived in a one bedroom flat and had apparently relapsed over a period of six months prior to admission to an acute ward. Once stabilised she was transferred to rehab.
Mandy had generalised anxiety disorder (GAD) which is a long-term condition that causes you to feel anxious about a wide range of situations and issues, rather than one specific event. People with GAD feel anxious most days and often struggle to remember the last time they felt relaxed. As soon as one anxious thought is resolved, another may appear about a different issue. Titration looked like it would go on forever, reducing her Diazepam by nought point five mg three times a day. However Mandy accepted the reduced dose and greedily swallowed down her all her medication followed by gulps of water then wandered off to the dining room.
We continued until each patient had had their medication then joined everyone for breakfast in the dining room because we were expected to eat with the patients each mealtime.
Coffee and toast with jam was just what I needed but as I sat to eat I was immediately struck by an offensive odour. One older lady to my left had obviously not washed yet there was another terrible smell. Graham screwed his nose up and said “She’s just sat there and shit herself and carried on eating!” to nobody in particular. “That’s Elsa.” he said with an Aberdonian accent. “She normally goes to the toilet but she uses her clothes to wipe herself and then hides them down the back of the toilets, eh Elsa? Elsa, say hello to Nancy, she’s our new student.” Elsa’s face was buried in the huge breakfast she was picking up with her teeth and she gave me a toothless grin. Nobody got up to help her and as I offered, Graham said “No, wait til after breakfast! This was rehab I thought. Does it really work?
Around the table, there was belching, farting and one young chap was snorting back the snot that was threatening to hit his top lip. He eventually gave up and wiped a huge glob on the sleeve of his t-shirt leaving a snail-like trail. Coffee finished, toast in the bin I helped clear the table and took my time in the kitchen. I was hoping that someone would deal with Elsa as I was already feeling queasy because I’d had to sit next to her throughout breakfast. She’d gone by the time it took to do the dishes but she’d left wet poop dribbling down the chair legs. Gloves and apron on and ten minutes later the chair was scrubbed and left outside in the back garden to dry.
Activities of daily living
To the bedrooms on the first floor now to try and entice patients to wash and dress before attending any appointments or activities. Oh my word! I’d knocked and opened the door to Sasha’s room and was aghast at the cereal boxes piled as high as the ceiling. At a guess I’d say there must have been over two hundred boxes and the only other floor space was filled by her bed and two or three black sacks. “Get out of my room.” stormed Sasha as she pushed past and slammed the door. I stood for a few seconds, stunned, then knocked and called out “I’m a student nurse Sasha. Is there anything I can do? Would you like me to help you clean your room.”
“Get lost.” Sasha muttered. I went to find Lisa and asked what I could do to help Sasha. “Not a lot.” Lisa laughed. “Her room’s been like that forever. She won’t let us in.” That can’t be right I thought, surely we have a duty of care? I went to the office to look through Sasha’s file and her painstakingly completed but outdated care plans to see if I could find ways to engage her. She was single, had no children and had been in care since the age of eleven when her mother couldn’t cope with her chaotic behaviour. She was thirty one and was diagnosed with Schizophrenia at eighteen. Sasha heard voices and was often heard talking back to them when alone in her bedroom. Apparently Sasha had no insight and didn’t believe she had a mental health problem. She’d been on the unit for six months and was awaiting housing but it was proving difficult to find a place that would meet her needs.
It was tiring but I worked hard with Sasha for the next twelve weeks, updating her care plans, engaging her in meaningful activities; things that would both interest and help her rather drum banging or painting by numbers. I appreciate that one of her care plans previously stated ‘Engage Sasha in activities.’ However, while these activities may help with dexterity and fine finger/hand movement I wasn’t sure that such things would support her development. It was clear that certain staff had intermittently tried to push Sasha into any activities and wrote in her notes ‘Declined to attend.’ and I wondered why.
I’d learned more about Sasha, along with others in the unit, and formed a professional bond with them. It was easy to see they weren’t interested in particular activities and that they had their own ideas about how to spend their time. At the end of my placement I loved seeing Sasha and the others laughing, smiling, engaging and growing in self-confidence and once again, I was sad to leave.
I would later bump into some these patients in various settings i.e. in the community or on the wards and I was either saddened by their relapse or delighted by their continued improvement.
Note to self: “Public service must be more than doing a job efficiently and honestly. It must be a complete dedication to the people and to the nation.” Margaret Chase Smith.