In August we hitchhike to Boston to find an apt to rent. We get the Boston Globe and the Boston Herald newspapers and go looking at places to live. There is this one place we really like; when the black landlord tells us “This is not a safe neighborhood for you girls, I will not rent to you.” We walk out of their thinking it was our choice to make, that maybe he was being too protective, because we did not feel unsafe walking in this neighborhood, but then again it was not dark yet.
We check out a variety of places until we end up down the street from the jazz school. It needs a lot of cleaning, painting and repair work; which we are willing to do; and the landlord is willing to provide the paint and supplies. We are in a red brick building on the top floor paying $75/month, having to carry very heavy furniture up 4 flights of stairs for here is no elevator. Neighbors come by and welcomed us to the community and the building even bringing us food; it is great being surrounded by lots of friendly people.
Our living room windows looked into the apartment about 10 feet away on the other side of a narrow walkway, privacy and space is a luxury in this densely populated city. As you walk in the front door there is a long narrow hall the length of the huge living room and small alcove which is barely big enough for a twin bed, the door way is on the left. My friend’s brother F has a brown Afro; a husky dude who is happy to pay $25 to live in the alcove while he attends the jazz school. Within a short time one of his school buddies has moved into the living room and is sleeping on the couch.
My friend M’s room is on the same side of the building as the living room with a window facing out towards the building next door. M has always been very messy, so she keeps her door closed most of the time. She is of Irish and Italian descent with beautiful red hair worn in an Afro.
The medium size rectangular kitchen is at the end of the hall which consists of wooden counter space with cupboards above and below on the 2 long walls, while the sink is in the center of the counter space on right side, the stove and fridge are along one of the shorter wall near the entrance, and we place a small table with 2 chairs at the window in which minimal light comes through. The first night we walk into the kitchen turning on the light and see hordes of coach roaches running all over the place to escape being seen, this really freaks us out. It looks so nice after being freshly painted white, deceiving ourselves into believing it’s clean. We decide to store all food in glass containers to keep out the roaches. We have a contest at night with a fly swatter; we quietly sneak in, quickly turning on the light and seeing who can kill the most coach roaches. We only use the kitchen to store food and cook in it.
Next to the kitchen, on the right side of the hall, across from M’s room, is the rectangular bathroom; with a large porcelain tub, a small sink and toilet and a window overlooking the courtyard. The Coach roaches are in too but not as many as there are in the kitchen
The entrance to my large room is also on the right side of the hall across from the living room. The window in my room overlooked a square courtyard that is only accessible on the first floor by windows; there is even grass on the ground. Sound traveled and echoed well; like in a tunnel or a canyon in the wilderness, lots of music students live here so all kinds of instrumental noises reverberate as the artists practice their scales throughout the building. I furnish it with a full bed, a bedside table, a LP record player and a chair.
I love buying new LPs that stack up and play throughout the night, I still need a distracting and comforting sound to be able to sleep, in order not to be awakened by sounds in the environment that my brain tries to make sense out of. I am dealing with a trigger that is connected to the Shadow.
PSYCHIATRIC MENTAL HEALTH NURSING
In September we start working at Boston City Hospital at the Mattapan Psychiatric Facility located outside of town. There are a few buildings situated on a hill, which are isolated by being outside of town, like many similar structures built at the time. The Psych Building is a two story structure with the Substance Abuse unit upstairs while the psychiatric/mental health patients are on the first floor. The building is rectangular with one hall way and the rooms coming off both sides; there are 2 patients to a room. There is a large Day Room in the center of the hall with a large therapy/meeting room across the way. Next door to Day Room is the Nurses Station which contains the medical records with table and chairs for charting. The medication room door is only accessible from the nursing station. There is a locked box on the wall that houses the controlled substances which we count every shift.
At one point a patient is having frequent seizures even though he is on medication, we start investigating the cause, when we examined the pills which are suppose to be Phenobarbital, and realize they are being replaced by Artane which is used for EPS. A staff nurse must be involved because they are under lock and key and are the only ones with access. Barbiturates are very popular medications being misused and highly addictive.
Phenobarbital is a barbiturate that is the oldest and most widely used anticonvulsant that also has sedative and hypnotic properties. It is use as first-line for partial and generalized tonic–clonic seizures also known as grand mal.
Our emergency response to a generalized tonic-clonic epileptic seizure is simply to prevent the patient from self-injury by moving him or her away from sharp edges, placing something soft beneath the head, and carefully rolling the person onto their side which is the recovery position to avoid asphyxiation, so the tongues does not block the airway. If a seizure lasts longer than 5 minutes, or if the seizures begin coming in ‘waves’ one after the other it is called ”status epilepticus’’ which we treat by administering Valium IV push. We believed a person could swallow their own tongue during a seizure or bite their own tongue, so we placed a padded tongue depressor in the mouth.
