I took care of a patient recently who made me question my skills, but not in the way I typically do. Typically I think things like, “what if I don’t recognize something that I should and they decline?” “What if I miss something crucial and they code?” “What if I’m going to the bathroom and they code?” etc., etc. Typically with very physically ill patients, I panic that I will kill them faster, or miss something that will lead to an irrevocable fatal event. But what about mentally ill patients? I’m not talking about patients that whine and are annoying who sometimes might get called “crazy”. I’m talking about patients with actual mental illness, possibly undiagnosed. How do I help them? What if I miss some kind of warning sign and they become a threat to themselves or others? What if they get hurt? What if I get hurt? How can I care for them wholly, not just addressing their physical ailment?
In my psych clinical in school, I spent most of the time terrified. Huddled in a group of people, I feared that if I somehow angered a mentally ill patient that harm would come to me and my classmates. So much of that is from a stigma that has been perpetuated through the years of deranged and violent “mental patients” in the media. Every movie or TV show that depicts a mental health facility is, in a word, scary. And lets face it, the facility where I did my clinical time was one of those places. This facility had been around for a century, with very few updates from waning mental health budgets. The staff was fantastic, but they can only overcome so much, and I felt that if I were a patient there, I would not be able to heal. Thankfully they have moved to a new facility since then, but I have not been back to visit.
Very few patients have made me feel that fear since being out of school. During report you hear things passed down, but I never had any incidents with anyone that made me afraid. Until this patient recently. This patient ended up in our care for a physical condition, that may or may not have been brought on from treating a mental condition in an unsafe way. At one point in the shift, the patient became agitated and hostile, jumped out of bed and came at me, which I was obviously not expecting. And what did I do? I panicked. I didn’t hit the staff assistance button, I didn’t call for help in the hallway, I panicked and stood there, trying to talk to my patient so that they would calm down. I had already called security for another reason, but they happened to show up at that time. Everything was alright and the patient calmed down, but I walked out of the room and burst into tears.
My ears and throat were pounding and I could feel the fight or flight adrenaline surging in my body. I couldn’t sit down and do anything, all from a minor occurrence with a patient becoming agitated. I felt relieved that nothing had happened, but I felt sad that I could not help my patient in the way that they needed. Sure I can do a Q1hr neuro assessment until I, and they, are blue in the face. Yes, I can sink a foley, start an IV, toss in an NG, and shit, why don’t we intubate and line while we’re in there? Toss in an EVD and a Udall so we can start CRRT, too. But can I provide that extra therapy? Can I help repair my patient’s spirit? Their feelings? Their identity? All of those things are what helps our patients once they leave the hospital, but what are we doing about them while they are in the hospital?
I know that my friends on the unit provide all that they can for their patients, typically at our expense (both mentally and physically), but is it enough? Are we covering everything? Should we even be responsible for covering everything? Is it actually possible? I’m not sure. These are all just the kinds of thoughts I’ve been having since my brush with psych nursing. And I have to say, god bless psych nurses, because I’m definitely not one of them.