You’re supposed to have a social work assessment during the first 24 hours you’re on Unit 3-6. I never got one. The reason I wanted one was because I thought I might get treated better if the staff knew, for example, that at home I’d been using an electric bed for fifteen years and an electric wheelchair for ten. In hospital, they’d put me in a manual wheelchair and tell me to push it myself. Duh. My legs aren’t broken. I have chronic fatigue syndrome so bad that if I need to be in a wheelchair then I’m also too bad to be able to push it.
Don’t you think that proper treatment of an inpatient might have something to do with knowing what her lifestyle was like at home? Reasonable expectations, and all that.
Kyle came to me another time, all snarky and snippy, and told me something about the social work report having been filled out. She used some existing reports she’d found somewhere—I have no idea what. She had no current information and there are three kinds of lies: lies, damned lies, and hospital charts. No attempt was made to have the patient confirm the accuracy of the existing information.
All of this crap that was happening grew out of the fact that I have diabetes mellitus for which there is no further treatment available. My Inpatient Client Treatment Plan (which I didn’t see for ten days) lists “Presenting complaints/symptoms” but does not list that I have diabetes. Or severe unstable obstructive sleep apnea, immune dysfunction, or lithium poisoning. So here’s the Unit 3-6 treatment plan: let’s not treat the patient for what she actually has.
The treatment plan also notes that “Pt. is angry, aggressive, rude, verbally abusive and not cooperative with admission process.” Do you suppose we might include in the notes that the patient just got committed? She was supposed to go voluntary but for some unknown reason she was legally committed to a locked ward by a doctor she trusted? I am guessing that when you are being booked into jail they don’t make note of the fact that you’re not too happy about it, but this is Psychiatry: you’re supposed to like what they’re doing to you.
Staffing of inpatient psychiatry is wholly dependent on the staff being able to see themselves as good people. In fact, they are doing bad things. They will not self-assess what they are doing to cause the problems; instead, they blame the patient. Kelly DeVaul, who used to be the nurse manager of 3-6 (and if anybody knows where she is these days, please let me know), told me that one of her biggest problems was getting the staff to understand what they were doing to trigger the problems. Getting a sixty-day commitment on a voluntary patient would be way up there on the list of things that make a patient angry and uncooperative.
But I was talking about Kyle.
My third contact with Kyle was when she came in to talk to me about something. My bed was placed facing the window and when people would come to see me, they would stand at the foot of the bed opposite me, which made sense from their point of view. From my point of view, they were standing in front of the window: I was looking into the glare. So I would point this out and ask people to move. I had this discussion with aides, nurses, discharge planners, doctors and the woman who is director of Psychiatry, Labor & Delivery, and a lot of other stuff. They all responded, however awkwardly, by repositioning themselves away from the window.
Kyle flounced to my bedside, pulled up a chair and snapped, “I didn’t know I was your lady-in-waiting.”
This is one woman with a really bad attitude who is totally unprofessional. She goes on to tell me that I am “rude,” “manipulative,” and “playing games.”
So here’s my question: Kyle hasn’t spent ten minutes with me in ten years, so how does she know this? Obviously, she doesn’t. She is substituting her personal feelings and moral judgment for competent professional psychiatric and medical assessment. Or maybe she’s reading the nursing group attitude instead of assessing the patient.
The odd thing is that a couple days before I left the hospital, Kyle finally shifted into professional mode and stopped giving me shit. She came in to notify me that my private therapist would be coming to visit, then she came back to update me on the time. Finally, she brought written notification about a program in which I was interested. I don’t know what got to Kyle that precipitated her change in behavior but it was an extreme change and remarkable.
Part of what is wrong with 3-6 is that it is significantly governed by little girls in a snit. Ask any guy and he will immediately recognize the behavior of bad girls in groups. There is a social dynamic about young women who gang up and support each other in malicious behavior. The quickest way to break it up is to introduce guys into the group. Guys absolutely won’t put up with this shit, and girls care more about pleasing guys than about continuing this behavior with other girls.
One night/morning I asked for juice and was told that “we had a meeting” and decided I couldn’t have juice. Four snotty little girls got together and made the decision because not one of them could have stood up to me alone. No-juice decisions are not made by “we”; they are made by the charge nurse based on the doctor’s orders. Except on 3-6.
What is so often absent on Unit 3-6 are professional assessments based on psychiatric or medical standards. What is substituted are judgments based on the staff member’s personal feelings and judgmental system of morality.