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.