A New Chapter: First Days in Princess Margaret Hospital

Tuesday November 8^th 2016

Admission to PMH: 9am

1:28pm

So I have 'failed' my first meal. It was egg and cheese salad, a pot of yoghurt and 1/4 cup peanuts. I managed the egg salad, and picked out all the cheese. And that's it. I figure that's equivalent to my peanut butter, crackers and carrot. I bought some cuppa soup so am having one now too. I refused the fortisip they tried to make me have afterwards. I feel so lost I just want my old meal plan and structure back. I just want to leave now. I'm not going to be able to do this. I don't know how to let go and trust. I'm so afraid.

How do I make myself eat if I don't want to be alive? I mean, I know rationally but when it comes to it and the food is there in front of me it's like nothing else matters. My head becomes consumed with something that's not me, and I go into 'survival' mode. Or rather, the opposite...

7:47pm

Summary of the afternoon:

•    Wanted to leave as felt unable to do this and to let go of control. Went to talk to Roger and have been put under the MH Act.  Will be reassessed in five days

•    Narrowly avoided nasogastric feeding (only because Yvonne stood up for me to Roger), BUT I will be if I don't manage meals 100%

•    Cried. And cried. Phoned Will. And cried some more.

•    Visited and explained rights by DAO. Requested review by judge.

End lesson:

Let go. Trust.

Old rules are VOID.

I cannot trust my mind right now.

Take it one moment at a time.

(Old rules have got me here. They are thus ineffective. Direly. Thus they are void and for now I am safe if I abide by PMH rules. By trying to gain control I have now totally lost it completely. To the point that police will be called if I try to leave the ward. I am now truly trapped. I am hurting so much I just can't describe the pain, the exhaustion, the panic and the torment in my head)

I can't believe this is my life.

What is there at rock bottom?

GOD. Hold onto Him.

And love, people, compassion.

Plan:

·      Treat this as temporary change to build character (short term)

·      Do as I am told exactly for 5 days until review

·      Trust in the team’s rules regarding what is currently best for me re food and exercise

·      Eat a little extra if hungry during this time and be free with cups of tea

·      TLC: treat this as my opportunity to rest and take care of myself: my sanctuary away from the world

·      As soon as able to I will leave, go back to Paula’s and to Meiko and do things much the same as I was doing them (eg. enchiladas, frozen fruit, vitawheats dipped in tea, frozen yoghurt, walks and yoga) but with more of a focus on recovery and improvement. (Ideally this will be in five days). 

·      The more I follow the prescribed treatment the shorter time period this will be.

Wednesday November 9^th

Day 2

Mum arrived unexpectedy this morning.  It was so good to see her.  But also more overwhelming in a way.

I have had attacks of panic throughout the day, despite the increased clonazepam dosages.  I saw the physio – my guidelines are 20mins gentle yoga daily (to be mixed up/split up into two sessions sometimes) and no walking; ‘right now my body needs to rest and restore itself and walking or other exercise will impede this.  It will also cause further muscle wastage rather than building muscle strength and and fitness’.

I feel exhausted, drained, numb and terrified.  I’m finding it so hard to let go of control.  It’s like my whole life is being stripped away and I have no control at all.

I climb into bed

My heart pounding

Like a metronome on the fastest speed

My thoughts feel uncontrollable

Like a train

Out of control

Unstoppable

Hurtling along the railway.

I settle into the crisp cold sheets

Shivering

The plastic hospital mattress

Crinkles beneath me

As I try in vain

To slow down my breathing

To forget the events of the day;

Being put under the Mental Health Act

Because I wanted to leave,

The tuncontrollable error

The cold grip of panic

The surrealness of it all.

How did I get to this place?

How did I lose control like this

When I was trying so hard

To gain it

But in all the wrong ways?

The tears pour down my face

I can't get comfortable

The bones of my knees

Dig into each other

When I lie of my side;

I can't seem to stop shaking.

I reach for Grandma’s rosary beads

And pray a jumbled rosary

Until I fall asleep.

I toss and turn

My dreams dark and foreboding

Consumed with death

And panic.

I lose count of the times I wake

During the night

My stomach gurgling

My body aching

Disoriented and afraid

Unsure of what's real

And what isn't.

A soft Samoan voice

Breaks my nightmare

At 2:30am

To take a blood glucose level

I feel a prick on my finger pad

And hold the tissue she gives me in place

As I fall back to sleep.

Morning arrives

I can hear the birds outside

My eyelids feel heavy

And I struggle to open

My gummed up eyes;

I climb unsteadily out of bed

And glance in the mirror.

I get a shock

As I barely recognise

The young woman

Staring back at me;

My eyes are so swollen

They look like they've been on steroids

Puffy and red.

