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…

Confidentiality Awareness

"What? You are just going to fax the letter over like that?" I asked, as my colleague was going to fax a letter regarding one of our patients to the patient's company. The company requested it, and the patient was aware - he came to sign a consent form (ah wow such thing exists?!) but he isn't allowed to even look at the letter. So yea, he gave consent for us to disclose his illness to his workplace, without quite knowing what his doctor wrote about him.

"Yes! The patient isn't allowed to read it so we can't give the letter to let him bring to the company! I'm just going to call to make sure that they get the letter" (they? who?!)

I guess most of us know where a fax machine is placed in an office in most companies. Usually anyone who walks past it can check and look at the incoming fax. Chances are the fax may then be passed from one to another (in a larger company, maybe office boy, secretary, some other "caring" colleagues). I feel so bad that this was done. I don't blame my colleague or anyone in the clinic, but the whole awareness about confidentiality issue in Malaysia is just low, very low. When I was trained in the UK, confidential used to be such a big issue. In the uni we had one whole 5 credits module about ethics and confidentiality; At work, we had one whole hour training about protecting patients and staff confidentiality.

Having watch this, I will be so careful to sign any "consent" form in the future. I mean we all as patients or service users or some kind of participants should understand where those private information about ourselves is going and what they are used for. Remember you always have your rights, don't be afraid to fight for them. It may take quite some time till we actually get there like in many developed countries, but it will not happen if nobody is fighting for it.

I hope people in the practice gain more awareness and give more respect too. Imagine this was you, would you be happy that your some sort of medical/financial report or ability test etc is passed around in your workplace or among some unknown people? 

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. 

Leaving the job

Tomorrow will be my last day at work, as a preparation of this emotionally difficult shift I've been thinking about it quite a lot these nights. After my second last shift on Tuesday I finally realized it's approaching. This is happening. 

I think I have always been someone who don't take leaving and separation well. But if everything else isn't a problem, would I choose to stay on? To work as an NA for more years? Just because I'm happy there, I have great caring friends there? No I won't. In fact I wouldn't have been as happy as I am if I'm still here for longer. My leaving makes many of us get much closer, also makes many of them closer. So this separation much take place, now or later. 

So I've convinced myself to accept it. Even I stay for longer, I'd probably grow more grumpy like a lot of people who have been there for years or even decades. So this is the best time to leave. It forms the best memory of my life. 

It's still difficult though, having the thought that I may not see many of these great people again in my life. I said my last good bye to my manager, and others whom I may not see, who have transferred to another ward... Not just the members of staff, even the patients, for some I have known there for over 2 years, other for over 2 weeks, I like them, I want to see them get better and leave the hospital... 

I feel bad having some friends feeling sad about my leaving, especially after all these great supports, chats, and quality times spent together. I feel bad to have made them sad. But I can only do so selfishly, at the same time hope they'd be happy for me (just like I did for another member of staff, who moved to another ward, and seen him happier there, even if I liked him to be on my ward). 

Let's hope I wouldn't be in tears tomorrow. We're still going to one of the colleagues' house for dinner, I hope I'm not drinking though, I can see if I drink I'm going to even more sad =.=.

Psychology In Malaysia

If you've ever wondered why I'd entered the Psychology field, here is a short reflection that I've written couple weeks ago, about my passion for Psychology and about my job in North London Forensic Service, NHS. 

Putting your heart into it 

The blog "Psychology in Malaysia" is run by a very inspiring friend. It's also the kind of subject I'm now becoming interested, especially after all these years in the UK. 

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... 

Just got to Moan!

I returned to work after a few days off yesterday, after some discussion with a colleague I decided to take up the response, and this little decision made yesterday the record of my life. I went to the female ward twice, and physically restrained and put two persons in the seclusion rooms.

