Category Archives: Mental Health

Forced Migration

Closure of a small portion of the aviary was necessary for reasons unrelated to the occupants. The number of feathered friends was few following successful moves to other worthy sanctuaries. The birds remaining were a ragtag flock of common species likely to fare well in transfers to two nearby wings of the facility.

It was the staff, the humans, whose feathers were ruffled with the news and the change to their routines. The flock nodded, blinked repeatedly and returned to daily routines. Staff flared, clicked, bobbed and shook until successfully reassigned.

The lead human, Old Bird, her beak grinding with occasional hisses and growls ran a fowl in her own disappointment over the surprise circumstance. Old Bird was agitated having had her perch pulled from her grip. Like her flock, she needed to fly, adjust perspective to create shelter and a more hospitable environment. Once the imminent danger was faced, Old Bird was able to flit, fly and sing familiar sounds in slightly different places.  Even old birds can learn new tricks.

Fiona Flamingo

She was wearing pink. A pink cap, sweater and pink corduroy pants. Ms. Flamingo’s feathers were ruffled on her arrival. She was mean-eyed and all of 99 pounds. Angry and suspicious she scowled, squinted as she clutched her only possession in her fist. It was a brass lock and key. She handed it to me and refused to answer any questions.

Fiona was steady on her feet for an octogenarian. Her breathing was good. Her wrinkled face hinted of years of smoking. Fiona was wary of the new surroundings. She refused food, medication or to change clothes. For days she refused to bathe. She was sad looking lying on top of the bed, fully dressed, wearing socks and sandals for a quick get- a- away. In our setting we can afford to be patient. There is no revolving door of fast admits and discharges.

As she began to nest Fiona’s feathers smoothed and she revealed her Achilles heel- black coffee, and diet coke. Diet because Fiona at 80 didn’t want to be fat. She held a great distain for too fluffy or fat. Fat can’t fly. Early conversations with Fiona concerned TV and electricity- both dangerous. These fears made her use of the patients’ lounge unappealing. Delusions about religion, the bible belt variety, electromagnetics and government were themes she discussed.

Fiona Flamingo found her areas of comfort. She began to thrive with aviary routines, her preferred staff, a few safe feathered friends,   regular meals and her ability to score soda and coffee while penniless. Of course, the long acting psychotropics helped with a brief       restraint when Fiona fiercely resisted.

Over time Fiona became more social and cooperative. She spent a lot of time near the nurses’ station rising,the earliest bird, before dawn.  Perched on one-leg, the other cocked back against the wall she waited for day staff to arrive with the promise of small caffeine rewards.  Fiona began to sing. She’d sing hymns in her room, sing to staff. She loved to sing and preen and occasionally, Fiona would dance. She   would light up. We could see the young Fiona emerge.

She began to do nice things for others. She enjoyed the younger male patients in a momma bird concerned way. She was creative.
Fiona called Mrs. Nottingham. I could hear her ask, “Is Nottingham here?” She stalked her favorite staff member and tried her darnedest     to convince her to take Fiona and “the boys” home with her. Luckily that did not happen. The staff member needed cover and distraction to make safe get-a-way at the end of shifts. It was not all sweetness and flight. Fiona would phone her also-old sister then squawk, rant    making mean accusations and then hang up on her.

This Flamingo got well enough to fly the coop. She left the Aviary, without the boys. She had a few sets of clothes and toiletries to take with her and I returned her Brass lock and key. There were hugs and even a few tears as Fiona took flight.

