Manic Stage of Bi-Polar

This patient has tried my patience constantly. This patient we have with us right now has been with us for over a week and he appears like an average guy in his early 20’s. He is probably 6 foot tall and he has the athletic build. He talks all the time and all he ever talks about is why he shouldn’t have to be here, how he is perfectly fine and also how he has an extremely important meeting to go to the next day and if he misses it he will lose out on thousands or millions of dollars. Its interesting…because I have heard that same story so many times! I have to admit I have become very annoyed at times. It can be VERY hard sometimes to stop and realize that sometimes people with bi-polar can be psychotic. It’s just that their type of “psychotic” is portrayed very different sometimes. They appear super “normal” and can hold ” normal” conversations but are extremely delusional, believing things that are not true. And the most difficult part about it is that they are extremely convinced that they are right about everything, they are fine and there is absolutely no reason they need to be in a mental hospital. Even when shown evidence showing them why they are wrong they will still find a way to fight you on it. Its extremely frustrating. I have noticed this pattern in a lot of patients with Bi-Polar Disorder. This patient constantly gives me attitude and when I put him in his place he seems shocked every single time. He can’t believe that I would give it right back to him. I know that I need to be more compassionate with this disorder. I think I need to realize that when someone is in a manic stage they are not thinking clearly at all and are psychotic and are verbally and even physically aggressive. I get annoyed at myself and think , ” How can I get annoyed at this person? They are the victim, they are the one suffering with confusion, delusions and a false reality.” I once again am humbled with realizing how blessed I am! We have no idea how blessed we are if we do not suffer from a mental illness. No idea at all. The fact that I can think clearly and not live within a confused bubble all of the time is a blessing in itself. I guess I just have some more growing to do, but don’t we all?

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Low functioning male who bites and spits

So we have had this patient with us for over a week now and he has been so hard to deal with. I will call him Matt. Matt is about 20 years old, 4 foot 10 inches, overweight and of Hispanic descent. He is also extremely low functioning, he functions at about a 5 year old’s level. He was admitted the night I was working and when he walked in and was being asked to sign some papers my co-worker had to tell him to take his hands out of his pants. This is something that has never ended, he always has his hands down his pants. Gross I know. That night he went to bed quickly and slept throughout the night. Oh and he was brought in because he had attacked his brother in a fight and had been biting his brother’s ankles. Anyways Matt slept the whole night and woke up at exactly 6:00am the next morning right when I was about to go home. He walked up to the nurses station and said, ” I need to go to school, I’m going to miss my bus.” I was tired and didn’t feel like coming up with some fake answer so I simply said, ” You’re not going to school today.” He looked at me like I had just told him the worst news of his life, yet… I continued. ” Your going to be staying here for a few days.” This time his eyes grew even wider and tears began to swell up in his eyes and then came the screaming. The long stretched out wail of Matt that we have grown to dread. He began screaming at the top of lungs, ” I hate you!! Let me out!!!” staring at me of course. He grabbed onto the nursing station door and began shaking it with all his might while he screamed at the top of his lungs. His face went completely red and he screamed directing it at me. I tried telling him that it wasn’t me keeping him there, that it was the doctor but that did absolutely nothing, he was too low functioning to understand what I was saying. I left a little traumatized from the yelling but got over it before I got home.

