A Letter to a patient

Dear Mr Chong,

This morning I was calling a few patients checking how they have been and trying to answer any question they may have. When I was calling this woman whom I usually called her house numbers as she didn't have a mobile phone, somebody else picked up, and told me she's no longer living. She committed suicide yesterday. The lady answered the call was her daughter. I didn't ask anything further, ended the call after sending my condolences.

It took me at least 5 minutes till I managed to type the note then tell my colleagues what happened. One of my colleagues guessed it straightaway before I opened my mouth, she must have seen it on my face. I keyed in "Deceased" on her profile and informed doctor much later.

I carried on with my work. Then later of the day I was calling you and realized that your phone was temporarily unavailable. I called your girlfriend and finally she picked up, telling me you were fine taking the medicine. About an hour later you rang me from Singapore, and when I said I was just checking how you were getting on, you said you were going to commit suicide. I know you, although only for 3 days now, I knew you were just joking, so I asked by what method you're planning. You laughed, I'm released. I was updated with your current condition, I know you're doing very well, coping well too. Afterall you weren't depressed, just some anxiety and palpitation problems.

This is part of my work. Sometimes a few people tell me they're suicidal within a day, I learn to judge well to make sure everyone stays alive, then happy if possible. I didn't take you seriously, so I didn't tell you that you shouldn't really be joking about committing suicide.


11 Sept 2013

Genuine Suicidal Attempt or Attention Seeking?

She was told by the doctor to come to the clinic to collect her medication and for an injection, after seeing the doctor in the hospital.

When she got here she looked like she was on the phone, but nobody heard her talking at all. Staff told her to come in to the treatment room. She gave no response, made no eye contact – as if she was so concentrate on a spot in the air. Then she walked towards the door, went out, and stood by the stairs. She looked down to the lower floors. A colleague said, “she isn’t going to jump down is she?” I was going to say “Is she looking for someone downstairs?” but before I even completed the sentence, her feet were already in the air, hanging her body on the rail. we all ran out. She didn’t do it fast as her left hand was still holding the stairs handle/rail. So one of the colleagues managed to grab her legs, another her arm.

She was brought in. She continued to say that she wanted to leave, and of course she wasn’t allowed. It took some time till she was injected and given stat dose. The doctor came from the hospital to see her.

It appeared to be something related to drugs, she seemed to be taking illicit drugs, and according to her, she will be charged for distributing drugs (or bringing drugs in from another country). She said she was innocent.

She calmed down later as the stat dose kicked in. Family member was contacted to bring her home. I’m not sure how she is right now, I hope people will all stay away from illicit drugs. 

If it was one of our busy days we wouldn’t have noticed and managed to stop this. Though we doubt if she really wanted to commit suicide, or she really just needed some attention and help maybe. Because of how the stair is designed, it wouldn’t be possible for anyone to jump down straight from 4^th to ground floor (other than a small baby).  She could only fall to the third floor, though her head would have landed on the stair case below. I’m sure she was aware. So attention seeking through a suicidal behaviour?

Sometimes when it comes to mental illness (and I guess many chronic physical illnesses), family members get fed up and lose their patience after a period of time, due to the time, money and attention needed to care about the patient, but also the stigma that come with it. But without any support from close family and friends, it’s almost impossible for someone to completely recover from mental illness…

Morbid Jealousy

There was this young beautiful girl, who from the age of 16, got into her first relationship with a working guy. She then became so obsessed, and had the delusions that the boyfriend was flirting with other girls, having an affair with others etc. She skipped classes, and went to her boyfriend's working place to "watch over" him, see what he was doing, who he talked with...

Over the years the girl got into various relationships, because of how beautiful she is, guys get attracted, and when she becomes attached, she also gets really obsessed and possessive, especially when the guy having any contact with other girls, despite how faithful the guys were. The girl slowly realized this a problem, and consulted a psychiatrist. Over the years she also gained insight with her problem -- a condition now called "morbid jealousy".

Morbid jealousy is a psychiatric condition where the person holds strong belief that his/her partner is being unfaithful without any convincing or "solid" evidence that this belief is true. It tends to happen over and over again no matter how many partner this person changes and how "innocent" the partner is.