As required,

I pee in a pan

So the nurses can continue

Keeping track of my fluid balance

-input and outout-

And tap on the nursing station door

The tears flowing once again.

After an increased dose of clonazepam

I'm weighed

At 39.8kg.

BMI 13.6.

I'm shocked

An all time low.

Just for a moment

Cold terror smacks me in the face.

Shit

I really am sick.

Back to my room

Deep breaths;

Breakfast is at 7:30am

Which is almost now.

Hurry Kas.

I have to be nasogastric tube fed

Unless I consume everything

On my tray

In the allotted time.

I want to disappear.

To climb out the window

(That has a stopper on it).

I need time to pray.

Only God can help me do this.

The only way I can keep going

Get through each moment

Just one at a time

Is by drawing on his strength alone

It is time

To let go

To completely hand over control

To trust.

Thursday 10^th November

Day 3

Mindfulness

Focus on the cold flannel

The soft slightly texture

Of it wiping away your tears

The sleepiness from your eyes;

Draw your attention to the running water

The sound of it gushing

From the shiny silver tap

Feel your feet on the floor

Your toes warm in your socks

The slight breeze drifting in

Through the window.

Allow anorexia to scream at you

To try to convince you

You are out of control

To threaten to set off

The firecrackers inside you;

The match is already lit.

Remind yourself

The calories you consumed for breakfast

Do not alter your worth

In any way

You are enough.

You are safe.

Don't push the fear, hopelessness and panic away

But make space for it;

Don't fight

Just observe

The urgings, the false promises.

Wet the flannel again

Drawing your attention

To your breath

To the coolness of the water

Flowing over your fingers

The quiet presence of your breath

The reality of truth

Of what matters

Of what is eternal

And real.

Let go.

Hold onto God

Lean into his strength;

Trust.

10:00am

I feel numb.  And spaced out.  And angry – I just want to die and yet I‘m being forced to eat and get better against my will – I have no choice in the matter.  It would be somuch easier just to fade away … even if I can’t have joy or laughter or happiness, I just wish for peace.  And I can’t find that anywhere.

11:52am

I just met with Roger and am feeling beyond shit.  Completely out of control and like my rights as a human being are being violated.  Here is the outcome of the situation:

·      He reassessed me early for the 5 day reassessment period of the Mental Health Act (due to the long weekend coming up) and told me that he is keeping me under the act at this stage.  I expressed that I don’t agree with this decision as I was particularly distressed on Monday, and although I meet the two main criteria (being mentally unwell and incapable of making decisions that prevent me from being a danger to myself or others) I voluntarily  commit to treatment 100% here as an inpatient, at least until I am deemed physically stable.  This is what I read in the information given to me that should enable me to come off the Act.  He disagreed and will review the Act next in 14 days.

·      I have applied to see a judge to contest this which will occur on Tuesday 11:45am.  I need to make a list of reasons why I should be taken off the act before then (eg. bloods, ability to make decisions, compliance with treatment, vital obs, re-feeding status).  I will see a lawyer on Monday to help support me in this.

·      Roger assured me this would not impact my nursing career (unless I was to go for a job very high up – he said colleagues of his who are psychiatrists have been on the Act and it has not affected their ability to practice once well again.

I may not even have to state I have been under it to the Nursing Council/ an interview, particularly if I get off it at the 14 day mark).

·      I am not to do any exercise (including yoga) until Wednesday next week, and then will review this with Roger.   This is despite explaining to Roger that the physio Maree okayed me to do yoga yesterday and we arranged I would do 20 minutes of gentle yoga per day, and no walking.  I had made peace with this arrangement.  I also told him that yoga is as effective for my mental state as a tablet of clonazepam, and I would much rather do that than take more tablets and be more drugged up.  However, he would not reconsider this. 

·      Roger will see me again on Monday to see how things are going (review status but not reassess the act)

·      My diet is to be increased to 1800 calories.

Hence, I have decided that I will take it one step at a time.  My plan from here is:

1.     Let go.

2.     Hold onto God.

3.     Trust the process and follow the rules  - focus on non-resistance - (food prescribed by dietitian, no yoga, no walking until review)

4.     See Roger and the lawyer on Monday (work towards this stepping stone to assess where he thinks things are at).  Make a decision at this time whether to go ahead with Judge on Tuesday.

5.     See Judge on Tuesday (with list of reasons to contest).

My nurse Nikki has been amazing and I feel very blessed to have her to support me in this.  I feel like this is all a nightmare.  I keep getting these intense waves of panic.

I have asked for extra prn meds to be charted as I won’t be doing yoga, and she has reassured me that a week without yoga or walking (a week focusing on eating well and physical rest and restoration will be the best thing I can do for my health, fitness, muscle strength and conditioning).  I need to keep telling myself that.  And use mindfulness to just LIVE IN THE MOMENT and try not to think too much.