For the first one, she was kind of abusive and fighting back when I got there. I had to restrain her on her feet (which I think I did it correctly), but my right arm was hurting awfully. After some struggles of 20 minutes as she wouldn't cooperate, we got her there. I got 4 bruises in both of my hands, and when I got home I found one big bruise on my thigh.Another staff even fell over. I thought the incident was bad, and so decided to take a break after that. After I returned, the alarm went off again, so again I went to the same ward. I saw a patient standing by the garden door completely naked, stood by her was a male staff and another female staff who was just about coming to help. I took over the male staff, and we tried to cover her with a bed sheet, and brought her to the therapy room. We helped her to put on some clothes there. She was still crying, shouting that she was very scared, and describing what happened to her in the past. The charge nurse then decided to put her in the seclusion on our ward (this ward is next to us). Although I see completely no point of doing so (why would you put someone who was scare and crying, and not harming/hurting anyone in the seclusion room?!), I did what we were told. She was crying and saying she was scared throughout.

So that was what happened to me as a response nurse, within 3-4 hours. I went home feeling sorry for them, tired, and telling myself I wouldn't want to be on this job for anytime longer than this. It wasn't that I don't like my job, it was just that I don't think we're helping them, and this is bad. This is of a caring job, we're supposed to be helping them.

This morning I came back for a long day (a 14.5hours shift with an hour break which you don't get it sometimes). I was supposed to take someone back to his parents' home (in theory this is meant to be part of therapeutic recovery). Because of what happened in the past, I came prepared. As we left, he was getting abusive to me... I couldn't convince him to come back with me, so I had to call the ward and they got the unit coordinator and the response team in a van to come to the train station to pick him back (we walked there). So all I had to do was to convince him to stay there, and wait for another escort as such (given that he thinks he was annoyed by me). It then went okay as things go and he came back. He was becoming remorseful and kind of apologized (but that is him, the fluctuation of his mood and behaviours). I got to say I felt fully supported by this qualified nurse who picked up the call and supported me throughout. She clearly knew what happened in the past and was imagining if that was going to happen to me, I was almost in tears. But later as things go I feel much better. (Other than those occasionally awful incidents, there are many other who can often cheer me up)

I'm actually on my break now. I don't know what I'm feeling and thinking, about this job, about working here, about the patients here. I'm not angry at or upset by any patient as far as I'm concerned, but I slowly realized what annoys me was the staff (the pm shift staff), and it had nothing to do with the patients who are not well (that's why they are here; although for many instances I'd say it was actually the system here that drives them unsettled).

It's a lot easier to in fact deal with the so-called mad people, then those who are "normal", but lazy, sarcastic, ignorant  and uncaring (especially when they are in a caring job!). 

Values of Life

Yet another October, my blog is now 4 years old.

There's been a lot of thought recently but I don't know what and how to write, perhaps too unorganized. Life has been pretty enjoyable. I remember telling a few friends and also my mum that I'm not aiming to be rich in my life, I am aware how important money is, but I'm not going to work for money. And guess what, within few weeks I kind of regret saying that HAHAHA. It's like the kind of lesson that God or someone wants me to learn. I start finding I need and do not have money in order to do a lot of things, especially we're planning a trip to Norway and Switzerland, and everything is about money, money and money. Really? Life do you have to do this to me?!

I just thought I want to lead a contented life through helping people in needs, and here I'm referring to people who need help psychologically or mentally. I suppose when people see no point of me leaving the country and go home (to, erhmm, survive with a rm2k salary, traffic jams, crimes, corrupted government, etc etc) as opposed to the kind of freedom, all physically, psychologically and financially that I have here. But really I see no point of being a health care assistant in a forensic service for any time longer that I've done so far, it really isn't fulfilling... I think I have far more potential to help people than what I do now. And I think I've been a lucky person all my life so maybe I can share some fortune with the unfortunates too?

