A brief summary: This is a fiction piece I'm just starting and I've decided to break my usual "rules" about writing and beginning the project while it's still developing in my head. I don't expect anyone to like this or even read it; it's only so that I can prove to myself I can write a story that isn't completely "done" in my head and it won't be too crappy. If you do like it, don't be afraid to let me know. I would love to hear it. It is in journal format through the eyes of a 23-year-old woman named Grace. Enjoy!
June 10th, 2007
My name is Grace Bianchi, RN-BSN. Oh, how I love to write those five letters after my name. The RN is for Registered Nurse. I am able to provide physical and emotional nursing care to the sick and injured. The BSN represents my level of training. I have a four-year Bachelor's degree in nursing, the highest before Master's. I received this training at the University of Massachusetts. I worked hard. I have just graduated with honors. I have plans to become a Nurse Researcher and all of my professors agree I would be good for such a position.
Why then, do I not have any job offers while I wait to get into my graduate program?
Well, I do have one. It's just not the job I wanted. Every one of my fellow classmates wants one thing after graduation: That coveted first year of experience on a Medical-Surgical hospital unit. I am no different. If you do well there, it establishes you as organized and a nurse who is well-versed in all of her technical knowledge. You can go just about anywhere from there.
Instead, however, I am to be a private-duty nurse for a person whose illness is even doubtfully real.
Don't get me wrong, I studied psychiatric nursing in school. I did my psych clinicals like everyone else. But while some of my classmates found it fulfilling, I just couldn't get over how these people were being treated as patients when, for all we knew, they were faking it. There is no definitive test for bipolar disorder or schizophrenia.
Anyway, my patient. His name is Matthew Edward Stanfield, age 25. Eldest son of Stan-Mark Pharmaceuticals CEO, John Stanfield. Graduated top of his class at an elite boarding school, then went on to Harvard as a Biology major. He had his first psychotic symptoms toward the end of his first year of med school. Due to multiple extensive hospitalizations, he was withdrawn from university and now takes courses from home.
Axis I (Mental Health Diagnosis): Schizoaffective Disorder, Panic Disorder with Agoraphobia
Axis II (Personality Disorders/Mental Retardation): N/A
Axis III (Physical health problems): Insomnia, Cardiac Arrhythmia
Axis IV (Environmental problems contributing to disorder): Emotionally distant parents with high expectations, perfectionistic standards for himself
Axis V: (Global Assessment of Functioning Score): 25; behavior is considerably influenced by delusions and hallucinations, inability to function in almost all areas.
I begin in one week. We shall see how things go.
(Author's Note: Sorry it's so technical. I wanted to convey Grace's sense of no-nonsense, clinical approach to things. The part with Axis I, II, and so on is from the DSM-IV [the Bible for American psychiatrists] and is like a profile for each patient, showing their treatable/incurable illnesses, physical health problems, environmental problems that may complicate treatment, and an overview of how they function in daily life)
My name is Matt, and I am a boy. Feel free to PM me :)
I have learned that the world is not a safe place. Not at all. But there are so many people who love me and want to keep me safe. And that is enough.
I look perfect. Poised, professional. Dark hair in a tight bun. Bobby pins to hold my troublesome stray hairs out of the way. My new scrubs, a graduation gift from my parents, are clean and wrinkle-free. Dark blue crisp cotton, with "Grace Bianchi, RN-BSN" embroidered on the left chest pocket in hunter green. Stethoscope around my neck, watch on my wrist.
I'm ready.
After his last involuntary hospitalization less than two weeks ago, Matthew Stanfield returned to his house in the elite Boston neighborhood of Beacon Hill. It's a charming old-style New England Colonial, but certainly seems too big for one person. Well, if he can afford a private-duty nurse, he can certainly afford a two-story house all for himself.
I head up to the door and knock firmly. I hear the lock click, and the door opens to reveal a matronly-looking older woman in flowery scrubs. His current private-duty nurse whom I'm replacing, I suppose.
"Hello!" she sings at me. "You must be Grace! I'm Martha. Well, let's not waste time! I'll introduce you to Matthew!" She turns and bustles down the hall, and I follow.
