What do I know?

Well, most of August's fun is over. I've worked four days, and man, I am not used to that. I'm used to Zumba classes and pool swims. But it was interesting and difficult and at times, upsetting. For whatever reasons, I drew the short straws on a couple of shifts and had very difficult days. I processed 6 discharges in one morning, and then the next day (of which I stupidly said out loud "this will be easy") actually had a worse day with no discharges. Hospital work is like that - very unpredictable. The part that continues to try me, and that is so very different from office work, is that many things can happen at once. A patient starts screaming and beating on the walls, another one slips in the hall and falls, the lab guy just walked in and needs you to unlock the door for the samples, the doctor was in mid-sentence to you, and you have a handful of narcotics to give to a patient down the hall. And guess what - you must deal with it all. Yes, ask for help, but eventually you must deal with it all. If a patient's assigned to you, you are the one who documents everything. And believe it or not, that's the soul of the floor nurse. Charting. So here's what happened that bugged me the most. One of the most challenging types of patients is those with the Axis II diagnosis (personality disorder) called Borderline. This is a bad name for the disorder - it's not like it straddles any borders - not sure what the origin is - but it's usually a female, very dramatic, has serious intimacy problems, lots of approach/avoidance and passive/aggressive (and real aggressive, too). High risk for suicide. And the worst part, as with other personality disorders, is that very few patients change, very few get better. Mostly because they don't want to. Not that they're exactly happy with their lives, but they are unwilling to do the hard work to change their behavior. And boy -- I'd like to hang this sign in my office: In psychiatry, only those that want to change will do it.

Anyway, I had a borderline patient. This was a young, 30 y.o. woman, many medical problems already from a life of living too large and extremely drug seeking. I was discharging her and she was apprehensive about that. But she'd been with us for a couple of weeks (a long time for this facility) and we had a solid out-patient plan for her. It was appropriate. I started working on the discharge process, reviewing her prescriptions with her, going over her valuables from the safe, having her sign off on instructions and commitments to attend meetings, etc. She fights it in various, frustrating ways. Takes hours to pack in her room. Gets tearful and has to rest in her room. Then the kicker is when she asks where her necklace is. There's no necklace documented in any of the forms. And we document it all, carefully, on admission. The tech that processed her admission, luckily, is there and remembers her well. There was no necklace. But the patient insists she was wearing it when admitted, even though she was so high at the time and off her psych meds, that she really remembers little else. She says it had sentimental value and screams and cries. I get the supervisor, who (excuse me, I must speak frankly) is a worthless sack of dirt that rarely does her job right and always complains about it. I ask her for the form the patient needs to fill out for a missing item. She shrugs - I dunno where the hell it is. So I have to ask some of the more seasoned nurses on the other floor to get me the form. I'm running around, this takes time, I have other patients standing at the desk that need me. It's starting to turn into a circus. She's still crying. I'm feeling a little overwhelmed when I look over and see that one of the docs just completed rounds and has put up 4 charts with orders for me to process. This is not atypical.

I finally get this woman out the door; it's really, really hard. She came in with a ridiculous amount of stuff, clothes and toiletries. And there are 4 big bags of prescription drugs, each contains about 10 pill bottles. Mostly highly abused things, like Xanax and Oxycodone. Many bottles are the same stuff from different docs. She had these in her bags when she was admitted, we just count them, seal them up and secure them, and return them when she leaves. Yes, seems crazy, does it not? And this is the capper -- as we're leaving in the elevator, I'm helping carry it all down to the car waiting for her (something I normally don't have to do, but whatever it takes to get her out at this point), I start giving her a little positive pep-talk about how she can get off on the right foot after discharge and she stops me. She says pointedly, "What the hell do you know about mental illness? You've never had a problem like me." And it stops me. Because (thank goodness) I am not jaded enough to ignore this and dismiss it out of hand. Yes, I definitely do not have a problem like her. Now, I haven't talked about this much on this blog, but I have had issues in my life and I have had treatment. I am doing great now. I am working towards a place where I can be completely open about that, I'm not there yet. Sometimes with certain patients especially, I will talk about it. When it's therapeutic and appropriate, and in a limited way (because it's not about me). But no way do I have any experience like her. And truly, can I know what that's like? No. So I get to think about that for a while. It will certainly inform some of my clinical experiences this semester.

On a lighter note, I'm reading an interesting book that a classmate recommended called Stumbling on Happiness. It talks a lot about the current research on what we humans do in pursuit of happiness and how we try to set up our lives and make choices to create a future of happiness. The main thesis is that we usually do that wrong -- because we assume that the way we feel now about things is the way we'll feel in the future. But research shows that's not true. I haven't finished the book yet, and haven't gotten to the part where he recommends what to do about that conundrum. Ha. But he does provide lots of good data to support his points.

I have more to say, but I'm tired. We leave in the morning to take Dani to NYU.

Ken and I went to Baton Rouge last weekend to see Karen and Jim and celebrate her retirement. She made boiled spicy peanuts for us! Oh my -- sitting on the patio, eating peanuts and drinking wine and laughing for hours. It was heaven. And here's the absolute best part - she loves retirement. Isn't it great? And yes, Karen's still good for a flash. Throw me something, mister.