I knew I would have to see him the next time I worked. Since then he’s been with us for a little over a week and he wakes up every morning thinking he’s going to be leaving that day…and freaks out all over again. The worst that happened with Matt was the last time I worked when he attacked a few of my co-workers. He randomly charged my male co-worker and began chasing him. While chasing my co-worker he even turned over the coffee table in the dayroom. Sadly the other patient sitting at the table was a man who is suffering with PTSD from serving in Iraq and that traumatized him even more. Anyways, my co-worker ran back into the safety of the nurses station and we called for more help, and began drawing up a shot. It took 3 male co-workers and 2 female to get him into his room, to hold him down to give him 3 shots. I didn’t participate in the take down but I watched as he attacked my co-workers, punching, kicking, biting and spitting at them. At one point he was on the ground holding on and biting on of their legs. He also bit his own lip so that he bled and then began spitting blood at them, blood landing on my co-workers face.  Throughout all of this he is screaming at the top of his lungs. The take down took over an hour until he was knocked out for the night. During all of this I gave attention to the other patients. Of course the PTSD patient was being triggered and so I let him close his door and stay in bed. The other one’s turned up the T.V to try to block out the yelling. I went around and took their vitals and almost everyone’s blood pressure was skyrocketing. I felt bad for them and tried to talk to them to distract to them and be happy for them. Eventually I just took them out to the patio to get them away from it. Thankfully Matt knocked out for the rest of the night and it was a great rest of the night. The next morning just as I was about to leave, on queue he woke up and came to the nurses station. I awaited an outburst, but instead he just said, ” Good morning, what time is it?” I told him the time and he said, ” Ok, I’m going to go back to bed.” It was as though he had forgotten about everything that had happened only hours before. Oh well! At least I could just go home…

My Psych Patients at the Moment

So work lately has been kind of chill, But then again my standard of “calm” or “chill” is probably much different than most other people. Lets see who I have been working with.

There’s Marco, a 20 year old Hispanic man who functions at the level of a 5 year old, When I informed him that he was going to be staying with us for awhile and that he couldn’t leave he went ballistic, screaming obscenities at me, threatening to hurt me, punching walls. He wakes up every morning and thinks that he is leaving, and once he is told otherwise he goes into a freak-out. Everyday.  Fortunately he can be calmed down pretty quick and then remains calm for the rest of day, until the next morning when he wakes up.

There is Sam, a 20 year old LDS missionary who was serving a two year mission in Argentina and suddenly became psychotic, but is super nice. He believes that a talk by one of the apostles was meant for him and that he is being prepared to be the next Apostle of the Church. He has been diagnosed with Schizophrenia and the saddest part about it is that he had never had any signs of psychosis in his entire life, nor did his family have any history of mental illness.

Then there’s Roxanna, a mother of 3, a petite 30 something year old who is extremely psychotic, delusional and very gamey. She is always asking me random weird questions, jumping up and down, dancing. One night she stayed up the entire night “talking” to us through the window, speaking nonsense. We literally just ignored her. She had spit a wad of flem into each hand and walked around for hours playing with it in her hands.

Then there is Gale, a 40 something year old who has cerebral palsy, is restrained to a wheel chair, never stops talking. I played her in chess and she beat me and she likes to murder animals for fun. When I asked her about it she showed no remorse. Oh and she thinks its November of 1992.

Next is Ryan, who doesn’t talk. He’s in his late 20’s, tall thin, ghastly looking man who functions at the level of a 10 year old. He stares at me for hours and mumbles incoherent nonsense. He can be re-directed but Is very paranoid in that he hears and sees things that aren’t there. The staring really does get creepy.

Next is Steve, a man that will be forever institutionalized. He’s in his late 40’s, believes he is a millionaire, sits in his bed talking to the voices for hours on end. He told me that he wanted to marry me and that we could go to Hawaii together. He was genuinely disappointed when I said I had a “boyfriend”.

Then there Is “Haley” who is actually a man, but he had a sex change so he is now a she. Haley is Borderline and is “suicidal” but most of it is just for attention. She has tons of scars from cutting up and down her arms and is very quiet. When I asked her about being suicidal she said would do it if she could find a way but just cant find an accessible way. When she told she was trying to hold back a smile. Later I found her in her room with a blanket draped around her neck. I just told her to go to bed. She just wanted the attention and once I gave it to her she was fine.

