What to Expect When You're Depressed - HOSPITALS - PART 2: The stay

HOSPITALS PART 2: The Stay

My first stay in the hospital was terrifying. The ominous sound of the heavy reinforced door closing behind me and bolting shut, seemed permanent.. There was definitely no escape. Without my clothes, with out my freedom, I have never felt so lost and empty. Once my custody was signed off to the One West nurse, I was taken to a small conference room and asked a bunch of questions that I don't remember. By this time it was quite late at night and I was exhausted and defeated. That first day finally ended when the nurse showed me to my bed. My new roommate said “Hello.” then immediately handed me a set of earplugs and announced I was going to need them. I quickly learned the other man in our small room snored like a bear

A new routine

After a pretty much sleepless night, I woke up to what seemed like chaos. I was overwhelmed by a noisy crowd of patients gathering for breakfast. You see, in the psyche ward (One West) there was no food service in your room. You had to eat at specific mealtimes along with everyone else. Luckily (or unluckily) my room was close to the dining hall. I must have had a bewildered look on my face as I was immediately told to find a tray with my name on it. Those who had been inside for a while picked up their trays and moved together with their friends. The rest of us sat wherever our trays lay and ate in silence.

At that first breakfast, I discovered there was a patient hierarchy. Not everyone was wearing an ill-fitting hospital gown. If you made your bed, clearing your dinner tray and behaved safely, you soon got your clothes back. After another couple of days, you could get 15 minute breaks off the unit but only if you answered the nurses' and pdocs' questions correctly. And so with these incentives in mind, I diligently worked to get my freedom back. Getting better had nothing to do with the equation. I just wanted to get out. If making my bed helped then so be it.

The importance of food

I also discovered that the longer you were on the inside the more you understood the importance of food. First of all it was a good way to kill time. I learned to eat slowly. There was no reason to rush. There was literally nothing better to do. As soon as we finished one meal, we starting counting down to the next.

Secondly, there was a group mentality to save any extra food. You were not suppose to trade or save food but it was a spirited activity at the end of every meal as crackers or pudding, or the full meals of those who have been discharged were traded or saved in the communal fridge. The only food officially available between mealtimes was what wasn't eaten on the other hospital floors. This was kept under lock and key and only available by request. It was therefore not convenient while that which was hoarded could be accessed at anytime.

It is not that extra food was disallowed. If you had out privileges you could use your 15 minutes to hit the hospital Tim Hortons or if you had someone on the outside they could bring in food as long as it was not in a plastic bag or containing something sharp (i.e. something that could be used to harm yourself. ). I think the popularity of food hoarding and bartering gave patients a sense of control in an environment where none of us had authority. 

Boredom is your greatest enemy

The ward itself was a relatively confined space and so boredom and rumination were my greatest enemies. Electronics were not allowed nor was there any computer access. I was stuck with old magazines and newspapers, adult colouring books, scrapes of blank paper and mini-golf sized pencils (which were deemed less dangerous than full-sized pencils). There were also some old board games and a half deck of cards. I was the only one who saw the irony in playing solitaire with half a deck in a psyche ward. I guess humour is the first casualty of confinement.

To help pass the time, I asked my wife to bring me a novel and a pad of graph paper so I could draw mazes. The more complicated they were the more hours they killed. This one took 5 hours.

Once a day, except on weekends, there was a special group session put on by the ward. These included yoga, mindfulness, water colour painting or journaling. I tried them all to combat boredom. I never considered any of them as a means to getting better.

I should add, there was one TV with a DVD player which was inevitably tuned to something I was not really interested in, such as the original TV series, The Prisoner. (Another irony?) There was also the original Wii gaming system which tended to be dominated by the younger patients. Mind you, I did get in a few games when my son came to visit.

With little else to do, I ended up talking to people. This was a monumental step for me in that I prefer to keep to myself. The “elders” however advised me to be social. Staying in your room, in your bed will never get you out of here. And so I heeded their advice and actually enjoyed some of the conversations. I found that the new arrivals focused on how unfair it was that they had been admitted while those that had been there a day or two were happy to engage in a wider range of topics.