It is getting to quite a common condition nowadays. As we would probably all expect that conditions like anxiety disorders and depression would be a lot more common, now probably every 1 in 10 people with a psychiatric condition comes to the clinic due to this problem, although most of them may not understand this as their problem (but only think that they can't sleep, get anxious easily, feel unhappy, got no appetite, is bad-tempered, gets agitated easily... which can simply appear as anxiety depression).

Here it's important to clarify that morbid jealousy doesn't apply when actually you find some convincing evidence, or when you are just feeling a bit insecure whether your partner gets a bit too close to someone (yes, just a bit insecure, which does not affect your life that much, and problem may simply be solved after you speak calmly with your partner), or when it's just part of a more sensitive type of personality.

For the patient's partner to come to understand that their partner has this problem would be helpful to the patient, and being understanding, considerate, supportive and patient to the patient will be significant to the process of recovery. 

I'm Lunatic!

I learnt this word - lunatic - from one of my patients. The first time I heard it, he was saying to me "you're lunatic!" I didn't know the meaning, but I thought it was related to "lunar", so I was thinking the word may be saying someone whose emotion fluctuates a lot (just like how the moon changes every day). Of course he was just having fun by saying that.

But that day I heard it a second time, and checked it online later, the online free dictionary says:

1. Suffering from lunacy; insane.
2. Of or for the insane.
3. Wildly or giddily foolish: a lunatic decision.
4. Characterized by lunacy or eccentricity."

At the same time coming out from the search is a BBC News - "How offensive is the word 'Lunatic'?" and it mentions that the word originally "referred to a kind of insanity that recurred according to the cycles of the moon". Hahaha so I was right to think about the moon, but still get the meaning wrong. It reminds me of Dragon Ball (hahaha) and other werewolf movies.

Anyway, it was inappropriate to use the word to "normal" people. But when my patient said that to me [jokingly], I [jokingly] said back "You're lunatic too!" He just laughed and continued to repeat that I was lunatic...

My whole intention of this post wasn't actually about introducing the word "lunatic". In fact it's an introduction...

I realized there have been quite a number of this so-called "mad" people in my life, mainly due to my work. I have also been talking quite a lot about stigmatization people hold towards those suffering from mental health problems. Whenever I thought about helping and standing up for these people, my patients come across my mind.

I thought I no longer hold these stigma and prejudices like everyone else. And I was wrong. The other day I went to Wood Green, and there was this man, I probably have seen him a few times, who was talking loudly in front of Morrisons, what he talked makes no sense. I avoided standing too close to him like everyone else, but undeniably I think he was mad, he was dangerous. (although I work in a forensic ward, but no, people with mental health problems are no more likely than "normal" people to commit crime, to hurt others!)

No matter how many "mad" people I have met, and how much fact about "mad" people I come to know, when I walk on the street I behave like everyone else. I'm not saying that I'm wrong behaving this way. But I realized I can only be confident to work with people with mental health problems, in a safe environment or, with patients I already know for a period of time, in any environment. I don't have the ability to approach a ["mad"] stranger on the street and attempt to help him/her.

What can we do about this? Create a safe environment any and every where, change everyone's attitudes towards the mental illness and the people who suffer from them.

How do we achieve that? I dont know... 

Another Leaving, this time a Discharge

先前写过一篇一名病人因癌症去世 今天我送走了另一个病人
可是这次他是被 discharged 了!! 这是我的 ward 里最年轻的病人 是我比较喜欢的一个
可是后期因为他有很多 overnight leaves, 外加我减少工作时间所以不常看到他
看到他被 discharged 真的很开心... 虽然其实有点不舍得 可是我还是不断告诉他请他不要回来
不管要做什么都要 think twice before doing any things that might bring you back
希望他有听进去吧 毕竟他还年轻 (才大我一岁) 大把前途 没道理把一生困在医院里 (话说爸爸在英国是医生 妈妈在美国是律师 父母我都见过 我一直不明白他怎么会在这里!! [医院])
话说在这个 ward 里工作已经一年十个多月 这才第三个被 discharge 的
话说第二个被 discharge 的还回来了 (不过没有回来我的 ward)
其他大部分离开的 有的回去监狱 有的去了更 high security 的医院 虽然也有两个去了更低 security 的ward 可是他们到现在都还呆在那里 每次在 grounds 看见他们都会问他们怎么还在
虽然这样问其实很残忍 (谁不要自由?) 可是其实我也很心疼看这些人把大把青春耗在这个地方

