Restraints

Physical managements are never fun. They're even less fun when the patient is about two times your weight and hasn't showered in weeks. But it is a great bonding experience with your fellow staff.

I had just finished rounding off when a patient approached me and told me another patient was hurting herself l in her room. Obviously, we moved to intervene, and when she would not stop, and instead began to get violent, we had to retrain her.

It is a testament to my coworkers that none of us hesitated to help, even though all of us were women and none of us found the stench of unwashed body to be one we wanted to carry through the rest of our shift. For a solid twenty minutes, we held her as she fought and screamed and swore, desperately trying to get free to grab a hold of any sharp object she could find. I have some lovely bruises now.

After it became clear that the PRN the nurse had given to calm her down was not taking effect, she called for help, and soon staff from our other units flooded in to help. I had to step back to continue rounds (an extremely vital aspect of our job), and came upon the other patients all grouped together in one of the dayrooms, their eyes wide. They had never seen anything like that before.

“Why couldn't you just leave her alone?” one asked.

“She was hurting herself,” I answered patiently. “We couldn't let her do that.”

“Do you call the police?”

“No—we're trained to handle it,” I smiled.

A few impressed gasps.

“Miri, we had no idea you were so badass!” one blurted, and I laughed.

The laughter broke the tremulous feeling of fear in the room, and peace and smiled returned. The rest of the night flew by, and soon I was driving home.

And, of course, the minute I came home, I dumped my clothes in my laundry basket, showered twice, threw my washcloth into the laundry too, and sat down to write about it all. It's a good reminder, I think, that my job isn't all fun and games and touching moments. Sometimes, it involves strength of mind and body.

That, and a whole lotta soap.

Secrets

There are some people who would look at the group I had today and say “Man, what a bad shift.” And in some ways, it was. These girls were somewhat sneaky, passing notes, sneaking hugs, gossiping about each other and the staff, constantly asking me the same questions in a rather rude tone of voice, needing constant redirection, constant supervision. It was exhausting.

And yet.

And yet today I ran a group longer than any I ever have before; for a full two hours, we talked. We talked about secrets, about regrets, about memories. I saw girls, one-by-one, open up their souls and truly look inside. I had girls who drove me crazy the rest of the day tear up in sympathy for another's past. They identified with each other—they were honest with each other.

I had some tell us stories they'd never admitted before; others tell about secrets they once were weighted down by that only recently they had allowed to surface.

I had a few who would not share their secret, but they were quite willing to share why they kept it: fear. They were afraid as to what their parents, their friends, their family, even strangers would think if they were honest. They were afraid of being rejected, of being labeled, of being mocked.

And the devastating reality is, their fears are legitimate. These are the girls who are bullied, who are mocked, who are scorned by their own family and told they are just attempting suicide or harming themselves for attention. Their illnesses are dismissed, degraded, and rejected.

Isn't that horrible? Isn't society horrible, that this is the norm for these wonderful, difficult girls? I want to encourage them to be honest, be open, and yet I cannot bring myself to fully advise them simply because I am painfully aware of the reality that the end result may be more harm than good.

And, of course, we talked about that too.

Names

It is rare for us to have patients stay longer than a week. Usually, they stay and leave so quickly you barely have time to remember their names. Some will return days, weeks, months later, and be wounded that you don't remember them. “In the time since you've left, I've worked with hundreds of kids,” I want to tell them, but I don't. I just pretend to remember their face, not their name. And they laugh at how forgetful I am.

I wish I could remember all the kids I worked with in inpatient. I still remember the ones I cared for in residential, and I pray for them by name daily. I knew those kids, their likes and dislikes, their quirks and thoughts. In inpatient, you're lucky if you know whether they are on good terms with their parents or not (usually not).

Sometimes, the kids will write me notes or draw me pictures thanking me. Those are the ones I remember. I put them up on my cupboards and I smile every time I see them. It's a reminder to me that even though I may not remember all of their names, I have made some small difference in their lives. Those notes and pictures, they represent to me all of those who I have worked with and cared for in just a small moment of their long lives.

I know I am just one person. I know that I cannot make much of a difference in anyone's life. But I also know that I can look back in my own life, point to one person, and say “There. He is the one who changed me. He is the one who gave me hope. He is why I am who I am today.”

And maybe it's vain, but I want to be that person too.

Quick Update

Hello all! So sorry I have not posted lately; my computer has been giving me a lot of problems, and as I write the posts in advance and then publish, it's hard for me to get a post uploaded. Please hang with me a while longer, and I'll hopefully have the money to get it repaired! Thanks so much for following!

