Acute Mental Health in-patient ward – my first morning

Beyond the door, people were milling about in all states of undress, one lady baring her breasts as she had a hospital gown on backwards and the ties were undone. Fortunately she had pants on, albeit they were large white paper ones, which covered her modesty. Others had hospital-issue pyjamas bottoms on, some bare-chested and bare-footed while some had on what looked like their own dressing gowns, clothing and footwear.

More dusky coloured walls on the left with old artwork, curling at the edges and hanging precariously with tattered tape. A large perspex covered board with photographs of unsmiley people and nametags, who appeared to be staff, hung on the right alongside a board that held welcome leaflets and other ward related information. Looks like someone had a fallout as they’d scribbled on the perspex over one particular face.

Heart thudding and having pressed the buzzer to get in I watched as this guy, who looked like an all-American Quarterback with a huge white smile, sauntered lazily towards the door. He unlocked it with one of the keys from a large bunch and nodded me in then he locked the door behind me. I guessed that, because he had keys dangling from his belt, he was staff because other than the pyjamas, it was difficult to identify who was a patient and who was staff on the ward. Man mountain introduced himself as Sam and pointed me toward the nurses office where I stood for a few seconds, hoping one of the three people in there would let me in.

“Hello. You must be Nancy, our new student. Come in now, come sit. Moreblessings get up and give this wee lady a seat now”. A young Northern Irish guy in jeans, sweatshirt and trainers raced on “I’m Derry, that’s Moreblessings and there’s Abimbola, Nancy. Would ye like a wee cuppa tea Nancy, would ye? Give us a wee minute and we’ll get ye one, eh”? I loved him already and despite some humphs and tuts from Moreblessings, I knew I was going to like it here.

The office was tiny. There was a rickety desk with some stacked filing drawers, a telephone and some office paraphernalia on it, and two old swivel chairs. Two battered-looking four-drawer filing cabinets stood opposite each other, a formica top stretched along one side of the office and held the fax machine, photocopier and few loose files. Above was a couple of  flimsy shelves holding lots of precariously balanced files and some nursing books. Dressed in a neat flowery jumper, calve length skirt with thick black tights and flat black shoes, poor Moreblessings huffed and puffed her bulk out of the chair in the far corner, between the filing cabinets, to give up her seat. Derry slid into the empty chair, leaving his chair for me.

Just at that, the office door burst open and in bungled two others, out of breath and laughing as they attempted to get their coats off in such a small space. “Yer late again Alison, Fadhili. Come on now. Hurry up.”

“Keep your hair on, I’ll just grab some coffee.” giggled Alison as she winked at me.
“You’ll just not. Come on. Some of these folks want to go home this morning.” said Derry. “Anyway, this is Nancy, our new student.” he added. Alison smiled and Fadhili nodded at me. The heat from our six bodies made the office window steam up and I was getting a rather icky whiff of body odour, badly covered up with strong but not unpleasant cologne. However, as Alison sat her neat bum on the table edge, she was closer to me and the sweet and floral scent that she wore was way more appealing. She too was wearing faded jeans with a striped shirt and trainers while Fadhili had on trousers, a shirt and tie and shiny black shoes.

Derry looked towards Abimbola who started to read out names from  a large whiteboard on the wall. “Helen, slept all night, no problems. Peter, he’s okay, just waiting to go home. Isaac, restless and sat in the day area most of the night.” He went on, discussing the twenty patients on the ward that morning. This was called handover and it happened at the beginning of each shift. It was brief and didn’t give me too much information but I dare say, enough to begin with as I had to memorise the staff names first. Finished, Abimbola snatched up his coat and heaved his large frame through everyone and left the office, waving wearily as he went. It was like a mass exodus then, as everyone else made a mad dash too.