今天送走他 我在想其实我或许不适合这分工
不喜欢离别 虽然有的病人比较不熟 可是相处久了 送走谁都会有点不舍
当然还是最希望他们的离开是好的 希望他们不再碰不该碰的东西 不再做不该做的事 病也不再复发...
还是庆幸今天能送到他 衷心祝福他 也希望其他病人会慢慢好起来并被 discharge.

还有一个老人家 一个超烦的老人家 超喜欢烦我的老人
他是个很挑战我的耐性的人 可是我这么久以来就今早差点对他"发脾气"
因为其实他很可爱 他只是很"病" 外加牙齿掉光 今天又拔了几颗 现在只剩三颗 所以他说话的时候很好笑 (也很难明白)
他的病情不轻 常常在 ward 里叫 要不是因为他年纪大 早被其他病人殴打了 (话说病人虽然是病人 敬老这件事 他们其实还真的是会的...)
昨天就告诉我他 700 岁了 后来又问我要不要做他的 sister (我想他 700 / 60 岁 怎么能做我 brother) 他还继续说 这样也就做了 Obama's daughter... 原来他是 Obama 的儿子 所以我要是做了他的 sister 我也就是 Obama 的女儿了 XD 能说他不可爱吗?
不忙又有心情的时候 耐心听他讲话其实很有趣... 他心情好的时候也会在 ward 的走廊上唱歌 然后会害我(们)也不自觉的跟他哼起老歌...
当然他凶起来生起气来还是很恐怖的 只是他不 violent 他也还是会对我还有几个他比较喜欢的 staff 很好...

有时间的话 我或许该多写这些 因为我想以后的我 会觉得这一切像梦 也会很怀念这一切... 

Good Bye

I have been thinking to write about this, but haven't really got the time for it. I work in a forensic mental health ward (as most of you would know by now), had never thought I'd have to face that - we have a patient that passed away last weekend.

Perhaps it's not right to say that I never knew I'd have to face this, because when he was sent to our ward he was already terminally ill. We spent a lot of time making sure he was okay. And this is a man with great sense of humour, I mean - a nice companion. Guess what, maybe it was such a coincidence, I blogged about him before, back then he was so, so unwell that I had to share my experience with him (Blog post: I want sex!!). Oh yes, he was the one who first saw me, told me "I want sex! I want sex", he was also the man who didn't use the toilet and slipped on his own poo in the seclusion room.

If you still remember, he was sent to highest security in the country because we couldn't have him there. He was then diagnosed with cancer and deteriorated. Staff there decided that they couldn't keep terminally ill patient in such high security, so they sent him back to us.

This man only saw me once a week, sometimes once in a fortnight, but he never forgot my name. On my first shift with him, he directly commented that I must be very hardworking at the end of the day when I went to sit by his bed. Slowly he deteriorated on our ward, up to a point he was so ill that they had to send him to A&E, and was then transferred to CDU (Clinical Decision Unit). I went there for about 8 hours last weekend. I met his twin brothers and had quite a long conversation (or according to him, it was more like one of the brothers "lecturing" me. hahaha). I walked him to the bathroom, and I gave him my right arm telling him this was his walking stick, he then hold my arm and dance, while humming a song that I didn't know. Of course he couldn't even walk properly, leave alone dancing.

But it was beautiful. I came to realize I brought this man laughters. Despite all the pains he was in, he was always positive. At times I found that too positive. I have to say this is the kind of experience I probably wouldn't forget. Unfortunately the rapport was built, then we lost him.

I didn't think about it at all when I was told the news that afternoon after he left. It was a "noisy" shift with some nice staff, nobody really mentioned it, I didn't think about it either. But that night I couldn't sleep, I thought about him and my tears dropped. I suppose it wasn't sadness, at least he is now no longer in pain.