The house doesn't look nearly as warm and inviting inside. The lights are all off and the curtains drawn, making everything murky. Martha's brightly colored clothes are the only thing I can see clearly in the darkness. I'm told a cleaning service comes once a week, but from the array of clothing, dirty dishes, and general grime all over the place, I assume they haven't been doing their job.
Martha notices me looking around and her smile becomes weaker.
"Matthew is unfortunately going through one of his depressive phases. He just hasn't gotten his meds worked out, and he's having a tough time. Are you familiar with his diagnosis?" she asks.
"Yes," I answer. "Schizoaffective disorder is characterized by episodes of schizophrenic symptoms such as hallucinations and delusions, and then by episodes of either mania, hypomania, or depression without psychotic symptoms. For such a diagnosis to be made, the mood and schizophrenic symptoms must not happen simultaneously."
Now Martha's smile is wooden. "Well, you have certainly done your homework. I understand you just graduated? That's wonderful, dear. Oh, and don't listen to your classmates--psychiatric nurses do not have to work in psych their whole careers. We can do just about anything. I applaud your decision to begin in psych, though."
I am about to interject that I did not choose to start off in psych when we reach the kitchen, and my patient turns to us.
My first thought is that he desperately needs to gain weight. According to his chart, he is 5'10" but only 125 lbs, and it shows. His faded red Harvard T-shirt and pajama pants hang loosely off of his bony frame. His short brown hair is greasy. Tired, blank hazel eyes gaze at Martha and I with all of the energy of a corpse. He still has a plastic hospital bracelet on one thin wrist, though the information is scratched out with black marker. More than that, he fills the room with the unmistakeable scent of body odor.
"What is he currently taking?" I edge around Matthew (who seems to not notice my presence) and go to the kitchen counter, where prescription bottles are lined up carefully.
"He doesn't respond well to most antipsychotics, though this new one, Seroquel, seems to be alright. He takes Zoloft as well."
"What does 'doesn't respond well' mean?"
She looks defensive now. "There was an incident..."
"Yes?" I'm getting impatient here.
"He was being given Haldol injections, but became very confused and ran a fever. I thought he was just going through a particularly difficult psychotic episode combined with just a little cold. He was admitted to his usual psych unit, but it turns out he had NMS. His symptoms peaked, but he was able to be revived and after time in the ICU, came home."
I stared. Neuroleptic Malignant Syndrome is a rare but serious complication of antipsychotics that involves a high fever, rigid muscles, and confusion. Sure, it may be hard to distinguish from ordinary symptoms, but shouldn't a good nurse be on the lookout for adverse reactions to medication? He could have easily died.
I look over at Matthew, who is currently sitting at the kitchen table, staring blankly at the wall. Severe depression, lack of basic hygiene, low weight. Whatever he's prescribed, he's obviously not taking it. And Martha seems to be too soft to make him.
I have a lot of work ahead of me.
My name is Matt, and I am a boy. Feel free to PM me :)
I have learned that the world is not a safe place. Not at all. But there are so many people who love me and want to keep me safe. And that is enough.
(Thanks crazykat, for your feedback. I will probably update frequently at first as the ideas struggle to get out.)
June 18th, 2007
Care Plan for Matthew Stanfield
Nursing dx: Low weight, refusal to consume nutrients properly due to depression and delusional symptoms
Intervention 1: Obtain copy of meal plan from nutritionist, supplement with Ensure
Intervention 2: If continues to refuse meal, 2 Ensures can replace meal
Intervention 3: If refuses supplements, counted as non-compliance
Intervention 4: >2 non-compliances in one day is grounds for hospitalization
Intervention 5: If refusing nutrition after hospitalization, NG tube feeding will be used.
Intervention 6: Weighed every other day in gown
Nursing dx: Non-compliance with medication
Intervention 1: Medication reminder chart
Intervention 2: Consequences for missed meds, i.e., not allowed to have certain priveleges
Intervention 3: Refusal of meds >2 days in a row=Hospitalization
Nursing dx: Suicide/self-harm risk
Intervention 1: All sharp objects (including glass, wire, etc.) will be locked up at all times, as well as medication
Intervention 2: While in a depressive episode, must wear pajamas w/o strings at all times
Intervention 3: Daily body checks/strip searches until further notice
Intervention 4: Constant observation, within arm's length of nurse at all times
How did he get this far without killing himself? I quickly realize he needs constant care and I will have to sub-lease my apartment until further notice.