Not Raped

Never raped, not me, not yet. I don’t identify as being traumatized in sexual ways as a kid or young adult. Instead, I was an object or recipient of ‘little transgressions’ perpetrated by males. These incidents have surfaced from 50 years ago. Tiny sexual assaults and sexual harassments in my earliest work experiences –the life lessons about what it is to be female.
• Walking along a road at age 11-12 saw a boy riding a bike toward me on the same side of the street. I did not know him. He punched me in the breast as he rode past.
• I did a lot of babysitting. The husband was responsible for paying the sitter and taking her home.
On several occasions, different men, would try to kiss me, cop a feel or speak in ways that made me uncomfortable.
• While in grade school I was working in the concession stand at football games. Men or boys wanting to be men would leer and make salacious remarks about my body. I pretended I hadn’t heard or didn’t understand and gave them ordered items that were paid for with a smile.
• Sitting in summer school Typing class (pre-keyboarding), I noticed a boy swatting in the dark
Hallway trying to get my attention. We made eye contact. He gestured, spreading two fingers apart. When my face registered confusion, he forcefully pointed below my desk and rudely gestured to spread my knees, so he could look. I had on a skirt. I mouthed NO angrily.
He ran. I was rattled, sweaty and felt sick. This is the first time I have shared this from
56 years ago.
• At 15 my summer job as a soda jerk was always uncomfortable working alone with the owner
on Sunday nights. Business was slow the last couple of hours. I would broom the entire parking to escape to his creepy stare and create safe distance. This began the sharpening of gut speak.
• By 17, I worked at a downtown shoe store selling bags, hosiery and cashiering. The manager was a peeper, (voyeur) assigning me to dust and restock high and low shelving as he hid or positioned himself to try to glance up my skirt. I learned to navigate by calling him out in a humorous way. Unsatisfied he became bolder telling me what customer he planned to visually violate making me sickly complicit.
• At 18 walking with a few friends in broad day light, boys on bikes rode up behind us and goosed our behinds. Eighteen-year-old me thought this was racism, today I realize it was sexual.

I never told anyone. I reasoned this is a part of growing up. I think I remained confident and competent particularly about work. As I woman it was apparent to me this is a part of the world, the truth of being female. We females develop work- arounds, strategies to better protect themselves. The truth remains, the evidence cannot be refuted, even “tiny transgressions” teach females they cannot be safe of body, work, income, identity or freedom.

The Aviary

My decision to accept a staff nurse position in mental health hospital was, at best, disconcerting to my husband. It perplexed him that after working solely with girls and women for 40 years I would consider and/or be able to care for adult men. He worried about my transition from the worlds of not- for-profit and privately- owned facilities with strong religious/spiritual missions to a state run, government culture and systems. It confounded him that I would go back to bedside nursing after years of management, entrepreneurship and community activism. Finally, it seemed most unreasonable to abandon beautiful, comfortable, modern buildings with nice equipment and ample supplies. After waving all the yellow, cautionary flags he said, “Do what you have to do.”

Please know while I appear confident and eager, I am not fearless, in optimal physical condition nor the quickest thinker at age 65. Day three of orientation, participating in Bridge Building Class was a first- time experience. Bridge Building skills are critical to employment. It entails de-escalation techniques and the use of physical and mechanical restraints for patients who become a danger to themselves or others. This was up close and personal, live demonstrations, practice and return demonstrations. Physical deflecting, blocking pads, spit masks, 2-4-way restraints and ‘the chair’. (recall Hannibal Lector, sans metal face cage). It was a lot to take in.

Nervous about the risks, in an adrenalin afterglow, I shared the day’s events with my husband while icing my knee. He was unusually quiet. In retrospect, I sense his concerns for my safety. I am typically close-mouthed about work. My spouse usually presents dinner and shares the details of his day. He tries to draw me out to share mine. His efforts go afoul as he tried to be comedic referring to patients as criminal, crazy and the like. I think the first time or two, I tried to ignore my ire- unsuccessfully. The third time- I gave my best Aretha Franklin, extended-arm, flat handed: “STOP! You better THINK about what you’re tryin’ to say to me!” “You can no longer talk like that! Those words are derogatory and mean. That language demeans me, my colleagues and my patients.” He was stunned. He is not a mean person. He simply didn’t know. Neither of us knew until that moment. Our rules changed. Both Maya Angelou and St. Mother Teresa have been credited with the adage, “When you know better, you can do better.”

Bless his heart. My spouse announced his newest brilliant idea a couple days after my patient/self-protective declaration. Excitedly, he announced, “I will now refer to your workplace as the Aviary and the residents as birds and various species! What do you think?” Our shared memory of the bird sanctuary in Liberty Park in Salt Lake City and our brief stint owning chickens held fond memories. “Brilliant!”, I agreed. As so it is.

I have no idea the social acceptability or if this breaches some mental health profession decorum. What I do know is that this is a way we can peripherally discuss our daily lives and for me to contain the anonymity of patients in a manner of loving observation and respect. The most fun comes with the wide variety of synonyms, idioms, and slang related to birds. For example; to bird- to watch, a lot of our work is observation and reporting. Giving the bird- this happens often and is ok if it’s a patient giving this sign of disapproval. It’s not ok for staff to act in kind. We have people who (WHOO) are owlish or nocturnal, and pacers who never take flight like emus or penguins. Sometimes patients repeated come to the nurse station or swoop like gulls and aggressive patients or those with a proclivity to escape reminds me of raptor behavior. But here a home I often am asked, “How were the loons or your loons today?” I kind of love this and them, the entire mismatched flock.