Ah anyway, we'll soon see where the life leads me. Yesterday I read the final words of this 40 years old Singaporean billionaire who suffered from lung cancer and passed away about 10 days ago. I think I'm right. I somehow feel grateful that I haven't been adopting the definition of success and values of the society nowadays. There must be times that we're lost, but do some reflection every day, just 5 minutes or even less, sit down and close your eyes, and think about how you've been doing today, and whether that's really the kind of life you want to lead, if you only had a month life left, and whether this is the kind of life you want to lead, if you look back 20 years later and see no regrets.

"Everyone knows that they are going to die; every one of us knows that. The truth is, none of us believe it because if we did, we will do things differently. When I faced death, when I had to, I stripped myself off all stuff totally and I focused only on what is essential. The irony is that a lot of times, only when we learn how to die then we learn how to live."

Behavioural Experiment for Social Anxiety - Walking a Banana

I have long heard about behavioural experiment in the CBT. We used to have a guest lecturer in the uni who shared quite a lot different types of behavioural experiments she has done throughout her life as a therapist. One of them that I remember quite well was working with a woman with OCD (Obsessive Compulsive Disorder), who was very obsessed with hand washing. And in short what they did, was putting their hands into the toilet bowl, reaching the water in it! then what? Without washing hands, they used their hands to eat!!!! It was like OMG, REALLY?! But yes that's what was done, the therapist was going it with the client, and really, nothing happened afterwards, and the client realized her obsession with hand washing really wasn't rational (of course this is kind of simplified, you should assume that they have done a lot of work in identifying irrational/negative thoughts, doing relaxation techniques and also discussing the rationale of designing such experiment etc).

Guess what I did today? Hehehe, oh the title tells - I walked a banana in Croydon, London. YES I BLOODY DID IT. Me and Krishna did it together, initially we didn't quite get into the state, and we were laughing and stuff. But after that we realized we really need to be so serious, so people know, yea we're serious about it. Believe it or not, so many people looked at us! (Well refer to the video below although it wasn't quite obvious in it). Some people asked Pei Man (she was following behind us and taking video). Some just stared, some tried to look covertly Haha. We went into the McDonalds, and obviously people were looking. I saw a guy taking pictures of us. I heard the staff saying "people coming with a banana on the string". At the end a guy approached us and asked whether he could take a picture, even asked for their names and age. LOL. The staff in McD also asked us. We left, another black woman on the street was like "what's this for?" Another two women walked past and we could overhear them saying "look at these stupid people". Hahahahaha. Stupid, I kind of enjoy this stupidity!! There were also quite ignorant people, who walked past like nothing happened. In front of the hotel, there were 4-5 teenagers, some just stared at us, while one who was obviously more extrovert approached us, and patted on Bobo (Krish's banana, and my banana is Nana), although another friend of his almost gave Bobo a big kick!

Okay up to this point you probably going to ask me, why were we doing this for? The idea came from Donald, our lecturer on the hypnotherapy course, who treats people with social anxiety. Oh yea this was one of this behavioural experiments with his clients. The idea is to do something and make people really look at you. In fact some people are often so self-conscious, being worried about what other people think about them, whether they look stupid, look anxious or too awkward etc etc. With experiment of this sort you probably find out the reaction could be quite different from what you think. But even if it was what you think (that "you look stupid", "you look so anxious", "you look like an idiot"). Those are just their thoughts! So what?? It's nothing catastrophic. Let them think what they want.

It's like people who are overly anxious doing public speaking, worrying they might make mistake. Well okay there are a lot of thing you could do to present your best, but what if you make mistakes? What if... you make a mistake deliberately?? Laugh it off? Chances are you are going to survive it anyway, why worry? This is my way of seeing it, though Don said people can test by making a mistake deliberately and see what happens, see what's so catastrophic about it. Of course this doesn't mean that I'm no longer anxious, and no longer worried in public speaking, but when you really analyze your reason of being nervous, rather than focusing on hiding your nerve/anxiety, the results are most likely going to turn up better.