And last but not least there is Tim, a guy in his early 20’s, when you first see him you would never imagine he would be psychotic. But he is, very psychotic and paranoid. He talks non-stop asking me questions, threatening to sue ( which is very common) us, demanding to be let go ( also very common). He believes he is perfectly fine, yet is very delusional. This is common among patients with Bi-Polar.

There are a few more that I have right now, I just can’t think of them right now. But yeah these are the patients that I have had for the past few shifts. The next time I go in some of them will be gone and some will still be there. So yeah a pretty chill group for the most part.

The saddening affects of Psychosis

I know that sometimes I laugh at the funny or weird random things that a psychotic person says but it really is so sad when I watch them feel feelings of fear or confusion. That is the saddest thing to watch. Yesterday at work I noticed a trend amongst the patients. We have a lot of Schizophrenics right now and a lot of them are extremely paranoid, they believe that people are trying to poison them and kill them. I talked with two of them for awhile and as I sat and listened to them rant and rave, both of them homeless, no teeth, dirty, with nothing to their name, they both looked at me with such extreme confusion, anxiety and fear about their future. They both expressed anger at the doctors for having brought them to this psych ward, neither of them could understand why they should have to be here, they were fine, completely fine. They both talked about how they knew they were somewhat confused about life but were totally fine to being out on their own. One of them actually became irate and began get very angry exclaiming, ” I better not get committed to the State!” The other kept saying to me, ” I just get all scrambled in my head, and if someone could just tell me what’s going on I could do it, you know just throw my thoughts around and throw them out side of me.” He wasn’t making much sense at all, except that I could tell that he knew he was confused. It was sad, really sad seeing him so confused about life, about everything. I could see a little glimpse of what it would be like to not have control, to not be able to think clearly and have control over your thoughts, your mind and your life. I sat there looking at him as he went on and on and I thought about how strong he had to be to carry this large of a burden, and how most people would look at him and only see a dirty homeless man, but because of my job I was able to see him for who he really was. These two guys reminded me a lot of another patient we used to have. I’ll call him Tyler. Tyler was a lot like these two guys, a male in his 40’s, confused and his confusion made him very sad a lot of the time. He would pace up and down the halls deep in thought. He would always tell me, ” I just feel so confused and worried all of the time, but I don’t know what I’m worrying about.” The look on his face was heartbreaking.  He was constantly worried that he was offending someone, he would go to his room and change his shirt multiple times throughout the day because he thought that his shirt was offending the other patients. Can you imagine being so confused like that all the time? and so worried and anxious about everything? I really cant imagine it. One time another female patient was up in the middle of the night screaming at the top of her lungs. It was so loud that all of the other patients woke up including Tyler. Tyler came running out of his room and the first thing he said was, ” Was that my fault?” It was kind of funny but yet so sad at the same time, the fact that he is constantly worrying about everything all of the time is so sad. The interesting thing about Schizophrenia is that some are so far gone that they have no idea where they are, who they are, what they are doing and they almost live in an ignorant bliss. But then you have the other half of Schizophrenics who are very aware that they suffer from it and this is much worse because they know what is reality and what is not for the most part but just have to suffer with hallucinations, bad thoughts, visions, confusion, sadness and  depression. These people try to live normal lives, they try to work and support themselves but it Is just too hard for them to function. Even when we get them on the right kind of meds they don’t ever fully work for them or if they do the patient a lot of times stops taking them. It really is awful to watch because these people want so badly to live a life like we do. They would give anything to live as happily and as peacefully as we do, and the sad thing about is they probably never will.

