Then and Now
Reprinted from "Seniors' Mental Health" issue of Visions Journal, 2002, No. 15, pp. 17-19
My name is Barbara Berry. I’m 56 yearsold and I’ve lived in Dawson Creek since 1982. Some of you may know me, as I am the president of CMHA BC Division. I qualify as a senior — just. You would have had a little laugh, I’m sure, at the jig I did when I received my first senior discount. At this point it is so new to me that it is amazing; later I’m sure it will be just ho-hum!
This edition of Visions is about seniors and how dealing with our mental illness changes over time. I think for many of us as we age, it’s also about dealing with both mental illness and physical illness and how that can impact the treatment of each.
When I crashed as a twenty-five year old, I was young and healthy. There was nothing wrong with me except chronic depression. In 1978, when I was thirty-two, I developed diabetes during a pregnancy which resulted in a stillbirth. As long as I ate in moderation and kept active, though, I was able to control my blood sugars. This even helped my depression.
For a long time, I was able to handle both the depression and the diabetes without medication. I did all things in moderation and was pretty darn proud of myself. Then in 1985, exercise and diet were no longer working for the diabetes and my metabolism was not responding well, so the doctor put me on insulin.
Over the next year, I became sicker and sicker with debilitating migraines. My depression worsened. I followed the diabetic diet to the letter. My mouth burned when I ate my meals, but I ate the six small meals prescribed. I was on a cocktail of pills that prevented me from taking even a decongestant.
Finally, a breakthrough came when I learned I was allergic to my insulin. I also found that I was allergic to half the foods I had been eating every two hours. Going back through my childhood with the allergy specialist, I discovered I had food sensitivities as a child. The beef-pork insulin I was given in 1985 reactivated those sensitivities, and now my bombarded system couldn’t handle it any more.
They fasted me in hospital for three weeks, followed by over a year of avoiding the foods to which I was allergic, and then slowly reintroducing them. They were able to withdraw me from insulin for a few years, but my whole metabolism had been totally upset. We’re still dealing with that.
Research has shown the impact of allergies on the brain. Even though I was able to maintain a good grade point average at university, in 1989 I couldn’t read, comprehend and retain a single page of the text book for my marketing course at the local college. My depression was severe: I couldn’t sleep, and I was overwhelmed with indecision and insecurity about my work. My mood swings were affecting my employees and my family: melt down!
We’ve looked at how the onset and progression of my physical illness of diabetes adversely affected my depression and its treatment. Now, I’d like to look at how the hospitalizations which treated both each time, differed.
In the spring of 1989, my family doctor put me on Three East, the medical ward in Dawson Creek, for a three-week fast to clear my body of the allergens that had slowly been killing it. Because my metabolism had been so badly affected, the doctor also put me on twicedaily physiotherapy. My depression was bad, and I couldn’t sleep and was jumpy, so he had the psychiatric nurses teach me relaxation techniques.
Most importantly, he had what I dubbed the “A Team” help me. The “A Team” consisted of the diabetic nurse educator, the psychiatric social worker (counsellor) and the dietitian. They met with me separately, and using their individual expertise helped me regain my confidence and learn new skills in coping with both the depression and diabetes — especially with the feeling of failure.
The nurse’s station was an open station with a counter where you could lean and talk to the nurses. If they were busy, they would hurry you along, but for the most part, the nurses would find time to visit you in your room, especially the night staff, who gave me back rubs at night to help me relax and sleep. You came to look forward to those twice-daily visits with the nursing staff. Those were special, and if you had no visitors, you at least had the staff.
Both my mental and physical health began to improve. My depression improved significantly, but we also discovered how responsive it was to the allergens. About a month after leaving the hospital, I began taking multi-vitamins to boost my immune system and subsequently began to feel poorly. It took us three weeks, but we discovered the culprit was a fish oil in the vitamins, and I am allergic to fish.
I continued weekly counselling sessions with the psychiatric social worker for about six months after my hospital stay, to help me cope with my return to work, but the treatment of my diabetes had set up a reaction which adversely affected my metabolism and my depression, and which still affects my mental health today.
Later, in the spring of 1996, I found myself in the garage, unable to turn off the car after I came home from a great evening watching a movie with a girlfriend. Suddenly, I didn’t want to live any more. It seemed easier to simply “go to sleep” while listening to Brooks and Dunne on the tape deck. After about ten minutes, I was able to force myself to turn off the car, go into the house and call my girlfriend. She made me promise to call my doctor, who referred me to our local psychiatrist. By June of that year, my fiftieth birthday, I was, for the first time in my life, on antidepressants.
I don’t know what there is about spring. That’s when I first crashed and that seems to be my pattern. When I crashed in 1989, I was on no psychiatric medications, and my family doctor put me on a medical ward. This year, since I was under psychiatric care, I was put on a psychiatric ward.
As in 1989, the depression and diabetes were intertwined. The diabetes is more advanced now. At first I was a Type II, but I am termed a Type IIa or a Type Ia, which means that my body is no longer producing insulin; so I must now take insulin shots, which I’ve been doing for quite a number of years. I also must take pills to counter my body’s resistance to insulin. So it is diet, exercise, insulin and pills that make up my regime. All four are equally important.