“Coffee Nancy?” I heard Derry say over his shoulder as he went next door to the kitchen so I followed him and said I’d have a coffee with milk. Out came the toaster, cereal and coffee mugs, clattering onto the stainless steel worktop and I watched as some staff helped themselves to breakfast. Derry just made two coffees and handed one to me saying “Do you smoke Nancy?” As I nodded he made eyes at me to follow him and we crossed the narrow hall to the smoking room.

We walked into the stench and brown hazy fog of cigarette smoke, that you only get when there’s no ventilation.  Despite the windows being open, they only open about half an inch, obviously so no one can escape. Several pairs of eyes turned towards us, though many remained staring blankly at the grubby floor or at the the filthy windows. Derry sat on one of the chairs, inviting me to sit next to him and I tried hard not to show my disgust at the state of everything; the chairs with cigarette burns, the floor where people had missed or just ignored the dejected looking dustbin in the corner together with the smoke stained walls and windows.

Still, I smiled around nervously and offered my introduction “Hi, I’m Nancy and I’m a new student on the ward.”
“Alright Nancy. You got a spare fag?”
Derry interrupted “Pete, the wee lass just started today. Leave her alone.”
“No it’s okay.” I said and offered the pack to Pete then watched as others eyed the box beseechingly, willing me to offer them one too. I didn’t feel I had a choice so I was five ciggies down already and it was just gone eight o’clock.

At that, there was a loud rattling of the kitchen hatch going up and Moreblessings was yelling “Breakfast time, breakfast.” as she loped along the hall. “Time to move.” said Derry. “I’m your mentor for this placement Nancy, but bear with me and I’ll catch you up in a wee bit. I’m coordinating the shift today. Have a wee seat, chat to a few patients and see how you get on eh?”

Moreblessings was still yelling and now Fadhili had joined in this sing song. “Medication.” he bellowed and I watched as he went down the hall, knocking on bedroom doors “Medication. Breakfast. Medication.” Patients trickled out from rooms, heading in various directions, some to the hatch between the kitchen and dining room for breakfast and others towards the queue for medication. One or two just flopped on chairs in the living area and gazed at the television.

I thought I’d be best in the kitchen helping with breakfast, as there wasn’t much I could offer on the medication side. This also aided in putting a wide barrier between me and a slightly aggressive young female who was eyeing me up and down and glaring at me. There was no queue as such and people just leant over each other to reach for cereal, milk and sugar or the hot buttered toast, some burnt and some still white. Not sure if this was a defect with the toaster or the domestic, who was also busy handing out green plastic cups of hot water so that patients could add either tea or coffee. Drinks and cereal sloshed as patients shuffled to small tables in the dining area.

Vacated tables had crumbs, slops and spills so I went round the other side of my barrier to wipe some of it up, but soon shot back  when Mandy, I learned, screamed “Fucking lesbian. Stop fucking staring. Ugly bitch.” This was the young lady who’d earlier on, had her nightgown on back to front. “Oh, ignore Mandy. She harmless really.” said Mrs Farrell, this tiny, sweet domestic lady in her Jamaican twang “She just having a bad morning.”

Breakfast was almost over and the last of the dawdlers were still in the queue for medication. I popped into the office to see that Derry had allocated patients to the four staff on duty; two qualified mental health nurses being Derry and Alison while Moreblessings and Fadhili were the  two nursing assistants. I had Supernumerary status which means that student nurses are additional to the clinical workforce and undertake a placement in clinical practice to learn, not as members of staff.*

I asked Derry what I could do to help as I was feeling a bit like a spare part and quite out of my depth, what with Mandy following me, cursing like a sailor on a drunk holiday! Derry said to just shadow one of the staff and not to worry about Mandy, she’ll be fine after some medication. Alright for you to say,  I thought as I bumped into Mandy when I backed out of the office and turned with a wobbly smile to say “Hi, I’m Nancy, a new student here. Is there anything I can I do to help you this morning Mandy?”

