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Psychiatric Intensive Care Unit

I’m finally ready to write about this. You know how I’ve talked about there being an infinite amount of rock bottoms, at least in my life? During my last hospital stay, I ended up in the Psychiatric Intensive Care Unit for the first time in my twelve years of being in London Ontario’s mental health care system.

To back up for a moment, let me explain that most psychiatric hospitalizations here in London – and I assume, this is a province-wide trend – begin at a regular hospital. Victoria Hospital, now known as London Health Sciences Center (LHSC) Victoria Hospital, has a psychiatric floor that is for short-term stays. If your treatment team decides you need longer-term care, you are transfer to Regional Mental Health Care (RMHC), London’s psychiatric hospital. There are exceptions to this rule, with some patients staying at Victoria Hospital for a longer period, but mostly, this is how our system works.

So, when I was hospitalized in the spring, I spent almost a week on the regular part of the psychiatric floor before being transferred to the Psychiatric Intensive Care Unit. At Victoria Hospital’s South Street campus, the old building that is scheduled to be torn down in the near future the intensive care area was called The Acute Care Unit, or the ACU.

Now that the psychiatric floor has been transferred to the new campus at LHSC on Commissioners Road, I’d heard hospital staff referring to something they called the “Pick-U.” I’d envisioned it as some kind of baggage pick-up area like they have in airports, which made no sense but I couldn’t help thinking about airports for some reason. One day I asked an orderly what the “Pick-U” was and they explained that it was how they pronounced the PICU, the Psychiatric Intensive Care Unit.

One of these days I will tell you more about the regular part of the psychiatric floor, which is actually quite welcoming and comfortable, especially compared to the old hospital, because I know a lot of you are probably wondering about that. For today, I will warn you that the following description of the PICU is pretty scary. I’ve been hospitalized over ten times, and never experienced the PICU first-hand, so please don’t worry about your first hospitalization landing you in this part of the floor. There are only six beds there (I believe. I was in crisis and so I wasn’t exactly counting stuff like beds but it is a very small area) and it’s only used as a last resort. I was moved to the PICU because they were worried that I wasn’t safe enough on the regular floor.

When I got to the PICU, the first thing I noticed was that the floor was dark. At first I thought it was because it was approaching night-time, but it was actually because power had just gone off in the whole building. Haha! Seriously, this happened a few times during my recent hospitalization, but the power had gone out while I was on a pass (that did not go well, by the way), and I thought that the lights were just off on this part of the floor for some other reason. It was kind of cliché: it was a dark and stormy night and Erin ended up in the PICU. Dun, dun, DUN!

The second thing I noticed in the PICU was the smell. Since no windows open on the psychiatric floor, air can be a little stale but you get used to it on the regular part of the floor. In the Intensive Care Unit, the air is completely stagnant. The unit is small, no doors open without a key, and most patients aren’t in a state to regularly want showers. On top of it all, the other patients I saw in the PICU were wearing diapers, so it literally smelled like shit.

The nurses’s station in the PICU is small and surrounded by plexiglass, with the desks facing the bedrooms. It reminded me of a Panopticon prison.

The night I was transferred to the PICU was terrible, to say the least. I was walked there by two police officers, a nurse, and an orderly.  Once my room was ready I was instructed to change into hospital garb so my clothes could be locked up along with the rest of my belongings. A nurse told me my parents had called, and I could call them if I wanted. They brought me a portable phone from the nurses station. After I spoke with my parents, reality set in.

I cried so hard that I literally collapsed onto the floor. The rest of the world felt so far away. I started having severe flashbacks to my childhood when I was abused with no hope of escape. An orderly half-picked me up off the floor and ushered me into bed, while my nurse prepared a large dose of Ativan. I begged for at least one of my stuffed animals from my locker of belongings; I needed something to cling to besides myself. They gave me both the teddy bear and my Bunny as I fell into a dark and dreamless sleep. I hadn’t slept in over 48 hours.

Previous to my stay in the PICU, I had been on Constant Care, which meant a nurse or an orderly sat and watched me literally 24 hours a day.  I had never experienced Constant Care before this hospital stay either. It helped me feel a bit safer at times and at other times I felt imprisoned. This is another topic for blog post, but Constant Care continued as I stayed in the PICU. I woke after my first night in the PICU with a familiar orderly watching me. She notified my nurse that I was awake and they brought me my meds and the breakfast tray that they’d saved for me. The PICU still smelled, I had to ask to go to the bathroom, and then had to wait for a man in a diaper to get out of the ladies room. The orderly watched me pee and then ushered me back to my bed.

