General

[posted originally on Nightingale]

A Latino male in his twenties had been brought up the unit from PES (Psych emergency). I was standing at the nurse’s station going over a chart when I heard the nurse in front of me proclaim, “Yep, your tax dollars at work,” pointing to her chart and looked for a sign of commiseration from me. I didn’t know what she was talking about, so I followed her finger to the part of her patient’s chart that said “SSN: 888-88-8888.” “Gotta be illegal!” she said.

As I recall, my face was set for ‘yeah-and?,’ but she mistook it for ‘I-agree-sister!’ “Do you believe the nerve of these people,” she went on, “sponging off the system like this? We really need more border patrol!” I was picturing the band of rednecks currently patrolling the border between Arizona and Mexico while repressing the urge to roll my eyes. She actually waited for my reply.

Feeling non-confrontational, but ever a wee bit sarcastic, I said “But who would we get to do our dishes?” Again, she mistook, and must have heard: “Were you raped as a child?”

[With ever reddening face and pointing finger]: “They come here and take our…..!!”,” Those people using our….!!.”, "I have worked too long and hard for...", “They need to…!!”

Some part of me was using therapeutic technique with this wounded soul because I recall muttering, “Mm-Hmm” and “Hmm.” There was a long pause. Lots of downward looking; paper shuffling. I think I heard panting - then, “I do my OWN dishes, thank you!”

To my rescue, came the seasoned unit clerk, peering up from his paperwork and over a pair of glasses perched at the end of his nose. He said to her, over said glasses, and without any hesitation, "And what about, ‘Give me your tired, your poor, your huddled masses yearning to breathe free. The wretched refuse of your teeming shore. Send these, the homeless, tempest-tossed, to me: I lift my lamp beside the golden door,’" - the inscription at the base of the Statue of Liberty.

On my walk home that night, I thought of all the things I wish I had said. I thought about how I wish I had stood up for that Latino man. He will get the treatment he needs; I was not concerned about that. I was concerned about the attitude coming from the long time SFGH nurse, and this was not the first time I had heard such prejudice.

By the time I reached Valencia and 19^th, I was livid. The man was human; the sentiment of that nurse was not. Part of the mission statement of SFGH is, “…to deliver humanistic, cost-effective, and culturally competent health services to the residents of the City and County of San Francisco.” What is a resident? Does he live here? Legally? Does it matter? Do we accept everyone, or only those with papers?

Frankly, I am willing to let the care of that man be part of ‘my tax dollars at work.’

Kamala

On my way to vote to neutralize Arnold's agenda, I shook this woman's hand. Needless to say I will never wash it again (sorry future patients).


I love it when women take on positions of power normally occupied by men. Here in San Francisco, Kamala Harris is our district attorney, Heather Fong is our police chief, and Joanne Hayes-White is our fire chief.

What a great town!

Psych Ward

Psych nursing is an interesting animal. Unlike other types of nursing, you only wear street clothes, you do not have a stethoscope around your neck and the meds are almost exclusively pills and injections – rarely IV’s. It might seem easier than med-surg nursing but the challenge is in the interpersonal realm. The psych unit can be a violent place. There you are, locked in with paranoid schizophrenics and manic-depressives. Three seconds after talking nicely with a patient, you might find that they fancied your right ear with a left hook.

I witnessed a ‘take-down’ the other day involving two patients. The first, the instigator, I will call Amy. Amy has been a long time hooker and is frequently homeless. Currently she is in a manic phase, which means her emotional levels are at an extreme. Manic-depressives seem to have boundless energy, talk a mile a minute, have a million great ideas that will inevitably lead to vast riches, of which they will happily share. They can also have a dark paranoid side.

I stood at the nursing station, situated centrally between two hallways in one of SF General’s locked psych units. To either side, two large day rooms allow visibility of the patient’s daily activities; TV, puzzles, and meal times await in the day rooms.

Just after dinner, I looked over as Amy was arguing with another patient, Cathy. Cathy began walking away from Amy and, of course, that would not do. Amy screamed, “Fuck you, Bitch!” Cathy stopped in her tracks and shook her head as if saying, “Oh, no you didn’t!” She then picked up a relatively full trashcan and hurled it at Amy. Picture it: trash flying everywhere; eight or nine patients with a multitude of fragile psyches up and out of chairs hooting or cowering as the case may be.

David is a nurse on the unit. A burly Bostonian, complete with the accent, David spent the better part of his career as a charge nurse over in the unit where they keep the prisoners. He was taking a break from all that now though and working on this milder unit. He has a hawk-like face and a the normally sunglasses-concealed piercing gaze of an on-the-ball secret service agent. Earlier in the day after I had interviewed a young man who was hearing voices, all David said to me by way of feedback was, “The next time you do that, I want your back to the wall. You were right out in the middle of the room,” nothing about the theraputic communication skills I was employing and of which I was so proud.

David sprinted into the midst of the fray barking, “Get me a rolling bed and four points!” I said, “OK” as I ran aimlessly down a hall of a hundred doors thinking, “What the hell are ‘four-points?’” and “where do I get a rolling bed?” Fortunately, there were other nurses there and they all knew where these things were.

David had Cathy safely pinned against a wall in the hallway, though she could not have weighed more than 100 pounds. The bed came down the hall and the four-points, I discovered, were restraints. Cathy was soon tied to the bed and had actually requested sedation, which she was given.

One of my reasons for becoming a nurse has been to reawaken the compassion somewhere inside me that I have for others, but of late has become faded and tarnished compared to the shiny days of my idealistic youth. As I watched skinny little Cathy tied down to that big bed, now crying softly to herself, I felt it. There it was - not so far away after all.