We at the hospital have core staffing numbers and are expected to use them to keep our productivity at 100% or more all the time. Yes, rewarded for shorting our staff numbers. How this improves patient care, i don't know. It does help the bottom line, evidently. Health care is business. Big business. And so i found myself on an adult unit that was overstaffed with two direct care staff and only 9 patients. I thought i was in luck, as my sinuses were applying drill-like pain into my skull causing inability to think and nausea. Instead, i found myself in the wonderful land of adolescent psych. I was watching a teenager in a manic episode for 5 and a half hours. He was 16, bigger than me, and had been taken off his meds by a fill-in doc. They do that. It makes no sense, but there it is. The lack of meds took him straight to the holy shit end of mania.
Let me stop a bit and explain how unfun that is. Imagine feeling euphoric and like you can take on the whole world. Everything is funny. Every neuron in your brain is on overdrive. You are brilliant. You are godlike. For like a day or three. Then it gets even better. You can't sleep, you can't stop jumping from one shiny thought to another. You shake and sweat. Nothing, and i mean not even two hours on a heavy bag, a hundred situps, pushups, etc., nothing makes it stop. The level of frustration and anger becomes all-consuming. The fun is over, but no one tells your brain. Then you start banging your head into a wall, hitting things, anything to distract your brain and make it stop, even for a second. Nurses and others try to help, but you can't focus enough to hear or process what they are saying. It takes a lot of people to hold you still while meds are injected into your butt. This makes you feel more like the hulk until they finally kick in and you get some sleep. The meds start working again within days of restarting, but the damage takes longer to fix. They have to hit therapeutic levels. And that takes more time that the mania took to rob you of yourself.
I was watching him the day after the head banging hell day. It wasn't a lot better. Good news was that he needed to be away from noise and commotion. He couldn't tolerate it. Neither could i with the drill in my head. So, this proved to be a good thing. Except for the inability to think, which continued to suck. For both of us.
After punching and kicking the bag and then listening to relaxing music and reading, he announced he was bored and couldn't sleep. Very Bad News. The next hour consisted of me staying calm while praying he did not get out of control by following his impulses. The following chronicle may seem funny. Imagine being stuck in his skin during it. Or trying to endure a drill in your brain while staying absolutely focused on keeping him calm during it.
Reading The Lion, the Witch and the Wardrobe (the second book, he is quick to point out) on his bed is interrupted so he can walk to the window, pretend to shoot things, talk into a walkie and dodge bullets. He seems to get hit a couple of times. He belches loudly and laughs. "Must be your superpower," i joke. He then pretends that walls are exploding before him as he lays waste to his universe with his mighty power. Back to the book. Up for a minute to pull a paper out of the trash to look at it and put it back. Jump onto bed. "Do not jump on that bed, please." He considers it. It has no springs. He gets down. Back to reading. "My head hurts." It should, he banged it hard enough yesterday. Off to ask about a cold cloth and get some water. Back to reading. Take cloth off head and start sucking the water out. Run around room doing this pretending to be a dog. "Please try to sit down a little. I know it is hard." He pronounces the cloth drained of fluid and grabs a box of tissues from the chairless desk bolted to the floor next to his bolted down bed. He decides to chew them up and spit them into his paper bag garbage. "They taste good." I try not to react. Less stimulation and adulation is best, but this is not good. He is shaking again. I worry he will escalate to the point he loses control. I wish i could get his nurse to bring him something to make it stop. He starts to act out routines from Jeff Dunham. I can't help it. I join in. We Jef-fah-fah for a bit and talk about his funny bits. My head is killing me. I check my watch and tell him that everyone on second shift leaves in 10 minutes. He has to try to sleep. He gets up and gets more water for him and his washcloth. He lays on his bed, face down, head at the foot of his bed, staring at the floor. He actually yawns. I promise to tell his nurse he can't sleep. He looks so exhausted. My relief comes down and i am off to the nurses station. So ends my night.
Back to productivity. He only has to be watched while awake. There is no staff for nights scheduled to watch him. The model says that he should be asleep. He is awake. The schedule is not designed for humans, only for numbers and productivity rates. It looks like there will be no staff for the other 13 kids tonight unless a miracle happens. Hospitals are not businesses, especially when the mentally ill are involved.
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