Ward Round

Penelope, an intimidated twenty-seven-year-old woman, entered the sizable, sparce, clinical looking room which housed two long tables placed side by side longways. Sitting behind the tables were her consultant psychiatrist, a registrar and a team liaison nurse. Also on the table was a blank monitor pointed in the direction of the hot seat, the chair that was bang slap in the middle of the room in which she was indicated to sit.

Dr Richards, the consultant psychiatrist who was sitting in the middle of the tables, was a very glamorous looking woman in her forties, which for the job title she had was quite young. She was wearing a flowing black skirt, with gold speckles going through it, red high heels and a black blouse. ‘Bear with me a minute,’ she asked of Penelope as she nervously took her cloth, brown messenger bag off her shoulder and sat gingerly in the hot seat.

Dr Richards pushed her laptop away from her, sat back and pulled down her face mask. She was of the mentality that her patients were less inclined to talk to someone in a mask, which in Penelope’s case was true.

She smiled at Penelope and said her famous saying, ‘well, how are ya?’ in her thick Galway accent. The registrar and team liaison nurse both looked up and were ready to record a synopsis of the meeting.

Penelope started to cry hysterically. Dr Richards was confused; she couldn’t understand what was wrong with the young woman in front of her. The team liaison nurse, Frank, got up out of his seat and walked around the long table to offer her a box of tissues which she gladly accepted. She wiped her weeping eyes and blew her snivelling nose loudly. ‘I, I, I, I just…...’ more sobbing.

Dr Richards had been working with Penelope for seven years at that stage and knew that more often than not she had her trusty iPad in her bag with bullet points on the issues she wanted to work through in the brief Wednesday ward round. Dr Richards had never witnessed Penelope cry like this before in all the years she had known her.

‘Do you have the ‘brick’ with you?’ Dr Richards asked her, referring to Penelope’s trusty iPad in such a way that she actually drew a smile. Dr Richards called it a ‘brick’ because it was old and was encompassed by a very bulky black leather cover.

Penelope was trembling as she retrieved the ‘brick’ from her bag, opened it and put in the pin code illuminating the screen with her famous bullet points. Frank got up once again, this time fetching the bin from beside the door for the soiled tissues and placing it beside her. Penelope shakily gave him the ‘brick’.

Dr Richards who glanced at the registrar wide eyed as he shrugged his shoulders in disbelief of the state Penelope was in. Dr Richards read the bullet points aloud:

• I don’t feel safe.
• I am suicidal.
• My dad upset me.
• I slipped and self-harmed last night
  
  • Something that hasn’t happened in a year.
• I don’t want to look after my granny anymore.
  
  • I’m afraid she will die on my watch and that I’ll be blamed.
• I have to put an emotional mask on for my family because I don’t want them to see how bad I feel.

Dr Richards let the words settle in the air for a moment, the only noise coming from the registrar and Frank typing frantically, before placing the ‘brick’ onto the table. She took a deep breath, ‘we will come back to the self-harm and suicidality,’ she smiled compassionately in an exceptionally soft tone.

‘The first thing I have to say is about dad,’ Dr Richards began, ‘dad just doesn’t get mental health!’ A little laugh escaped Penelope’s mouth. ‘That is an understatement,’ she mumbled through the sobs. She blew her nose loudly once more, dropping the mucus infused tissue straight into the small black bin. She took out another handful from the box, dabbing her eyes once more. Dr Richards continued, ‘there isn’t anything really we can do about dad,’ she picked up her phone and simulated hanging it up dramatically, ‘that’s what we need to in regard to him!’ The whole room giggled. Dr Richards always had great advice. Penelope nodded in agreement.

‘The second thing I want to come to,’ Dr Richards started, ‘was your granny. How is she?’ she enquired in a caring manner. Penelope cleared her throat, ‘she has her good days and her bad ones. She fell last night and had to get five stitches in the back of her head.’ ‘Mmmm’ Dr Richards moaned in consolidarity and put her elbows on the table and her hands to her forehead. ‘That’s a big worry!’ she peeked between her hands, before she sat back once more, her arms crossed.