Us vs them
There was very much an “us vs. them” mentality in One West with the psychiatrists and the nurses being the “them.” This actually helped to break the ice with other patients. The One West “elders” were more than happy to share their knowledge. They pointed out the surveillance cameras which were everywhere but the washrooms. They also provided insights into why certain questions were asked and why specific routines were implemented. Our common goal was to get out of One West.

While I complain about the boredom, I definitely preferred it to high drama. Whenever a patient was physically threatening himself or others, a “Code White” was declared over the hospital PA system and security guards were quick to arrive. I never actually saw a code white - we were generally sent to our rooms when one was called - but I did hear them. "Code White One West, Code White One West. Code White One West" (Always repeated three times.) in a calm and measured tone. Then once the crisis was over and the patient was restrained (and drugged, if necessary) the all clear was given. On one such occasion I learned Code White etiquette. I overheard two security guards talking about how much they prefer subduing patients who were punching as opposed to those who scratched and spit. I made a mental note just in case I ever found myself in a Code White situation.

Good behaviour.
Surprisingly, it only took a few days for me to get used to my new norm. I was over my bewilderment and fear and was now actively scheming to get my freedom back. One of the One West “elders” had taken me aside and told me the keys to escape. He advised me to focused all my efforts on looking calm and sane. He told me to make my bed, clear my meal trays, take my meds without complaint and stay out of trouble (ie. No Code Whites) . Finally I had to make sure I answered the sanity questions from the nurses and pdocs without crying, shouting or showing any other signs of agitation. The questions with their appropriate responses were :‘Do you hear any voices other than mine?’ No. ‘Do you have any suicidal thoughts?’ No. ‘Do you want to harm yourself?’ No. ‘Do you feel safe?’ Yes.

And so after a week or so of good behaviour, I was discharged. Is this how I learned to manage my mental illness? No. But it was how I got out of One West the first and second time I was there. My second trip to the hospital, when the police escorted me was basically the same as the first time except I didn't need anytime to acclimatize myself. I was on my best behaviour right way and had my street clothes within two days. I was out within the week,.

Psychiatric Ward vs Psychiatric Hospital

My third trip to the hospital was split between two weeks in One West, then another 6 weeks at a psychiatric hospital. What difference! The psychiatric hospital was a much more relaxed and compassionate environment. When I arrived I was assigned a private room with its own toilet and shower. I was allowed to keep my clothes, my mobile, and my dignity. They even gave me the WiFi password.

Unlike One West, which treated every type of psychiatric illness, the hospital had a ward just for depression. It was quiet and reflective space. There was no feeling of “us vs. them.” There was no incentive to get out as quickly as possible. In fact they told me up front the exact day I would be discharged. I would be there for six weeks exactly. There were no “get out of jail free” questions here. I was there to get better.

Boredom and rumination were not an issue. There were lots of activities to do including walking in the mood garden, exercising on gym equipment, accessing a full gymnasium to shoot some hoops, yoga, art therapy, small group discussions on coping strategies, relaxation, mindfulness, community outings (e.g. bowling), three different TV lounges, pool tables/table tennis and computers with Internet access. Moreover, there was 24 hour access to snacks and coffee. After dinner there was no bartering for food or hoarding it in rooms. Everyone just got up and left.

I recognize that it's not practical for a psychiatric ward to have all these amenities and so drawing a comparison between a ward and a hospital is not really fair. I know the staff at One West did their best with the resources they had, but perhaps there are some ways they could improve.

When I was finally discharged from the psychiatric hospital, I walked out with confidence. My medications were working well with minor side effects. As aftercare I was set up with a number of appointments. I saw my pdoc within the week and was referred to a Cognitive Behavioural Therapy (CBT) class. I felt a good foundation had been laid for me to build my recovery on. Don't get me wrong, I was not cured but at least I was able to successfully challenge some of my distorted thinking. 

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