“Ah, your a student, I thought you was one of the Doctors, I hate Doctors. Ask if I can have leave? It’s not ward round today and that’s the only time you get to ask for leave, but I’m not waiting ’til Wednesday. I need some clothes, look at me in this fucking dirty ‘ospital gear.” she ranted. I asked where her clothes were, what did she come in with and whether we could perhaps find them together. “They ain’t here. Someone nicked them in the night. Jealousy, that’s why. Jealous cos I’m a model and I get given good gear to wear. And that’s why they nick it. Fucking poofs and lesbian, all of them. And the staff, there at it too. All of them” she rambled, confusing me now, and I didn’t know what to think about her clothing. I offered to help her seek out her clothes but off she wandered, still cursing and muttering. Quieter now though.

“Go and have a wee break Nancy, you deserve it.” Derry grinned.

*Nursing & Midwifery Council, 2014

Journey to the other side – arrived at my first mental health ward placement

This is what I was training for; my first Mental Health placement on a mixed Acute In-patient ward in East London.

I’m normally a bit of a snob about public transport but, unsure whether I’d find a parking space, I headed off towards the bus stop at an ungodly hour. I relaxed and  enjoyed the ride, seeing places I’d not previously spotted when driving. Your proverbial man in a not-so-grubby mac sauntered out of a  grimy massage parlour, picking his nose with his pinky and devouring the contents. Nail bars and lots of them, a more upmarket Gentlemen’s Club next door to a greasy spoon where two young girls stood brushing their long ponytails into place, right behind the counter from where they’ll be plating up full English soon.  It was all over too soon, the hospital came in to view and off I hopped, keeping my eye out for parking I could use tomorrow.

If the reception that greeted me on arrival was an any indication of the day to come, I’d have turned on my heels pronto. It was cold and still dark when I arrived at the huge glass doors where there were too many buzzers to comprehend this early in the day. I slapped my already freezing knuckles on the cold glass and waved frantically at the obese gentleman, who was wearing a white shirt that said Security and appeared be asleep with his eyes open, behind a flexiglass screened reception desk. I heard a click, the doors opened and said gentleman nodded me in, urging me forward with another tip of the head and barked “Yes!” while I was still half a dozen paces from him.

The Scream, Edvard Munch

‘Hello, Lavender Ward please, I’m a stu …….’ Obese man harrumphs ‘Sign in. Along the corridor, left and left, in the lift, first floor’. I got the corridor bit so off I went, my trainers squeaking on the lino covered floor, loud and lonely in the silence that pervaded the building. The scuffed mint green walls were adorned with patient artwork, some almost childlike though many screamed of fear and desperation. I did wonder whether this was the right place for the display. Others may think differently but if I was visiting a relative or being admitted during my psychotic state and taken along this corridor I might have felt apprehensive. Distressed and paranoid possibly.

As the door to the lift opened, the acrid smell of pee nipped the inside of my nostrils, and I gagged at the the freshley gobbed phlegm slithering down towards the buttons. I pushed the first floor button with a spare pen and as there was no place for it in my bag, I cheekily I dropped it down the gap in the lift.

Outside the lift there were five wards and I stood at the locked door to Lavender ward with its wire mesh glass window and another buzzer at the side. I’d arrived and just took a moment to breathe.

Note to self: Must ask why the flexiglass reception and a rude security guard in a Mental Health Hospital? It certainly didn’t give off a welcoming environment.

End of term exams increased my anxiety ten-fold

Studying day and night for four exams; sociology, psychology, biology and nursing skills, stopping only to go to the loo or  shout down the phone at sales people, almost broke me. Thankfully the boys were revising for their exams too, so they understood and kept out of my way, tapping on my bedroom door only to ask if I’d like a coffee. Wine was the answer!

Pre computer, the worldwide web (www) and wi-fi, I was struggling to get my head round the biology terminology in the extra large books from the course reading list but, when rummaging in the sale box at my local bookshop, I was delighted to find a pop-up biology book for kids. Job done! I did suggest in class that this book ought to be on the course reading list.

