No, this isn't a 9/11 post. After quite a bit of thought, I've decided to declare this blog a 9/11-free zone for the day. There's a lot I could say on the subject, but very little of it's new, and the things that are personal and unique to me are things I got into trouble for saying immediately after the event. A number of people told me that I shouldn't/couldn't/didn't have the right to be feeling what I was feeling, because I hadn't been there/wasn't one of the main victims/was a traitor for not plastering American flags all over everything I own.
I really don't want to go through that again.
I believe very firmly that 9/11 traumatized everybody. One of the ways it did that was by becoming one of those omnipresent, inescapable public events to which there's only One Right Response. None of us could get away from it, and -- at least for a few weeks right after the day itself -- there was very little room for any kind of authentic, rather than culturally scripted, response.
This is coercion, plain and simple, and too much of today is going to be more of the same. So I'm opting out, thank you. I've spoken my last words on the subject.
So now that I've gotten that out of the way, can we talk about schizophrenia?
* * *
Wait, no, back up. Yesterday ended badly, so I need to remind myself that it started well. Church was a pleasure; my visit to the assisted-living facility was a delight; I even got some good publishing news. (The long-delayed third novel is scheduled for June, and The Necessary Beggar will be out in mass-market paper in March.)
But because I'd had a busy day and hadn't had time to exercise, I arrived at the hospital tired. Sometimes it doesn't matter; sometimes the energy of a shift will burn the fatigue right out of me. Sometimes, no matter how tired I am when I get there, I wind up in The Zone, where I'm moving with the flow of the department: saying the perfect things to patients, somehow showing up at exactly the right place and time to get or give needed information, successfully juggling piles of blankets and multiple cups of water while dodging ambulance gurneys and portable X-ray machines.
Last night, I wasn't in The Zone. Last night, I was doing one of my best Inspector Clouseau impersonations: knocking into people, dropping things, forgetting names. The chaplain as bumbling idiot.
The shift wasn't a complete loss, by any means. I had at least three really solid visits with patients who were very glad to talk to me and very grateful for my help, both spiritual and practical. Two of these visits involved depression and grief issues. Because I have depression myself, this is home ground. Depressed patients tend to be very comfortable with me, because they can tell I know the territory. And I'm walking proof that they aren't going to feel that way forever, that things can get better.
Score three for Clouseau.
Enter Patient X. Patient X is kind, alert, engaged, and thoughtful. Compliments me on my jewelry. Asks for prayer. When I ask what we're praying for, names the war, the victims of 9/11, and the environment, not immediate health concerns. (This always warms my heart, although I always pray for health issues too.)
A nurse arrives. I tell Patient X I'll be back later. The next time I go back, the doctor's in there, and I overhear part of what sounds like a very lucid conversation.
I return to Patient X after the medical staff has left. We start chatting. And suddenly things go seriously south. I start getting stories about shape-shifting roommates, extraterrestrial relatives, and characters from television shows undergoing top-secret medical experimentation. And then Patient X says, "But please don't tell anyone."
My heart sinks.
For a layperson, I'm pretty well educated about mental illness, and I'm intensely sympathetic to the issue. There are very few mentally ill patients who scare me or leave me at a loss. I've talked to depressed patients, suicidal patients, bipolar patients, patients with MPD and borderline personality disorder. I've had very pleasant conversations with self-aware schizophrenics who needed to vent about how hard the illness is. I once heard a hilarious and heartbreaking rant from a patient who said, "Do you have any idea what a pain in the neck it is to be hearing these voices other people can't hear and don't want to hear about?"
But I've never figured out how to talk to patients who are actively delusional, the "Saddam Hussein is burying Swiss francs in my garden and my neighbor turns into a kangaroo who implants electrodes in my skull while I’m sleeping" crowd. I don't want to shame or abandon these patients, who are usually very lonely and isolated, but I also don't want to play along and reinforce their delusions. It doesn't help that they're almost always bright, charming, personable, and clearly starved for human contact.
I want to give them human contact, but I don't know how to do that safely. So I usually stand there, try to smile, nod until I start getting scared that I'm reinforcing their delusions just by nodding, and then beat a hasty retreat, feeling wretched.
Last night, I felt wretched. Patient X had trusted me enough to share very personal stories, and had asked me not to tell other people about them. But Patient X had also come in with a medical complaint, not for psych issues. The stories were symptoms of illness, weren’t they? Did the med staff know about this? If they didn’t, did they need to? How could I know without asking? And how could I ask while honoring X’s request for confidentiality?
I finally decided to fudge the issue by telling someone about the general tone of the stories without sharing the details.
Let's back up again. I'd arrived at the hospital worried about whether I'd have to start all over with a new set of ED staff who didn't know me. Earning staff trust and getting into their long-term memories can be a very long, difficult process. So when I showed up for the new shift, I was delighted to see a number of people I knew, including Nurse Y, someone who's referred me to a lot of patients and who’s also complimented me on my work with a number of them (including, significantly, psych patients). And Nurse Y was the appropriate person to tell about Patient X.
So I approached Nurse Y. "Excuse me, but is Patient X's medical team aware that there are major psych issues?"
Nurse Y, clearly cranky, pulls up the records. "Yep, it's schizophrenia."
"That's what I thought."
"Well, you called it, good for you." Snarkily. "You know, it's not illegal to be crazy."
Me, in shock: "Of course not! Nor should it be!"
"Crazy people get sick, too."
"Of course they do! I just -- "
"And schizophrenics can reason pretty well, when you think about it." This thrown over a shoulder as Nurse Y walks away.
I stood there, feeling about half a centimeter high. Nurse Y has watched me work for almost two years. Nurse Y, in the past, has known that I'm someone who advocates for psych patients instead of shaming them. And suddenly all of that's gone? I have to start all over again after all? I was never actually in long-term memory, or the files got erased when I switched to a different evening? And even worse, I’ve violated patient confidentiality to deliver unwanted, redundant information?
It was near the end of my shift. I was upset. I went and sat in a deserted lounge for a few minutes to calm down, and then marched back into the ED and up to Nurse Y (PITA for Christ, PITA for Christ, PITA for Christ). "I want to be clear on this. I wasn't trying to stigmatize Patient X. I was trying to make sure that Patient X got appropriate help."
"Don't worry about it, we're good." This thrown back over a shoulder as Nurse Y walks away. I don't think Nurse Y has heard me.
It's now a few minutes shy of the end of my shift, but I decide to leave a little early. I walk over to the board to remove myself from the "chaplain" box, in which I always write my name and the hours I'll be working. But it's empty. Somebody's already taken me off. I've been erased.
Now feeling thoroughly wretched, I head back to my car. On the way there, I see one of the security guards, someone who's watched me work with psych patients even more often than Nurse Y has, since he's usually one of the people guarding them. I vent. The security guard listens, looks sympathetic, makes encouraging noises. "Of course you were trying to help! Y can get like that. Don't take it personally."
When I got home last night, I had e-mail from Kim about something else, and since she's an ED nurse with psych experience, I asked her about this case. Had I done the wrong thing? Should I not have mentioned the psych symptoms? She assures me that I acted appropriately, and that the medical team needed the info. That made me feel a lot better.
But I still don't know how to talk to delusional patients. Does anyone have tips?