Wednesday, November 4, 2015

Psychiatric Nursing

42


The psychiatric nurse's office was part of a small Victorian style house that had been subdivided into offices, all in the psychiatry/psychology theme. Walking down the short hall, beyond the right angled stairs, I saw a door to one professional's office at the front of the building, his name on a plate outside the closed doors, further down the first floor hallway was a door with her name on a metal plate. I made the mistake of knocking on her door; she was finishing an appointment and had to explain to me that I was to sit in the waiting area and stay until she opened the door and called for me. Without a receptionist or apparent sign, I wondered how I was to have known this.
The waiting area was likely the former dining room of the house with the coat closet underneath the stairs, turned into a coffee nook, and the kitchen was just beyond the the waiting area as I discovered when a professional entered from there on his way to his own office. The chairs of the waiting area all coincidentally faced the door to the psychiatric nurse's office so I had little choice but to sit and face it. So I wouldn't look too eager when she opened the door, I decided to 'rest my eyes'.
A few minutes later the nurse I'll call 'Samantha' opened her door and ushered me into her office. I wondered how the previous client had left without me seeing them and later learned that clients left ten minutes before the hour and she had just been finishing her notes on the client, not that they were still with her when I knocked. Her office was apparently the one time family room of the house, it was spacious and divided by the furniture into two sections, one with couch and chairs for counseling, and one with desk and cabinets to serve as her office space. She was probably about fifteen years older than me and pointed me to the couch. I chose to sit in the middle and she organized her stuff, then settled into one of the facing chairs.
She asked why I was here and I told her I thought she knew as I hadn't been told. This stumped her a bit as this was apparently a routine opening line for her first appointments to get the conversation going, not stopped. Instead she had to refer to her notes for a bit and then told me that I was here to be counseled for my eating disorder. Eating disorder? I asked. Yes, that I had some problem with eating food and she was going to help me understand what it was and get beyond it. I wasn't sure how, but I was willing to see.
So you aren't comfortable eating food? She asked. I told her I was very comfortable eating food. But you just don't eat enough? ''According to the hospital's paperwork I eat an average of three thousand calories a day,'' I returned, a fresh fact I had gotten from my appointment with the hospital's dietician. How is that possible? This question confused me for a bit and I tentatively answered, ''By getting it and eating it?'' No, she clarified, how is it possible I lose weight if I had really been eating that much per day? ''I don't know. That's why I went to the doctor about it a year ago and repeatedly since.'' Do you throw up your food after you eat it? ''No, if anything I'm more likely to have the runs after I eat.'' So you use laxatives? ''No.''
It was clear she was starting to get frustrated and decided to skip talking about eating at all. She instead asked me the general placement questions of where I was born, did I have siblings, parents? What brought me to Colorado? Etc. These questions I was able to answer to her satisfaction and I guess her goal was to loosen me up so she could return to the subject of my 'psychological eating disorder'. ''Is that what the psychologist at the hospital concluded?'' I asked her. No, he hadn't thought I had one, but the primary doctor had concluded that there was no other explanation for my weight loss and so he had made that diagnosis. ''So he overruled the psychologist's findings in his own field?''
I seemed to have a knack for asking questions that aren't supposed to be asked, I guessed, as her ire began to well. That's not how it works, she explained, once the doctor had ruled out any medical cause for my weight loss, then the psychologist acquiesced to his findings and had been the one to recommend her as the person to provide routine counseling about the issue. ''Hum,'' I replied.
Our time was up and the next appointment details were worked out.
On the second appointment, I was sure just to arrive and take a seat in the waiting area after looking at the offerings in the coffee nook. It turned out they did have a few packets of hot chocolate mix and so I made myself a cup using the coffee to mix it with. It reminded me of my early years working at the branch grocery store where my mother and the meat cutter were the first in the store and would keep cups of coffee next to them as they worked. I had tried some myself on the days I had tagged along with my mother, but didn't like it. Mother had recommended trying it with cream and sugar, but I still didn't like it and asked if I could get a cartoon of chocolate milk instead from the dairy display case. She said I could and then about halfway done with it, it occurred to me to mix it with the coffee and sure enough, I really liked that combination. ''That's called mocha,'' my mother explained to me when I told her of my discovery and I made sure to have it for all my subsequent Saturdays joining her to the branch grocery store.
Samantha called me into her office and I once again settled down in the center of the couch and she took the other chair facing the couch. I was curious as to the change of chair, she simply mentioned that she changed which chair she took from time to time.
She opened this session by telling me how she was treating a patient going through multiple sclerosis and she had the problem that when she was done with the sessions, she would suddenly feel like she had the multiple sclerosis symptoms herself. I listened and nodded, unclear why she was telling me this, I assumed it was just to get the conversation going. After a pause, perhaps expecting me to say something back, she told me that she had reviewed the psychologist's report and concluded that we'd use it as a starting point rather than talking about my weight loss. So she asked me about my relationship to other children when I was young and I mentioned that my relationships seemed fine and that I even had friends of both sexes which, in retrospect, seemed unusual. But she didn't think so as often times boys and girls played together in their earliest years. Did I consider myself 'an Oddball' as a child? It wasn't a term I was familiar with and I had to ask her what it meant. Once she told me I said I didn't think so, that while of course my stuttering did make me stand out among my classmates, I never really avoided them because of it.
Then we reached the topic of my teenage years and how I had told the psychologist that I felt separated from my peers and started socializing with adults at that point. I agreed and mentioned how it was a case of my peers were more interested in girls, and my friends who were girls started to avoid me, I guessed because they didn't want anyone to suspect I was 'their boyfriend'. So, since I had other interests such as computers and science fiction, it seemed natural just to socialize with the people who were interested in that stuff, it happened to be people who were older. So I stopped seeing my school friends then? No, I still saw them every day and occasionally did some stuff with them socially if it didn't involve the dating scene. So you weren't interested in dating? Nope. Why do you think that was? I momentarily thought of mentioning my 'situation' to her but just wasn't brave enough and instead just shrugged my shoulders.
Our time was up and we affirmed the next appointment.
Between that appointment and my final one with her, I received my copy of the hospital records. There was the dietary survey report which I already had a copy of, its final pages ironically noting that I needed to reduce my calorie intake lest I gain too much weight. Also included were the nurses' notes from my four day stay at the hospital and, to my surprise, the doctor had flat out lied to me about my weight having gone up during my stay as the weight measurements of the day I got in versus the day I left revealed I had lost two and a half pounds during the four days, not gained anything. The C.T. scan revealed no brain abnormalities that would explain my weight loss and the lab review of my stools during my stay revealed undigested food mater was coming out my hindquarters. To me, this very clearly proved that something was, physically, not working properly between the time food entered my stomach until it left the other end.
With this information in my mind, I decided I finally had something I wanted to talk to the psychological nurse about.
But other matters came up, instead...




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