Still, no matter how much I’d studied, outside the exam halls, I felt the familiar onset of palpitations, sweating, tingling fingers and toes. I’d read that this was the blood rushing to where it was needed ie the brain and large muscles, to activate the body for  fight or flight*. So, I had this thing where, by using breathing techniques and distraction, if I could stop the tingling before it got up to my wrists or ankles, I could prevent a full blown panic attack. Today it wasn’t working.

Standing rigid (freeze*) as the other two hundred and odd students found their way round me, out comes my tissue, liberally soaked with lavender oil; known to be another stress reliever. I desperately sniffed in copious amounts of the stuff and I wasn’t taking any chances as I dabbed the tissue on my wrists, under my nose and under my ears? The well-used tissue was then shoved up my sleeve so I could inhale at my leisure during the exams. Who cares that I smell like my gran’s underwear drawer?

Well guess who passed all four exams? Okay, the highest mark was just sixty eight per cent but I’d only gone and done it. Now this really was a big deal because, with six poor GCE’s, I’d always thought I wasn’t very clever. When teachers tells you often enough that you’re thick, it cuts to the quick and you start to believe it.

The queue for the public telephone in the student union room snaked down the corridor as excited students waited to give the good news to parents or partners. Despite the fact my tummy was screaming out for food, I too wanted to share the good news. I called the boys’ dad at work and I hadn’t even gotten the words ‘I passed all four’ out when he snapped ‘did you take twenty pounds out of my pocket this morning?’ I said ‘yes’ and he hung up. I was hurt and mortified but carried on chatting cheerily into the phone, while my heart was breaking, until my ten pence ran out.

Note to self: “Don’t let the man bring you down.” — Maya Angelou

*Flight, fight or freeze is the body’s response to perceived threat or danger and which prepares the body for flight or fight; the physiological and psychological response to stress prepares the body to react to the danger.

Favourite moment on a general ward

I really wasn’t looking forward to this placement because, not only did I dislike the area or the hospital, it was also a general male ward and generally where you get all men, you get burps, farts, snot and phlegm, in no particular order. The first time I was asked to collect mucus made me gag at the thought but holding a sputum cup of sticky green bodily fluid had me dry-retching and reaching for the ladies. I dreaded the day I had to hold male poo samples.

An lovely elderly chap called Derek, who had prostate cancer along with other age-related ailments, used to smile and wink at me when he saw my disgust and I realised it wasn’t very professional walking around with my face screwed up and my nose in the air.  He used to love telling me stories about his life during the war and how, once home with his lovely young wife, they’d never spent a day apart. He also told me that his wife was on another ward down the corridor and he missed her terribly. I’m no Linda Carter but before she went off shift that day, Wonder Woman, despite groans from other nursing staff, managed to get Doris’ bed wheeled right next to Derek’s for the afternoon. I got to see why they never spent time apart; holding hands, whispering and giggling like teenagers and dipping custard creams into each others tea.

The next morning I asked a male nurse where Derek was and, with a nod  eyes rolling upward, he said: “He’s gone upstairs.” When I asked why he replied flatly: “He’s dead!” I stopped by the ladies to dry my eyes before looking in on Doris and her family to pass on my condolences. When I heard the laughter, I wasn’t sure I was at the right curtains but Doris could see my shiny shoes and she called me in to introduce me to her family. They wanted to thank me for the humanity shown the previous day and told me how much it had meant to both parents; they’d had their final chuckles and they were both at peace in their own way now.

Most patients love good students on the ward because they’re the only ones who sometimes have time to stop and chat, to ask patients about their needs and wants. While poor nurses are run ragged doing medication and ward rounds, writing notes, and updating no end of needless care plans while phones are ringing and everyone wants a piece of them.

Note to self: “Be who you are and say what you feel, because those who mind don’t matter, and those who matter don’t mind.”