I also forget to mention, at this very same day when Don realized we're going to do his banana walking experiment, he was also interested in joining. So I gave him a string and he got himself an apple to walk, but that apple fell off. And what did he do?! - he went to a toy shop, got himself a pink piggy soft toy, which could fart if you sat on it - and he MADE the shop assistant showed him how the pig fart in front of a long queue / big crowd of shoppers. Then he put the string on the big pink pig and walked it back....... You probably going to say he's such a weirdo. Hahaha well he is... not. I suppose it can get addictive, so additive. But to go to shop and ask for certain things to be done, is part of assertiveness training (and other things). And doing all those things can get quite addictive! Well, in fact at the same time you're also helping your clients and being a problem-solver.

I just have got to say, I have really enjoyed it. And Krish did too - know what? She's a mum of two, and she was as passionate as me if not more, in stuff like this. Hahahaha.




P.S. I just think it's important to give credit to Donald Robertson, given how much of his ideas I quoted here (you can google about him if you're interested).

The Power of Social Networks

Warning: What I'm going to write is probably quite random to an extend that the title may turn out irrelevant.

Last week I was attending the Stage 2 of the Cognitive Behavioural Hypnotherapy diploma course. Then we sort of discussed the opportunity of practicing as a hypnotherapist in the future, and Donald shared his experience, tips and advice of setting up one, including a website as a start-off point. He then also mentioned twitter. And with this I have something to say, I realized there have been a lot of random people following me on my personal account, just, for example, for me saying the word "dissertation", there was a proof reading company following me, then I mentioned "hypnosis", and there I attracted another 3-4 people following me. Other than that there is also a pet food company (I think it's because I said I'm going to "walk a banana like how people walk their pet dog")... Really?!?! So you think I'd need to buy food from you for my pet banana? And there were some photographer, random whatever commercial stuff. 

So I sort of tested this, for the following days I tweeted a bit more about hypnosis, and really, there are then people who offer hypnotherapy in the area coming to follow me. (Sorry if you are one of my followers and were wondering why I've been talking so much about hypnosis - especially if it didn't interest you). 

This is kind of powerful, just to make yourself having more followers, although I'm not sure about when it really comes to offering your service (or selling your products), eh but, there is no harm of doing it, really. Don also mentioned some people use blog, write about controversial issues in the field. I suddenly remember one of my posts that received quite a lot attention - at that point I thought about this one - "Swollen Fingers due to Excessive Writing" (wow huibee you're random). And honestly, this completely random post (even the pictures went missing due to my setting after I joined Google+) is still receiving attentions! Now I remember the top post of my blog, which is "A Letter by a Malaysian living in the USA", ironically though (well done if you realized before I said it) - I live in the UK, not the USA, so that wasn't written by me (acknowledged in the comments... a few times)... But I'm not sure why it appeared to be the first source people come across if they google it. Now this is a very good example of controversy. (Just if you're interested, this post in 2009 received on average 2+ view each day now). 

So I guess one important thing now is to do more reading, to assure the quality of my post/tweet (unlike most of my personal posts hahahaha). Though, to call myself a blogger I think I need to start writing a bit more regularly, and I do hope to share more about my reading and experience on hypnosis and my work in NLFS, while protecting my patients' confidentiality!

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

Virtual World

It's the last day of term. No, not yet. I have yet to graduate. It's the last day of Spring term, I still have Summer term! Had quite an "interesting" lecture day in Mill View Hospital today, which is really not what most of us had expected. We thought we were going to get more practical kind of things but who knows?! They made us travel there then what? Sit in the lecture theatre for whole day!

And I'm going to talk about the final talk "Projected Research and Business Developments" by Susan Conboy-Hill. Let me try to be unbiased and say what this talk is about. They are trying to bring in technology to "do" treatments. So here she talked about the people who are hardest to reach, people who stay at home all the time, people who are scared of human interaction or touching, people who hate leaving home, people who are scared of crowds (perhaps, I added some of these myself), yet all are people who need psychological helps. And they proposed (or in fact are going it already) this "virtual world" where people can learn about interaction, get support, feel "well-being".

