It’s true that kids can have mental health disorders without a trauma history. I’ve seen kids with perfect families and fabulous childhoods still suffer from mental disorders. I remember this girls mom, who happened to be a nurse, calling and asking to talk to me after her daughter had been in the facility for a few weeks. She had given up custody to the county so they could pay for her daughters treatment. I know we talked about this earlier, but that is literally one of the only ways to get residential paid for. It’s expensive and most people cannot pay out of pocket. Giving up custody of your child so they can receive proper treatment is selfless, until it turns selfish.
When she called and asked to talk to me, I wasn’t surprised. She had called many times to talk to me and ask how her daughter was doing. She had originally been coming to visit her daughter multiple times a week. This made my heart happy because like I said before, that didn’t happen to often. At the end of that phone call, I’ll never forget the tone in her mother’s voice.
Hopelessness.
This girl who happened to be only 12 when she first starting cutting herself was now 16 and in residential for the fourth time. She was bounced around from hospital to hospital, facility to facility. After each discharge she would have a suicide attempt and end up right back in another placement.
Her mom, being a nurse, understood mental health. Her dad wasn’t in the picture because he left when she was young but according to mom he was “normal.” There was no known mental health family history. No known trauma. Normal pregnancy and birth. No brain injuries. Sometimes it just happens. She was sad and when I would ask her why she would answer with an honest “I don’t know.”
There were multiple times where she would cry and ask, "what's wrong with me? Why can’t I be normal? Why isn’t my brain working right?" She had been on every medication combination possible with little success. Multiple therapies. Nothing had worked. And we do not know why.
After that phone call that night with her mom, the calls stopped coming. She stopped showing up for visits. She didn’t answer the phone when her daughter would call.
She had given up.
My first real medical emergency that I had to attend to was with this girl. She had long blonde hair and big blue eyes that were always filled with tears. She was overweight and sedentary most of the time because she was simply too sad to move. I don’t think I ever seen her smile.
The night was going like all the others, quiet. The calm before the storm. I started my evening medication pass and finished up the charting just as my walkie started to scream. I recognized the voice; a staff member who was wonderful with the kids and who to this day I think is one the greatest youth leaders I had ever met. His voice was filled with anxiety and was loud, but he was also calm. He called the medical emergency and I ran over as fast as I could to the unit. With the emergency bag on my back and another nurse running along side me, my heart was racing because I was not sure what I was about to see.
I had only been a nurse for about a year when this happened. They trained me to deal with these types of situations, while rare, they did happen and I knew that I was prepared. But in that moment so many thoughts go through your mind. Will I know what to do? Will I have to do CPR? Is this person still alive? What am I about to walk into?
I was so grateful to have another nurse there with me that night because trying to take care of her alone would have been difficult. I was out of breath when we finally arrived to the unit and my hands were shaking. The staff who had called the medical emergency was waiting at the door for us and quickly ran us into the room where she was.
I had never seen so much blood.
Let me stop there and tell you what had happened.
When you’re in residential, it takes time before you can earn privileges. The one thing I loved about working there was being able to slowly normalize life for these children, as much as could be anyway. If they could follow rules, be safe, and avoid restraints and fights for two weeks then they could slowly start earning privileges. Being able to use their hair straighteners and curling irons, wearing make-up and jewelry, going off grounds for outings to the movies and shopping. It gave them something to look forward to. It gave them something to strive for. It was motivating. It was nice for them to feel as normal as possible. As if being a teenager isn’t hard enough, throw in a little mental illness, a dash of trauma, and a sprinkle of residential lock-up and it’s almost like purposely creating a bigger problem.
I spent a lot of time advocating for normalcy for these children. Although you can only do so much, I like to think that I was helpful in doing this for these kids.
Anyway, another girl on the unit had earned the privilege of being allowed to shave her legs. We had a lot of self-harmers so it was rare that they were ever allowed to have razors. But a few here and there were safe enough to do so and therefore we let them. At first with supervision and then alone.
We all make mistakes. If you’ve never worked with a group of teenagers, then you don’t know how scatter-brained it can make you feel. It’s stressful and overwhelming and sometimes things get overlooked and forgotten. Sometimes things that shouldn’t be.
After this other girl was done shaving in the shower, she forgot to give the razor to the staff. And the staff forgot to go and get it.
So with the razor blade that was left in the shower, this poor suicidal girl used it to mutilate her body.
Hundreds of cuts. Hundreds. When I arrived to the room, she was lying on the floor in a pool of blood. We couldn’t see where the majority of the blood was coming from. She put her clothes back on after she did this and they were soaked with blood and sticking to her skin. As soon as I seen her and the blood, I dumped out the emergency bag onto the bed and grabbed the scissors and peroxide and gauze. I didn’t have enough gauze. The other nurse started cutting of this girls clothes so we could see what we were dealing with. I dumped peroxide all over her legs and started wiping up as much blood off of her legs as I could while the other nurse attended to her arms.
Her arms, her legs from the thigh to the heels, her stomach, her back, her neck. There was hardly any skin visible that didn’t have a cut.
She was saying that she was getting lightheaded and dizzy. She was losing a lot of blood. The ambulance was called and we were waiting for them to arrive. It felt like hours when it was minutes in reality, but my heart was racing and I wanted to find where the majority of the bleeding was coming from. I watched the puddle of blood grow larger as the other nurse and I held pressure to the cuts that were gushing blood while another staff member held gauze to the cuts on her stomach and neck, trying to get any amount of bleeding to stop.
I felt such a sense of relief when the squad arrived. I took a deep breath and started to clean up the mess that was left behind as the ambulance pulled away to take her to the near by hospital.
She came back the next day to the residential facility and the amount of stitches she received was almost un-trackable. We had to clean each one and count the amount of sutures each day. It took two nurses to do it and it was so time consuming and exhausting. The day that she was finally able to have them removed was also difficult. As I was removing the stitches she started to cry. I thought it was because they were hurting, but she informed me that she was afraid. I asked her what she was scared of and she said, “now that the stitches are out, there’s more room for me to cut. I don’t want to do that again.” She was afraid of herself.
If you’ve never been in such a state of mind, consider yourself lucky. It’s not a place you want to be. Nothing is worse than being afraid of your own mind because there is no where else you can run to.
She went on to tell me that her mom had given up on her. I had already known this, but I wasn’t going to be the one to say it. She said that was why she had cut so much that night in the shower. She said she didn’t remember picking up the razor blade. She said she didn’t remember feeling it cutting her skin. All she said she remembered was wanting to die. “My own mom gave up on me so why wouldn’t I give up on myself?” She said she got out of the shower and started to dry off when she looked down and saw the blood. Putting on her clothes and walking out of the bathroom was a challenge because she said she was already starting to feel lightheaded.
“I didn’t know how bad it was until the squad came. I didn’t know it was so bad. I didn’t mean to. I just wanted to die.” I believed her. To this day I believe her. When you’re in such a mental state that nothing else matters to you except finding a way to end the pain, finding a way to die, your mind is kind to you. Adrenaline kicks in and you don’t feel the pain. All she knew was that she wanted to die and when the opportunity presented itself with the razor blade left in the shower, her mind took over and the rest is history.
She discharged home to a foster family after over a year long stay in residential. I’d love to say that every patient I discharged was better; that I had cured them from all their pains. To this day, however, I wonder if this girl made it to her 18th birthday.