At least my salary is excellent.
Last edited by PaleMoon : 08-06-2010 at 06:46 AM.
Reason: typos/mistakes
My name is Matt, and I am a boy. Feel free to PM me :)
I have learned that the world is not a safe place. Not at all. But there are so many people who love me and want to keep me safe. And that is enough.
Martha has gone, and I have the patient all to myself. It's just as well, because as it turns out he's quite agreeable during a depressive episode. I say agreeable, but really mean he doesn't do much so he'll listen to me, to a point.
He let me bathe him, so at least he's clean. He'll take his Zoloft, but refuses the Seroquel, saying it "messes with his mind." Well, that's the whole point of psychiatric medication, but I won't fight it until he really has problems with psychotic symptoms.
Meals are our real point of contention right now.
"Matthew, it's time for dinner," I call out. He shuffles in, still in the hospital gown and boxers I weighed him in this morning. He gained a quarter of a pound.
"Don't want it," he mumbles, slumping in a chair.
"That's fine. Do you want to replace it with Ensure? You can't do it forever, but you can do it for now."
"No, I don't want dinner at all. The Ensure is crap," he snaps.
Alright, time to be assertive. I look him straight in the eye.
"You refused food and supplements at lunch, too. You know the new rules. If I count this as another non-compliance, you're going to the hospital. And they won't be as nice as me. They will tube-feed you. So, is that your final answer?"
"Yes. But you can't make me," he says with a growl.
"Oh yeah? Watch me." Looking back, I shouldn't have been so baited. But he frustrates me so much. What is so hard about eating, for God's sake?
Matthew stalks away, presumably to hide in his room. I dial his psychiatrist, Dr. Yin.
"Hello, Dr. Yin? This is Grace, Matthew Stanfield's new private-duty nurse."
"Ah, Grace. Yes, I remember you. What's wrong?" Dr. Yin's voice is calm and soft, with just a trace of a Chinese accent.
"Well, do you recall the care plan I outlined for you? Matthew has refused food and supplements twice today, and if you remember, that means he must be admitted to the hospital."
Dr. Yin sighs. "You seem to be a very competent and good nurse, Grace. But his parents have given me strict instructions that he must not be hospitalized excessively, and he was just discharged three weeks ago."
I tap my fingernails on the counter in frustration. "Well, 'excessively' sounds a little vague. He is severely, chronically mentally ill. Of course he will need lots of time inpatient until he gets stable, which he is far from. Did I mention his BP is only 86 over 49, and his pulse is only 42?"
That gets his attention. "Really? That is serious. Is he showing signs of dehydration?"
"Yes, as well as dizziness, shortness of breath, and I heard arrhythmia during his physical exam today."
There is a brief silence on the other end. Then: "Alright. I will order an emergency admission to a medical unit for stabilization. If he needs to be transferred to the psych unit, I will arrange that once he is stable."
"Thank you so much, Dr. Yin."
"My pleasure. Try to keep him calm during the transfer. His agoraphobia is going to act up. He may have a few Haldol injections left. Use those, okay?"
"Right."
Now the challenge is to get him to the hospital. I unlock his medicine cabinet, and lo and behold, he has a sterile syringe and just enough Haldol for one last dose. I head upstairs to his room, where he is huddled under his comforter.
"Hey, Matthew. I have some meds. They might make you feel better."
One accusing eye creeps over the top of the bedclothes. "You're just sedating me so you can take me to the hospital." Well, he's not a former Harvard medical student for nothing.
"That's right. But you know what, you'll feel a lot better once you're-hey!" He's fast for being so weak and dehydrated. Luckily, I step in front of him just in time. I'm small, but sturdy, and though he's much taller than me, our weights are similar. I wrap my arms around his waist and pull down, making sure he doesn't hit his head. On the floor, we have a brief struggle, but his exhaustion shows.