After a seizure, it is typical for a person to be exhausted and confused. Often the person is not immediately aware that they have just had a seizure. During this time a staff person stays with the patient – reassuring and comforting them – until they appear to act as they normally would and have returned to their normal level of awareness. Many patients sleep deeply for a few hours after a seizure, and headaches may occur. Those present at the time of a seizure would make a note of how long and how severe the seizure was.
We treat many people with Psychosis, which comes from the Ancient Greek word meaning “psyche”, for mind/soul, and “-osis”, for abnormal condition or derangement which refers to an abnormal condition of the mind, and is a psychiatric term for a mental state often described as involving a “loss of contact with reality”. People suffering from psychosis are described as psychotic. Psychosis is given to the more severe forms of psychiatric disorder, during which hallucinations and delusions and impaired insight may occur. The term psychosis is very broad and can mean anything from relatively normal aberrant experiences through to the complex and catatonic expressions of schizophrenia. Sometimes we get people off the streets experiencing a bad acid trip that are psychotic. People experiencing psychosis may exhibit personality changes and thought disorder. Depending on its severity, this may be accompanied by unusual or bizarre behavior, as well as difficulty with social interaction and impairment in carrying out daily life activities.
The Antipsychotics, we use to control psychoses such as schizophrenia, include: chlorpromazine also called Thorazine, thioridazine known as Melleril, and haloperidol called Haldol.
The extra pyramidal motor system is a neural network located in the brain that is involved in the coordination of movement. Extra pyramidal symptoms therefore are symptoms that manifest themselves in various movement disorders. The extra pyramidal symptoms, often known as EPS, are a neurological side effect of antipsychotic medication, also known as major tranquilizers.
Extra pyramidal symptoms can begin within a few hours, days or weeks or even years after commencing treatment with an antipsychotic medication. Common signs and symptoms include: Involuntary movements, Tremors and rigidity, Body restlessness, Muscle contractions, Mask like face, Involuntary movement of the eye called oculogyric crisis, Drooling, Shuffling gait, Increased heart rate, Delirium and Symptoms can be very distressing and frightening.
We are Psychiatric Staff Registered Nurses functioning as: Primary Therapist, Group Psychotherapist and Family Therapist. I become a Psycho-dramatist and am a Consultant for the Rehabilitation Unit, to assist non-psychiatric staff in dealing with difficult patients and psychiatric problems.
The nurses supervise the medical workers staff trained in Psychiatric Care. The nurses have clinical supervision with the nursing director. Clinical Case supervision is a hospital Policy for all staff, which is for one hour a week to discuss and get feedback on: patient care, to explore patient transference and staff counter-transference. We do follow up and Home Visits since there is a state policy to integrate the mentally ill into the community. All staff is required to attend a weekly therapy group focused on issues with patients and staff.
I am exposed to new theories and treatment approaches for mental health nursing, learning to work with families from Virginia Satir, and experiencing many great teachers through the connection with Harvard residents. Nurses get to define the program every year before the new residents arrived this has already been done before we started working.
We have an open door policy on this Adult Psychiatric Ward with 20 in-patients; which including 3 barbiturate addicts, alcoholics detoxifying, and 10 Day-Care patients receiving services during business hours. The ward functions on a team approach using the therapeutic community milieu approach to care which is holistically oriented. We have daily community meetings with the patients; to give positive feedback for improvement made; and to discuss issues that have come up; and exploring ways to resolve conflict and encourage growth.
When we first started treating the barbiturate addicts we gave them Pentobarbital, also known as Nembutal 100mg, and the street name is yellow jackets, we administered it every hour till they were feeling elated, we would then total up the dose given, which would be their starting dose, then it was decreased over 7 to 10 days. They literally are “bouncing off the walls” as they stagger from side to side down the hall, their arms out as their hands contact the walls. The major problem we have with this approach is when there is liver involvement, for example: once a patient all of a sudden passed out and required immediate intervention. We detoxify the alcoholics with Librium which mellows out the cravings and delirium Tremors as long as they give a true report of the amount of their alcohol intake.
Our 10 Day Care Patients are on the unit Mondays through Fridays, from 9am to 3pm. All in patients and out patients participated in the program’s activities. During those hours: we played indoor games such as cards and dominoes; outdoor games such as volleyball and baseball. We have individual sessions with all patients, a variety of therapy groups, community meetings and morning meetings to start the day.