My first general ward placement – see why I chose mental health

The first eighteen months of our uni course included general nursing and students, along with the aforementioned pushers and shovers, made a mad dash for the announcement boards to see where we’d be placed for the next eight weeks and I got ‘Gynaecology & Urology’. This was back in the day when we still had mixed wards, which was shocking and probably embarrassing for the mainly females, due to the nature of the ward.

I was so excited that ridiculously early Monday morning, in my new blue and white striped uniform with my upside down watch and the obligatory shiny new black DM’s. The nurses were all welcoming and there was a nice friendly male nursing assistant, Phil, in his mid thirties, who was to show me around the ward. He seemed to have a good relationships with both the nurses and the patients, a bit on the cheeky side, but he was lazy and would habitually  try to fob menial and yukky tasks onto gullible students like me. I quickly let him know that while I don’t mind sharing the load, I was also a mature student who needed to learn certain nursing skills as well as his assistant tasks.

A few weeks in, Phil was grinning when told me to remove a catheter from a male patient and that he’d be back in five minute to check. On his return I told him I’d completed the task and with eyes agog, mouth agape, he paled immediately, thinking that I’d followed his instructions. As students, we all knew, you didn’t carry out such tasks on your own if you’ve never done it before so I didn’t. How would I know you had to deflate the balloon before you removed the tube from the penis?

We’d learned about all the different types of poo while in Uni, one of which was fecal and was one type we’d probably never come across during our training. Anna was only forty-six and had colon and bowel cancer which had now spread to the lymph nodes and she wasn’t expected to recover. She’d called asking for the commode and she was so weak, I had to help her onto it. No sooner had she sat down she said she needed a sick bowl and immediately projectile vomited, propelling runny poo all over the bed and down Anna’s clothes. She was mortified and kept apologising as I stood behind her rubbing her back and saying ‘it’s okay, not to worry. You’re okay Sweetheart.’  while my eyes and nostrils were stinging and I was gagging silently. I really felt for Anna, I did. My heart so went out to her and I burst into tears.

I was sad to leave this placement because the staff were so lovely, always including me in their daily chats, sharing all the chocolates and laughing at me when they saw me heave at the sight of bodily fluids. General nursing wasn’t for me!

However, I’d learned how to make hospital beds, empty bedpans and clean up shit as well as making gallons of coffee whilst at the same time, remembering to document patient care in their notes to be signed off by qualified staff.

I didn’t realise how much I’d miss the patients and the relationships we built during such a short period and the times we’d laughed and cried together. I felt so humbled by this experience, when these lovely people, despite their illness, pain or suffering, shared with me their life stories and their innermost fears and secrets, some of which they’ve never been able to talk about.

Note to self: “Listen to that inner voice of yours. It’s not you, but it’s for you.”
― Kiyo Giaozhi

Three months into uni and I want to give up

I just wasn’t getting this studying lark. I foolishly thought I’d be learning about Mental Health nursing but we had so many seminars and lectures about all the oligies like sociology, biology, physiology and psychology, trotted out by bored lecturers using big words. By the time I’d figured out how to spell sternocleidomastoid*, the topic had moved on and my notes had more holes than Swiss cheese.

Another bugbear was the alarming amount of classes we had to endure each week in communication and interpersonal skills. People just have these, right? Hmm, the shoving and pushing together with the teeth clicking and tutting, rattling newspapers, talking or sleeping through lectures and being generally disruptive in class should have been enough of a clue.

It’s been said that there’s no such thing as a stupid question. Well, I beg to differ here because some students asked stupid questions, argh! with disturbing regularity. Just kill me already! ‘It says here to write my name in black ink, does that mean I can’t use a blue pen?’ And these same students managed to interrupt and disrupt lessons with their stupid questions, so much so, that the topics were cut short, meaning we had to go through the whole bloody lesson all over again in a few days.

