Please Do Me Just This One Small Favor

Hi all,

I'm back with the inpatients full-time, just in time for the post-holiday rush. By December 23rd, after a mad week of discharges, our numbers had gotten really low -- we were about half full maybe with a pretty dreary lot of sad sacks. By the 27th, though, we were teeming with manics and psychotics and we've stayed that way ever since. High census and high acuity. Lots of patients and lots of them just bouncing off the walls, that is.

Today was one of the few days I've had here in which our acute unit closely resembled what I imagine (fear, really) the old state hospitals were like. One patient was standing catatonic in the hall, while another was in the fetal position on the floor, this one was yelling obscenities to some relative on the phone, more screams were coming from down the hall, this one was demanding to see his doctor, that one cheeking meds, the other one vomiting, and this little piggie goes wee, wee, wee, wee all over the floor.

Into the fray come a couple of patients who are more personality disordered than they have mood disorders or psychotic disorders. Which I've come to think of as meaning that they have a pathological lack of perspective and timing. So it's at this minute that one of them decides to stand in the doorway of the recently calmed-down, praying-and-yelling-while-in-the-fetal-position-in-the-hallway lady. This is the equivalent of your little brother putting his finger three inches from your face, saying, "But I'm not touching you." And the other one demands to see the nursing supervisor -- now. Some bad behavior had gotten both of these patients onto this acute unit from a less-acute one, so now they're bent on acting out so badly that they'll get moved back. Which is generally not how it works, but remember the pathological lack of a bigger picture thing.

On a better day I might find that kind of strategy sort of pitiful and pathetic, albeit annoying. Today it makes me a little resentful. Listen girls, I want to say, we've got our hands full here with folks who think they've had microchips implanted in them by the CIA and that other people can read their thoughts, the heating system is poisoned, God Himself is punishing them, the radio talks to them and who knows what else -- so you two just have to buck up so we can take care of these folks who really do need taking care of. I don't say this, of course. What I do is ask one of them to take a time-out in her own room, and explain, not as patiently as I might've, to the other that the nursing supervisor will see her when and if she is able. It doesn't work, so I go back to writing notes and let the unit staff try to calm them down before I get sucked in any further.

It's an acute psychiatric hospital, so sure we'll have acute patients. But we don't usually have so many who are so difficult to manage all at the same time. Nerves fray, tempers flare. So please, oh please, if there is a God, let there be enough cigarettes to get all the patients through the next smoke break, and I promise I'll never ask for another favor again.

Happy New Year,

Madeline