Thursday, July 30, 2009

The day after the ward round meeting we had a family meeting with Sam, his psychologist and his care co-ordinator. It was agreed that Nell could join us. She's family too after all.

In fact Sam sometimes has some problems with Nell. Sibling rivalry and all that ... but it is writ large. Sam was the older brother, the popular one, the one destined to succeed. But now the ball is on the other foot. Nell has become the popular successful one while Sam languishes, detained on a psychiatric ward.

We were worried he might become aggressive or at least antagonistic with her. But that didn't happen. He searched for things to praise her for. Most were very off the wall and not necessarily grounded in reality ... but he was trying to celebrate positive aspects and said he loved her.

Everyone seemed to think the meeting had gone well but I continue to be upset that Sam seems very psychotic despite his medication but that staff are pleased with him because he is calm.

Wednesday, July 29, 2009

Sam phoned the other night. Nell was here with a friend so he was keen to talk with them but seemed quite mad to them!

Later when I talked with him he explained how the day before he had been crying, thinking about his mum, and needed to walk into town. He was out on leave and he thought they'd had to call the police.

I phoned the ward and it seemed when on ground leave (walking around the car park!) he had insisted on going across the road to some sheltered accommodation with another client who was allowed to do that ... then started to walk into town. He didn't run off and his escort walked with him and called the ward. Two other nurses came to them in a car and Sam agreed to come back with them when they explained that he didn't have leave for that. The staff on this ward are good at not panicking and dealing with issues proportionately. So often that is not the case.

Sam had a ward round meeting with his psychiatrist today.

He gave him a a bunch of daisies he had picked in the courtyard. Then he explained why he had wanted to walk away. So he got his local leave reinstated. He's such a charmer!

Tuesday, July 28, 2009

Nell is home fo a few days to see her cousin and her uncle and aunt.

When she came with us to see Sam at the weekend Sam insisted on telling her about how we had deserted him and left him to live on the streets and that the only reason he was on the ward was because he had nowhere else to live. Nell said she knew that wasn't true

... but perhaps Sam need to say that for his own self-image when meeting his sister who has what must seem such a positive and exciting life to him.

Sunday, July 26, 2009

Jane and I went to see Sam for a family meeting with other staff. But there was confusion over the dates. So it was just Jane and I with Sam.

We met in the small meeting room just across from the patient's lounge. The TV was on full blast. There was a lot of loud talk and shouting. It was sometimes hard to hear Sam above the noise. I found the atmosphere stressful and oppressive. If I'd also had a more severe mental illness I wonder what an effect such an atmosphere would have had on me.

From the start Sam was unwell. He was initially quiet, then aggressive and confrontational. Lots of previous delusional beliefs that we thought had been resolved started being raised again. He said he had been told to kill me but wasn't going to do so. He talked of guns and drugs on the ward. He said he as frightened. He talked of his anger about things we had done in the past that were not what had happened that the family meetings had been working on with him. It was as if all that work had come to nought.

We stayed through it though and by the end Sam seemed to have calmed and become more cheerful.

When we left I had to walk around for a while in the quiet fresh air to come down from the stress and pressure of the ward. Yet that is regarded as an appropriate place for mentally ill patients?

Saturday, July 25, 2009

Sam's uncle and family are visiting from a different continent. We see them so rarely. He is excited by the fact he has a young cousin he has rarely met. So I arranged to visit with his uncle. He seemed so excited on the phone the day before.

But when we arrived he was quiet and listless. When he did talk it was of things inside his own head. He hardly recognised his uncle and seemed unaware of his presence despite having seemed so keen to see him.

It was disappointing to see him so withdrawn with 'psychotic' symptoms that had not been there the week before.

Friday, July 24, 2009

At the ward round meeting I raised the issue of Sam's weight.

I'd wanted to make it the main issue. But of course they would just see us as being negative and not recognising improvements.

There have been improvements for Sam on this medication. I do not dispute that. But mostly they have been to his mood rather than his mental state. He still has lots of symptoms that would be described as psychotic ... but he is no longer angry and disruptive. He is amenable. His behaviour has been seen to improve. So whatever is still going on in his head they see him as better.