Three months in and just before Christmas, we were given an essay to complete over the festive period, something like ‘How is my life is different since starting Uni.’ Ok, that sounds simple enough. Or it did, until I got it home and read how I had to write in an ‘academic’ manner, using references and to use ‘reflection in and on action.’ I’d only passed a few GSCSs and as far as I can remember, we didn’t use referencing and not one of them mentioned ‘reflection’ or ‘academic writing’. I re-wrote this essay so many times, trying to sound clever but failing miserably and just feeling even more stupid. What, with this and the bubble gum blowing class disruptors, boredom, big words and stupid people, I was wondering if uni was the place for me.

What example would I have set for my sons had I not completed the essay and got a whopping seventy eight per cent as a result?

Note to self: “Character consists of what you do on the third and fourth (and fifth) tries.” – James A Michener

*One of two thick muscles running from the sternum and clavicle to the mastoid and occipital bone; turns head obliquely to the opposite side; when acting together they flex the neck and extend the head

The beginning of three years at university and my first anxiety-ridden presentation

Within weeks of starting Uni, I learned just how stupid some people are! How many lack personal insight and have no idea of personal space or people skills. I was able to study my fellow students as they shoved their way through the doors I was entering and jumping ahead of me to get the seats at the front of lectures or lessons. Now, I know I was really skinny but trying to get two people through the narrow single doorways at Uni was nigh on impossible and, if they thought I wanted to bring attention to myself by sitting anywhere within a ten-foot radius of any lecturer, they were sadly mistaken. Those lardy arses who bulldozed past me, snorting, kissing their teeth or tutting were welcome to their prime seats.

Having only recently recovered from a lengthy psychotic episode, I still felt really shy, nervous even, and constantly prayed to someone who’d help me stave off the ever-impending anxiety attacks. I’d sit somewhere in the middle of the halls and quickly avert my eyes or pretend I was taking notes if I caught a whiff of a question coming my way from the attending lecturer. I was so busy monitoring my pulse and breathing, I probably missed half the lectures anyway.  Still, most of the lecturers appeared to be reading straight from books, which meant I could catch up by going through the same book or reading any handouts during breaks or at home.

What I hadn’t bargained for was the seminars and classes, which normally lasted between one or two hours and, where we were expected to work in smaller groups, normally around eighteen to twenty students. We’d be further split up to around 2-4 people, to discuss some topic or other, then complete a written task before presenting our understanding back to the group. Or, because of the sweet packet rustlers, the stupid questions and other disruptors, we often had to complete the task at home then feedback to the larger group. Oh, my word! If I’d known that I would have to stand up. In front of everyone. And speak? I would never have applied for the course.

No way was I making an absolute arse of myself. I practised for hours in front of a full-length mirror at home, where I’d present my findings calmly and with a flourish, maintaining good eye contact and waving my hands theatrically. Cracked it; I could do this. Huh! For all that, the first time I presented to the class, I dropped the acetates I was relying on to distract my peers as I spoke. Taking in huge gulps of air as I bent down to retrieve said slides, I could feel the heat rising up my neck and hear my heartbeat pulsating in my ears. Then I swayed and felt dizzy, increasing my anxiety tenfold. ‘Please do not let me have a panic attack’! Though not sure who I was asking. By now, I could see my heart leaping out beneath my clothes like Jim Carrey’s character in The Mask and felt sure everyone else could see it.

It felt like an age as I raised my head and saw my well-meaning contemporaries smiling, encouraging me, willing me to get over the finishing line, so I began. With trembling hands, a fake smile and what felt like a massive boulder in my stomach, I managed to stutter my way through my presentation and answer some easy questions. There was no theatrical waving and no calm, just relief when it was over and I was able to watch my peers presenting. Not sure I should be glad but, I could see I wasn’t the only anxious student in the room. Those following me muttered, mumbled, lacked eye contact, had hives creeping up from their chest and for some, their presentation wasn’t even relevant.

Note to self: “Today I will not stress over things I can’t control.”