Tuesday, December 3, 2013

Eight Letter Words

He’s a tall man, about 6’2”, black, looks younger than his 46 years.  One of the doctors here told me that ‘many people with schizophrenia oftentimes will look younger in their face'.  It’s their stoic look.  They don’t show a lot of emotion, they won’t use a lot of muscles to frown, or to smile.  This guy, he’s been in and out of locked facilities most of his life. 

As a young boy, he witnessed his father commit suicide.  When he was in his teens, he watched his brother kill himself.  We don’t know where his mother is, or was.  He won’t talk about it and the records are sketchy.

He doesn’t come out of his room much.  Paranoia, say the experts.  Fear, says I.  He’s been assaulted more than once by patients in the hospital.  Before coming to the hospital, he had many, many fights out in the world.  It’s difficult for him not to retaliate.  “I like it in here, I’m staying in my room.  Will you tell me when it’s dinner?”

We all share two long hallways, med room, treatment room, two day halls with windows floor to ceiling.  Steel screens outside of them and a small balcony overlooking the shrubs, lawn, picnic tables, basketball hoops and trees.  Windows that don’t open.  Years ago, when we were fully staffed and often took the guys outside, one of them scaled the outside fence faster than anyone had ever seen him move.  He jumped to his death while patients and staff watched in horror, scrambling to stop him.  

Courtyard isn’t used much these days.  Not enough staff to secure the unit and take people outside at the same time.  We have a dining room and 12 sleeping rooms.  34 patients, 6-8 staff work each of three shifts.  Administrators survey the unit, walking through quickly, keys in hand.  Saving grace for staff is going home each day after one, or possibly two shifts.  Overtime is often mandated, as there are such low staffing  thresholds.  

Of our 34 patients, some will leave.  Some never.  Maybe when they age out, no longer a threat to society, they're transferred to a lower level of care facility, lower level of security.  Where doors are sometimes left unlocked.  Patients are often transferred, only to return after another incident weeks or months or years later.  We get to know the guys.  They think they know us.

This is one of many state mental hospitals around the country.  I thought the one I worked in was unusual for the number of assaults on patients and staff.  I blogged about it a while back and was amazed at the responses from other nurses across the country.  “It’s just like that here, too.”

Three years ago, one of our hospital staff was killed by a patient.  She was strangled to death in the corner behind a building.  We think it was because she didn’t have a cigarette on her to give to the guy.  We really don’t know.  After this incident, there were speeches, letter-writing campaigns, meetings with unions and management.  Rallies were held in the state capitol and in front of the hospital.  Newspaper reporters requesting to talk with anyone who had information and/or would stand up to be heard.  Many of us spoke out and felt the brunt of it from our supervisors.   There was a lot of crying and hand-holding.

Our colleague was buried, we heard her family settled in a lawsuit with the State,  though never confirmed by anyone I know.  Millions of dollars were spent on new state of the art alarms for the staff.  Staff alarms to be used at the time of attack, or in some other emergency, to call for help.  No prevention here at all.  Very little doctor-patient interaction.   Physicians, social workers, psychologists come and go.  Hospital administration preaches ‘continuity of care’.  We don’t see it.

Last week, two staff on my unit were assaulted.  The patient I mentioned was nowhere near the incident.  He was safe in his room.  One of the staff members was treating the attacker for a medical  condition he has.  She’s a Registered Nurse, a short little Filipina who has worked here for many years.  She had other staff in the room with her.  That didn’t stop the attack.  The other staff member, also a little woman, an RN,  has worked for years on the unit.  She was unlocking an office door when she was punched along the side of her head, falling to the floor.  Both of them are off work on workers comp.  The patient continues to walk the halls.  Medicated and watched.

Security is just an eight letter word here.  Officers appear on the units once or twice in an 8 hour period.  They respond after an assault.  Staff carry alarms and keys and watch each others’ backs, always on vigilant alert, reading the patients and any change in their behavior.  Families worry for our safety.  Every staff person on my unit has been assaulted at least once, including myself.  Former colleagues will never work again from the injuries they suffered.  Physical and psychological damage.  PTSD is rampant.

When I talk to outsiders about this work environment, they can’t understand how it can continue to happen.  Why doesn’t someone do something about it?  Mental health advocates and administration claim the patients are patients, not inmates, and won’t allow ‘guards’ to patrol the units.  Staff is trained to restrain patients when necessary, not trained in self defense.  Staff here are professionally trained to provide excellent patient care.  And they do.

There is no security here.  Until we walk out the door to come home.  Later, we cry in our pillows.  We worry in anticipation of the next incident.  We’re care-givers, that’s why we took this job.  To be of service to patients who require care,  who need support, encouragement, understanding and love.  We pull together at holidays to give the guys special treats and entertainment that they otherwise wouldn’t get.   Most of the men here have been abandoned by their families, don’t really have any friends outside.