But ...

Since he has been on this medication he has gone from twelve to seventeen stone in weight. (About 170 pounds to 240 pounds.) Most of it is in his midriff though he has filled out all over. This is just in a few months. Until we raised it nobody appeared to be aware. They weren't even weighing him. So at least now there is some evidence of his weight gain.

Such huge weight gains are hugely detrimental to health - and this is a hospital! But he is allowed to order take out pizzas, curries and burgers. If they can control his medication then surely they can also control his food.

Thursday, July 23, 2009

Last week before we went away we had attended a "ward round" meeting.

I wanted to discuss Sam's weight and Jane wanted to discuss future leave. In the end everyone was arguing for more leave for Sam - saying how important getting out into the countryside for long stretches was for his recovery. We were astounded that we had to say virtually nothing.

So he was granted four hours leave three times a week for extended visits. His daily leave was increased from one hour accompanied leave to two hours.

That was over a week ago.

There have bee problems on the ward that nobody has explained to us since then. So Sam has had no leave at all until the last two days where he has had a walk around the grounds.

Sam was so surprised and excited to have been given such leave.

He must have been dreadfully disappointed that it has not happened.

Yet again he has been lead to distrust those who detain him. Nobody has thought to explain to him the reasons for the change.

So guess what ...

... yes, he has become more poorly again.

Wednesday, July 22, 2009

We'd been away for a few days over the weekend so Jane arranged to pop in to see Sam on Monday evening. She booked in at six - what they regard as a good time.

She arrived and signed in as usual and the receptionist phoned the ward. Soon a nurse came down and collected someone else from reception and with a smile said he would be back soon. Fifteen miutes later another nurse came down to collect the delivery of a take out meal. He also said 'Hi' to Jane mentioning that Sam was listening to music on his bed.

The take out meal delivery man was driving a very large luxury car. Not the typical vehicle for a pizza delivery boy. We've heard stories of drugs being delivered to wards by such means. All of a sudden it felt possible and real.

The clock ticked round and when it got to well after six thirty Jane decided to leave - with a message to the ward to say he could stay no longer.

Sam rang me.

He'd been sitting in the meeting room. They'd told him that Jane had arrived to visit him. But she had not come.

He could not understand this and thought we were lying to him. He got very cross with his mum, assuming it was her fault and that it was she who was mad and making up fantasies. It took a while to persuade him of the truth.

Jane rang the ward to explain that Sam was a bit excitable ... and the nurse apologised profusely for what had happened.

Something has been going off on the ward while we were away but nobody is saying what. Also there are a few new patients and that often unsettles Sam. I think they are also understaffed - perhaps staff illness with the flu outbreak.

But with everything else going on nobody has noticed Sam getting unsettled and more poorl. Because he is quiet and causing no problems he is down the list of priorities.

Sunday, July 05, 2009

When we arrived to see Sam yesterday he seemed a bit cross or frustrated. He looked as if he could easily become irritated or surly. There was little in the way of friendly greeting from him. We had hoped to take him for a short walk with a nurse. He was eager to get out as soon as possible.

Once we did and he'd had a couple of cigarettes he began to relax and become more chatty and friendly.

It must be so difficult being cooped up on the ward for most of the time. There is little to do on there. Anyone couped up in such a place with another dozen or so young men would soon get angry and frustrated. I would send anyone mad. But if you are already mad and mixed with other mad men then ...

Interestingly the nurse accompanying us was saying almost exactly the same thing.

Saturday, July 04, 2009

Sam has spoken on the phone a few times saying how much he enjoyed his birthday and his presents.

One present from a friend was a poster that she knew Sam would like. He has never before in any of his hospital rooms wanted to decorate it or put anything in it to make it nicer or more homely. It is as if he refuses to accept that hospital rooms are in any way his - that he wants no part of it - that he intends to move out as soon as possible. Making it nice would imply he wanted to stay there.

Well he put up the poster on the wall and a picture of his young cousin wishing him "happy birthday". He also displayed his birthday cards around the room.

I hope this acceptance and more positive attitude to the hospital ward is constructive.

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