Ninja Nursing:  Dispatch from Psyberia #1  
4/18/11
Those who are unhappy have no need for anything in this world but people capable of giving them their attention” - Simone Weil

The Agony of Power and Powerlessness:  or The Art of Trying to Run a Secure Unit in a few steps, (though they could easily seem the drunken steps at closing time in a  place you have no recollection of arriving at).
The first step: 
 Learning to submit, to actually accept you are powerless to compel anyone to do the really good things, like smile, laugh, love you, have an orgasm, want to get better, get straight, get sober, take good care of their parents, children, loved ones, self.  What you can usually do are bad things, terrible things.  You can join them in misery, you can lock them in a room, strip them, put them in a johnny, give them sedation against their will through an intramuscular syringe, or intravenous syringe. When put in such bold terms, its a wonder we ever stick our key in the lock and walk unto the Unit.  
Fortunately, it usually is always more subtle, nuanced, artistic and generally more satisfying than the more extreme options.   As a former supervisor used to say to me,   “Extreme cases do not make good treatment.”

Getting started is not nearly so important as where you finish up. Somebody must have said that, but that’s how I’m starting.  I’m a psych nurse, have been one for longer than I care to admit.  I started out at Danvers State University, I mean Danvers State Hospital, which had been opened by the Department of Lunacy.  You can confirm that by looking at the manhole covers from the 1890s.   Person hole covers, those not filched for their heavy metal value.  The Department of Lunacy was taken over by the Department of Mental Hygiene, changed to the Department of Mental Health. I went to work for the same state hospital taken over by a non profit organization, then a for profit, and then...It is the same hospital, with a lot of the same staff, and many of the same patients.   Some old doc I used to work with said it  best,  “It’s the same damned cage, someone or something smacks and rattles and everyone changes places, then finds a new spot.  Continue.

Think of this blog, as an electronic Ninja Nursing Handbook, basically Psych 101 for the real world on The Unit.  Funny how everyone says when they are close to graduating nursing school,  “I can’t wait to get out of here and into the real world.” I can’t imagine anything more real than a Secure Psychiatric Unit.   I’m sure Doctor Guzman has something clever to say about that.   He’s the guy supervising me, who I taught everything he knows.   So starting out.   How does one enter a locked Unit?
Carefully, like a birdwatcher.  You have to keep yourself intact and quiet, so you don’t draw attention to yourself, kind of like if you were feeding birds, and there was a cat nearby. Stealth in camouflage, but not macho, camo in white.  Wait, watch listen. Listening is the most therapeutic thing you can do. There are so many kinds of silence. There is an empty bowl, a full bowl and the poets would remind you there are 100 terms for silence, but in psych on a locked unit, you should read or sense the Unit, its mood, its emotional weather. Every culture has a story about the farmer plowing his fields when comes to a pile rocks.  He wants to go around but that’s where the treasure is.

The new nurse enters The Unit, with a delicacy and sensitivity.  I watched, I waited. 
First I checked my own affect and mood. Diagnostic gold is figuring out how those around you are affecting you. I listened, not straining, but carefully to what was being said.  What did the silences say?  Freud, yes him, a current to be resisted but a current nonetheless,  “Never mind what the mouth speaks, what is the right hand tapping out?”  Here is the beauty of the milieu: you get to watch and live intensely, since we are all of us somebody’s patient sooner or later.  We get to learn from the most extreme, we at our most passionately human. Passion means to suffer.  Pathology, the thing we study, is passion.  So we first wait and watch and then we recognize each other for who we are and who we might become.   The same old shrink taught me that good therapists teach patients that they are done with therapy.   They never needed them in the first place.   But in the  back wards, reason is often in limited supply.   We do not want to succumb to backwardness, we have to offer hope, but not idiotic political hope like turning cancer into ice cream, but a quiet sane hope that with consistency, and reason, and gentle realistic expectations things might get a little better by the end of the moment, by the minute, the hour, the shift and tomorrow and tomorrow and tomorrow.