Excerpt #2 from Mental Health Journal
Yesterday was the most mentally intense day of my student nursing career thus far. I did not abide by the 15-minute rule and I suffered for it. I will admit that. My patient was a narcissist and had antisocial personality disorder. I had eyed his profile on the morning report sheet thinking he would provide me with an interesting day and a great starting point for my disorders analysis paper. The morning reporting nurse quoted him saying "I want to be a personal assassin and kill all the pedophiles, drug traffickers, wife-beaters, and gang members." Added to this list was a subset of individuals he wanted to take care of because of "personal" reasons; his 6 month old baby included.
So back to the 15-minute rule.
Hindsight is 20/20 and I think this rule is fabulous. It may have spared me quite a bit if I would have listened to it, including a very intense pounding headache which lasted for hours.
The day was fascinating. Communication is such a complex skill. The psych ward is filled with people whose greatest tool are their mouths; patients and providers. I can see myself watching, learning, soaking up techniques from every direction. I see the way a skilled doctor can readily release information from a person just through proper intonation. She asked him "Why?", the way a child asks a parent. This happened directly after he bragged about his marksmenship and the ex-girlfriend he was planning on killing.
I had sat with him earlier that day and heard the exact same story, told with less clarity and more anger. I didn't ask 'why'. I didn't even think of that as an option. We were probably on our 30th minute of the interview, 15 minutes gone too long for a student nurse. I didn't ask 'why' because I was working so hard on perfecting my mask-like appearance- the one that I wanted to so clearly portray as 'what-you-are-saying-is-not-affecting-me." Every look of disgust, appalling gasp, cringe, tear, or incredulous laugh I wanted to express got shoved down my throat deep deeper all the way down- away from the surface. It worked, so he continued, talking and talking about insane ideas he may one day make a reality.
But at the end of the interview, the one the doctors were conducting, a glimmer of hope sprung out of his mouth. They had asked him "We will make this very clear and we're sure you already know this. YOU ARE IN HERE FOR SAFETY REASONS."
He nodded.
"But," the male doctor continued through a very serious tone, "is there anything else you want to get out of being here?"
The patient said quietly and what appeared to be, genuinely: "Yes. I want to stop thinking like this."
It wasn't much, but it was enough hope for me to grab onto. I needed something. I am still grappling with the idea of these people who supposedly are born without souls. I don't get it. It doesn't fit very well into my idea of life, or my idea of God. It is too confusing, too big, too much for me to wrap my head around. When I was talking with the patient in the morning, when it was just him and I, he emitted a coldness that made me wonder. I listened to him explain the clothing he had picked out to assassin people in, meanwhile the thought sat heavy and motionless in my mind like a dark raincloud. Does this man have a soul?
During his afternoon interview with the doctors they were able to pull out more subjective information regarding his childhood.
Abusive deceased father- check.
Alcoholic mother- check.
Disruptive childhood and depression- check.
Cruel brothers - check.
Not many friends and a lifetime of being made fun of- check.
History of violence. none.
History of arrests. none.
Mainly, the theme that rang loudest in my ears, was his desperate desire to feel that he belonged somewhere and that he mattered. It wasn't something he was offering up; and it wasn't anything I was able to extract from him; but watching the doctors simmer down his anger and his grandiosity to a puddle of humanness was too much for me.
Again, the question haunts me. How does this happen? What are the factors involved here? Have I, in some way, contributed to someone elses state that may be similar to his? Has my meanness, my lack of insight, my insensitivity been a proponent of evil. Was the quiet homely girl in 6th grade that I teased and called "musty Misty" from a tribe similar to his? A tribe of the less fortunates. A tribe of the kicked dogs. A tribe of the silently enraged and plotting?
Wanting to kill your 6 month old baby in the gruesome way he detailed to me is a thought he will have to take 100% responsibility for. I understand this. In fact, his entire life is a life he will have to take 100% responsibility for. And for whatever genetic defects are present in him, the creator of those will handle that. That is not my business. But my business is healing, is offering the light, is suggesting the person climb up the mountain not off the cliff. I am learning. I am trying. But some days are harder than others.
Saturday, June 5, 2010
Excerpt from a true teacher
Second semester of nursing school; mental health. I have been spending my time in a locked psych unit (as a student, not a patient :)). We have an assignment to journal- to process the interactions and our observations and experiences.
I am at a school that is not the most organized or efficient, but they make up for it in student support. The culture of the school allows for intimate relationships between students and teachers and I'm finding it to be incredibly helpful.
Journal #1
Teacher asks: What is one concern you have about this clinical rotation?
From the last paragraph of what I write:
I don’t like the idea of assuming what people are feeling, hearing, and seeing is “not real”. I want to give them the benefit of the doubt. This is a spiritual matter I am talking about. I often wonder about these people and the spiritual oppression or possession they may be under. I wonder how many of these people are needlessly suffering under demonic control. I wonder about freedom. What would freedom look like for each of these people? Is it always so gradual, or could it be immediate? Why would God allow a human to exist that has no conscience and then chooses to do bad things? I guess my concern is following the stories and observing the paths of which the human experience can travel down, and of knowing how I am not much different than the tortured soul in front of me.
