Liv
“Can you be on meds today?” Hannah asked wearily, Hannah is the nurse working with me today. We’ve just taken handover from the night team who look like they’d been run ragged all night with the patients on Avon Ward - with what they handed over, it doesn’t sound like being run ragged was far from the truth. Avon Ward is a 14-bed male acute psychiatric unit within the city of Cliffburgh, both Hannah and I work here as psychiatric nurses and have been for around three years.
“I got you, girl. You owe me coffee though” I respond, looking up at her with my eyebrow raised.
Hannah hates being on medications because of the amount of incident reports we have to complete when patients inevitably refuse their medication. The people we help on Avon are typically here against their will, meaning that the risk of leaving them untreated in the community is often too high that they need to come into hospital involuntarily. It does also mean that people don’t enter this ward without a fight - psychiatric wards are described to be like prisons and are entirely traumatising. Your autonomy is taken away and every risk is assessed. You’re checked on every fifteen minutes (including during the night) so even if you want solitude, you can’t have it.
Hannah placed her hands in a prayer position, looked up and muttered thank you, god before turning around and heading to the nurses station to allocate the shift. We have at least three patients on one-to-one care today; they aren’t something we initiate lightly. One reason why we start a one-to-one is due to the risk someone poses to themselves, if they’re suicidal and wanting to act on their thoughts and urges to harm themselves. Another reason a one-to-one could be started is due to someone’s risk to other people. Take Frank, he’s been in and out of this ward like a yo-yo for the last 20 years. He takes drugs and becomes psychotic, stops his meds and ends up admitted involuntarily back to Avon. It’s a vicious cycle and I pray each time Frank is discharged that it’s the last I’ll see of him. The nature of our work would ideally result in only having one interaction with someone, often when people are discharged I’ll say that while it’s been nice, that I hope in the best way that I won’t see them again. I’ve met the same people again, especially Frank, more than I want to admit.
I sigh, heaving myself out of the chair I sunk into for handover. I walk into the next room where the clinic is situated and arrange my charts ready for the morning round. I’d just gotten around to stocking up my trolley with medication cups and placing my hair into a bun on top of my head when Frank and his one-to-one walked in.
“Well hello darlin’, don’t you look like a sight for sore eyes?” Frank bellowed as he sat himself on the chair next to my trolley. “What’ve you got for me today then? Xanax? Little bit of weed wouldn’t go amiss either”.
“Ever hopeful, Frank. I admire that about you.” I say while chuckling and rolling my eyes. I pulled Frank’s chart from the pile I’d made and opened it up. Frank is a 46-year old man with a diagnosis of schizophrenia, nowadays his admissions are short and sweet but he used to be in hospitals like this for months on end. With each admission, he is re-titrated on his Clozapine and after a period of stability, is sent back out into the community. He normally lasts anywhere between 3-6 months before relapsing and needing to return to the ward. He made it 14 months out of hospital a couple of years ago, it’s a triumph that Frank holds over the doctors that tell him that he’ll never see outside of this ward for longer than 6 months. Frank is close to the end of his titration back to his usual dose and he knows what this means - he’ll be discharged by the end of the week. I open the trolley and dispense 300mg Clozapine and check it against his chart.
“Juice or water, Frank?” I ask, not looking up while I dispense the plethora of medication that Frank takes alongside the Clozapine.
“Juice. Apple. Always.” Frank spat each word. To someone that doesn’t know Frank, they’d assume he was angry and likely to escalate; but I know Frank and his all-consuming love for a crisp cup of apple juice.
I don’t know why I offered Frank the option, I know his preferences. I’ve been working solidly for the past three months on the ward and more than overdue some time away from the ward. I haven’t booked any time, despite being urged to by my colleagues who are dealing with my burnt out ass. I’ve been avoiding going home due to Dad’s condition. Dad is dementing due to all the alcohol he drinks to cope with Mum’s death, it was sudden and Dad had to play both roles with an angry teenage Austin and an 8-year old me. When I look at it like this, it’s hard to blame Dad for how he coped with losing the love of his life; but both Austin and I were kids who had to grow up before our time because of how he coped. I’m angry at Dad, but my guilt reminds me that it is his first time living too - which is what makes it so fucking hard.
“Right you are, Frank. Down the hatch.” I turn and pass the small pot to him, he looks at the pot and then back at me.
“What’s up with you?” Frank narrowed his eyes at me as he asked, not reaching up to take the pot with his morning medication in it. I stop for a second, wondering how I should go about this.
“Nothing, Frank. Just tired and in need of coffee is all. Here’s your meds.” I try to pass him the pot again but he doesn’t take it. His eyes stay on me and somehow, they narrow further.
“I’ll take my fucking pills when you tell me who shit in your cornflakes this morning” Frank retorts, he never misses a beat. His eyes remain on me, his arms down in his lap and not taking the pot with medication in it that I’m still holding out to him. “You’re a damn nurse and you wear your emotions slap-bang on your face. I’ll ask again, what’s up with you?”.
I have to give it to Frank, he knows that if I want him to take the medication in my hand then I’m going to have to give him some kind of nugget of information.
