Highly Aggressive Male who hears Voices

So we don’t normally get highly dangerous patients but sometimes we unfortunately do. This guy was SO scary when I first met him. I thought I was going to get beat up for sure! I will call him Jose, he is a 270 pound 30 year old guy with a shaved head. He paced up and down the halls only to stop and glare at you and then returned to pacing while randomly yelling obscenities. The first time I met him my co-workers told me that he was with us because he hears voices, becomes violent and had been kicked out of his “group home”. I said ..” OK, so why is he not in jail?”

So anyways, the first night I worked with him he slept the entire night and I didn’t even have to talk to him, nothing. The next night was officially one of the worst nights in my almost 2 years of working at this job. For the first 5 hours of the shift Jose was on edge, ready to explode at any second, and he would. Randomly. I hated it because I could never see it coming and since this was my first time meeting him, I didn’t have any rapport with him whatsoever. My co-workers had told me that he responded well to music so I put on hard core rap for him and he would stand behind the glass of the nursing station and nod his head to the music. This would pacify him for about 10 minutes at a time and then he would be going off again, yelling, ” F*** You!,” and trying to break out of the door. I couldn’t breathe, I felt like I was suffocating. On top of dealing with Jose, I had 9 other patients to take care of, asking me questions, needing things, acting bizarre. I didn’t know how to connect with him and calm him down and I had the pressure of him going off if I didnt. At one point he escaped and I had to call a Dial 9, this is where your co-workers will come running to wherever you tell them over the hospitals intercom and help. That was one of many that I called that night. So, from 6:00pm to 11:00pm I failed miserably at keeping him calm for more than 15 minutes at a time. He was so extremely labile, going up and down so quickly. I could tell he was responding to a lot of voices but I was too scared to push him, to say anything that would make him worse. I just didn’t know how to gauge him yet, and I was scared to literally get too close to him. After 5 hours I was SO mentally and emotionally drained that I was in a trance. I felt like I couldn’t move, talk, think, do anything. My co-workers made me switch units for the rest of the night. I was grateful and I prayed that the next time I came to work he would be gone, but of course… he wasn’t.

When I walked in for the next shift I was with my male-coworker and the second Jose saw us he started screaming, ” F****** B****!” and began trying to jump over the glass window. My co-workers told us to leave for awhile. When we came back they told us it was my guy co-worker that had triggered him. Apparently he gets triggered by males and works tons better with females…So they were basically forcing me to work with him again. They assured me that since he had been with us he had not attacked anyone and so I should be safe. I dragged myself onto the unit and I just told myself to not be scared of him and to just treat him like I would treat anyone else, a friend.

It worked wonders! He responded so well to me its not even funny. I worked with him for 2 days straight and he was almost perfect for me. I still had to give him more attention than I did for the other patients but he never yelled, screamed, escaped or punch a wall! I told him that when he started to hear the voices to come talk to me and tell me and that I would help him. He nodded his head in agreement. When he came to me and told me I did what I always do with the “voices”. I distracted him. I asked him about what sports he likes to play, how many brothers and sisters does he have, ext…It is amazing how quickly this can help someone with voices. It doesn’t keep them away forever but it helps enough for them to call down until we can get them an anti-psychotic which is what really will help.  We ended up talking a lot, I got to know a lot of things about him. He once said to me, “I don’t get why people are so scared of me.”

When it was time for bed I made his bed for him, and he said to me, ” Will you stay and talk to me?” It was then that I realized that all he had wanted was someone to show him some love, kindness and to treat him as an equal. He had wanted love and attention just like any other human being. He didn’t want to be treated as someone to be afraid of. It’s amazing  how alike we are as human beings. At the end of the day we all want the same thing, to be loved. And I think that is something that Jose didn’t get enough of as a child.

Drug Induced Psychosis

I don’t think I’ve shared a story about a patient who came in psychotic because they took drugs yet so here it goes. I will call her Crystal. Crystal had been using Meth and the first time I saw her I was a little creeped out. She walked pass me and stared at me craning her neck back to watch me as she walked in the opposite direction. She was tall with big curly black hair that was disheveled, flying in 50 different directions. She was taken to her room but then they called me shortly after because they were having trouble getting her to sleep. I walked over to the Unit she was taken to and when I got to her door, one of my male co-workers, a man in his late 50’s was standing in front of the door keeping it closed. He told me that she was trying to get out and that I would have to carefully sneak in. He told me how she had jumped onto his back completely naked and had begun humping him. As he tried to get her off of him, she had reached under him and grabbed his private parts. That was when they had called three female staff to come help. I snuck into the room and found her standing in the room naked dancing. My two female co-workers were trying to cover her up with a robe. I immediately jumped in and began helping but every time we got the robe on her she would take it off. She was deliriously happy, with the biggest smile on her face, dancing around, saying the strangest things. The most bizarre thing she did was crane her head to the side and walk towards me with wide eyes as she made a clicking noise with her tongue. This was defiantly one of the weirdest/creepiest things I had ever seen.