I straddle him and pin one arm down, searching for a vein. Damn, they've really shrunk. Well, I wasn't the best in my class at injections for nothing. I quickly find a good enough spot and give him the Haldol. A little goes into the muscle, but it's the best that could've been done. He quickly calms down.
When the paramedics arrive to take him, he's wrapped in his comforter for warmth and ready to go. They seem familiar with him, carrying on a one-way conversation about his schooling and family as they do their thing and get him in the ambulance.
My shift is over. Nothing to do now but wait.
Last edited by PaleMoon : 09-06-2010 at 04:38 AM.
Reason: typo
My name is Matt, and I am a boy. Feel free to PM me :)
I have learned that the world is not a safe place. Not at all. But there are so many people who love me and want to keep me safe. And that is enough.
Matthew spent a month in the hospital, half on the medical and half on the psych unit. He has gained 8 pounds and is now barely at a normal BMI. They had to briefly tube-feed him, but apparently it's nothing he's not familiar with.
He has been home almost a week now, and his transformation is remarkable. His Zoloft is working again, and he is taking his Seroquel as well. He doesn't look like he's one step from death now. He wakes up, dresses, and can do some brief studying for his classes. Luckily, his professors are understanding. He is beginning to supplement less and less. More than that, he has a spark in his eye and we have some pleasant conversations.
Today, however, our quiet routine was interrupted by a knock at the door. Matthew is too anxious to answer it, so I open the door to see a small severe-looking older woman in a crisp suit and pearls. His mother, perhaps.
"My name is Eleanor Stanfield. I am Matthew's mother." One point for my intuition. She steps inside without being asked and looks around, her hawk-like gaze taking in the whole downstairs, which is luckily cleaner than usual.
Matthew looks up nervously from his desk. "Hello, Mother," he says.
"Hello, Matthew. Aren't you going to give me a hug?" she asks, opening her arms. They stiffly embrace. It's possibly the most awkward hug I've ever seen.
Once they separate, Mrs. Stanfield immediately turns to me. "Miss Bianchi," she says, glancing at the embroidery on my scrubs. "I am very concerned about Matthew's recent admission to the hospital. I left strict instructions that he must be treated at home. I am told by Dr. Yin you urged him to admit Matthew. Is this true?"
"Yes, but-"
"I find that very distressing, both to Matthew and to me. But then again, you are a new grad, aren't you? You seem quite young."
"Yes, I am even younger than Matthew, but I assure you, I have his best interests-"
"Well, I don't think my son appreciates being bossed around by a little slip of a girl younger than him! Aren't you frustrated, Matthew?"
"It doesn't matter, Mom," Matthew says. He seems irritated that we're talking about him as though he's not there until now.
"Of course it matters! She's inexperienced, incompetent, and ignores our specific orders for your care. Dismiss her!"
Alright, now it's my turn to be pissed about being talked about. Being fired for doing a good job? Well, it seems like I can't win here.
"Well, they're your orders, but I'm doing better now. Besides, it would take awhile to find a new private-duty nurse. I'd have to move back in with you and Dad and Sophie until we found one," Matthew says, shrugging with his hands in his pockets.
Oh, that gets her. She pales and nervously unclasps and re-closes her Coach handbag. "Well, that would be quite unnecessary. If you like Miss Bianchi, you can keep her. But just know, Matthew, I don't approve."
"That's alright, Mom. You've never approved of me or my choices," Matthew says, his cold grin matching his mothers'. They look more like mother and son now than ever.
She leaves in a huff and I turn to Matthew, surprised I still have my job. He sees my rather dumbfounded expression and chuckles.
"My mother can be...overbearing. I learned a long time ago not to listen to her. Besides, unlike Martha, you can cook."
Huh. So he does have a sense of humor. The most complicated thing I can make is mac and cheese with a side of broccoli.
Still, it's a nice change.
Last edited by PaleMoon : 09-06-2010 at 04:38 AM.
Reason: typo (thanks Shine)
My name is Matt, and I am a boy. Feel free to PM me :)
I have learned that the world is not a safe place. Not at all. But there are so many people who love me and want to keep me safe. And that is enough.
