Its also about speed; we needed to try to overwhelm Mr Brown with speed and organisation. The door was opened quickly (which was actually rather hard since it had three locks) and I led the charge, my head down and my eyes glued to Mr Browns right arm. I caught a couple of glancing blows to the shoulder and head, but luckily nothing connected properly and soon we had his arms and legs pinned. The last officer came in and supported the patients head and we slowly lowered him to the ground. We had done a good job; we had our man immobilised and no one was hurt not even the patient.
As we lay there, the doctor calmly waltzed in and complimented us on such a nice takedown. He jabbed a very big injection into Mr Browns buttocks, then calmly removed himself from the room. It was now time for us to make our exit.
At least this time I wasnt the last out. The two lads restraining the legs exited first, and then Sergeant Perkins and I left, as we had the arms, followed very closely by the last officer who had held the head. The door slammed shut and the bolts were thrown across. Mr Brown didnt bother to get up; he just lay there staring at the wall.
Its pretty hard to forget some of the more colourful characters and even harder to forget some of the more violent ones. It is an unfortunate fact that violence is not uncommon in a psychiatric ward, whether it is to oneself or to others. Some days it seemed as if the unit was a big cauldron, brimming with pent-up anger and excitement. Such strong emotions, such raw energy, are not easily diffused in a closed environment; they have nowhere to go.
As I resumed my vigil outside Mr Browns room, I thought about how having another male or two in this place would help. Thankfully the unit eventually hired a full-time muscle man, a giant of a guy that even a crazed patient would think twice about crossing. Some nurses felt this was not needed and sexist; I just thought it common sense.
Food for thought
Jeneil had walked at least half a dozen lengths of the ward, and it was time to put a stop to it. The problem was Id never had a confrontation with her. Thus far, our working relationship had been polite, brief, and very superficial. The nurses never allocated Jeneil to me as I was still relatively inexperienced. I lacked the knowledge necessary to deal with the complexity of an anorexic patient, but today was different. Due to a shortage of staff, my name had been put on the board next to Jeneils.
Howre things? I asked her as I trotted alongside. She was walking at a cracking pace, and I was nearly jogging to keep up.
Fine, and you? she replied.
Good, good, although todays a bit different. Im your designated nurse for today.
Jeneil gave me a big smile.
Then itll be an easy day for you. You dont have to do anything for me. I can take care of myself.
Her words stressed how out of contact with reality she was. She was a walking skeleton. Jeneil looked so frail and thin, a stiff breeze might knock her over, and the fall would break every brittle bone in her body. She had fur on her limbs and face fine, soft white hair that covered her like a soft, silvery white coat, which grows because the body needs to provide some insulation since the patient no longer has fat stores to help keep them warm. Marching like this was one of the tactics she used to lose weight when confined to the ward.
Well I paused, trying to find a safe way to say what I needed to, without sounding confrontational, but it just wasnt possible. Im sorry, but youre going to have to stop walking.
Well I paused, trying to find a safe way to say what I needed to, without sounding confrontational, but it just wasnt possible. Im sorry, but youre going to have to stop walking.
She began to walk faster.
Who are you to tell me what to do? Just stay out of my way.
I had seen what my colleagues had done in the past if she wouldnt cooperate, but I didnt want to have to confine her to her room.
You know the rules, Jeneil, and besides, you agreed youd go along with them, I reminded her.
Jeneil reached the end of the ward and did an about turn. I again found myself playing catch-up. We walked in silence for another length of the ward. She suddenly stopped and turned towards me, her mask of polite civility was gone, her eyes were smouldering.
You dont know me. Youre new here, and you think you know how to help me. Is that what youre trying to do, help me? Her voice began to climb an octave or two. You dont know a thing, and besides, we all know youre struggling anyway. This place isnt for you. Get out before you hurt someone.
I had been told that anorexia sufferers could be very manipulative, but I was not prepared for how cutting Jeneils comment was.
This was a huge change from the chats wed had before conversations about the weather, news, events although at the time, even these had felt strange; it was odd to happily chat away, all the while ignoring the matter of her weight.
Well, if thats the way you feel, Ill get someone to take over your care for today.
Jeneil didnt respond, but went to the lounge and sat down in front of the television. I retreated to the nurses station.