Before she even finished introducing the whole ideas of it, my colleagues already started to raising hands objecting how this can probably work, then I joined the debate... We are psychologists (or "worse", we were trained "critical thinking" so much that we criticise everything all the time lol), we emphasise human interactions and think it's incredible central to human lives, well-being, contentment, satisfaction, recovery etc etc.

So I asked her, if Yuko (she just happened to sit next to me so I used her name) had problems interacting with people and thus is prescribed with "Virtual World", how is this going to help her with her situation and to get back to normal life? She answered, "how do you know she wants the interaction?" and carried on with her whole idea of how this can work. I agree, recovery quite often doesn't mean get back to "normal" or "how it used to be", and recovery can simply mean "a sense of well-being" very subjectively, but does she mean Yuko is going to spend the rest of her life in "virtual world"?!! Sometimes in Psychology, even Yuko doesn't know that she wants the interaction, at least not until we help her to do it, then slowly she realizes she really enjoys it and gets the most benefits out of it.

I'm so against technology in some ways. Of course I love technology too. I remember seeing a quote on the train, saying if the world hadn't invented mobile phones, we'd all interact more. Yes, so true. It was meant to assist communication, but nowadays how often do you sit in front of a friend but s/he is using phone on facebook/whatsapp etc?!

I appreciate the kind of convenience technology brings us undeniably. Or I wouldn't be able to Skype with my mum whenever I want. I also appreciate that technology can help with recovery, for example if you have a spot above your eye you google and find out what it possibly be then only decide whether to seek help. But technology can't be a treatment as a whole. Just because we're human... People can often read self-help books and understand more about themselves, can learn how to make themselves feel better etc. There can also be an iphone or android application to help people understand depression or monitor alcohol intake. But how are we going to treat someone with bipolar personality disorder with......... an app? with virtual world?!!!

She acted as if she's very "in" and initially perhaps she also kind of thought she'd get all kind of agreements and acceptance from us because we're the generation who have used and benefit most from the technology ever since. I suppose she was quite shocked to have heard us and turned really defensive, and didn't really make obvious points to answer most of our questions. I don't mean that I don't see the potential of their proposal. But I hate spending so much time in front of the laptop, with the phone. I still do it because there's this habit/addiction/whateveryoucallit. I certainly don't hope to see in the future facebook/twitter/smart phone apps replace all part of our social lives. (She loves twitter so much..) Oh let's go out for dinner... I mean in virtual world?!

And one day when I see you, I lost the ability to interact. (we all are certainly losing it... I just think we should stop before it becomes part of evolution)

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 :(

"I want sex!"

No no, it wasn't me who said that, lol. I was doing response today, and went down quite a few times to an acute ward, doing reviews on this man in the seclusion room. He's a massive mad man, and has hit two of our TAMVA instructors (who are supposed to be very professional and the top people in restraining patients). I'd never met this man till today. But I have heard a lot of stories from others who have done response in the past two weeks. One of the significant event that I remember was that he pooed in the seclusion room, and made it really dirty, then that day when they tried to do a review, he stood up, slipped on his own poo and fell on his own poo! (hahahahah, how dramatic is that?!) Apart from that he's always naked (not today, just half naked) and very very inappropriate to female staff.

Today when I went, I was thinking I would be really useless, as a little young female nurse. It turned out he's obsessed with females again, then was telling the other staff that he wanted to talk to me (the other female staff around are at more mature age..), so I became a lure, to keep his attention, while they put his food and drinks via the toilet sides and unlocked the room before he realized. I found that quite funny, because I basically just had to talk (through the interphone/viewing panel), then I've done my part. xD Though one of the times he kept asking me to come closer, then when I told him to put the mattress back to where it should be, he started repeatedly saying "I want sex!" The nurse in charge said directly, okay! it's over!

