Carol is in her sixties, a small-boned woman with reddish-brown hair. She is diagnosed as acutely depressed. She lies in bed under the covers with her back to the door. She lays in the dark with the door and window blinds closed. The staff let her.
She was admitted June 18. I am moved into her room on Monday, June 24, because I have seasonal affective disorder and the blinds in my room—as in most rooms—are broken closed. There is no light.
In the new room, I open the blinds and the door, and dispel the darkness. Carol responds with hostility, which doesn’t faze me. My official policy is that I will give a roommate nine hours of darkness for night sleeping and ninety minutes during the day for a nap. Other than that, the blinds will be open to the light. That is the way normal people live, and I think that inpatient psychiatry is about returning people to normal living. Apparently the staff does not agree; they facilitate and enable Carol’s depression.
The first day, every time I leave the room, the window blinds and door are closed when I return, presumably by Carol. I make small, cheerful conversation with her, which she grumbles about. She has not gotten out of bed for breakfast or lunch this day, nor how many days previously? In the afternoon, she has visitors—daughter and sister?—then returns to bed, apparently without eating supper. When it is time for her night medication, no nurse enters the room. Instead, the nurse calls on the intercom and asks her if she will take her medicine. Carol says no and that’s the end of it. No effort is made to build a therapeutic bridge to the patient.
Apparently Carol has been claiming she “can’t” eat. Someone, I think a speech pathologist, comes to see her. The woman examines Carol and finds nothing wrong with her mouth. Carol balks at sipping liquid, though she has told me that she’s thirsty. When the staff member tries to get Carol to eat some cookies or crackers, Carol refuses, saying everything gags her. The doctor comes in and persuades her to have ECT.
In my little conversational gambits with Carol, I have discovered that—
- Prior to being admitted, she was taking Prozac, which frequently causes loss of appetite.
- Her dentures are on the windowsill, not in her mouth, which probably has a lot to do with her refusal to eat.
- No effort has been made by the staff to get her to drink, consequently she probably is so dehydrated that she doesn’t have enough saliva to eat a cookie.
My guess is that the Prozac stopped her eating, which then became a habit, and now she is too dehydrated to know or care. She is always in bed, but awake during most of the day. She says she feels too tired to get up; she says if she could just get enough sleep, she’d feel better. Dehydration and malnutrition cause a feeling of tiredness that is not relieved by sleep.
The staff ignores her. Shift after shift, she is left alone in bed. Once, one of the counselors—fresh out of college with a liberal arts degree—comes in and says to Carol—a woman old enough to be her grandmother—“So what’s happening? What’s going on with you?” Carol mumbles a generic response. The staff person pauses less than a minute, then says, “Well, if you want to talk about anything, you know where to find me,” then the girl leaves the room. To my knowledge (I am ill and frequently in bed in the same room with Carol) that is the only staff contact Carol has in eight hours. I wonder what the staff notes for Carol look like that day. (To be continued)
For the antidote to inpatient psychiatry, see Dr. Nasri Ghaly at http://annecwoodlen.wordpress.com/2010/12/29/dr-nasri-ghaly-psychiatrist-part-i/