Tales from the Psychiatric Nurses Station – Child/Adolescent Part 1

It has been a while since I’ve written on here so I thought I would come on and say hello.  Alot has happened on the unit that I have worked for about a year.  Among the lack of sleep from my thoughts racing due to the kids on my mind from all of their traumas to being in school again to work on my Bachelors degree.  I’d like to give you two the brief case studies  on my most memorable patients and how they’ve impacted me.

Over the past year I have learned a lot about child and adolescent psychiatric care.  Never before in my life did I think a small child would have to endure the pain, horror, and terrifying abuse that some of these children have had to face. Seeing the look on the faces of these children who have been sexually abused by relatives, family friends, or rarely strangers; rips at your very soul.  I find sleep escapes as the child’s face enters my mind’s eye, an image of them cowering in the corner fills my thoughts. I’m paralyzed with reality and I am not a confused child who is inexperienced in the trials of life and all that is evil.  I am not the abused.  The same child has been to 4 or 5 different foster homes in the span of 4 weeks.  She has no one to love her and she asks me “can you be my mommy?”

I want to so badly.  My heart aches and bleeds as I have to say “no darling I cannot but I am your nurse and I do care about you.”  At this point I have spent 6 weeks with this child and this is her third admission.  I have seen her grow up and she does feel like another child of my own.  She was taken by her mother because her mother was a crack addict who burned her with cigarettes, neglected her needs, and sold sexual favors using her body to a man who then raped her as a 3 year old child.  In foster care she was emotionally abused, 2 of the homes could not handle her aggression, the most recent home she again was sexually abused.
  I woke her up every morning and gave her a big hug when I worked on the child side of the Unit, when I worked with the Adolescents and she saw me I’d hear “Ms. Packer!” as her voice reverberated the entire floor and she came running behind the desk into my waiting arms.  Anytime I left the Unit for any reason including to use the bathroom, she would be given crying and throw herself on the floor or grab onto me “No Ms. Packer you can’t leave me you can’t go!” Everyday she drew me a stack of pictures that was an inch thick and I called her Picasso.  She is a sweet child who has been given a hard hand to play in life.

Now with  the teenagers the one who I will remember the most is the boy who when he first came in I thought he was going to be the next Jeffrey Dahmer.  He came in for increased aggression and hiding weapons underneath his bed.  He said that he had killed some cats by smashing their skulls against rocks and then burying their bodies in the yard but nobody could ever find evidence of this.  He was obsessed with the apocalypse.  He would tell me how he wanted to go live in the city so that he could learn how to be street smart and that he thought that people who live in the city could survive if the apocalypse were to happen tomorrow.  His ramblings began as nonsensical flight of ideas that were all around the apocalypse and could he survive.  He was adopted from Russia at the age of 2.  At the orphanage  he was on phenobarbital all around the clock to control his behavior.  They told his mother that they couldn’t find his medical file when she went to retrieve it had his adoption.  One thing about a medication like phenobarbital is you can’t stop it cold turkey after being on it for an extended period of time you or you will suffer withdrawals that include  seizures and even death.   The crib this child had slept in utilized restraints and they used them on him at the age of 2 years old.  I didn’t know that they made cribs with restraints in them.  As he left the orphanage he left without a complaint he waved goodbye and didn’t cry, unlike his roommate who was hugging the nurses at the orphanage and didn’t want to let them go. According to mom on the plane ride home she immediately noticed something was wrong as a pleasent child who walked calmly with her out of the orphanage clearly under the affect of phenobarbital at the time, was gone and he became increasingly agitated and angry all the way home to the united states.  Once they got home the medical records were there waiting for them on the fax machine.  Mom learned the ugly truth.  He had been restrained 23 of 24 hours for most of his life, at the age of a few years old he knew his crib and nothing more.  He has a condition called reactive attachment disorder and he is clearly a textbook case.  When you first came on the unit he was defiant and silly, he thought that he didn’t need to be there, we weren’t going to help him, and it was all a big joke.  For him he learned early on that insulting people is an easy way to learn about their true nature.  People are more honest in the way they respond to an insult than they are to a compliment .  He realized that when you insult people over and over and you anger them to their core they will tell you what they really think about you.  In order to test the true motives of the staff members he began picking us of 1 by 1 learning the true motives of each and everyone of us.  I admitted him but I wasn’t “safe”, he didn’t trust any of us.  He wanted us to think that he was a horrible murderer in waiting so he told us that he had plans to kill people in a list of everyone that he hated and how he was going to kill them.   Legally we are obligated to tell the police about this because it is a safety hazard if someone is planning to murder someone else.  No list existed just like him insults were just tests to see who the real person was on the inside.  For instance I was trying to open a lock on 1 of the doors and I was looking at him while talking and my key was not going into the lock and in the snottiest, most irritating voice he said “Maybe it would work if you look at the door instead of trying to look at me.” and I said “Yeah no kidding right?”  At the beginning I admit I had little hope for him, then 1 day I was walking down the hall and as he passed he looked at me while smiling for the first time and said “Hi Ms. Packer how is your day going?” I answered as I normally would while bursting my seams on the inside as I knew a breakthrough had been made.  A few days later he was getting ready to go home and we talked for a good 2 hours, I shared my observations about how I thought he was a good guy on the inside but he didn’t want anybody to know it and how he really didn’t want to hurt other people’s feelings but it was the quickest way to learn who people really are.  At first he resisted that my assumptions were accurate but then endorsed them.  We talked about how his weapon for the all taken out of his room, how to guns in the house would be all locked up and taken out of the house, how this would make him feel exposed and possibly naked since he had used the hordes of weapons to surround himself for so long and create this false sense of security.  At the end of discharge I gave him and his mother the number to the unit as I had a feeling that they would have issues seeing eye to eye once they got home.  Sure enough I received a phone call a couple of hours later he said that once he looked in his room he realize that it did feel empty and then it was much worse than he thought it was gonna be, he wasn’t prepared to feel so exposed and unsafe.  He was concerned that he made a lot of changes and his mother did not trust him and I explained to him that his mom remembers seeing him before he got better and that it will take time for her to build trust in seeing the new him and slowly  get his things back.  His last words to me were “thanks you’re cool.” To hear that from a teenager who swore that the apocalypse was coming just 10 days before meant more than words can say. 

I look at these 2 kids who have very different paths in life. I see that they both can be written off so easily because they have emotional and psychological disabilities.  As a nurse there isn’t much more that I can do in the inpatient setting other than stabilize them so that they can be graduated to the outpatient or day treatment level of care.  The mom in me wants to care for, hug, and love them and never make them have to go away and feel pain another day in life if they have nowhere to go.  Like the child , my Picasso who has nowhere to go because she is a ward of the state, since the age of 4 she has had no mommy, no daddy my heart aches for her and my soul weeps for her.  The teen and I talked about have a good mom and dad who took him out of hell who took him away from the bed that was his mom and dad.  The changes some in our society seek I fear will not make the situation better and I fear it will create more scenarios like that of the child in my case study, no one deserves to be born into that.

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