Shes got a sharp tongue, hasnt she? remarked Mary, one of the senior nurses on that day. Mary had spent 20 years working in psychiatry, and shed dealt with many people like Jeneil.
It caught me off guard, thats for sure, I replied.
Dont argue with her, just stay calm, and be firm. If you have any doubts, shell sense them, and tear you apart.
She was right, of course, but what disturbed me the most was how rational, nice and intelligent Jeneil was when she wasnt confronted. It was so sad. I still didnt understand how someone so sweet could be so messed up. I went home hoping that I would not have to look after Jeneil the next day.
The following morning I found Jeneil confined to her room; in fact, not only confined, but on bed rest. Mary, who was sitting by her side, stood up, and motioned for me to follow her outside the room.
Shes dropped below her minimum weight, so shes confined to her bed, Mary explained.
Jeneils target weight was 45 kilograms, and she was now 44. Jeneil could manipulate her weight as easily as she could people. She could gain or lose a kilogram or two just by altering the amount of fluid she took in one day. At one point, her room had to be searched as she would hide a bottle of water under her bed or in her wardrobe, and quickly drink a litre of it before being weighed. A solution we came up with was to do random, unannounced weighs. She also used to try to hide things like a mobile phone or some other object in her underwear or clothing to affect the reading. Now she was only weighed in her underwear.
Another tactic was employed at dinnertime, when she would cut up the vegetables and meat, and move them around the plate to make it look like she had eaten something.
I was not given any patients that day. My job was to sit by Jeneils bed and make sure she didnt get out and walk. I didnt speak to her and she didnt speak to me. Ignoring a patient was the opposite of what nurses do; it felt unnatural, but then again, there was nothing natural about this whole situation, and not speaking, in this case, was safer.
Just when it appeared things couldnt get any worse, they did. Jeneil began writhing around the bed. When she wasnt writhing, she was lifting her legs, or raising her head and chest, off the bed. She was exercising. With a sense of utter helplessness I rang the call bell. Mary entered the room and tried to reason with Jeneil.
Unfortunately, there was no reasoning with Jeneil. Her weight dropped to 40 kilograms and she was transferred to the intensive care unit.
The psychiatric department had a meeting about Jeneils transfer to the intensive care unit. All the nurses and all the doctors were there. We were not a specialist anorexia unit, and some suggested maybe Jeneil should have been in one, but she had already been in the best anorexia hospital in the country, multiple times, with no success.
Now 26, Jeneil had battled with anorexia from the age of 16, although it wasnt until she left high school that her weight loss had become so noticeable that her family sought medical intervention. She had no apparent reason for her condition. She came from a normal family, with a brother and sister who were healthy, and seemed happy. It just didnt make sense.
Jeneil died in the intensive care unit. Her heart gave out. Even if she had somehow been able to change, and had started eating and leading a healthy life, she would have had to live with permanent damage: her organs had suffered; her growth was stunted; her bones were brittle; and she would never have been able to have children.
Jeneils death was tragic, but Im not sure if it was avoidable. Ill never forget the head psychiatrists words when news of Jeneils death reached us: When they get to the stage Jeneil was at, its almost always fatal.
Catherine, meet your new neighbours
Our psychiatric unit was unusual in that we didnt have separate facilities for the very young, the very old or the very aggressive. It made for an interesting mix of people. For some patients, this was all they knew and nothing surprised them. For others, particularly those involved in the world inside their head, there wasnt much that could shock them. But there were some people whom you or I might consider normal rational people who suddenly found themselves in the middle of this madhouse for whom time in our ward was certainly an eye opening experience.
Catherine was 18 when she was brought to the psychiatric unit. She was polite and clever due to graduate from high school in a few months time. She had great grades, and had been accepted into university. She had a bright future in front of her. Until she did something that could potentially affect the rest of her life. She attempted to overdose on paracetamol.
Catherine needed help, and wanted people to know it. She thought by overdosing on a legal drug it would make people take her seriously.
Paracetamol is one of the safest yet also the most dangerous drugs in the world. Most people think it harmless, and why wouldnt they? Its often the first line of drugs given to children, even infants. It is safe, completely safe, in the right dosage.