PICU

The PICU, or Psychiatric Intensive Care Unit, was where I spent most of my time in the state psychiatric facility, and where I had all of my ECT. Because of this, quite honestly, I can’t remember much about this time. Luckily for me I kept a special “Things to Remember” journal, which documented funny or disturbing things that happened, details of my physical health problems including what foods to avoid, reasons why I was in hospital, and other such things that I deemed important to remember.

This post is written in consultation with that journal.

The PICU is a locked 8 bed psychiatric unit where people are detained (that’s right, we were all prisoners of the Mental Health Act) presumably because they had complicated or enduring problems.

I, for example, had the double whammy of physical and mental problems concurrently. I had been diagnosed with a very rare autoimmune disease, and had to adhere to a very restrictive diet, and was physically unwell, often needing a nurse escort to nearby hospitals for appointments and surgeries. On top of that, shamefully, I was a major flight risk, having had escape attempts at multiple hospitals, incurring the involvement of Security. I was also a risk to myself, having had a suicide attempt on the open ward, and I was completely psychotic, experiencing hallucinations and delusions. Although I joke that my diet is enough to send anyone mad, it was the most dark and out of control I have ever been. Honestly, I am glad I have forgotten much of the substance of my stay.

The other patients on the ward had similarly complicated issues.

Ann is a 50 something women who would only answer (strangely) to “Isabella” and probably has a diagnosis of mania with delusions of grandeur. She believes herself to be Princess Diana. Unfortunately she believed I was Kate Middleton, and because it was easier than trying to convince her otherwise, I was often employed to participate in her fantasies. She was extremely jealous of anyone I talked to or who visited, particularly my mother. Her sentences often started with: “My Father in law, Prince Charles” (clearly her grasp on the structure of the royal family was somewhat askew) or “When I was at Oxford/Cambridge.” She is very kind though.

Lesley was the only male on the ward and disliked this intensely. (There is too much oestrogen on this ward” he would grumble). He was waiting on transfer to an all male ward that Isabella informed him that all the patients would be criminals (she was probably not far from the truth). Isabella also accused Lesley and I of “sexual misconduct” while we watched TV…A situation very unlikely given that Lesley had confessed to me that he thought he might be gay.

Nicole was pregnant with a blackened front tooth. The baby was clearly unplanned, as she often talked coldly about the foetus, prompting beration from the nurses and Isabella.
Pregnancy did not stop her smoking habit and she chain smoked as much as she could get away with. Her favourite phrase was “I need to get out of this place…I have drugs to pick up and money to count.” She could be kind in the most unexpected ways, though. For example, she bought me chocolate I could eat from the travelling kiosk when I didn’t have access to money.

Dani was a schizophrenic musician. She was slight, strange and spent hours solving complicated algorithms on the whiteboard. We once asked her why she didn’t teach, given how much she knew. “Because I am mad!” she laughed. “Aren’t we all!” Nicole responded. True that.

Louisa was your typical mum. She was Christian, wore courderoys and harboured an intense dislike for Nicole. Overall, she seemed incredibly normal to be detained in a locked ward, and I often wondered what brought her to us. She lived rurally and claimed to be flown to hospital by the Royal Flying Doctors Service. So much cooler than being driven in the back of a Volvo. In any case, her stay in the locked ward was short.

The other inmate has been lost to my ECT memory loss. Perhaps this is due to a short stay. Or perhaps I never interacted with or noticed them. All I know is that try as I might, although my longstanding rule of psychiatric hospitalization was to avoid contact with other patients…in such a small ward, myself and those I have described became a little, strange, family. We knew what it was like to be crazy. We banded together. Us against the nurses. And strangely, (perhaps it was institutionalization), that little family helped me survive the most difficult days of my life.

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Les Miserables

“I’m in a skanky mood!” announced Isabella, waltzing into our dining area. The rest of us looked up briefly, then continued with our breakfasts.

“Well don’t be.” snipped a nurse, engrossed in the mountain of paperwork she had to complete for the day.

“I think it may be time to retreat to the nurses station..” our male resident student nurse joked. We all laughed, including Isabella. We liked Josh.

And so it goes. A fairly regular morning on a locked ward. We all had our madness, and we all accepted it.

This post again is written in conjunction with my Book of Things to Remember. The memories I have of the locked ward are kind of like the memories you have of when you are two. You think you remember something, but it’s really because it is a story that has been told so many times. I think I remember these events, but it’s really all down to my Book of Things to Remember.

Early on in my stay I opened a door and found a second TV room. Marvelous! Some time to myself, and actual choice over what to watch. I settled down on the couch then glanced out of the picture window.

It was there I saw something that chilled me to the bone.

Old people. Lots of them. White hair, perms, wheelchairs, walkers. Sitting down with blankets over their knees, heads lolling to the side. I crept up to the window and let out a blood curdling scream.

A nurse rushed in. “What is it?!” she asked, flustered. I pointed dramatically out the window. “What? That’s the geriatric ward.”

“What if I end up there?! I have been in hospital for months…what if I’m…a…” I lowered my voice, “a lifer.” By now I was in floods of tears.

“oh Rachael, you’re being silly! You will get better and out of here. I promise.” She patted my shoulder, the staff equivelent of a hug as they weren’t allowed to touch us unless absolutely necessary.

I knew she was right, but I never felt the same way about that room. Somehow that room latched onto my deepest fears that I would never get better. It wasn’t the people that made my stomach flip, but the concept. Ridiculous, as those patients had probably been admitted months rather than years ago, by caring family members concerned about memory loss and increasing fragility. Logically I knew this, but I still stayed away. And so did everyone else, and I never did find out why.