In the daylight, and with the lights working in the building, I could see that my room in the PICU was roughly the same size as my room on the other part of the floor. This room, however, had no furniture besides my bed and the chair that the orderly sat in. To the right of my bed was a window that stretched the span of the room, where I could see the trees of London glowing in the sunshine. The walls perpendicular to my windowed view were normal drywall, but the wall parallel to the window was made of plexiglass. Curtains with Velcro at the top and sides for easy removal clung to the glass to give me at least a little privacy. I can’t remember if my room had a door. I don’t think it did.

The two other patients I saw out of their rooms were in their sixties to seventies, babbled nonsense and paced the floor constantly. A woman with a thick accent was reminded by her nurse about three times every twenty minutes that her son wasn’t dead and that he was coming to visit later.

I stayed pretty dissociated, avoiding both eye-contact and talking with anyone unless I absolutely had to.

Without a clock or anyone coming or going except through the nurses station entrance, the hours in the PICU passed slowly. In my last room I’d had belongings that my mom had brought to me after my admission: some books, my journal, a colouring book and crayons, magazines, and comfortable clothing. I had toiletries and my shoes and all of these things together made my hospital room mine. They reinforced that I had an identity outside of the hospital. Without them, with me in the PICU I was no one. I was merely another patient, stuck and hopeless. The effect was maddening.

When I wasn’t dissociated or having flashbacks of some kind, I sat on my bed mentally beating myself up for fucking up so badly. I’d had a lot of freak outs and meltdowns during this hospital stay. I’d never felt more out of control; I’d never felt more crazy. More than once I was threatened with restraints. It had to stop. I had to control myself. I realized that my good behaviour was the only bargaining tool I had.

Up until landing in the PICU, I hadn’t cared about anything. Being in the hospital for the first time in years made me hate myself with a vengeance.  The only thing I wanted was to be dead. I hadn’t realized how comfortable I had been on the other part of the floor until I was moved to the PICU. Now, I couldn’t stand the smell, I didn’t want my family to visit in fear that they would think I was truly one-hundred-percent crazy, and I had no access to my things. I couldn’t even write in the PICU.  I felt my grip on my identity as a human being slipping rapidly from my grasp. Any longer in the PICU, I felt like I’d never ever get out. It was an almost death, this suspension from the world. And I didn’t like it one bit.  If I was going to live, I had to get back to the freer part of the floor.

I’d finally began to feel something stronger than self-hatred: a desire to survive long enough to get out of that place. To show the hospital staff that I wasn’t a crazed animal. To show myself that I was strong. To show my family that they mattered to me.  I had something to fight for, which is another way to say that I had a reason to live.

As soon as I expressed a strong desire to cooperate with my doctor and nurses, I was moved out of the PICU. I stayed on Constant Care but I started asking for what I needed. I even got my orderly to look the other way as my parents snuck Digby into my hospital room.

He seemed a little confused being at a hospital, but he was definitely glad to see me. I smiled for the first time in over a week. That is my underwear and socks at the end of my bed, and my teddy bear was out of lockup too. (Yes, I’m aware I just shared a pic of my undies online!)

I stayed in hospital for three weeks total, two under Constant Care and then one on my own. I got passes to go out and then passes overnight. Finally, I was discharged.

Two months later, I’m still nowhere near where I want to be, but I’ve stayed out of the hospital. I don’t want to go back to that place so I have to take care of myself. I am learning how. Digby keeps me grounded and small things like setting survival goals are really helping.

What are survival goals? Here are some of mine:

I’m not allowed to kill myself until:

- I get through today.

- I fill these Etsy orders and make a bunch of buttons.

- I see my friend Maranda one more time, hopefully in September or October.

- after I write my first book.

After first being discharged from the hospital, my survival goals were even smaller. I wanted to survive long enough to sleep in my own bed again. Then I wanted to survive long enough to dye my hair. My friends were moving out West in a couple of weeks and I wanted to see them off. Then I had to dog sit. One by one, day by day, these little goals added up to several weeks without attempting suicide. And now, as you can see, I’m thinking in long term steps, planning things for the next few months, and planning things for my life.

I still hate life and hate living, but I’m also getting a kick out of showing people what I can do. Showing myself what I can do. I’m going to die one day, either by suicide or natural causes, but until then, I want to push myself so I can say I gave life my best shot. All I’ve ever wanted to do is be a published writer, so I have to do that before I die. And then if/when I’m a published writer, maybe I won’t want to die because I’ll have reached one of my dreams.

I have so much to share with you and sorting out my thoughts has been difficult lately. But yeah, here’s a big post for you, sharing a bit more of my recent crisis. I’m still not feeling like myself, but I’m getting there.

What are some of your survival goals?