Inpatient Treatment

The Routine- Life as a psychiatric inpatient

(Apologies in advance for this jumbled nonsensical blog post)

I had no idea what to expect when I first arrived on the ward. I remember that Katy Perry was on the radio, that the patients sat round tables and sofas, reading or chatting, hands tucked around a plastic mug of tea. I remember that I didn’t believe I’d really be staying, that after the assessment the doctor would allow me to go home, that the whole thing would have been a big misunderstanding, that he’d understand when I told him I didn’t really need to be there. And I remember being shown to my room and going through my things with a nurse and sitting at the edge of my bed when she left and starting to cry. What now?

I stayed in my room a lot those first few days, from time to time being coaxed out by a nurse, told to join in playing cards, to talk to the other patients, to have something to eat. I still couldn’t believe where I was, that this was actually happening to me. I was admitted on a Saturday, and by the time Monday rolled round I was starting to find my feet, to learn the routine. The Routine, I soon realised, was what my inpatient experience would be centered on.

The days meltmeltmelt into one. Being an inpatient is strange; time seems to slow down, speed up, cease to exist- all at once. I remember feeling the days drag, while simultaneously wondering where they went, or if they’d even really happened at all.

After a week I found myself living for the routine, slipping into it easily; it punctuated the days, became the sole indicator that I was, in fact, still alive.

The day started at 7.45am with changeover; the night shift would walk the day shift through the dorms, pulling back our curtained cubicles, a chirpy ‘morning Alice!’ rousing me from sleep, unless of course, the raucous laugher coming from the nurses station as staff arrived had not woken me first. Most patients got up after changeover for breakfast at 8.30am. If you were like me, you were dragged from bed somewhere between 9-9.15 for morning meds, slouching half asleep against the doorframe of the treatment room. If you were me, depending who was on, the nurses occasionally brought my meds to me if I hadn’t surfaced by 9.30am. Morning medication was met with either a bright ‘hello poppet’ or a stern ‘close the door’ for a lecture, depending on whether or not there had been any incidents the night before.

After meds, again, depending who was on, you’d either crawl back into bed, or (as happened me more than once) be quite literally yanked out of bed, the dorm locked behind you, and frogmarched to the bathroom. It wasn’t unusual to find a 3, 4 person queue outside the two bathrooms. Or to find slugs in the shower. Or faeces on the floor. Or to have the door unlocked while you were brushing your teeth/on the loo/in the shower. Or to open the door on someone else.

10am is morning tea and ginger nut biscuits. Depending on the ward, you may drink from red plastic mugs. There is a bottle of squash and plastic cups on the windowsill.

If it is Tuesday, Wednesday or Friday, there is Occupational Therapy if the doctor deems you safe enough to attend. Obs depending. (There are two levels of observations- close obs (every 10 minutes) and general obs (every hour). On close obs the nurses will open your curtains and check under your blanket and tell you to keep your curtains open and your upper body visible. If you are me, the nurses will get tired of coming in every ten minutes and finding the curtains redrawn and the blanket back over your head.) Occupational therapy usually involves drawing pictures, painting flower pots and doing crossword puzzles. Sometimes it involves meditation. Occasionally, you’ll get a 1-1 session, where you are allowed to do something that will challenge your own anxieties. If it is Monday or Thursday, you will anxiously pace the narrow strip of back garden while waiting for the doctor to call you in. If it’s the weekend and you are not on leave, a nurse might take you for a walk, or the young health care assistant will blow dry your hair or paint your nails.

Lunch is at 12 noon. Midday meds at 12.30. Visiting hours from 1-2pm, or if you’re lucky, leave (usually escorted). Tea at 2pm. OT 2.30-4.30pm. Dinner 5pm. Evening meds at 6pm. Visitors from 7pm-8.30pm, or, if the nurses are nice and you are ‘having fun’ with your visitors, they might be allowed to stay until 9, or as on one occasion, until 9.30pm. Showers to be had before 9pm. Tea at 9.15pm. Or 8.45pm if Big Brother/I’m a Celebrity/other reality TV show is on. Night meds at 10pm. Patients get angsty if any of these things do not happen at their scheduled times.