In fact he is a "legend". I wish someone can study him in depth. Because back then he was so, so ill, so unwell mentally. But the physical health problem "took over". Don't ask me how this can happen. Nobody knows. We all wonder. Because most of us met a version of him that was so crazy so mad so unwell so... you name it. But we all met this "version" of him who's so grateful, so positive, so friendly. He was always grateful, with the time with we spent with him, with the help we offered him.

On my last shift with him, he was in the bathroom when a member of staff came to take over me. I insisted to wait till he came out so that I could tell him I had to go and a goodbye (no, in fact I always say "see you later" rather than "bye"). With him you never knew when it would be the last time you can see him. I'm glad I waited, because that was indeed the last good bye.

Rest in peace.

‎"Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around."
- Leo Buscaglia

A Day in the Life of a Mental Hospital Patient

Just read this:

A day in the Life of a Mental Hospital Patient

Going to a mental hospital is nothing to be ashamed of or embarrassed by and I encourage everyone to take that step if they find it necessary. Life can be overwhelming and sometimes we just need to heal.

I find that quote good - stigma-free. Maybe becoming a patient for a period of time will make me a better carer too? Anyway, that isn't the main purpose of my post..

I can't help comparing how a day of this particular person (no longer patient)'s day compared to those that are on my ward. Some parts of it are quite similar, but I just really want to point out the main difference, which is the rehabilitation activities. Similarly, we have all those structures (certain time for meals, medications, basic activities like garden breaks), but how about the rehabilitation part? Someone on my ward can sleep through the whole shift (7.5 hours) and not doing anything. Others can just get up only for meals and leaves and do nothing else for whole day. What's good for keeping them in there and not doing anything meaningful and productive? And worse, not even helping with their mental states and general health (well most of them are obese). There isn't structured rehabilitation activities, if there is, there are way too loose (e.g. one to one session that only takes place every one to two weeks, psychology sessions that happens only once a week etc). What can they do other than those?

Sleep + Eat.

And can you believe for these people to Sleep + Eat peacefully every single day, how much are we taxpayers paying for that?!!!! It's okay if it helps, but does it?

One used to tell a member of staff, when the latter told him he's good at cooking, he can be a cook when he leaves the hospital, the patient said "no I'm not going to work. I'll receive benefits for the rest of my life." So oh yeah, more money for his benefits, travel pass, accommodations etc. This is what the service leads them to. Ouch! that's my moneee :(

Who are you? Go away!

Had been working for 11 days in a row which covered at least 15 shifts. What a dramatic day today, but let me talk about yesterday first. Went down to cover another ward's closed obs for 1.5hour, and I never had any good experience in that ward till yesterday - first time! The patient came out from his room after I sat there for 10minutes or so. Then I was talking to another staff saying I had never seen their rabbits (their ward has pet rabbits!!). So with the staff's agree I took the patient out to the garden and visited their rabbits. Very-the-cute. I heard one is pregnant so I asked which, the patient said "white one, the white one is the chick". That made me laugh (just found that funny). After that I played table tennis with him - never touched that for years! I wasn't playing too bad, though I kept telling him slow a bit because I'm and never be good on it. Overall the 1.5hours obs were good. :D

TODAY! well, after a long and tiring long day yesterday, I was allowed to come to work at 7+,8am today. First thing came in, I took a patient out on ground. Uptill Harefield Close, he started to turned left, I thought he just forgot as he is never well. So I called his name, at least 15-20 times! and get no response :S. Called on radio to the ward for few times, no response either. D: At the end called on C3 reception base, which [finally] someone respond to my call. Briefly said who and what happened on the radio. Then I started hearing unit coordinator started calling all response team to camlet 3. I know I was going to get the support. At the same time being worried because he was walking fast and far, I didn't want to get lost myself, especially I didn't know when radio was going to be out of range. I kept go on radio saying which road we were and towards what direction (morning with sunshine, this is the only time I'm good at direction! thank god!). Up till a place I called him again, he turned back and said "Who are you? go away!" (He sometimes would greet me with a big smile - and they are the same man!) So I could only follow him with a distance. Then we actually walked all the way to town (using a very long route). I borrowed mobile phone from one of two men I saw, which he happily lent me his iphone. When I was reporting, the patient was already very far from me (he's at least 6'3, and he doesn't walk slow!). Charged nurse from the ward asked me to go back, just go back. I replied with "I don't even know how to go back!" no phone, no wallet, not even a coin, no oyster card, no card (if got home key I can go home to get some money lol). So decided to try my luck on meeting a nice bus driver who would just take me to the hospital anyway (I believe everyone would). But upon reaching the bus stop, the response team came in a van! OMG, the whole feeling was just too complicated that I forgot to feel happy that they're finally here, yes I mean I forgot. The other charged nurse from my ward was in the van (sometimes call her mama xx as they all like to treat me like a baby). Then I told them the direction where I last seen him, and we managed to get him. But again he asked who they were (I didn't go down the car, just in case it was my problem) and shoo them away. We called the police. The police took quite sometime to come which isn't really usual (probably because today is a bank holiday - Good Friday). He told the police he wasn't a patient but a law student =.=. But police officers managed to get him into our van. Throughout the journey he kept on talking which.. his speech couldn't be understood. Though he also kept saying 'please stop whispering about me thank you'. (Sometimes we weren't even talking... =.=) Reached the ward, nothing much to note after that.