His behaviour is entirely unexplainable (apart from the word 'madness'). His speech is incoherent, and is so obsessed with females. At the same time he is also strong and can be so violent. He can be naked in front of so many staff not feeling a thing; He stuffed his food below the door; He doesn't use toilet but anywhere of the room...

He will be sent to a high security hospital next week. I'm just wondering how people like him get well.. I'd like to learn that and be part of someone like that's progress, but then it seems the control and restraint that we learnt is nothing when we face someone like him.. I know some of the guys on my ward used to be very mad before too. I hope some time in the future I'd get to explore the more severe area. :)

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 despise you

I wasn't feeling very well (physically + psychologically) when I went to work today. Physically unwell was due to the weather - the temperature just dropped so much suddenly T__T

I am not very sure why I wasn't in very good mood, until before I got home, I spoke to one of the patients in games area, and that really helped. I think I helped him, and in return that has helped me indirectly.

What we discussed made me realized I am really not happy with those qualified nurses who want to work awful loads of bank shifts and long days, but come to work and sit in front of computer, surf the net and do online shopping, otherwise gossiping about others. These people think only about their pay, never have one to one with their patients, never spend time outside the office, never understand their patients. They never think how to help the patients. They never know whether their patient is happy, is feeling safe, is ok, is progressing in the ward. They care nothing but money.

I don't know how they become a nurse, a nurse without a heart of helping patients getting better. I told the patient I wanted to speak to the ward manager regarding that, and he said no. He said he was telling me because he treats me as a friend, and those are friends talk, he said it's ok, he can get himself out of there and he is progressing, he can talk to the consultant every week (or sometime fortnightly). I feel sad for this whole system, for them. Those people are so well paid to help them, yet they get no help, nobody talks to them. There was once he requested to have a one to one with his named nurse, the named nurse asked him to wait till weekend, but nothing happened during the weekend. The fact is, those named nurses are supposed to ask to have one to one with the patients! Then I told the patient, I know and have seen all these happen in front of me, yet I could do nothing. That's why I was so upset. Actually it might not be true.. I think I could do something.. =)

Equal Opportunity and Diversity

Attended a mandatory training course today which covered Equal Opportunity and Diversity, Health and Safety, Fire, Safeguarding Vulnerable Adults and Children, Infection Control, and Confidentiality and Information Governance. The first session was the one with the most discussions and debates, that the presenter didn't even manage to complete 50% of her slides within the given time.

As a woman, I think quite often we receive positive discrimination (PD). PD, according to the presenter, is unlawful. Give a very obvious example. The ward that I'm working on is a male ward, although there are slightly more female than male staff in the ward, there are quite a number of jobs that could only (or preferably) completed by male staff. E.g. searching service users coming back from unescorted (ground/community) leave, there are about 4-8 times a day in my ward now (more coming); doing their UDS (Urine Drug Screen) etc. And yet, I couldn't really think of a job (in my ward) that can only be done by female. So see? It could be unfair... (just could be, because we are very nice females, so we would even that up with doing some other jobs for the male staff).

The presenter gave an example of "positive action" (which is lawful) - a university lower the entry requirement for the ethnic minority (I think she used "Blacks" during the presentation, which I think isn't appropriate), so the Whites have got to have 3As to enter while the Blacks could enter with 3Bs. She added further, it ended up with more Blacks dropping out, simple because they couldn't follow the course, as they were not as competent.

What do you think?

In that room, there were more ethnic minority (opps! so no longer "minority"?), there were more Blacks than Whites as well. I don't know what the others think. But to me, to give this example at the first place, IS already a discrimination itself! Think about it again. One, the whole example based on that "fact" (what they believe genuinely, but I don't think it's true at all) that Blacks are less intelligent than Whites (so that most of them can only enter with 3Bs, so that they would drop out even after they were admitted). Isn't this a discrimination? Nobody pointed that out, and of course I wouldn't. Because I'm neither a White nor a Black, and I wouldn't want to cause more debates or war. Two, I see no point of giving this example!