PTSD from Rape

This story is pretty sad too, something I don’t like to think about ever happening to anyone that I know, especially after having seen what I saw with this patient. I will call her Kelly. Kelly was a petite 18 year old girl with pretty blonde hair. She had been suffering with bulimia for the last few years but other than that had led a pretty normal life. The first time I met her I came onto the Unit and heard screaming coming from the end of the hall. Nobody else seemed too concerned about it and so I thought she must have a reputation for screaming for attention. ( Something that does happen a lot ) I slowly walked to the end of the hall, not really worried about it. I opened the door and found the room completely dark with Kelly curled up on the floor rocking back and forth screaming. I stood over her and said her name loudly. She didn’t stop so I said it again this time louder and with an annoyance in my tone. Kelly jerked to a stop, looked at me in terror and began screaming, ” No, don’t hurt me!” I realized in that moment that this was not for attention but real affects of PTSD. She began moving around, standing up and sitting down over and over again. She was holding herself “down there” crying and saying, ” It hurts!” She would double over in pain. I tried to distract her by asking her questions about her life, ” Where are you from?” ext…it worked for a couple minutes but then she would remember where she was and what had just happened to her and she would start screaming and crying again. It was absolutely heartbreaking and awful to watch. She kept moving around, she would get up and start walking down the hall but then crumble to the floor crying and holding herself. She felt like it was physically happening to her over and over. I tried to explain to her that she was experiencing symptoms of PTSD and that flashbacks are part of that. It didn’t go far and soon we gave her some meds that helped calm her down and put her to sleep. For the next week Kelly improved to where she would sit and talk to me, she told me how she had gone to a party where these two guys that she knew had raped her. The one held her down while the other raped her. She was heartbroken because she had been a virgin before this happened. When she would cry and scream she would say, ” I’m disgusting now! I’m dirty and disgusting now. I just want to kill myself.” She also became very jumpy, she would jump anytime anyone came near her and if she was having an anxiety attack I would have to be careful as to not touch her and if I was going to I would tell her, ” I’m going to touch you ok, so that I can help you up.” It was so sad to see her go through such a hard time and I have no idea what happened to her when she left. I just hope and pray that she got through it and will live a happy successful life from here on out.

The Pica Kid

There was this kid that came in once a long time ago when I first started this job. In my whole 2 years of working here I don’t think I have ever heard such a sad story as this one. I will call him Jacob. The first time I saw Jacob I felt like I wanted to cry. He was the tiniest, malnourished 18 year old I had ever seen. If I didn’t know any better I would have thought he was 12 years old, his body was emaciated, his skin extremely pale, his teeth mostly rotted from years of taking meth. He looked like he had been malnourished for years and he had lost his sight in his left eye. Since he was 18 we had to put him on the Adult Unit but we were worried about him, not knowing if he would be able to handle it.

Jacob had an extremely traumatic background, he was born into a family of two drug addicts. While Jacob was still in his mothers womb she used Meth and then when he was born she gave him Meth for years and years, up until he was 9 years old. She would also inject Lysol into his arm. On top of this both of his parents sexually abused him for the first 9 years of his life as well as trade him for sex to drug dealers. When Jacob was 9 years old the school nurse saw how abused he was and he was soon taken out of his parents care and put up for adoption. He was immediately adopted into a loving family and for the last 9 years had been living with them. Even though he had been given a safe loving environment the abuse had left too big of a scar on him. He suffered with Pica, a disorder where he eats random objects in hopes of ending his life.

When I walked him onto the Unit I sat him down and went to get him so food. I brought him some yogurt and cheese strings and pudding. I watched as he ate the food quickly, enjoying every bite. The pudding made it all over his face and when I asked him a question I could tell that he was too scared to make eye contact, I supposed something that had lingered from years of abuse. I couldn’t leave him because we were afraid he would try eating the plastic spork that he was eating with. They had told us that he would take off his t-shirt, rip it up and eat it. He would also drink Drano and eat his own feces in hopes of killing himself. So we were pretty worried when he first got to us.

Jacob was with us for a couple weeks and he never once tried to eat anything that wasn’t food. He was always hungry and asking for extra food and we gladly gave him anything he wanted. He was however extremely messy and had no concept of hygiene. We also found him in his room masturbating constantly, another effect from years of sexual abuse.