I think I had done well, and am grateful I had done running in the past (and still doing sometimes when the mood comes xD). Most staff think the same though some think I didn't really have to follow him for that far. Following him up is not necessary, as all we need to do is report what happened then we have done our part. But I felt I could manage, so I didn't choose to give up. :D But then now I think it's actually quite bad if he walked to somewhere I don't even know, and I'm there with no money, phone, identity etc. (I probably wouldn't have gone after him then). Then again everyone saw me would ask how I am / how I feel (they might not be able to believe their baby can take all these xD). They even planned to cancel another patient community leave as I was put down to take someone else to Hyde park and Camden town today - they think I'd done and walked enough. But at the end I still chose to go. And so now I'm knackered.

Overall, good experience, learnt something. I still like my job :D.

(When I typed that last sentence, all in a sudden remember that another patient called me fucking bitch when we couldn't facilitate smoke break. ehmm.. another long story, but then other patients actually tried to comfort me, so I was okay)

I don't want to see this happens

A bit of heartache. A patient was restraint to be given his depot today, and I was part of the restrain members. This patient, he had been muted for about 2 years, and when he first came to our ward, I was the first person he spoke to, and the ward manager was quite impressed that I managed to get him talked. Now that I saw that happened, I feel pain for him. He's not a difficult patient, 100% not. But this happens every week. Because he doesn't want to consent that he has got mental illness, by accepting the depot voluntarily, it simply means he has got mental illness, so he would decline, so we would need to restrain and inject him. He was strongly defending, 6-7 of us were holding him, and he still managed to move. After this, I've got no courage to look into his eyes. For no reasons, I feel guilty. =.=

This reminds me of another patient's words. At first he defended himself, he fought back. That led to more medications and seclusion, so he learnt, he learnt to be complied, because he wants to get himself out of here. Are patients actually getting better, or do they just learn to pretend better?

NHS, are you helping them?

Took a patient out on grounds today, had a very thoughtful conversation with him, or should I say, he has told me about his thought regarding the way this place treating mentally ill patients, and whether or not this is helping them.

I have had this thought probably since the second month I work there - are we helping them? are they progressing? should they be here or in the community? You wouldn't believe it until you actually work there, that how much money NHS is spending on them, and what is actually coming in returns.

Well, I'm not a qualified nurse, neither am I a clinical psychologist (yet), I might not give the most accurate fact that reflects the truth, but the patients, they are the central of the whole system (the hospital, the treatments, the multidisciplinary team, the nhs), shouldn't their thought count and be deeply considered? I know, some of them are really not that well, what they say might not be beneficial to themselves, and they might be saying all these simply because they want to get themselves out of the hospital. But this particular patient, he just spoke out what I think, that there is no point of keeping them there, for years and years, doing nothing every day, not knowing when they will be discharged, not being involved in the outside world etc etc. If we want to give them treatment and make them better, we should do it every day, every single day, not like once a week. If we were to organize courses, make it a daily one, not like once a week. The thought of not knowing when they can leave is simply depressing - and I strongly agree with this. They all know they are wasting their time, their lives, missing many important parts of lives, losing contacts with theirs loved ones. I actually feel sad when I heard these, because I know he is right.

