Again, as I lay on the bare mattress, I was asked what I needed. Again, I asked them to make the bed. The other girl said, “But you’re in it.” Amber snapped, “I’m not going to play this game with you!” and walked out, leaving me lying on a bare mattress in an unsnapped gown. Diarrhea and soiled sheets and the nurse says it’s a game: this is inpatient psychiatry at St. Joe’s.
I lay cold and half naked for two hours. When I am starting to shiver then some unknown, unseen person comes in and throws a blanket over me.
When the day shift came on, I heard a good aide, George, in the hallway. I called out and he came in, made the bed, snapped the gown, and generally took care of me.
The previous evening I also had in-bed diarrhea. The staff came, cleaned me up, and changed the sheets while I remained in bed. It is what a competent nursing staff does.
[Days later, when Amber again comes to my bedside, I try to engage her in conversation. I quietly ask her about when she left me on a bare mattress. She pretends to not remember what I’m talking about. I have reported it to the doctor and nurse manager. I know they have talked to her; I know she remembers. When I finally step her through the event, she “remembers.” When I ask her why she did it, she turns on her heel and says, “I don’t have to listen to this” and walks out.
[Once again, it is the Levine Syndrome: you don’t have to deal with anything you don’t want to: walk out on the patient. This is the single biggest difference between staff behavior under Levine and under his predecessor. In the old days, staff did not walk away from patients. Now, at every turn, they flounce out, saying, “I don’t have to listen to this.” They don’t have to learn; they don’t have to have an open mind; they don’t have to be responsible for their behavior. Anything—anything at all—that conflicts with their self-image as all-knowing, righteous people—they just walk away. What’s a bedridden patient going to do? Hop out of bed and chase them down the hall?
[On the night I came to Unit 3-6, R.N. Olga was the admitting nurse. She noted my “CPAP” (Continuous Positive Air Pressure machine, used for the treatment of sleep apnea). I pointed out that it was “an auto-BiPAP.” “Oh, yes,” she said, “a BiPAP.” “An auto-BiPAP,” I countered. “Well, Anne,” she said in a condescending voice, “I think I know what ‘auto’ means.” When I asked her to explain it to me, in terms of a BiPAP, she refused to continue the conversation: I don’t have to listen to this! I later found that Olga had entered it as a CPAP.
[Fact: A CPAP has one pressure setting; a BiPAP has two pressure settings, one for inhalation and the other for exhalation. Those machines cost about a thousand dollars apiece. An auto-BiPAP is the next generation of breathing machine. It costs about $3000 dollars and has a computer chip that resets the pressure with each breath. I have severe unstable obstructive sleep apnea. The needs and treatment are different and wouldn’t it be nice if the nurse understood that?
[Olga is a nurse on 3-6. She doesn’t have to listen to anything that makes her uncomfortable. New ideas make her uncomfortable, so she learns nothing about a variant on an old disease, or the new technology for treating it.]
- There are gross inconsistencies from one shift to another. Each shift or charge nurse is allowed to do whatever she wants. There is a failure to communicate policy and an absence of supervision.
A supervisor, upon hearing of Amber leaving me on a bare mattress, said “That doesn’t sound like Amber.” What the hell does she know? Amber works nights and the supervisor works days. The night shift on 3-6 has always been out of control. They have little or no contact with doctors, supervisors, or any other kind of staff. Once a night, a supervisor walks in, says “How’re things going,” the charge nurse says, “Fine,” and the supervisor walks away. Don’t mean a thing. Night shift drifts further and further away from good patient care and toward selfish, good-staff care.
And staff members present their best face to the supervisor. That isn’t the face they present to patients. Solution? St. Joe’s has a permanent night staff (Katy’s been doing whatever she wants to for at least twenty years). Other hospitals rotate night shift employees. Nobody gets to create their own empire; everybody has to rotate through days and evenings and be exposed to proper behavior and normalizing routines.
On days, R.N. Wendy assured me that Dr. Steve Wechsler could see me, no problem. Dr. Wechsler is my close friend, Health Care Proxy, Trustee and Power of Attorney. When he arrived on evenings, Nurse Olga refused to let me see him. She ordered me to get in the wheelchair and go to the Day Room. I was too sick to get out of bed. Olga refused to let him come to my bedside because “This is a mental unit, not a medical unit.” This is where discrimination against people with physical disabilities begins: with a nurse working evenings who is free to make up her own rules. And what she did not add was that gave her power, which she liked a lot.
Inpatient psychiatry is all about power; nothing about kindness.
Sunday 21 April
I awake at 6:00 a.m. and the day begins. I need to poop—quickly—and call the nurse. Shannon comes in. In the past five days I’ve seen about fifty women in uniforms but I’m starting to sort out the goodies from the badies. Shannon is one of the goodies.
She gets the bed up, helps me with socks and catheter bag, and I go to the bathroom. I’m sorta-kinda constipated a little; the last diarrhea was 48 hours ago.
Back in bed, I ask for two cranberry juices a glucose check. Shannon brings the juice and says she has to ask the charge nurse for the glucose check. The charge nurse is Katy.