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Psychosis

I will never forget the first patient I had who was in an active psychotic episode. When we get to my experience on the inpatient floor, you will hear a lot more stories about this, but I think it’s important to briefly touch on it here and tell you about my first time seeing this.


I had only been a nurse at residential for about two months when this seventeen-year-old boy was brought in by the police for admission. I was not the nurse that was doing his admission, but I was in the nursing office when it was being done.


He was very belligerent and unable to properly answer any of the questions that he was asked. You could see the fear in his eyes as they darted back and forth, scanning the room. He had been held at a juvenile detention center for six months due to multiple robberies and assaults. He had been refusing his medications and was extremely unstable.


After a few minutes of the nurse attempting to do his assessment, she decided that it was a better idea to let him go to the unit to get acquainted and that she would try again tomorrow morning.


We didn’t think anything of it as the night went on. It wasn’t the first time that we had admitted unstable kids, obviously.


I was working second shift that night and as I was finishing up with passing medications to the kids on this boy’s unit, the boy ran into his room and slammed the door. I assumed that there was about to be a restraint so I stayed on the unit and headed over towards his room. When staff opened his bedroom door, he was laughing hysterically and said, “you all worry too much!” The staff asked him not to slam his door and I left the unit.


Around nine-thirty at night, I got a phone call in the nursing office. It was a staff member saying that they had no idea what to do for this kid. I asked why and he said the boy was psychotic. I walked to the unit and when I got there, it took everything I had to hold it together.


Here he was, this seventeen-year-old boy with blonde hair and blue eyes, really tall and probably at least 250 pounds, standing on his bed up against the wall, crying.


I asked what was going on and the boy instantly started screaming. “Please don’t kill me. I’m sorry! Please!”


Like I said, this was my first time working through a crisis with a patient suffering from psychosis. I wasn’t exactly sure what approaches were best yet with this population. So I did my best to stay calm and understanding and non-threatening. I reminded him over and over again that he was safe and that we would not hurt him.


He started to punch the wall, saying he was killing the bugs that were coming out of it. He said that they were “monster bugs” that were “aliens trying to kill everyone.” He was so scared and I’ll never forget the look on his face as he stood on his bed and covered his head with the blanket, saying he was trying to “keep the bad guys out.”


The residential facility where I was working at, like most all residential facilities, do not have emergency medication in times like this. We will talk about this a lot more later and I’ll give you my sometimes unpopular opinion about it. Unfortunately, this boy needed something to help him calm down so that he could be safe. Once he started saying that the staff were turning into monsters and that he was going to have to kill us, I knew that in order to keep not only him safe, but also the staff and myself safe, I would have to get some help.


I called the squad and they took him to a local ER. He was too severe to come back to residential and I never seen him again.


Once I started working inpatient and seen these things a lot more frequently, I always thought of this boy. I think it was because of the way he looked at me when he said he was scared. I can honestly say that he truly believed that he was seeing these things and that he really thought bad things were going to happen. A lot of people will say things like that aren’t true. You see it on the news all the time. People being arrested for awful crimes, saying stories that sound made-up like I don’t remember, I was out of my body, the voices made me do it. I’m telling you right now, that is real. I’ve seen it so many times.


Being unable to control the things you see and hear must be terrifying and my heart breaks for this population of people who struggle with psychotic episodes because no matter how unreal they may sound, they are real to them.


People often look at this population as insane and crazy, but me, I look at them as another human being struggling to gain control of their own mind. There is nothing scarier than that.

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