Returns

The worst part about my job is not what you would expect, or what I expected when I started working there. It's not the biting, kicking, yelling, threats, aggression, or anything like that. It's not staring at a room of girls and boys so young and already wanting to give up on life. It's not tensing slightly when a patient who's in for attempting to kill their parents walks by you. It's seeing them come back.

Some patients, we know they'll be back; the only reason they left in the first place was because their insurance ran out or they learned how to lie. But others, well, we really never want to see them again. We want to believe that they are living a happy life somewhere out in the world.

At least four times in the past month alone, I have had favorite patients of mine, those who I really thought may make it, come back. Some are optimistic, saying they just need a little more help, and then they'll be okay. Those are the ones who usually commit themselves. Others stare up at you with sad, huge, lost eyes, wondering why they're here again, why they can't break their habits. They are the ones that suffered breakdowns, and simply snapped. It's tragic.

Unlike a lot of patients, these children are sweet, kind, and considerate. They know the rules and respect them; they remember the staff and are kind to us. They try hard in groups, talk to us when they're feeling suicidal or when they want to harm themselves, and generally do anything in their power to understand what went wrong.

These boys and girls, they want help. They want to get better, and they want to make a difference. Interestingly enough, they are the ones who tell me that someday they want to do my work. If they can win these battles, I tell them, they will make fantastic staff.

I keep a mental list of these girls. I pray for them whenever I'm reminded of that list. I keep the notes they write to me up on my walls, and pray for them whenever I see them. The way I figure, they can use all the support they can get.

And, after all, a little prayer never hurt a soul.

Aggression

It occurred to me today that almost all my posts are about our suicidal/depressed/self-injuring patients. I don't really know why that is; I suppose it may be because they are the ones that I think need so much support and love. But they are only half of the residents.

They other half, they are aggressors.

These are the children that , when they are first admitted, will kick you, then wait. They will yank your hair, and wait. They will slap, spit, yell, curse, threaten......and wait. They wait to see what you will do, how you will react. They are testing the waters. They want to know how much they can get away with before you lost your temper. They run hot or cold; either these patients will flare up with fury, or wait, spreading hatred like ice across a lake, slowly but deadly.

These are the children who will toss racial slurs at their peers, make death threats, even attack them for no reason. They keep us on our toes, and they make the other patients, the ones who would never harm anyone but themselves, nervous.

These boys and girls are, quite frankly, nasty. They are admitted for burning down their homes, attacking their family members, even bringing guns to school. They are angry, and they want to spread their anger.

Unfortunately for them, we've seen it all before.

The Achilles Heel of these children is not punishment or negative reinforcement, it is kindness. When someone kicks you, kicks you hard, you want to kick them back. But that is what they want. What they can't stand is a disappointed look and a gentle voice asking them why they would disrespect someone who is trying to help them. To see if it's genuine, often a few more vulgar insults have been thrown into the air. A reminder that you are not disrespecting them, but they are most certainly disrespecting you, will make them feel ashamed. Any human in the world hates that feeling.

Some will try to hide their shame by acting out more, and when more patience, more kindness, is offered, they will simply throw up their hands and storm off to sulk. Others will apologize. Some will suddenly decide they like you, and then the aggression is pointed elsewhere.

These children are far more complicated than those who hurt themselves, but I believe that most, if not all, of them loathe themselves so much that they turn their anger outward, a shield against the world. Some have been heavily abused; others are the abusers. All of them are still children.

Kill them with kindness, I think as I stare at my bruises. Kill them with kindness.

And hide your surprise when they greet you with a smile and a hug on your next shift.

And maybe be sure they aren't holding a shank.

Challenges

It's easy to let one day slide into the next working here. The faces become blurred, the stories run together, and even the staff begin to all look the same. Since I last wrote a post, I have done three physical managements, worked with probably a good 50 girls, and counted the minutes till shift change God-only-knows how often.

I love my job, I love the girls I've worked with and continue to work with, and I enjoy most of the staff. But even chaos becomes mundane after a while.

Today was what we call challenging and what non-staff would call flat-out impossible. Even our longest veterans agreed it was in the top 5 for crazy days. Every 10 minutes or so, someone else would go off. Chairs were thrown, tables tipped, windows and walls punched. A challenging day.

I admit, it got to me after a while. My girls could not go to bed because some of the other patients down the bedroom halls were making the entire area unsafe. It felt like I had one girl crammed in each corner, hands over their ears or mouths, eyes wide, hunched into little balls, and I could do nothing to help them because I had to help with the patients who were the threats. Challenging.

And yet, at the end of the day, I go home knowing we did good. The threats were dealt with, the children comforted and asleep, the group rooms tidied and the nurse's desk organized. Some will probably go out for a drink; I will go home to a book. I like books. They are like alcohol for the soul, sweet, addicting, and diverting.

And I will gather the strength to face the challenges of tomorrow.