The patient I first mentioned, he’s still in his room.  He comes out to toilet, to shower, for meds, and anytime he can eat.  Three days a week, he goes to the hospital’s version of a classroom/school where he watches TV, plays video games, listens to music and gets his hands on more food.  You can always find a little bag of chips in his pocket.  

If you want to push it and ask him. 

Wednesday, November 6, 2013

It's Been a Long Day

(original 2011)

It seems like a year ago, in reality, just 14 days ago. We were in Brookings, the morning started off with a bang. Literally. When I got up from sleeping and knocked over the ancient metal TV tray onto the floor. Oh my gosh. It made such a loud noise, startled my son Tom sleeping on the other side of the room, yelling out as if he was protecting the place, "H E Y !!!!!". Oh my gosh, I can't stop laughing every time I think about it.

A few minutes to write is what I need. Please, just a few minutes for me all to myself.

Dad slept in the guest room that last night in his home with his big and black cat 'Hey, Kitty' keeping him company. Sleeping in the guest room because his own bedroom furniture is loaded on the truck.

Tom took off later that morning in the U-Haul truck with more stuff than would fit into Dad's new place. I know, because some of it is still waiting in my garage for me to sort through. Everything left behind at Dad's home will be thrown away or cleaned up with the help of his realtor, sold at an 'estate' sale, and the check sent to Dad. That was a good reply for him asking about this or that, "Let Chris sell it and she'll send you a check for it".

I wondered then how long Dad would be able to hang onto this 'independent' living status of his. His vision loss has deeply affected his lifestyle. He can't read a menu, he tells me food on his plate is a blur, and knows the fork from the spoon only by touch. Even as I sit across the table at dinner, I'm just a blur. He is able to see long distance a bit better, able to recognize buildings and other landmarks, stop signs when he's riding on his scooter. He can sign his name by memory, when I put the pen on the paper; he can't see where to write at all. He can't see that with all the weight he's lost, his clothes are hanging on him. He couldn't even see the ants in his drink last night. When I pointed them out to him and offered to get him a new drink, he yelled at me, "I'M not throwing away a perfectly good drink! I can't see them anyway", noting as he finished it off. Jeez, what can I say?

It's certainly been a difficult move for dad. After spending quite a bit of time with him, I dont doubt it's a good move. Oh, he still regales anyone who will listen with his stories of building the Brookings port, and starting the Elks Travel Club, and his four years in a POW camp after being captured at Wake Island. He can tell those stories four times in a ten minute span, and each time, it's the first time for him. For many of his listeners, it gets old fast.

I guess we're all doing our best. He is. I am. The kids and grand-kids are. I guess best has to be good enough. Because he is NOT making it in independent living. Too many of us know now that he can't do that any longer. He gets lost when he leaves his place. So now he won't leave much. He put his wallet in a safe place, and then lost it for two days until he found it in his freezer when he opened it up to get ice for his nightly Manhattan. The neighbors are worried about him, and so am I.

So, next week he moves again to assisted living/memory care. He doesn't know yet. That's the conversation we get to have on Monday. I lay awake at night wondering if I'm really doing the right thing. He needs someone to take care of him, right? And yet, he could just as easily die in his bed in Brookings as here in Napa.

Well, I've Changed My Mind...

* (original, 9/7/2011)
The screeching stop I was waiting for has slammed me in the face.

Now the delusional side of Daddy has decided to 'stay where I am'. He continued to go on and on about the friends he has (doesn't have any longer, really, at all), about all the things he's done in that town (which he's unable to do now), and he's made up his mind.

And my younger brother who talked with him a half hour on the phone tells me to do what Dad wants.

The three days I was with him, when I saw him, from both a daughter's standpoint, and that of a Registered Nurse, specializing in community, senior health and psychiatry, doesn't amount to a hill of beans.

So I am to ignore the wishes of a delusional old man, and go on knowing he doesn't know what he's doing and that's okay.

I work every day with adult males who cannot take care of themselves. Don't you think I recognize that when I see it? Am I supposed to stand by, morally and legally and say, okay, do what you will.

I guess I am.

Wednesday, October 30, 2013

The Greatest Feeling in the World

The greatest feeling in the world?  Well, let me tell you.  I sat down this morning after procrastinating most of a month on another essay.  I had a deadline for submission to ____.  After thinking long and hard on it, I finally put my thoughts down on paper.  I finished writing, went to look up the submission  address, re-check the format requirements, etc.   Imagine my total surprise when I noticed that I had written on the wrong topic.  Ha ha ha.  

