Hospitalization Reflections: Inpatient Psychiatry Can Do Better
I recently spent two nights in the Emergency Room at a local hospital here in the Washington, D.C. area being treated for a UTI (Urinary Tract Infection) & the acute Psychotic Episode it triggered. This is the first Psychiatric-related hospitalization I have had since 2018, when I had a full inpatient hospitalization for Suicidal Ideation, also in the DC area. I had another previous hospitalization, also primarily for Suicidal Ideation, in 2017 at a rural hospital near my Undergrad University. My experiences during this mini-hospitalization this past week were in stark contrast to the first two I experienced, & I wanted to reflect on the experiences. While I still experienced some of the limit’s & discomforts of a Psychiatric hospitalization during this episode, it wasn’t nearly as unpleasant or dehumanizing as previous admissions have been because of the way the Doctors & Nurses treated me.
When I arrived at the Emergency Room, I believed something was going wrong with my medication. I was having swelling in my extremities & abdomen, & had recently put on a lot of water weight. I had also been experiencing heavy fatigue in recent days. I had experienced a rapid onset of Voice Hallucinations & vivid Thought Insertion with self-harming themes, & I could feel myself preparing to go into a larger episode. Because I had been under extreme stress recently, with my grandmother dying, losing my best friend, & recovering from COVID, I thought maybe that had triggered something & my medication levels were no longer right. I couldn’t get through to my Psychiatrist On-Call & it was a holiday weekend here in the USA. I knew I needed a Doctor, & the Emergency Room was my only option. I came to the Emergency Room with the intent to voluntarily admit myself to the Psychiatric Ward.
The Doctor that saw me initially was extremely friendly, & I found her demeanor calming. When I explained what was going on she listened intently. When I explained all the physical concerns I had, she took them seriously & asked more questions. She then ordered a series of labs: bloodwork, urine, & an EKG. This was how we found the UTI, which I didn’t know I had. This doctor doing her due diligence & looking to eliminate physical causes of my episode led to the correct diagnosis & spared me who knows how much time & grief. Unfortunately, physical differential diagnosis is often skipped when it comes to Psychosis. Once the UTI was diagnosed, she had me started on Antibiotics right away.
The Nurses that took care of me during my time in the Emergency Room were all excellent. Often, when I have been on Psychiatric Wards, the nurses have been rude & neglectful, & even screamed at patients. The Nurses that took care of me during this brief hospitalization were kind & attentive, & did their best to make me comfortable. The first Nurse I had had to collect my belongings & have me change into a hospital gown; however, she let me keep my fluffy bathrobe & gave me two hospital gowns to tie for modesty. She also brought me a pair of the infamous grippy-socks. I have had hospitals take away street clothes before & give some kind of Ward “uniform”; however, it was often done with a punitive attitude & any signs of distress over this rule were met with mockery. This nurse was genuinely compassionate about my potential discomfort & wanted to alleviate as best she could allow.
I take many medications, & getting my medications sorted out for the time I was in the Emergency Room was a bit tricky. The Nurses I had took helping me with this seriously though, & genuinely cared about me not getting off my medication schedule. On Psychiatric Wards I have been on before, my medications have gotten messed up & no one has cared, I have even had previously prescribed pain medication withheld from me, causing significant distress. These Nurses were serious about making sure my medication was correct, even though they were overwhelmed with patients.
The Nurses I had also helped me in “little” ways. My Gastroparesis was flaring due to being in the hospital, so I wasn’t able to eat much of the food that was brought to me. The nurses were very good about bringing me apple juice & ice water, both of which helped calm my angry stomach & keep my medication down. I also eventually started getting really chapped lips, & asked a nurse if she could bring me a lip balm from my bag. She explained that getting my bag out of locked storage would be onerous & the Emergency Room was super packed, could she get me a generic from the Nurse’s Supply? I assented, Of Course, that’s fine! She not only brought me a tube of Vaseline for my lips, but a bottle of body lotion. It was a very humanizing gesture.
My Psychosis peaked Monday night with a vivid Hallucination/Delusion Episode, & I woke up Tuesday suddenly feeling like myself again. A Clinical Social Worker from the hospital Psychiatric Ward came to speak to me, & it was decided my episode had been caused by the UTI & I was safe to go home with outpatient Psychiatry follow-up & continued Antibiotics.
I have the advantage of, generally, retaining the ability to describe my experiences well even in heavy Psychosis. My speech does get affected to some extent, but I’m usually still coherent enough for people to understand well, especially if they’re familiar with the medical terminology I use. I also don’t “act out” much during heavy Psychosis, having more of a tendency to shut down rather than call out or physically react. Both of these things improve people’s reaction to me. I am also a white young woman with a baby face. I am not the type of person people implicitly read as threatening. I was also going to a hospital in an affluent area with an address in my chart from a nearby affluent area. All of these things could affect how the staff at the hospital reacted to me.
Even so, this hospitalization showed me what Psychiatric hospitalization for Severe Mental Conditions could be like. These Emergency Room Nurses are extremely stressed & worn thin—a patient literally died while I was there—but they were still able to prioritize my well-being & treating me like a human being. To me, this shows what can change when Heavily Stigmatized Psychiatric patients are looked at with compassion, & how far the effects of dehumanization of patients really go in Psychiatry. A humane treatment of Psychiatric patients—even Psychotic ones—is possible.