He was always so sorry for these things though. Always apologizing and wanting to be better. I remember one time he said to me, ” I feel shame and guilt for the things I’ve done wrong.” He then told me how he had murdered his families two pet dogs by stabbing them to death.

I could tell that he sincerely was sorry and just couldn’t cope with all of the abuse. He was masturbating, killing animals, eating objects. The reason he had come to us initially was because he had laid down in a river in the middle of the winter hoping to freeze to death. He wanted to die more than anything. He had no hope to live, no reason, no happiness.

When it was time to leave his adoptive parents didn’t want to take him back, they felt that he was affecting their other children too much in a negative way but in the end they decided to take him back. When he left we all thought he wasn’t going to make it, that he would only end up in a worse situation.

A year later I was out with my patients on smoke break in the courtyard and I noticed one of the other patients from a different Unit. He looked familiar but I couldn’t put my finger on it. Towards the end he walked up to me and said, ” Do you remember me?” When I heard his voice I said, ” Jacob?!” I had never forgotten his voice because it was the only child-like thing about him, the only thing that hadn’t be tainted by his abuse.  He was taller and filled out, he no longer appeared emaciated or sickly. He held himself with more confidence and joined into conversation with the other adult patients. When he had been here the year before he had never spoke to the other patients, he had played video games all the time.  I didn’t ask him why he was here this time but just told him that it was good to see him. That was the last time I saw him but I was so glad that I had seen him. I was glad that he was alive and doing even a little bit better. The fact that he was not on my Unit was a good sign because my unit meant you were doing very badly. Jacob was a very sweet boy and I really do wish him the best.

27 year old Med Student with Schizophrenia

It really is sad to see someone who wants so badly to lead a “normal” life not be able to and be held back by their mental illness. I will call her Deanna, shes a 27 year old girl of Asian descent who has a bachelors degree, took the MCAT and was interviewed for a medical school. Her parents started noticing some delusional and bizarre behavior and that’s how she ended up with us. When I first met Deanna I would have never thought that there was anything wrong with her, she was extremely polite, seemed to be very aware of social norms and could hold an intelligent conversation very easily. I was very surprised when I heard that she had taken off her clothes the night before and ran herself into the window multiple times. She suffered badly from Schizophrenia and had voices telling her to hurt herself. Deanna was very good at hiding her internal stimuli but I would catch her every night sitting on her desk in her room talking to herself. You see some people with schizophrenia are very aware of their disorder and are embarrassed of it. They try to hide it as best as they can but it is still obvious to us. Deanna also thought she had a husband named Jordan who lived in the Unit with her. She came up to me one time and said, ” Can I have an extra towel?” When I asked why she told me that it was for her husband Jordan. It was pretty awkward when I asked her where he was and she pointed down the hallway to nobody. I said I couldn’t see him and she just said, ” Oh, ok.” and sadly walked away with her head down. I think she realized in that moment that maybe he wasn’t real. Another time Deanna walked up to another male patient who had just arrived on the Unit ( keep in mind, this patient was also extremely psychotic and confused) and said to him, ” Do you want to have sex with me?” He stared at her in complete confusion and disbelief, waited a few moments and then said, ” Well…not… right now…”

She was extremely introspective, always writing in her journal. Its seemed like this was extremely therapeutic for her, this was her way of coping with all of the “demons” in her head.  Deanna was also so sweet, asking me how my day was going ( which is pretty rare). She was someone I could actually sit down and talk to about life. The last day she was with us I talked to her quite a bit and she told me all about how she wanted to go to med school and how she had already taken the MCAT. Here there is this extremely intelligent woman wanting so badly to be normal and functional and she cant be. It made me be so aware of how blessed I am to be able to function and do the things I want and need to do. Schizophrenia is something that Deanna will always struggle with, she may never lead a normal life and I had so much compassion and love for her at that moment. I really do hope and wish her the best for her life.