The symptoms that presented with this crash, as for the last, were for depression. I had been hiding in my bedroom, lying in bed unwashed for two weeks, recoiling when the phone rang or the doorbell rang, or when someone knocked on the door. Unbeknownst to my husband, I hadn’t eaten in those two weeks, nor had I taken any medication. Somewhere in my mind I must have decided I didn’t want to die, so I plucked out my eyebrows one day. When that didn’t gain my husband’s attention, the next day I shaved my head.
That gained his attention, and I went to see my psychiatrist. She put me straight into the hospital, and immediately informed my family doctor that I was on the unit and that I was showing ketones [a sign of malnourishment] — not a good thing for a diabetic.
In 1989, the psychiatric ward was Three West, a ward among other wards. The present ward is in a new wing on the ground floor, which gives it a patio with smoking privileges. While that is good for the many patients who smoke, it is separated from all the medical wings, which presents other problems.
On this ward, the nurse’s station is quite large and is glassenclosed, keeping the nurses and other staff are away from the patients. You speak to the nurses through the windows, which sets up a distance between the patients and the staff, and as a result I felt no sense that they had any genuine involvement with me. The nurses did come out of their “cage,” but it wasn’t often.
When I was initially taken to my room, the nurse immediately grabbed my bag and went through it, looking for any sharp items which were not allowed on ward. There was a brief do you mind? while the search had already begun. Scissors, etc. were confiscated, and would be returned to me when I left. Again, I didn’t feel any sense of welcome: just in for “sharps” and gone! There wasn’t any animosity, just a message of “let’s get the business done!”
Also confiscated was all my diabetic supplies and testing equipment. All of that would be done at the nursing station under their supervision. Thus began my life of being called four times a day for medications: breakfast, lunch, dinner and bedtime. We lined up and took our medications, and did testing for diabetes or other conditions on a first come-first served basis.
There were two nurses on duty each twelve-hour shift — one of whom was designated for meds. Medications are a very serious duty on a psychiatric ward, as there are some heavy-duty psychotropic drugs they have to deal with. Whatever my family doctor ordered on my chart, the psychiatric nurses stuck to rigidly. However, on a medical ward, the nurses know that if you have an insulin reaction on that dose, you can, for the next dose, drop it by two units. I had to wait until my next visit from the GP for that to happen. Some days I had as many as three reactions in a day.
During my second night there, I had an insulin reaction after “lights out.” My training is to go first to the fridge and get an orange juice; then, take my blood sugars, and after waiting ten to twenty minutes, depending on how low my blood sugars are, take some further orange juice and test my blood sugars again. I repeat this routine until my blood sugars are at an acceptable level, and finally eat a protein and a carbohydrate to stabilize my blood sugars.
I had been sleeping when the reaction woke me. I stumbled out of my bedroom on instinct and found the kitchen and a box of juice my husband had put in the fridge for just this purpose. The nurse on duty came out of her nurse’s station and scolded me severely. She sent me back to my room with strict instructions not to do this again. If I should have another reaction, I was to remain in my bed and ring for the nurse.
This dictate is, I’m sure, a ward policy made for the wellbeing of the diabetic patient. However, it would have been so much easier for me if it had been done as part of an orientation to the ward, rather than as a scolding during a reaction. But then, there had never been an orientation to the ward, except by my roommate who was not a diabetic.
It sure would have been nice to have had a little human warmth during a difficult time. I felt very alone and very determined not to have another nighttime attack!
The Diabetic Teaching Unit teaches us to have our diabetic testing equipment accessible at all times. They teach us to carry it on our person, so we don’t get it in difficulty out shopping or at work. Now I had to wait on the convenience of others who were not always available.
I entered the psychiatric ward with feelings of extreme anxiety and suicidal thoughts. When I began eating properly and taking all my meds, those thoughts disappeared. However, events on the ward, the lack of reassuring contact with the nurses, and highly elevated anxieties around my diabetes, in fact, kept me from reaching the degree of wellness I had hoped to achieve upon entering the ward.
When you enter a hospital, we all know you give up some control, no matter what ward you’re on. You give up control for the good of your health. I’ve been in and out of hospitals since I was nine months old. Hospitals and I are old friends. They, and the wonderful people who provide the care in them, have helped me overcome many illnesses and lead a happy and productive life.
Both wards — medical and psychiatric — cared for me and provided me with much needed medical care, but the difference was that the medical ward provided it in a warm atmosphere that fostered my well-being and independence. When I left, I knew I had a ways to go on my journey of recovery, but I felt I had a team behind me who thought I could succeed.
The psychiatric ward provided me with care in an atmosphere of isolation, coldness and dependence. When I left, my anxieties were still high, and I still felt inadequate to set out on my journey of recovery. I was anxious to leave because I felt I had no team behind me except my psychiatrist. Within a week I nearly committed suicide.
Then and now, when it comes to the care of my doctors, the care is equally good: warm and human, yet professional. When it comes to the care in the hospital, there was no comparison; although this may be due partly to all the critical changes to health care which have taken place in the twelve years between hospital stays.
The bottom line, however, is results. As we get older, it is especially important that our physical health concerns are looked at as part of our mental health concerns — as part of the whole picture. When I was first hospitalized, this was certainly the case, and I had the positive results to show for it. Now, all these years later, the care I received interfered with my physical health, and my recovery was that much harder.