Saturday, June 27, 2009

Some of what happened in the hospital - welcome to the NHS detox...

I had intended to keep notes or a diary while I was in hospital for 16 days - hoping to make it the basis of a saleable article. I managed a day. There was plenty going on inside unruly Mr Brain and it soon became apparent that I was going to feel disloyal to my fellow patients in so doing - I'll still try and write something but it's obviously going to have to be heavily disguised; there's enough material for a damn good TV drama but I feel guilty about the very concept of using others and their troubles as 'material'. Hey ho.

Here's the short of it though and I hope it will be reassuring to those who are preparing for an inpatient detox, because I found the experience rewarding and strengthening. Partly, the enhancement to my confidence came from dealing with my fear of people: an NHS detox ward is a mixed bag and there are moods and tantrums and people who've been in prison and unpredictable behaviour and conflict, all things which set my fear antenna twitching like Herbert Lom in the Pink Panther series.

This was my fourth detox but my first one inside and my first one in Wales. My previous community detoxes have been fairly free and easy affairs - a substance misuse worker pops round and doles out your diminishing daily dose of sedatives, Lithium where I've been.

Inside every thing is more clinical and more serious. A full physical examination to start with, which to my delight led to an immediate referral to the dermatology department and a regular and adequate supply of treatments for my eczema. I've been asking my GP for such a referral for months only to be told, "It's not bad enough." In my semi-full time intoxicated state and with my confidence at rock bottom until pint four I was loath to disrobe to show the full extent of my problem and speaking up for my views was beyond me - I suffered in sullen silence.

Then there's a contract to sign. Extensive and admonishing. Don't form relationships with other patients; you are advised not to exchange phone numbers; inappropriate behaviour will lead to expulsion; you must not enter other patients' rooms; you must stay on the ward for three full days before you are allowed out; if you go out you must tell staff where you are going and when you will be back and you must be back then (one patient failed this clause and the police were informed; more in concern for his safety than anything else I like to think).

My bags were logged and searched and toiletries and medication removed to the staff office to be doled out when applied for. It didn't help my nerves that I was earnestly told to keep my mobile phone and cash on me at all times for fear of thievery.

The withdrawal medication here was Valium (diazepam to its mother) and it was available only on completion of a questionnaire of symptoms; score enough you get a swig of strawberry swoozy juice. Antabuse tablets are dissolved too to stop patients stashing tablets under their tongues. The upshot is instead of a five day swoon I'm off the stuff in two. Another patient advised licking of hands to simulate the sweats that get one point and other symptoms are are easy enough to lay claim to - headache, sensitivity to light and noise, anxiousness.

There are also six super vitamin jabs, administered with varying degrees of sensitivity to the buttocks during the first three days.

The days are routine and easy. Breakfast at 8am; medication at 9am; lunch at noon followed by more meds (we all soon fall into the jargon); dinner at 5pm followed by, guess what, more tablets; sandwiches come at around 8pm and the final doses at 10pm. Telly off and in your rooms by midnight during the week and 1am on Friday and Saturday.

There's a TV ban during the day to encourage patients to go to the Therapeutic Day Programme (TDP) which is the main purpose of the stay in the eyes of our hosts. But there's a pool table, a small library of books, visitors from 2-5pm and 6-8pm and a permanently filled smoking room. This little privilege has it's own rules, designed to render it as unattractive as possible - windows open at all times, air con on at all times, no chairs (a patient told me these had to be removed after two patients recently used one to bar the door while they fought inside, but the rule was in place when I attended the TDP as an outpatients), no cups. The kitchen is open to us and there's always something to eat - bread, salads and leftovers in the fridge and endless, endless cups of tea and coffee made all the easier with the super hot water tank that means you don't even have to boil a kettle.

The rooms are small but comfortable: a sink, a wardrobe, a three drawer desk unit, a reclining medical bed.

It's a closed and consequently gossipy world. Some patients (close to a majority I think) were returnees and know each other from previous stays or from the small South Waleian world and villagey Cardiff. There's bitching and moaning about the staff and the treatment - principally about the non-administration of more diazepam or codeine painkillers. We all get on pretty well though, people with only one thing in common really, addiction, but there's only the odd contretemps.

Once you're well enough, the TDP beckons. I've attended before as an outpatient but didn't take much from it, this time it's a far more beneficial programme - I know the others so don't fear them or want to make a particular impression and although I was still among the quietest in the group I chipped in when I could.

During my stay, we lose three patients before their official discharges. The first is the most upsetting. A patient who has a history with the ward and is often unhappy with his treatment - complaining of being messed around in unspecified ways - walks off one morning. There's gossip about them while they're away with rumours of violence when drunk. Hours later they return unnoticed by the staff and drunk as hell. I meet them in the smoking room, unprepared, and am given an overly enthusiastic handshake and bearhug. I'm not sure why, but a no-grassing rule seems to have a hold and he's not simply reported to the staff. I retreat to my room, shaken by the invasion of a loud drunk man and hear him laughing and shouting up and down the corridors. I'm later told their behaviour got worse, bordering on the threatening and cracking cans of Stella in front of the rest of the patients in the TV room. Finally the staff spot the incursion and I'm told they leave quietly enough.

The second leaves just a day early. They fall asleep in the TV room after dinner, snoring loudly and simply cannot be woken by staff, who grown concerned and the suggestion is made that they may be 'over medicated', knowing what I know this is far from unlikely. The staff search the patient's room and find nothing; though I'm told later by another patient that this is because they aren't looking in the right place. Outraged, the patient orders a taxi home, a doctor arrives to formalise the discharge and they're away, happy enough I think.

The final patient to leave is another involuntary discharge and it happens while I am an outpatient on the TDP after leaving the ward. They were on the programme with me and I'd known them inside. Not an alcoholic (most of us are, I only encounter three drug users; two methadone and one amphetamine) but a meth addict. I'd got on very well with them but God they loved to speak, and I know they'd got a few people's backs up in a minor sort of way. One day I come in for the programme and am told something kicked off the night before - a row over noise or talking or something that comes close enough to a fight for the methadone addict - who I'd seen going through terrible physical withdrawals and maintaining a really positive attitude to their new drug-free life - to be asked to leave in the morning.

I've written about the TDP before. I can't remember the full programme but I learned a hell of a lot more this time. They call it a relapse prevention programme and it's really a short sharp self help course - anger management, conflict resolution, spotting psychological traps and dangerous situations, relaxation techniques' a support group including former patients. Art therapy too, which accounts for my lovely collection of tiles with marks on them and a not-too-bad Easter Island head sort of thing.

I also get a referral to the gym and get a real boost out of my short iron pump. I'm told I can meet a physiotherapist on the outside but am yet to hear anything. If nothing comes through soon I'll use the GP referral scheme - that's the plan at least.

I could go on for hours but that's a potted version.

If you spent it, thank you for your time.


Anonymous said...

I really enjoyed reading this :)
I feel well informed. Personally, I'm surprised about the mention of a smoking room because I thought all our hospitals around here were no smoking. I got told off when I was having a fag outside the Heath.

Glad to hear you're still going strong :)


The Drinker said...

Hey Ana, hope yer feeling OK.

I think it's allowed because patients are essentially locked on the ward for three days and the staff recognise that trying to come off booze and/or drugs is quite enough on its own. It is under threat however as the NHS should be smoke free (I smoke but I quite understand the reasoning of course).