* * *

Usually we were fortunate enough to have our own ensuite in our rooms, but one day Isabella claimed hers was broken. She went to the public toilet and suddenly there was a lot of shouting.

“When someone is in the toilet, taking a shit, you don’t just fucking barge in!” growled Nicole, slamming the door closed once more.

“You’re fucking disgusting Nicole! You know that!” Isabella didn’t like any mention of bodily functions, they were far beneath her. She walked past me saying “This sort of thing would never happen at the palace. You know with your Daddy, Prince Charles.”

“I can’t deal with you right now..!” shouted Nicole from behind the toilet door. “I’m in the middle of a drug deal!”

I snapped my card on the table: “UNO!” I said triumphantly, basking in congratulations from other patients and staff.

Yeah, this kind of thing happened all the time.

* * *

One morning we were all singing. It was a terrible racket, with the din of people who could sing combined with those who can’t. Lesley looked like he was about to implode, and retreated to his room.

“You lot should be in a musical,” a nurse joked.

“yes!” Isabella piped up, “Les Miserables!”

We all fell about laughing, including the nursing staff.

“That was really funny!” Nicole said appreciatively, holding Isabella’s shoulder. “You should be funny like that more often!”

Isabella looked pleased with herself.

“No touching!” a nurse directed at Nicole.

A few days later Lesley finally got his transfer, and Isabella missed his company. She wrote him a letter, of which the envelope was covered in childlike drawings of hearts and flowers.

“Can you please send this to Lesley in the all male ward? I am worried about him. I am not sure he will survive a criminal attack.” she asked a staff member.

“Sure.” the nurse responded, absent mindedly placing it in the “mail out” tray. “Hang on a minute…what does this letter say?” she asked, suspiciously eyeing the hearts. “I can’t send anything inappropriate.”

“Oh, it’s appropriate. It just says that I am missing him and that I hope he hasn’t been killed yet.”

The nurse ripped open the envelope and read it.

“I can’t send this!” the nurse said, horrified.

“Why?” asked Isabella, pouting.

“Because it’s just…” the nurse shook her head, “no. No way is that being sent.”

Isabella stalked off and Dani and I looked at each other. What we would give to read that letter! Somewhere out there Lesley avoided a surprise oestrogen attack.

If he hadn’t been killed of course.

Yes, life was never dull with Isabella on the ward.

Lessons from a Locked Ward

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1) In the famous words of The Eagles; “you can check out any time you like, but you can never leave”. Escape is borderline impossible. And if you do succeed you will soon find yourself in the back of a paddy wagon. There are air lock doors and two story fences. There are single rooms but no privacy. Physically and legally you are detained for as long as is seen fit. The only way out is through good behaviour and compliance. You are a prisoner of the state, and the sooner you accept that fact, the sooner you will be trusted to an open ward.

2) Never mess with the nurses around handover time. Unless you are dying. And even then you will most probably be told to wait. If you really want to grab a nurses attention, go to the toilet. You will be interrupted almost immediately.

3) Money serves no purpose. Instead, follow the currency of the three C’s: cigarettes, chocolate, and Coke (the Cola kind, though the street kind would probably make you popular too).

4) Never enquire about someone’s diagnosis. It is the equivalent of asking why someone is in jail. Or why someone only has one leg. Or what’s up with that speech impediment. You get the point.

5) Hospital pants are entirely underrated. Comfy, free, and you don’t have to wash them. Winning!

6) No matter how nice the nurse or hideous the patient always remember the golden rule that it is “us against them”….

7) … Except for student nurses. They are awesome. A midway point between you and authority.

8) When in doubt smile and nod (except when it is Nico propositioning you).

9) Locked wards lack structured therapy as the patients are usually too sick to participate. Generally your possessions are removed as well. Get very adept at entertaining yourself. And by entertaining I mean watching Deal or No Deal.

10) If you only remember one thing, make it this: there is always someone crazier than you.

Jail Break Version 3.0

It was less than 2 weeks after being discharged from The Dungeon that I ended up rehospitalized in the states psychiatric facility. my ‘Hospital in the Home’ nurses took me down to triage and I before I knew it, I ended up being admitted to an open mixed gender ward.

But I was on a path of self destruction, and the staff knew it. i can only remember snapshots of my time on the ward. The nurses caught me in the corner of my bathroom, a pair of leggings wrapped around my throat and my eyes bulging. So my clothes and shoes were confiscated. I was given a tear proof canvas sack to wear and moved to a single observation room with a camera in it. My sheets were made of tear proof canvas as well. I could only use plastic silverware.

Somehow I managed to get hold of a biro, and used the lid to gauge deep gashes into my thighs. Once again I was found out and this time was enough. I was moved to the locked “Psychiatric Intensive Care Unit” next door.

My first thoughts, when I arrived on the new ward were to escape. I had a brief Jurassic Park Moment where I attempted to climb the tall escape proof fence. Escape version 3.0. The nurses didn’t even bother trying to catch me- this fence was truly escape proof. Today was the day I ended up with a forced injection in my bum. I fell asleep, and woke up on ‘special’, where I had my very own nurse follow me around all day and all night.

I have never been so self destrucive. I didn’t care. Weeks later I look at the scars all over my legs and arms and think…why? What was it worth?

Now I carry scars I will hold forever. Scars to remind me where I have been, and where I will never go again.