Unlike yesterday when another patient told me that he has wasted too much time in the hospital, he wants to get out and carry on with his life, I was still aware that this patient will still have to stay for longer, as I know his condition isn't really good, especially when he first came, he was so unsettled. But patient that I took out today, I deeply hope that he would get himself out asap and never come back.

You know, I don't mean that all the patients should be discharged in 2-3 months.. There are always cases taking few years until they really recover. The thing is, when we keep them in there, why are we keeping them in there? And are they progressing? Are we helping them? I mean if we were to keep them for 10 years, make sure they are getting better in these 10 years, but not getting depressed not knowing when the stay would come to an end. Like what the patient said, they would have to be very strong, very tough, to be able to stay there for that long without any suicidal thought. I could imagine that, it's not easy, at all.

And guess what, I will listen to him - the day and the time when I become a clinical psychologist, I would do my best to make sure myself, also including the system are helping these people (just that, by the time I wouldn't be in the UK anymore). I know how advance this country is, but it doesn't mean their methods are always right and good, and sometimes, things keep on developing, and it could simply and blindly not developing to a right direction.

Patient Kicked off

It was my first day doing response in the ward yesterday.

Firstly I think I'd explain what is "response"? Basically every single staff and visitor would carry an alarm whenever they are in the ward. And when emergency cases happen (e.g. patients trying to attack you, patients fighting, patients doing self harm etc), we would press the alarm. In every ward, there would be one staff who is doing response in every shift. They carry a radio, a bunch of keys and a pager. So when someone presses the alarm, it would first come on the pager, saying, for example XX ward, staff base (or games area, or dining room, or west corridor etc, wherever the emergency case takes place. and yes, the alarm would locate where the person who presses the alarm is).

My first ever experience doing response yesterday was in another ward down stairs, which is an acute ward. I was the first two arriving there, and saw a patient was kicking off, but was restraint by 2 female staff (which apparently was from that ward itself), so the male response team took over the restraint (we learnt this during the TAMVA course, see my previous post).

The patient was very very unstabled, apparently he was responding to external stimuli, asking "why are you doing this to me? come fight me! you coward! come fight me. you spoilt my life. i lost everyone in my life now. now! come fight me" etc etc. For 10 minutes, he was talking with another person who doesnt exist. Staff trying to calm him down, but he couldn't listen to any of us and just carried on shouting. He tried to hit his head, tried to kick (his hands were restraint, and at the end so were his legs) and refused any medications.

About 15 minutes later, he stopped. And I could see his hands really trembling, he asked, "what happened?" The staff said they would discuss it later, they want him to rest for a while first, and calm down first. He said "I'm really scared. What happened? What just happened? Did I hurt anyone? I'm really scared" Despite staff stating that he did not hurt anyone, apparently he was so worried and scared about what just happened, he had entirely no memory on what just happened, and his hands were really shaking. At this point, he took his medications, but still asking what just happened. We left his room after he took the medications.

I went back to my ward after that, about 3 hours later when I was on another response in the same ward, I saw him, and he looked really fine, calm and steady, pacing in the ward. (This second response was another patient refusing depot and got a bit aggressive).

I'm happy he wasn't sent into seclusion room. I guess one main reason was because their ward seclusion was occupied at the moment, if they wanted to send this patient to seclusion, it would have to be the seclusion in my ward.. and that would really keep my ward busy and more unsettled. But I'm happy not because of this reason, I think sending patients like this into seclusion room wouldn't help them, when you're in an total empty room, four walls, one mattress and nothing else, for 24 hours every day, that would just make their conditions worse. They would simply become more unsettled.

It's the first time I really noticed one patient actually kicked off, it was really a shock in me, especially when I saw how he trembled and scared not knowing what himself just did. and am glad how settled my ward patients are. Though it's good, that I start doing response and see what is happening in other wards.

When I went back to my ward, passed by my manager's office, he asked how it was and I told him what happened. He said "good stuff", I thought that was just his habit of saying it. But when I went back to office, they all asked me how it was. Haha, the charged nurse told me, Phil worried that I couldn't handle it, but she said I look like I could survive everything, and I'd proven her right. =)