I don't know what made the Whites always think they are more capable, more competent than the Blacks. From the people that I've known, I can confirm that Whites are no more intelligent than Blacks. Of course I have a Psychology degree, I should know how that conclusion came out, that some researchers did some research that they thought it was very well considered and fair - then concluded that Whites are simply better. I can tell you two things. One, it COULD be true in the past, but it's definitely no longer true. Given that they always think they're better, so they are far less hardworking (ok, I mean they're lazy), over decades they ended up with people who think they are good but only in talking Big. Two, the 'fact' just can't be true. Because research can never be fair, in a field (i.e. investigating intelligence) like this. Language is one thing, culture is another (and many more). Of course a Black could be born and brought up learning and speaking only English, in the Britain (as an English speaking and English culture example here), but how about his parents and external families? How about friends that he makes? Can the intelligence tests consider all these factors? It just can't be fair.

I don't know why I get myself into that Black & White Intelligence debates. It seems that I'm in favour of Blacks. But the fact is, no, I'm not, I'm just not in favour of Whites (see my post Discrimination), especially when it comes to the feelings that they think they are better in any and every way than the others.

Of course, there are very intelligent Whites, very intelligent Blacks, very intelligent Mixed, Brown, Yellow, Colourful, whatever. I'm not writing to offend anyone, especially my White friends. I'd happily accept if they're in "fact" more intelligent, yet this thing can't be proven (and we dont have to! What is the point of doing that?). And more importantly, I wish the Whites are aware, that their thought of they're better naturally, are going to make them less competitive and more lazy, are making them worse which in some days later, would reflect through genes.

P.S. I wouldn't disagree that myself is also discriminating. Afterall, that's just a mean of "categorizing" like I mentioned in my other post. There are always debates. But I'd suggest the presenter who do topics like this should have more concerns.

Just a little add-on

I mentioned languages, so often one of my White colleagues enjoys correcting others' grammar mistakes, I remember there was once my Black colleague replied, "please! English is not my first language". Exactly! Can you speak Mandarin, Malay, Hokkien, Cantonese like me? If you could, I'm going to speak English just as good as you do! Although, I'm quite happily corrected, because that's a mean of learning, but sometimes this man could be annoying to others who don't pay as much attention to grammars.

Discrimination?

I didn't realize myself take that by heart, that I woke up early in the morning, recalling what they said, just like that. I thought I've been in this country long enough to be immune from discrimination - remember there was once when I was chatting with the ward doctor (a british who was born and brought up in the uk, and of India origin), I told him I don't care about (racial/colour) discrimination anymore, I'd just take it, because we're all human and it's normal to discriminate (in other word, it's just "categorizing"), I even gave him an example that through the 3+ years part time job that I've got during Uni, White people from this country are certainly far more lazy than others (and are only good in "talking" instead of "doing"), and I said "see? I discriminate them as well".

Yesterday came in a shift realized my favourite colleague was sent out to do two community leaves during one shift, and somehow I felt they bullied her, of course I didn't put it that way, but when she came in, I just said XXX you're a star!!. Then the other two started to tease me, saying "look at you". I know they were joking, but still I told them I came in 4 shifts in a row, and going out every single shift, which they didn't really listen to. The two person who teased me, one was a nursing assistant who never really does community leave, and whenever she is put down to do it, she would pick the person that she wants to take (and there are only 2 of them), or else she would do whatever to get herself out of it. While another is a qualified who probably has done only 1-2 community leave since the ward started 6 months ago. Opps, I forgot - both are Whites.

The whole incident was behind my mind all day long. I really didn't realize I actually mind it. It seems like my brain didn't manage to resolve the conflict feelings through dreams (a theory by Griffin & Tyrrell), so I was waken up and ... decided to blog about it ha ha.

And yes, I feel better. =)