MY MENTAL HEALTH
I start personal group therapy as a requirement for my job; I co-lead a Psychodrama group with another staff, so we are in a therapy group, which lasts about a year. There is a woman in the group who had recovered from Polio and has a son about my age thus we do a lot of work together, she plays my father while I play myself or she plays herself while I play her son, after awhile it doesn’t really seem to matter for the roles blend because the issues are similar. I work hard on my father issues: feelings of loss, guilt, anger, and abandonment; development tasks of trust and security. It is easier to role play the issues rather than talking about them because I am less guarded.
Sometimes on the weekends I go visit my family in Pawtucket, RI. One weekend Mother and I play with the Ouija Board; it appears to move on its own, picking up speed and darting all over the place very quickly, saying “I am sorry it is not your fault”. I did not know what that meant; tears were running down my checks, because a part of me knew what was being said. My mother starts to tell the story of how “You wanted a bike”, “Your father was working a lot to pay off a hospital bill from my miscarriage”, “You would cry when he would go to work” and “We lied to you, telling you he was going to work to get you a bike, we didn’t think it would become a problem”, “It’s your father who is telling you ‘It is not your fault he got polio.” It was freaky, scary and comforting all at the same time. I realize that my father chose not to get vaccinated or maybe he was just putting it off for a more convenient time and seeing that he was overworked it made him more susceptible to getting polio.
I am still seeing D who has also moved to Boston in a high rise of 15 stories and it is difficult for me to look out the window or even go near it. Being 22 yrs of age I now drink more frequently, to the point of blacking out. I am using alcohol to be more social, it has helped me relax and give myself completely to D so I won’t lose him, besides it decreases my inhibitions which also contribute to other risky behaviors.
My experiences with drugs start. At our first work Christmas party with the psychiatrists and staff, I asked M “What is in the pipe they are passing around the circle.” I am so naive. We have a Christmas decorating party at our place, inviting about 20 people, and placing chairs up against the walls of the living room. Someone passes around a pipe and within a short period of time we are experiencing an inability to control our limbs, come to find out we have been smoking animal tranquilizer called angel dust/PCP, I will never do that again feeling to out of control. The group was so out of it giggling and laughing, we were all connected by a large string of white lights, while we were replacing the burnt out bulbs before placing them on the tree which was set up in the alcove.
I am obsessed with D, one night I realize he is in his apartment with that same girl again! I take Benadryl 50 mg to go to sleep but it has the opposite effect on me getting me so agitated that I go to his place banging on the door but they pretended they are not there. I decided to confront them both, so I sit in the hall waiting for them to come out. I so want the truth to be brought out into the light of day.
In the morning they are surprised to see me; they back up into the room. She has a box of boots in her arms that D bought on one of our shopping trips, I comment asking “Are those the boots we bought for your cousin?” She throws the boots at him. He now has to explain to both of us what is going on. I am so emotionally distraught and want everything out into the open, even if it means more pain and suffering, so I say “I thought we have been planning on getting married?” He responds with “Yes we were, but I love both of you.” I go into shock and disbelief as does she while he talks like a two headed snake. I leave to go home to lick my wounds.
I continue to see him for a short while, as I allow him to seduces me with more lies, but I know I do not want to be with a liar, and that I need to move on. So I act out by dating an x-patient which is inappropriate and doesn’t last long because he becomes an obnoxious substance abuser, besides D finds us together and makes the guy leave. D gets jealous, becoming very controlling, and slapping me across the face. This is the last straw for I refuse to allow myself to be physically abused; later after he leaves I realize that he has stolen my month’s supply of birth control pills. He leaves and refuses to believe it’s over, and when he calls to apologize I refuse to ever see him again. So much drama, anxiety and pain, while I explore why I continue to be attracted to unavailable men, who are unwilling to commit to one person, looking at my relationship history and thinking I must also be projecting my stuff on them. I must not be ready for a committed relationship.
MY COPING MECHANISMS
I love walking all over Boston: from my neighborhood to Cambridge, downtown and to all areas of the city. On Saturday afternoon, we Folk Dance on Harvard’s courtyard campus, where they teach a dance, which we do over and over to different songs, I love group dances. I take a silkscreen class in Cambridge to stimulate my creativity, and planning to do it on clothing. We participate in the Anti-Vietnam demonstration near our place; the police are on horseback with riot gear, Billy clubs and dogs chasing us out of the park. “Johnnie Got His Gun” The Movie was briefly at the theater for 2 weeks before it is banned because of its controversial nature.
Weekly we treat ourselves by going out to eat at McDonald’s; coke, fries and cheeseburger for 75 cents. We buy cheap food at the market; lots of chicken pot pies and Kraft macaroni and cheese each costing less than 25 cents, sometimes 5 for a $1 and we really enjoy these meals.
This has been a great year living and experiencing life in Boston Massachusetts, learning and working in Psychiatric Nursing, and looking at and exploring my own Mental Health Issues through a commitment to my own therapy which is the underlying reason that I have found myself here.