Eventually my co-worker gave her a paper cup to take her pills with, she threw the water at us and then walked directly at me and put the cup over my hand. I was extremely relieved! haha I had thought she was going to hit me or something. It took over an hour to get her to take a pill. In the meantime she was dancing, laughing, grabbing my co-workers private parts, at which I began laughing so hard I would have to leave the room, calm myself down and then come back in. At one point the three of us began dancing with her just so that she would be cooperative and take her pills. Eventually she did take them, and fell asleep on her bed. All in all I can say it was a night I will never forget! Hilarious and eye opening at the same time. I guess I should say, Don’t Do Drugs.

Schizophrenia and its confusion

Schizophrenia…what a complex mental illness.. One of the aspects that I hate the most is the memory loss that comes along with it. The person has so much going on their head that they can’t focus on any particular thing. This in turn makes it very hard for them to remember things. This event took place the same day that I was taking on Sam  ( from my last post).

This female patient who I will call Sandy is in her early 50’s, she is a petite build with long brown hair and glasses. For the first few hours she was extremely nice, smiling, being extremely polite. I noticed that she kept asking me the same question over and over again though, ” When are we going outside for smoke break?” She must have asked me 6 or 7 times in one hour. At first I became irritated thinking she was simply being impatient until I realized that she just wasn’t aware that she had been asking me. Eventually we went outside and spent a good 20 minutes outside in the courtyard. When we were finished, I led everybody back inside and back onto the Unit. Almost immediately Sandy walked up to me and said, ” When are we going out to smoke break?” I responded, ” Um..We just went to smoke break.” Sandy responded, ” No, we didn’t!”

This conversation did not go or end well. She demanded evidence that we had just gone out. She thought I was lying to her and cheating her out of her smoke break. She escalated quickly, yelling and screaming at me, threatening to sue me. ( Like I haven’t heard that one a million times) She began slamming her hands on the nursing station door as she screamed at the top of her lungs things that didn’t make any sense at all. There was no talking sense into her. I grabbed the sheet of paper where we document where the patient has been all day. I circled the Unit Patio and showed her the time. She still didn’t believe me. I gave up trying to convince her and began to walk away. This made her very angry. She began walking towards cornering me against the wall. I began to get nervous at this point, convinced that she was going to attack me. Instead she randomly yelled, ” How would you like it if you had dentures?!” She then proceeded to reach into her mouth, take her dentures out of her mouth and throw them at me. Luckily they didn’t hit me and they fell to the ground. I then slipped back into the nurses station to get away from her. She then began to demand to speak to a supervisor. My co-worker who was standing next to me said, ” I’m the Supervisor.” Sandy replied, ” You can’t be the Supervisor, You’re wearing Red!”

At this point I had to turn around so that she couldn’t catch me laughing. The look on my co-workers face was too funny.

Sandy eventually calmed down and by the end of the night was smiling at me again being polite. I guess she had just forgotten again. What can you do?

Acute Psychotic Break

I had an interesting experience at work the other night that I wanted to share. I think this is something that most people don’t know about, at least I didn’t know it could happen until I started working here.

 When I arrived at work the other day I was told that among our 10 patients on the Unit we had received a new one that day. I will call him Sam. Sam is a High School math teacher. He is a tall lanky man in his mid 30’s with short brown hair and glasses. They informed me that he did not have any history of mental illness and had never experienced any psychosis before in his life. He was an extremely normal, average person, just like you and me. These cases are always the scariest because if the person doesn’t snap out of it within a few days they could stay like that forever. Our job is to make sure they get a lot of sleep so that their brain can heal.

I walked out onto the Unit and Sam immediately walked towards me cornering me into the wall. He was repeating something and it took me a few seconds to realize that he was repeating his own name over and over again. He stared at me with an intensity that scared me for a second. Keep in mind I didn’t know yet if he was the aggressive type yet. So in return I put out my hand and said, ” Hi Sam, nice to meet you. Do you want to go watch some T.V?” He stopped, stared at me and then began saying, “T.V, T.V, T.V….”  He followed me to the dayroom where other patients were sitting around watching T.V and coloring.