Phones are handed in to be charged, initials and a tick under ‘phones in’, scribbled on a page. Tumble dried clothes retrieved from the machine, draped around the shoulders of anyone who is having a bad night- a comfort blanket of sorts. Bed around 10.30pm . If you are one of two young people on the ward, you will stay up and watch Family Guy and be woken up during American Dad after falling asleep on the sofa. In bed, you will lie awake listening to the snores of your dorm mates, an argument between a patient and a nurse, or wake startled every 10 minutes as the nurses pull back your curtains (which you’ll soon realise are best left slightly open) to shine the torch in your eyes.

The days then, are separated into nice manageable chunks, the time in between spent pacing the garden, or sunbathing on scratchy hospital issue towels on the narrow strip of grass, or chain-smoking (the ward sister being a smoker means the trusts ‘no smoking’ policy gets paid little heed), or watching day time TV, or routinely checking the laundry room for an empty machine (if you are me, you will leave your wet clothes in the machine at night and by morning the nurses will have dried and folded them for you), or sleeping, or listening to Dolly Parton, or sitting stiffly watching the doors of the ward open and close. The Routine becomes all you know, a strange sort of comfort. Soon, you begin to look forward to mundane things like medication or tea time, the ritual of three ginger nut biscuits in the morning and butter drenched pancakes at night, of Family Guy at 11pm. Mostly, because there is nothing else to do. Or for that matter, to look forward to.

So you begin to function within a framework, your day planned around a few set times. You simply just fill in the blanks. It is order and control amongst the chaos of your mind, and it is soothing, makes the days less long and empty and scary, knowing there are little goalposts to reach throughout the day. I clutch to these goalposts during my first few weeks, I use them to deflect from why I am really there. My purpose each day becomes reaching the end of it, surviving it. I imagine it like a video game- you know when, each time you reach a new level, a little message pops up and says ‘GAME 34% COMPLETE.’ It is like that.

But it is also embarrassing, humiliating frustrating, having your existence reduced to a timetable, merely watching the hands on the clock tick tick tick until it is time to complete the next basic task. But that’s the thing; you are in hospital because these basic tasks- waking up at a reasonable time, washing, dressing, taking your medication, eating, doing something other than staring at the wall, going to bed before 3, 4am all feel so damn impossible. You are in hospital because somewhere along the way, you forgot how to take care yourself. You forgot how to live. So you are there to learn again, to learn how to ‘manage your condition’, to ‘cope’.

It learning how to live, when it is something so instinctive to others. And therein lies the frustration- the routine signifies an awareness that your life has become unmanageable, that your illness has you in its grips, that now you must be retaught how to take care of yourself, much like a child.

And a week, two weeks, two months later- however long it takes, the routine stops being a comfort and becomes your prisoner. You soon realise there is nothing nothing to do, nowhere to go, nothing to think about expect where you are, and why. The Routine becomes suffocating, stifling. Everything morphs and shifts and turns inside out, upside down, and you crack, trapped in the fishbowl. Weeks of doing the same thing (or rather, the same nothing), day in, day out, coupled with all the huge expanse of empty time, forces you to think. I pour all my thoughts onto paper, hunched over my notebook in the dark, or on the bathroom floor, scribbling down every one that pops into my head, until eventually, the nurses unlock the bathroom door in the middle of the night and coax me into the office and ask me to tell them my thoughts instead.

I arrived on the ward believing I didn’t need to be there, that I wasn’t ‘ill enough’ to need to be in hospital, but in being forced to employ structure into my day, I began to realise that I couldn’t manage- wasn’t managing on the ‘outside’ the way I believed I was. And in being forced to sit and think about it all, about why I was there, I began to realise that the only way out was to talk about those things, to open up, to share some of the chaos that had made my life so unmanageable and led to my admission.

Psychiatric hospitalisation is not the welcome break some imagine it must be- in lots of ways, of course, the routine is a comfort, but in so many more it is endlessly maddening. To have to relearn the basics, to be encouraged, pushed to do the things your illness so often prevented you from doing. To lose your freedom, to be confined to a single corridor, a narrow strip of garden makes you painfully aware of all the things you have lost, are continuing to lose to your illness. To be isolated from friends, family, the semblance of the life you led on the outside is glaringly lonely. To have nothing to do or think about catapults you into the dark parts of your mind you were trying to desperately to escape. It is endlessly challenging. It feels like you have been plucked from reality and placed into a safe little bubble, but it’s not the comfort that concept seems to elicit: it is bloody hard work, it is both learning how to walk, talk again, and facing, head on, the darkest bits of your mind.

(Oh- and of course, when I am discharged I continue to abide by the routine- I have to).









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