Week Two, Down

Wednesday:

Of course I can't speak about specific patients, but if I were to make a composite, generic patient out of all the patients I had today, s/he would have attempted suicide at least once, come from a broken home(s), been neglected, emotionally abused, sexually abused, physically abused, suffering from hallucinations and nightmares, unable to sleep, on between five and fifteen psychotropic medications, and s/he would be around 13 years old.

Yes, I was on the children and adolescent psych unit today, locked in with the fourteen children who have been lucky enough to snag beds on the unit.

They wake up around 7:30 and they shower and they wait for breakfast. While they wait, they line up to get their medications from the unsmiling, burned-out nurse. (The only time she smiles is later, in a treatment provider meeting, when she cracks jokes about a child who has been horrifically abused.)

In the late morning, the children go off to the gym and while they are gone there is a treatment provider meeting. The psychiatrists and nurses and social workers go over each patient and in between making decisions about treatments, they make sarcastic comments and joke and laugh about things that horrify me: sexual abuse, accidentally over-medicated children, abusive parents. . .There is a rare, serious moment as they talk about two children, former patients, who have recently killed themselves. (The clinical instructor doesn't allow us to say "committed suicide," we have to say "died by suicide," a semantic distinction that seems to me to be completely moot.)

In the afternoon, I sat at a table with four children and we played with Play-Doh and I listened to them earnestly tell me horrific stories about their lives. They are eager for attention, eager to have someone listen to them, so I do.

There were two of us on the child and adolescent unit today. Everyone else was upstairs with the adults and when we meet up with them later, we hear stories of patients attacking staff members and being put into padded seclusion rooms.

This is not the place for me. I feel nothing but relief at being on the other side of these locked doors, the freedom side, and sadness at these children who are not going to be fixed in the week or two weeks or three or four weeks that they are here. They'll have medications that keep them stabilized until they leave and start missing doses or mom and dad can't afford to pay for them anymore, and then they'll slip downward.

Thursday:

I was on the child and adolescent psych unit again today. This was my last day there. Thank god.

The children were relatively well-behaved today. When they're not well-behaved, they face some strange consequences. For example, last night one of the patients passed another patient a note, so today every single patient's journal and all writing instruments were confiscated and put in locked contraband boxes. When patients break other kinds of rules--speaking back to the staff, say--their clothes and shoes are taken away and they are put in hospital gowns and slipper socks and they are not allowed to leave the unit to go to the gym or to art or other types of group therapies. That can go on for days.

Today in the treatment team meeting, one of the psychiatrists was told about a patient whose chronic and now worsening condition was exacerbated by contact or lack of contact with the other patients. "During our session we role played how to talk to other people," he said. Then he continued in a perfect deadpan, "You mean that didn't fix the problem completely?"

In the afternoon, I shadowed one of the case managers who works with the children.  One of her patients had to go to court this morning and that led her into a largely educational rant about the lawyers who represent the children. In this state, every single child, no matter their age, is appointed legal representation when they are admitted to a behavioral health center. Parents don't often know or understand this and the lawyers aren't always particularly good about explaining it to them, so parents get angry that their child has a lawyer and they think that something sketchy is going on, law-wise. It's a strange situation. The lawyers drive the case managers crazy because they don't necessarily understand the treatments used in behavior health settings (whether it be drugs or other types of therapy) but they are supposed to go to court and argue for or against treatment on the child's behalf. It makes for an interesting dynamic.

I listened in on calls to parents, too, made by one of the psychiatrists and the case manager. Parents are often confused and at the end of their ropes with children who are suicidal, homicidal, violent, depressed. And sometimes parents are ditching their kids or punishing their kids by bringing them to the facility. Sometimes parents are crazier than their kids and their crazy feeds the kid's crazy.

Part of what makes me so uncomfortable in this facility--not just on the kids' unit, but on the adult unit, too--is that it's the one place I can picture myself ending up as a patient. When I was doing rotations in the hospitals, working with patients who had just come out of surgery or who had cancer or cirrhosis or whatever physical ailment was plaguing them, I never thought: That could be me. But looking at these patients who are incapacitated by depression to the point that they're catatonic or who are so anxious that their anxiety causes them to hallucinate, I think: That could be me. That could very easily be me.