Throughout the next few hours Sam followed me everywhere I went. He became fixated on me, staring at me and repeating the last word of every sentence I said. He would also randomly fall to the floor bursting into tears for minutes at a time for no reason at all. He would eventually get up and then go back to repeating random words over and over. At one point he was staring at me repeating a word over and over and so I decided to try something. I clapped my hands twice as hard as I could in front of his face. He immediately stopped and jerked his head towards me and looked at me as though he had just woken up from a deep sleep. I did this a few times throughout the night if I needed to get him to do something. When it came time to eat, I sat with him and spoon fed him jello. Even when the jello was in his mouth, I would have to mimic ” chewing” so that he would mimic me and be able to eat. After I got some jello and a piece of pizza into him I decided to test something. I began asking him simple questions like, ” Is my shirt blue?” ” Are you a boy?” ” Is this pizza?” Each time he answered by saying either Yes or No and he was incorrect each time. I then decided to make a face by sucking in my cheeks and pursing my lips. He imitated me perfectly! I continued to do this and he mimicked everything I did perfectly! I found it so interesting. I went back to the nurses station and told my nurse about it. She told me that he was exhibiting two things. First, Echolalia which is the automatic repetition of vocalizations made by another person. And secondly, Echopraxia, which is the automatic repetition of movements made by another person. I loved learning something new!

The amazing part of this story is that when I came to work the next day Sam had completely come out of the psychotic episode which was AMAZINGLY fast. Normally it takes up to at least a week to ten days to clear. Sam had cleared in 2-3 days! He had completely cleared, but of course could not remember anything that happened. He just wanted to use his labtop so that he could submit his grades for the summer semester. The doctors didn’t know what had sent him into a psychotic break and they may never know. It could have been biological, psychological…I guess there are some things we will never know the answer to but I was so happy to see him back to his normal self, and he was a very nice guy!

Detoxing and Borderline Personality Disorder

I know its been quite a while since I posted anything. But today I thought I would share about how work has been for the last couple of weeks. Recently we have been working on opening up a Detox/Rehab Unit and so in the meantime my unit ( Psychotic) was being given tons and tons of Detoxers. People that are detoxing off everything, Heroin, Alcohol, Prescription pills, Meth mostly. I must admit that I have a very hard time working this population of people. I try my hardest to have compassion for them for them, and it is very hard not to judge them sometimes. Most of them are needy, constantly asking for something, most are manipulative, calling you ” Honey and Sweetie” so that they can try to get something out of you later, and most are med seekers, saying they are in pain so that they can receive more meds when they are really actually just fine. They can be mentally and emotionally exhausting. I don’t want to generalize and say that they are all like this but I have found that some are. Another reason I have a very hard time having compassion for them is because they can be very rude and do not have a lot of manners, demanding that they want things immediately, as well as entitled, believing they receive the very best treatment at all times. I find myself rolling my eyes when they are not looking and avoiding eye contact so that they wont start asking me for something.

 I have also found that some detoxers also have Borderline Personality Disorder as well. This explains their need for my attention and the mindset that they are the victim and will never be able to get out of their current situation. They will talk and talk about how everyone around them is out to get them and ruin their life and that if it wasn’t for all of the bad things that have happened to them then they wouldn’t have such a terrible life. I found that if I smiled and made eye contact they immediately took that as being weak and thought that they were now able to walk all over me. When I first meet them I have to establish that I can’t be pushed around by my facial expressions, the way I speak and body language. If this isn’t done from the first day I meet them they will try to push me around and manipulate me for the rest of their stay.

 I have come to the point where I will listen, nod my head and give them validation but I no longer attempt to give any type of advice because I realized at some point that most of them have no desire to actually change their lives, they just want to be heard. When I do find a detoxer who talks about sincerely wanting to change I am so excited! I love to hear about how they really want to change their lives around and I am quick to give them information on rehab facilities that they can go to afterwards.

I do wish the best for this population, I do care for their well-being. I just have a hard time helping someone that doesn’t want to be helped. I have really learned that we as human beings cannot be helped until we are ready to receive it. It is up to us. And through this job I have learned so much patience, love and understanding. I have also learned to not judge because It is not my place. I am grateful that I am given that opportunity to learn that each time I go to work.