Teacher response:
There is alot to respond to here, but the most important thing is the last part about the spiritual situation of these patients. We talked a bit about this after clinical this week, but this is what I would say to you. I don't know why a lot of bad things happen. I have seen patients that I suspected were truly evil, and I have seen plenty of suffering. Mostly there is a continuum of good to evil in all of us, and it just depends on how spiritually grounded/disctracted we are at any given moment. THe healing from addiciton, for example, has an awful lot to do with finding a spiritually grounded center again after a lot of, often, pretty bad behavior and harm to loved ones. It is a humbling journey to re-build those relationships. At the same time, I have seen deep spirituality and devotion in families despite devastation from chronic mental illness. WHy is one family strengthened and another is destroyed? It seems to me that it is in the same old spiritual path we all walk. Illness is illness. It is not the whole person or the whole story. If we can educate patients about that, then when the depression is so powerful that it feels like God is far away, maybe the person can recognize that it is the depression talking; it is not the reality that God has abandoned them. Whether you call it demons or something else, the reality is that the path back to God is a healing journey that includes spiritual care and ministering to the deep pain that we find in front of us. In the healing care we provide, God exists in us and that strength, hope, and love is what we give to our patients. There is no room for darkness in that ministering.
THat's my take on it from my own practice. We sell hope for a living, as far as I am concerned. That is of God...whole story in a nutshell. We represent the light and the truth, and the darkness doesn't hold up too well in the face of that light. I watched Star Wars on TV the other night. It's a bit like that scene where Luke confronts Vader, unwilling to accept that Vader had totally turned to the dark side. Luke's belief in the "good in him" helped Vader find that good in himself. Remember how Veder took his mask off and thanked LUke as he died renouncing the darkness? Most patients don't have it spelled out that clearly, but it's that kind of a process that we support as we help them to find their inner spiritual strngth and goodness. OUr unconditional acceptance of their value as children of God is often the vehicle for their being able to find spiritual peace.
WHy is there so much darkness? I don't know. That question is above my pay grade, and I've basically stopped asking it. I do know that this life is about growing spiritually to become more like Jesus. We are all a mess at one level or another. It is the journey towards godliness, spiritual communion with God, forgiveness of self and others, etc. that matters. You and I have been blessed with that ministry of healing. That's all I really know. I have that job, and it is a blessed thing to be doing. I sell hope, and it is my gift. I need to use that gift the best I can to serve my God. The rest is up to Him. This whole business is an act of faith. It's a great life!
I am at a school that is not the most organized or efficient, but they make up for it in student support. The culture of the school allows for intimate relationships between students and teachers and I'm finding it to be incredibly helpful.
Journal #1
Teacher asks: What is one concern you have about this clinical rotation?
From the last paragraph of what I write:
I don’t like the idea of assuming what people are feeling, hearing, and seeing is “not real”. I want to give them the benefit of the doubt. This is a spiritual matter I am talking about. I often wonder about these people and the spiritual oppression or possession they may be under. I wonder how many of these people are needlessly suffering under demonic control. I wonder about freedom. What would freedom look like for each of these people? Is it always so gradual, or could it be immediate? Why would God allow a human to exist that has no conscience and then chooses to do bad things? I guess my concern is following the stories and observing the paths of which the human experience can travel down, and of knowing how I am not much different than the tortured soul in front of me.
Teacher response:
There is alot to respond to here, but the most important thing is the last part about the spiritual situation of these patients. We talked a bit about this after clinical this week, but this is what I would say to you. I don't know why a lot of bad things happen. I have seen patients that I suspected were truly evil, and I have seen plenty of suffering. Mostly there is a continuum of good to evil in all of us, and it just depends on how spiritually grounded/disctracted we are at any given moment. THe healing from addiciton, for example, has an awful lot to do with finding a spiritually grounded center again after a lot of, often, pretty bad behavior and harm to loved ones. It is a humbling journey to re-build those relationships. At the same time, I have seen deep spirituality and devotion in families despite devastation from chronic mental illness. WHy is one family strengthened and another is destroyed? It seems to me that it is in the same old spiritual path we all walk. Illness is illness. It is not the whole person or the whole story. If we can educate patients about that, then when the depression is so powerful that it feels like God is far away, maybe the person can recognize that it is the depression talking; it is not the reality that God has abandoned them. Whether you call it demons or something else, the reality is that the path back to God is a healing journey that includes spiritual care and ministering to the deep pain that we find in front of us. In the healing care we provide, God exists in us and that strength, hope, and love is what we give to our patients. There is no room for darkness in that ministering.
THat's my take on it from my own practice. We sell hope for a living, as far as I am concerned. That is of God...whole story in a nutshell. We represent the light and the truth, and the darkness doesn't hold up too well in the face of that light. I watched Star Wars on TV the other night. It's a bit like that scene where Luke confronts Vader, unwilling to accept that Vader had totally turned to the dark side. Luke's belief in the "good in him" helped Vader find that good in himself. Remember how Veder took his mask off and thanked LUke as he died renouncing the darkness? Most patients don't have it spelled out that clearly, but it's that kind of a process that we support as we help them to find their inner spiritual strngth and goodness. OUr unconditional acceptance of their value as children of God is often the vehicle for their being able to find spiritual peace.
WHy is there so much darkness? I don't know. That question is above my pay grade, and I've basically stopped asking it. I do know that this life is about growing spiritually to become more like Jesus. We are all a mess at one level or another. It is the journey towards godliness, spiritual communion with God, forgiveness of self and others, etc. that matters. You and I have been blessed with that ministry of healing. That's all I really know. I have that job, and it is a blessed thing to be doing. I sell hope, and it is my gift. I need to use that gift the best I can to serve my God. The rest is up to Him. This whole business is an act of faith. It's a great life!
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