I sigh the tension out of me, deflating like a balloon. I'm tired - so tired - and my wrists hurt and my ankles hurt and my butt hurts where they stuck me twice. I just want to wrap myself head-to-toe in a big, fluffy blanket and hide alone with my body heat, my blood, and my heartbeat. I want to be left there, undisturbed - don't come knocking until the last traces of winter melt away. I want to stop hurting, I want my mom to accept me, I want to go somewhere that feels like home. I want Daniel to be okay. Lying there with one arm tied above my head and the other strapped next to my side, my tears drying like paint in layers on my skin, I realize that I'm too needy, I want too much. No matter what happens, I'll always find away to make it complicated. Maybe that's what it means to have a mental illness.
I sniff and nod. "I-I'll calm d-down," I promise.
A silent code of eyebrow raises and skeptical lip-chewing circulates among the staff. Some of them move away to make room for a new figure breaking out of the dark, colorless background. The person wavers just inside my line of vision. "How is she?" comes a wary voice.
My stomach flops over.
It's Dr. Fox, edging in, craning his neck to study me. He rubs his chin and frowns, as if I'm a difficult math problem that's taking him a while to solve. He doesn't appear to be as upset as I imagined, but his shoulders sag.
My throat closes in shame. "I'm sorry," I mouth, unable to look away. I wonder what kind of equation he sees in my eyes.
He nods, glasses catching the cold light. "I know," he says softly. Rubbing his hands together, he turns to Jenny. "She's okay," he tells her. "You can discontinue the restraints. She's exhausted; let her go to her room and sleep."
"I'm exhausted; let me go to sleep," Evan mutters under his breath.
I go completely limp. Hands reach out again, keys jingle. The soft sound of leather licking through metal precedes the release of my right ankle. I wiggle my toes; they're still there. A warm, gloved hand rests on my shin in case I decide to kick anyone in the face.
After a momentary and breathless pause, Evan reaches for my left hand, unlocks the metal buckle with the mysterious, minuscule silver key, and delicately slips my wrist out of the cuff. He puts some pressure on my upper arm as a subtle reminder that I'm the animal and he's in control.
The process is repeated with my left ankle, and then finally, my dominant right arm. I don't move. I don't make a sound. I don't even twitch.
Staff grab me under my arms and pull me up off the bed. The bare mattress makes a sucking noise as it tries to take me back. I blink several times, attempting to figure out where my feet are and what they're doing. My skin feels like stretched rubber. I'm drenched in cold sweat, my clothes clinging tightly to my back. The sticky memory of my body leaves a foggy outline on the mattress. It evaporates into the chilled air, leaving no trace that this ever happened.
"Come on, let's get you to your room," says Dr. Fox. My limp ragdoll self is half-dragged, half-led into the swaying hallway. The drugs they gave me trickle into the cells and crevices of my brain, gently rocking my thoughts to sleep. My legs feel like spaghetti.
The corridor spirals on and on, walls moving in and then away again as the hospital chokes on this clump of people pulling at me, taking me to my room, to storage. I feel sore and weak and sick like I did the morning after I survived the car accident my mom and I had last fall, but this is worse. Much worse.
This time, my mind aches, too. The memories of the last few minutes sink their spines into my brain and I cry with big, shuddering breaths. My breathing is jagged like ocean waves breaking on rocks. The staff members' soft, soft hands keep me steady; hips bump me into my room. I drop on my bed like a stone. They cover me with a cool sheet, then a blanket. What they did makes me want to hate them, but they're so sad for me - Dr. Fox just told them what happened, why I exploded. Jenny and a couple of others linger at the edge of my room until I fall asleep.
--
Clinical Notes:
Pt seen in session with LCSW Meredith Loughner and pt's mother Aubrey Russo present. Pt was informed that her close friend was involved in an MVA and is not expected to survive. The young man is in a coma with significant head injuries and has been placed on life support following prolonged attempts at resuscitation. Upon hearing the news, pt became extremely upset, and despite our efforts to comfort her, she was tearful, screaming, not directable, and even pushed objects on top of my desk to the floor. She then ran from my office and tried to elope from the unit.
Shiloh was given an IM of Haldol 5mL, Ativan 2mL, and Benadryl 50mL with minimal initial effect. She still demonstrated harmful behaviors with aggression towards self and others despite firm limit-setting and comfort measures. Pt was immediately taken to seclusion and placed in four-point restraints as ordered.
I saw the pt face-to-face while she was in restraints. She demonstrated enough self-control to be released shortly after the restraints were applied. The medication helped to calm the pt at that point and she was escorted to her room by staff.
Pt was seen at bedside. She is currently sedated and asleep. We will have to increase her level of observation due to destructive and unpredictable behavior. At this time, her condition is not stable and her prognosis is poor, as this is an extremely traumatic event for her. ELOS cannot be determined until I can further evaluate the pt.
ORDERS:
Haldol 5mL, IM, q6 hrs PRN agitation/anxiety
Ativan 2mL, IM, q6 hrs PRN agitation/anxiety
Benadryl 50mL, IM, q6 hrs PRN agitation/anxiety
Violent Restraint: Initiate 16:40 hrs
Right Upper Extremity: Keyed Leather
Left Upper Extremity: Keyed Leather
Right Lower Extremity: Keyed Leather
Left Lower Extremity: Keyed Leather
--
Violent Restraint: Discontinue 16:47 hrs
Restraint Debriefing: Yes
Pt Demonstrates Understanding: Yes
Increase level of observation to continuous camera monitoring while pt is alone in room
Continue 15 min in-person checks
Increase Zoloft to 250mg, 1 tablet PO qDaily
Add Abilify 5mg, 1 tablet PO qHS
Continue plan of care
--
YOU ARE READING
Freedom of Sketch
Teen Fiction-Completed- After seventeen-year-old artist Shiloh Mackenzie is accused of assaulting her classmate and setting her school on fire, her dark and graphic portfolio catches the principal's attention. Suspended pending a psychiatric evaluation, Shiloh...
