by Charles O'Meara, RN I was working in a community based mental health program when I met Margaret. Her parents called the agency looking for some kind of help and their request traveled from a receptionist to a psychiatrist to an APRN to a meeting where the APRN reported what the parents had said. They were aging, Margaret was psychotic and not getting better, hadn't left the house in six years and they were concerned about how she'd survive if they became incapacitated or passed away. Because it was part of my job description, I took down all the necessary information, called Margaret's parents and made an appointment to visit their house and talk to them and assess Margaret. Let's cut to the chase. Margaret's parents told me that, among other things, she would not bathe because she believed the plumbing was "haunted" and spirits would attack her. She wouldn't drink water from the tap for the same reason. As I stated, she hadn't been out of the house, not one inch, in six years. Sometimes they heard her running through the house at night moaning and screaming. She would not look them in the eye, she would not eat at the dinner table with them and hardly ate at all anyway. That was just the beginning. I went upstairs and knocked on Margaret's bedroom door. Once inside, I encountered a scenario that usually only appears in textbooks and a cluster of behaviors rarely seen altogether in a single patient. Let me take a short detour. I know that you think you know what mental illness looks like, but allow me to say in the nicest possible way, you probably don't. Most people with a mentally ill friend or family member experience one or two symptoms. Maybe the person they know is manic and paranoid. Maybe the person they know hears voices and believes the voices are angels. Margaret had a whole bunch of stuff going on in spades. She engaged in "shrining," something I've seen only a few times in more than two decades. Shrining involves taking a group of objects (usually all the same or related) and organizing them in a very specific way. The end result looks very intentional and looks like...well, a small shrine or alter or construction purposeful arrangement. Here's one example. Margaret had a shrine made of food containers, full and empty, a shrine made of shaving supplies (razors, blades, shaving cream cans), and a shrine made of small metal parts from various mechanical devices. Margaret always wore light blue clothing, top to bottom, always the same shade. She shaved every part of her body - head, eyebrows, all of it, every hair. Her mother helped her with her private area. There was a television antenna mounted upside down on the ceiling of her room. It was the large metal kind that used to go up on roofs of houses, attached to the chimney, in the days before cable, like this: Margaret pointed to the floor where there was a mattress and a kitchen chair upside down. She explained that she slept on the floor, under the mattress, using it as a blanket and using the chair as a headrest. Along with the black plastic bags covering the windows, Margaret told me that this was how she kept "thought waves" from attacking her brain while she slept. Margaret ate only instant oatmeal and chicken noodle soup and drank only instant iced tea and orange juice. She also spoke with a form of echolalia, repeating the last few words of her sentences, something like this:
Me: do you sleep well on the floor? It looks hard. Margaret: It's not too bad. Too bad. Me: What would happen if you slept in the bed over there? Margaret: That would be, would be dangerous. Dangerous Me: Why? Margaret: Because I might be attacked, attacked by the thought waves, waves. It's too far from the antenna. The antenna. You might want to read all this over again and get the full picture cemented in your mind. Here, in one individual was shrining behavior, delusional thinking, paranoia, obsessions and compulsions, unusual speech patterns, auditory hallucinations and probably some things I've forgotten. And all of these behaviors were fully formed, not vague. Margaret's parents had a vague notion that this was mental illness and that perhaps some pills would help. Remember I said that Margaret hadn't been out of the house in six years? Her last outing was a trip to the local hospital when she became loud, dangerous and unmanageable at home. Margaret was dragged, literally, kicking and screaming from her house and taken to the emergency room, placed on a psych unit, medicated and, as far as she was concerned, tortured. When she got back home she made it clear: no meds, no hospitals, no doctors. But now, as I said, Margaret's parents were worried. They were in their sixties and had some chronic health problems. Margaret was in her late thirties and clearly couldn't take care of herself when mom and dad were out of the picture. So, here's what happened. After at least a dozen visits, I was finally able to convince Margaret to try an antipsychotic medication. After a lot of talking, the dose we used was 25% of the normal adult starting dose of this particular med. This was donebecause we didn't want her to experience a side effect that might frighten her away from medication forever. Slowly, slowly we increased the dose until we got to what would be considered a low to average dose of this medication for an adult. And Margaret began to do better. Much of the behavior I described stopped entirely or had decreased dramatically. She began spending more time out of her room with her parents, eating the food her mom made at the dining room table and talking with her folks. There was no more screaming and running through the house at night. Things improved to the point where I no longer needed to see Margaret and her parents picked up her mediation and administered it. Then, one day, I was leaving work and walked down the hall to wait for the elevator. When the elevator doors opened, I didn't pay much attention. It had been almost a year since I had seen Margaret's parents and I didn't recognize them. And there was no way I could have recognized Margaret, who blurted out, "Hi Chuck!" And there she was, heavier (not obese), with a full head of thick, curly light brown hair, eyebrows, bright eyes, a big wide smile and wearing different colors, none of them light blue. Night and day. A hundred and eighty degrees. Stunning. I learned that Margaret had gotten her driver's license and now left the house regularly to do errands or help her parents with shopping and transportation. I have held on to this story because I need to do so. It needs to exist. Every time someone loudly criticizes me for being a pill pusher who shoves "poison" into my patients and "uses them as guinea pigs," I tell them this story, if I think they will bother to listen. Sometimes medication doesn't do anything. Sometimes it produces bad reactions. And sometimes there's Margaret. |
charles o'meara, r.n.I have worked as a registered nurse for more than two decades, ninety percent of that time as a psychiatric nurse. Archives
June 2017
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