Cognitive Dissonance

As a young nurse, in 1978, I went to the University of Alabama to pursue a pre-medical degree. With a demanding financial situation, I had to work part time. I found work immediately. I had applied to a hospital I will not name. I was seeking work as a medication nurse, and after my interview with the director of nursing and a metric exam, I was hired, part time.

In that part of Alabama there are two major mental institutions ran by the state. The hospital where I was employed was not necessarily a mental hospital, but rather a hospital for physically ill mental patients; so, it was a mental hospital full of physically sick mental patients. I was rather naive, and training began immediately. The patients had to get their psychological meds and their physical meds, so I was taught to use a mortal a pestle to grind medication, put it in a 50cc syringe, mix it with a juice, and forceably administer the medication to a restrained patient. This was not always the case, but it went against every moral and human decree I had ever been taught; in private life and as a nurse.

There were two medication nurses and I had the west wing which consisted of roughly 25 patients. I was used to giving meds to 60 or more, so naturally, I thought this would be easy.

As I began my rounds, I came upon a very pleasant older man who shook my hand and introduced himself. He was a war veteran and was quite adept at telling entertaining war stories. I prepared his medications in a med cup and he swallowed them with a little water. "This is gravy, I thought".

I went on down the hall, and had some difficulties, but nothing major...until I came upon a little old lady in "B" bed in a semi-private room. She was holding a black pocket book tightly to her bosom and her eyes were darting around the room. I introduced myself, but got no response from the lady, so I prepared her medicine in a med cup and opened a container of apple juice. I would give her her meds and be on my way, very much ahead of schedule. No such luck. I told her it was time for her medication and reached for the pocket book. "Don't touch that ever! That will make you sick!' I took a few steps backward to regroup and tried to get her pills in her mouth. She promptly stood on the bed, bouncing...holding the pocket book and screaming, " I've got to s**t!" She jumped from the bed and headed straight for the bathroom, not closing the door. She did indeed need to relieve herself. I pressed the call button and got a nurses aid in the room to help me. Once she got the lady cleaned up, I ground her meds with the mortar and pestle and mixed them with apple juice in a 50cc syringe. The nurses aide helped me administer the meds orally. She needed both her psychotropic drugs and he other meds for severe bronchitis. I hated to give them this way, but it was necessary.

My next patient was Cecil. He had an I. Q. equivalent to a six-year-old. He also was one of the 7 or 8 patients who had active tuberculosis. Cecil did not cover his mouth when he coughed, and as far as his meds...I had to bribe him to get him to take them. The way we bribed him was to let him call his mother for 15 minutes. He was happy then, even though his mother did not want him to call her and made us painfully aware of that fact.

(I'm not covering all the patients, just for the record). My next patient was a very nice man. I prepared his meds and sat down by his bed. We began a conversation in which he told me he was just an alcoholic and wouldn't give me as much trouble as the others. He then promptly blew his nose on his top sheet. His roommate thought he was an Admiral, and would drink water constantly. We had to keep the water pitcher away from him. It was borderline comical to watch him completely empty a pitcher in constant gulps from an overfilled glass; then beg for more. He had to be addressed as Admiral as well or he became extremely agitated.

I met another nice gentleman who was on his way outside with the occupational therapist for a patient football game. He took his meds right away, with no problem, and went outside.That was the end of my first day. Not so bad. I will skip a few months and get to the rough stuff, now.

I went in one afternoon and prepared my med cart. In the room with the gentleman that told me the war stories and had been so very kind, I was shocked. He was strapped to a straight chair, and fighting like mad. The nurses aide said she would help me give his meds, but they would have to be ground into a powder. Mortar and pestle and a 50cc syringe in hand, I prepared his meds. While I was doing this, he looked me square in the eye and said, "I hope you die tonight and go straight to hell!" I can't put into words the feeling of what I heard from him. It wasn't human...it just wasn't. I wanted to run. The demeanor of the mental patients could change so rapidly and severely, it was like demonic possession.
His friendliness had obviously dissipated. I gave him the meds with much difficulty. He held most of the solution in his mouth and spat it directly on me. I tell you, I was disturbed by what happened. I don't know how much medication he got, so I checked with the charge nurse and she agreed we need not give him more since his meds were so potent.

I went back out to my cart and someone walked up behind me and coughed multiple times across my right shoulder. It was Cecil. I led him to his room and an aide strapped him to his bed. There would be no bargaining tonight. Evidently he had been behaving badly all day.

I had the usual difficulty with the lady and the black purse with the exception of the bathroom incident. I heard the charge nurses talking in the hall. We had a new admission coming in. An emaciated young teen that required a crib. They brought him in and put him in a room at the end of my hall. Then they left him.

I had to force medication down Cecil, and I heard a terrible whine coming from the room of the new admission. I was the only person at the end of the hall; everyone else was at the nurses station. I looked in the room, and this poor guy was naked and teetering on top of the railing on one side of the crib. He was a teenager, but couldn't have weighed over 70 pounds. He was about to fall. I didn't know what was wrong with him physically as he really hadn't been formally admitted. I was screaming for help when I got him over the rail of the crib. He couldn't walk, so I had to put my hands around his waist. He began defecating with diarrhea consistency, and throwing up on me. Finally, after much yelling, one of the nurses was kind enough to do her job.

That night, I called my mother from the phone in the hall and told her I was probably going to come home. I would try another day. The next day, the gentleman that went outside to play football looked at me with that pure evil in his eyes of cold blue. He had nothing to say, but muttered under his breath. I pulled some information from a thick chart where he had been institutionalized for a long while. He had killed his wife and her boyfriend with a butcher knife.

The next day, I went home.