Monday, July 5, 2010

The Apocalypse

FINALLY!!!!! A patient with some character! WOOT!

Today my rotation sent me to the acute psych unit at the hospital. This is where the patients go to detox, get on their meds, sober up, and come back to reality. I was so glad to finally get to this unit. I was able to get past the three locked doors and into the unit. After finding the charge nurse, she took me on a mini tour of the floor. There was plenty of office space for various physicians, nurses, and meetings. Then I was able to see the patient rooms. I was surprised to see them rooming with other patients; there were 2, 3, or 4 to a room. After the tour, I was just in time to attend the interdisciplinary team meeting. The nurse quickly went over each of the 19 patients and the physicians and social workers took notes. It wasn’t quite what I expected, but it was insightful none-the-less. Then I went to the day room to pick out a patient…

“Gabriel” was a male. He seemed very nice and very open and willing to talk to me. I can only wish that he had been the patient I had spoken with for my process recording. “Gabriel” was an angel sent from God to warn the people of the world that they were evil. He could see the souls of those around him. (I had a good soul, thank-you-very-much.) “Gabriel” went on to talk about some of his grandiose delusions and how he found out who he was only three weeks ago. There was a lot more about his relationship with God and Satan, but there is just too much to put down on paper.

Here’s the thing that really got me. Usually when someone starts making up stories and saying things like this, a person can just tell that it is fiction. You laugh and go on. “Gabriel” IS an angel. He truly believes this. What is difficult to understand is that there is an interwoven mesh of reality and delusion. Much of what he said about people in the world today was based on fact. Some of the statements he made, I would agree with whole heartedly. After a while I was truly captivated by his story. Being a Christian, it was difficult for me not to challenge his theology, but I was good and realized what not to say to him. I really tried to work on my therapeutic communication, and while there were a few blocks, I realized what I had said afterword and tried to stay on track. I feel like I am getting better, but I still have a long way to go.

After lunch I went to look up “Gabriel's” chart to find out what his diagnosis was. Initially he was diagnosed with Bipolar disorder. For a while he was functional and going to school while he was on meds. Then during a matter of a couple of days he crashed. Now he is admitted with schizoaffective disorder. Apparently, the physicians don’t really know what is wrong or what triggered his sudden decompensation. This is the really scary part of nursing for me. What do you do for a person like this? His meds just don’t work anymore. He’s completely delusional and doesn’t seem to be getting better. I spent a lot of time in his chart today trying to find some answers, but came away with almost nothing.

Today was an exciting day in my mental health clinical rotation. However, it was also my last full day for this summer semester. I am really disappointed that I didn’t get to spend more time in the acute setting. This is what I’ve been waiting for all semester and now it’s over. I think it’s a shame that I only get to spend six weeks in a class that is so interesting and relevant to all areas of nursing.

As I mentioned in another blog entry, I’m not sure that I see my self going into mental health. However, I think with more time in the acute care unit I might become more interested in following that path. I have noticed that the staff nurses don’t really do very much. They’re kind of like “Nurse Vending Machines”. They give out the meds when it’s time. They discharge and admit patients while filling out loads of paperwork. There really isn’t very much therapeutic interaction with the patients. I suppose that’s why you would want to go into the practitioner levels of education. If I go into mental health nursing, I’d want to help patients in a more direct manner. I guess only time will tell.


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