Penelope started to uncontrollably sob once more. ‘Mom,’ sob, ‘said,’ sob, ‘it,’ sob, ‘was,’ sob, ‘bleeding,’ sob, ‘so,’ sob, ‘badly that,’ sob. Dr Richards stopped her in her tracks. ‘Whoa, whoa, whoa, stop.’ She was looking into Penelope’s puppy dog eyes and asked, ‘where did it happen?’ All Penelope could get out was ‘Waterford.’ Dr Richards then offered her in a soothing manner, ‘there was nothing you could do there, there would have been nothing you could have done there. If she’s going to fall, she will fall, no matter who is on duty!’ ‘Yea, but….’ Penelope started and was shot down by Dr Richards gently as she asked how old Penelope’s granny was. ‘Ninety-one,’ Penelope managed to get out. She was starting to calm down. She blew her nose again and Dr Richards carried on.

‘Now,’ she spoke softly, ‘explain this emotional mask that you wrote about.’ Penelope took a deep breath in and started to explain how she felt she had to shield her emotions from her family to stop them from worrying. Her body language conveyed how uncomfortable she was, her shoulders were hunched, and she was rocking back and forth in the chair not making eye contact. Dr Richards stopped her in her tracks once more, ‘look at me,’ she smiled, awaiting Penelope to lock eyes with her. She continued, ‘you are in here for a reason, and your family know that…. right?’ She asked gently. Penelope started to cry convulsively.

‘What’s wrong?’ Dr Richards asked confused. She was worried deeply about this young woman in front of her. Once Penelope calmed down a bit, she was able to say, ‘they have enough on their plate with my granny and I feel…...’ Penelope stopped. Dr Richards encouraged her to continue. ‘…. I just feel like such a burden!’ Penelope managed before she started blubbering once more. She was visibly shaking.

‘Does this have to do with the self-harm?’ Dr Richards asked with a furrowed brow. Penelope just nodded. ‘Ok,’ Dr Richards pulled her laptop towards her again as she looked for the nurses notes on the incident.

Suddenly a face appeared on the monitor that sat on the table beside Frank. Penelope jumped out of her skin at the sight of Rebecca, the nurse who was Penelope’s key worker who was working from home. ‘Sorry,’ she gesticulated her apologies to the best of her ability.

Dr Richards could see from Penelope’s behaviour that she was extremely distressed and anxious. She reassured her that the self-harm slip was just that, a slip. ‘You are someone who has gone from inflicting injuries upon yourself daily, years ago, to now…...maybe once a year? Am I right?’ Penelope nodded and threw more soiled tissues into the bin. ‘That is progress!’ Dr Richards commended her, ‘as well as that, I think you’re being too hard on yourself!’ she looked at her laptop once more. Penelope sat there convulsing with tears.

‘Let me have a look here,’ Dr Richards thought aloud. Penelope was shocked when Dr Richards suggested increasing her medication, something she had never done on her own volition before, Penelope had always been the one to suggest it. They had gone through the gruelling ordeal of medication reduction on her previous admission. Penelope, disappointed with herself just nodded. ‘I just think you need a little increase to calm you down enough to be kind to yourself and look after yourself,’ Dr Richards smiled. The registrar and Frank nodded in agreement.

Penelope retorted between sobs, ‘but it was so,’ sob, ‘hard to come off….’ Dr Richards recognized her concern, ‘it’ll only be short-term. Only for a couple of weeks just to get you through this bad patch!’ In the smallest voice Penelope said, ‘ok.’ She felt like a failure.

Dr Richards smiled until Penelope looked up at her and handed her back her ‘brick’ over the table. Penelope got up out of the hot seat and retrieved the ‘brick’. ‘Be kind to yourself!’ Dr Richards reminded her with her eyebrows raised. Penelope knew that was the end of the consultation and returned to her room.

Dr Richards sighed once Penelope left the room through the squeaky white door in recognition of her hardship. ‘Poor girl,’ she said to herself before summoning in the next lucky contestant.

Photo from Pixabay