AutoFrustrate

I sent a quick text to my boss at work today.  I referred to patients in our usual abbreviation ‘pts.’ My dutiful file system photo album, entertainment, education, a.k.a. phone; changed it to say pets. In essence I bothered her at work while I am enjoying a day off  asking how we can obtain MP3 players for our pets. Granted, she is a dog-owning, canine lover but sometimes these little corrections might lead someone to think I’d fallen off the wagon….and on to my head.

Psych

No joke, it’s true. I’m a psych nurse. I retired once and returned to nursing full time within two years. “Why?” many asked. Lots of reasons,  and a topic for another day.  “But you’ve not done this before,” friends and family commented with concern. I admit I felt pulled and challenged to commit to something I once feared.  Good news, It’s going well and I really like it.

It’s been nearly a year working in a state hospital with severely mentally ill patients.  The vast majority are lovable in spite or because of their illnesses.  There are many terrific people who work in this system. I need to write about it as a way to process and take care of me, to increase awareness and reduce fears about mental illness and hopefully to inform and entertain.  Characters, events and tales are fiction and any resemblance of actual people, places are coincidental.

Psychiatry was the last rotation of my nurse training decades ago. I hated it!.  I found the location and  patients frightening, and the staff callous and as damaged as the patients.  The instructor, Mrs. Castle was spooky with a flat facial expression and Mona Lisa smile. Therapeutic communication seemed inefficient and vague.  At the time, Castle offered two memorable lessons:  the benefits (soundless steps)of her crepe-soled shoes and the importance of coffee to stimulate a well timed and formed BM in the AM.  Stick with me people, nurse stories often discuss seldom spoken topics.

In spite of my resistance, fear and arrogance, dang Mrs. Castle pounded in a lot of learning, techniques, and communication tools that have sustained me throughout my nursing career.  So there’s a big lesson here that I have tested repeatedly and almost always continues to amaze. Fear and resistance guide to the exact challenge that should and can be faced.  It never fails to teach or guide me to where or whom I need to know.

Why would a grey haired grandma on Medicare go back to direct patient care in an antiquated facility, with some of the sickest mentally ill?  A Psychiatrist that I hold in high esteem suggested that she could see me working with this population. It was as simple and direct as, “I think you could do this.”  Secondly I prayed about where I could be most useful.  Finally I am at a point in life that I have a heart that is both tough and soft enough to love those seen as marginally loveable or lost.  I laugh it off but also believe this period will be my Mother Teresa years.  Psych nursing can be less physically demanding and a good fit for those who move a little slower than yesteryear.

Applying and interviewing for work can be intimidating.  Heck, getting someone to take a look a 40 + year work history is nearly miraculous.  The old rule about, it’s who you know, or using your contacts to grease the wheels still holds true today in my experience, at least to open a door or getting a call.  Well obviously I got the job. My husband thought I had lost my mind…………more on that later.

Cartoon Coping

As a kid,  I had no imaginary friend. I did have a constant cartoon station playing in my head.
It was a audio-visual processor with instant replay, color, speed control all set strictly for comedy.
This was before color TVs,when 3 TV stations existed and operated a mere 19 hours of the day.

My independent network was a big source of entertainment boldly satirizing characters, and reordering.
dialogue that regularly improved my position as hero. Instead of dreaming, I watched reruns and edited,
rewrote and directed in my head.

It was shocking, albeit satisfying to learn I possessed a gift of a that not everyone enjoyed. 
My network,Cartoon Coping, served me well.  It helped me be funny, to laugh at myself, to laugh at
and with others,process hurts and transgressions,to be playful and to be flexible.
It would wax and wane as life and work appeared (or pretended to be)  more adult.
It was the abrupt blackout of my personal network that initially went unnoticed and I later grieved
when treated for my first episode of depression.

Cartoon Coping never returned with same reliability under the adjusted network owner. Character drawings
and fun loving story lines appeared during more elevated moods and temperament. Perhaps watching was
no longer useful or was replaced with new found amusements.  Fortunately both my capacity and appetite for
humor are well intact as I rely more heavily on real friends and family and study for coping. Life is funny
in moment and in the retelling.