Truthfully, I’m fucking exhausted. I’ve been working six days a week, pulling 12-hour days to avoid going home. I need a break, I’m burnt out but I know if I accept the time off then realistically there is only one place I should go. Home. It’s only ninety minutes down the road, Clifton Falls is a small town with a population of around 2,500. It was my base for the best part of 22 years before I moved out to the city for work. I always say that the move was due to work, but truth be told, I wanted out of Clifton Falls. It suffocated me daily and there was never anything that was secret. The small town life, while idyllic, also means that anyone and everyone knows your business.
“It’s time for me to take some vacation days and go home, Frank.” I sigh, I motion the pot of medication towards him again and he takes it slowly. Frank has been nursed on Avon intermittently over the last three years, which also means he’s been nursed by me for that length of time. Frank can read me better than I care to admit and it’s only now that I’m realising just how much he notices.
“Girl, you look like shit. No offence intended,” Frank raises his hands and shrugs as a gesture to keep things civil. “You need to be careful with yourself, you’ve got one life and you’re spending every single day in this ward trying to avoid whatever is going on outside. You’re gonna have to face the music sooner rather than later, so face it and then enjoy life”.
I chuckle and thank Frank for his candor. His very brutal and up-front candor. Frank then begins to take his medication with his apple juice. He finishes the last tablet and remaining apple juice with an audible gulp before dunking the pot and cup into the bin beside him. He stands while I initial his chart to indicate he’d taken the medications and cross Frank’s name off my list of medications to administer this morning. It’s one less incident report I’ll have to do before lunch, but Frank is pretty good with his medication now he’s towards the end of his admission to Avon. Frank nods to his one-to-one and then to me before rising from his seat and whistling his way out of the room, his one-to-one follows quickly in his footsteps, anxious not to let Frank be over arms reach away from him. I know this is something that annoys Frank so I make a mental note that he’ll likely need some PRN soon. The next patient comes in for their medication and I start the whole process again, another 12 times after that so each patient has their morning medications. I’m predicting that I’ll need to do 4-5 incident reports after this round but I can hide myself away while I do those.
I finished the medication round an hour ago and have been sitting in a side room since while I log on and complete these incident reports. I’m nursing a coffee and typing intermittently on the forms but my head is entirely elsewhere. I’m working so much because it keeps me in a bubble from my problems and gives me a reason as to why I’m not coming home. I get to the section on the forms where it asks me if the next of kin has been informed of the incident and a fresh pang of guilt hits my heart. One day, probably sooner rather than later, it will be my Dad’s name on these incident forms. Austin gave me an update a couple of weeks ago, via text because Austin doesn’t call. The crux of it being that Dad is deteriorating to the point where he no longer takes his medication because he doesn’t recognise them. Dad even asked Austin who Lacey was - Lacey is Austin’s 6-year old daughter (and honestly, she is the only positive about going home). Lacey shrugs it off at the time but you can tell she longs for a relationship with her Gramps.
My train of thought is busted when my phone rings in my pocket. It’s likely to be Immy, my best friend and housemate, making some sort of plan for this evening. When I pull my phone out, Austin’s name and his photo are beaming on my screen. I immediately feel my stomach drop. Remember how I said that Austin doesn’t call? The only time he has ever called me is when Lacey was born. I jump up and shut the door to the side room before sliding across the screen to answer the call.
“Hey Aus” I answer tentatively.
“Hey Liv,” Austin responds back, it sounds deadpan. I can picture his face on the other end of the line, he’s always been a worrier but has a face like stone 99% of the time. It’s when you see Austin frown, or his lips form a tight line that mean his worries are bigger than usual. I can’t see Austin right now but it’s as if I can hear him frowning. “It’s time, I need you to come home”.
His words hit like a brick wall and I feel the air being sucked out of my lungs. I knew this day was coming - hell, I even said to Frank earlier that I knew I needed to take some time and go home. I didn’t realise that it would be this soon, y’know?
“How bad?” I ask, quieter than I intended. I don’t realise that I hold my breath after that, and will only breathe again once Austin’s response comes down the line. I hear him sigh, and I already know he’s put his free hand through his hair while thinking of a response.
“It’s bad, I don’t know how much longer we can safely keep him at home. He’s obsessed with going to the falls, especially at night, he got half-way there on foot before his at home carer woke up and realised he was AWOL”.
I feel my blood pressure start to rise, I have strong feelings about one-to-ones who fall asleep while working. That’s a story for another time, I have a more pressing issue to deal with at this present second.
“I’ll be there after shift. Are you at the bar tonight?” I ask, sitting back on the chair and looking up at the ceiling. A silent prayer that this won’t end in the way I’m already expecting it to. The rest of the call was uneventful; Austin confirming that he’d be at the bar, me confirming that I’d look after Lace and Dad until Austin comes home. The call ended as quickly as it started, or that’s how it felt. I sat in silence for a few moments, soaking in the silence before I return to chaos. I finished the rest of my shift in what felt like a fever dream, and before I knew it - I was on the road heading 60 to Clifton Falls.