The greatest feeling in the world, right then, was having had written that piece at all.  And then,  learning it was the wrong one!  And laughing about it.

So here you are, without further ado, the top ten of Kathy’s Greatest Feelings in the world:

#10     Falling in love for the first time.
#9       Birthing my first son.
#8       Being with my favorite Uncle when he died.
#7       Finding ancestors and relatives here in the USA, and in a far-away country.
#6       Delivering three more beautiful sons.
#5       Birthing my gorgeous first daughter.
#4       Loving and being loved by fabulous family & friends.
#3       Traveling the world, friending fabulous people far and wide.
#2       Falling madly, totally, Head Over Heels in Love AGain, At My Age, when it was completely unexpected.
the #1 - Greatest Feeling in the World:           Doing it My Way.

Quit Beating Yourself Up

“Listen Kathy, I came to terms with this years ago.  Daddy left us.  He left us to start a new family, he didn’t want this family, so he left.  Quit beating yourself up over him.” 

Daddy died October 1, in his sleep, alone in his bed.  We received a phone call, well a voice mail to call.  We were pretty sure what that meant.  We’d been estranged, pretty much no communication for past two years.  Dad and our family.  The ‘step-family’ swooped in a while ago.  They were in, we were out.  Nothing new. 

For a while now, I’ve been spending time going over the past with my dad.  The good, the bad and the ugly. 

October 1959.  I was 11, just starting puberty, my brothers were 10 and 8.  Our little family moved to South Lake Tahoe.  Dad was a blue collar worker.  Mom’s collar was secretarial white.  Dad was a builder, he could do anything.  He figured he could make his dream stash in a small country berg that was destined for great things. To look at it now, the Lake is about the only thing up there that looks like it did 50 years ago.

We were quite the dysfunctional family as I remember.  Fights, money troubles, women troubles.  Two years after moving to Tahoe, Daddy took off with another woman to live in Oregon.

Junior high graduation came and went.  He showed up for an hour.  For the remainder of our young lives, my brothers and I received just about nothing from dad.  No cards, no love, no birthday cash, no memories there at all.

Basically that relationship never changed over the course of our lives.  Dad became and Grandpa Russ and Grandpa Russ was no different than Daddy Russ.  Sometimes we saw him, heard from him, other times we didn’t.  There were good times, short family trips, mini vacations, stories shared, new children, grand-children, great grand-children brought into the world.  It all seemed so normal.

Two years ago, I told my dad that my sister-in-law was planning a big surprise 60th birthday party for my brother.  Dad wanted to go!  He was excited!  I was excited! And though he’d had some recent impairments, lapses in cognition, judgment, memory,  I told myself, we can do this.  I’m an RN, a professionally trained, educated,  psych nurse, he’s my dad. 

Well, after three Emergency Room visits in three different cities, trains, planes, and ambulances in three different states, we made it home after never getting to the birthday party.   Out of his home environment, Dad completely lost it in a series of confused, psychotic and violent episodes. We dragged home bewildered and lost.

As a young man, Daddy survived three years of prison camp in WWII after being captured on Wake Island.  He later helped build the port in his tiny fishing village.  He traveled and loved and was loved.  My travel bug I’ve gotten from him.

As I said, since his death, I’ve gone over all my dad’s mistakes enough times to see all the things I’ve done wrong.  He was just doing his best.  I was doing my best.  His dad left his mom when he and his two brothers were little boys, off to sail the world as a merchant marine.

When I learned he was dead, I didn’t want a service.  I’d said my goodbye long ago.  Overnight a change of heart set in.  We did need it, my kids, my self, we needed to say our goodbyes.   So we had a small, home garden family service.  My brothers didn’t attend.  They had their own goodbyes to do, in their own style.  So, on a bright and beautiful fall sunny Sunday, it was time to say a few things about Grandpa Russ.   

“Remember the fresh salmon he brought to us when we were up camping in the Oregon woods?”
. . . “Or the time he chewed out the restaurant chef for not buying local fresh crab?”
. . . “I only remember how grumpy he was.”
. . .  “I remember when he ‘disappeared’ with Grandma Mollie for a couple days when they were both visiting their first grandson.  Long after they had divorced.”
. . . “How about the time he took us out in the Pacific in his fishing boat?  And Pauline got sick, throwing up over the side?  Hah hah hah”

Come together in a circle, hands holding hands, soothing threads of ‘Amazing Grace’ in the air.  Peace, gratitude, chuckles.

…“Okay, let’s see how the Niners are doing!”

I didn’t say much at the service/wake.  I listened.  Why speak ill of the dead.  Or the living? 

A final word about my dad’s dying?  I wish I felt worse than I do.