Being a teenager is hard. Being a teenager who thinks they’re in love is harder. Being a teenager who thinks they’re in love and also has a mental illness is chaos.
When you’re stuck in an environment for too long, you quickly learn to adapt. You do what you see being done. No matter how hard we would try, we could not stop the kids from “falling in love” while in residential. They might have mental illnesses, but they’re teenagers! They’re going to have feelings and make mistakes. That’s one part of being a teenager that makes them normal. Of course it’s often toxic, mixing one person with a mental illness with another. But who am I to tell these sixteen year old kids they’re not having real feelings. I met my husband when I was seventeen and here we are 12 years later. But anyway.
The residential facility had nine units. They are separated by gender and age and diagnosis. The units combine for school and meals and some activities, so it doesn’t take long for the kids to get to know each other, even if they’re on different units.
I’ll start by giving you some background information on this girl. We’ll call her Emily.
At this point in my career, I had seen a lot of awful things and heard a lot of heartbreaking stories. I’ve dealt with many suicidal children with severe depression. Emily, however, was different.
Most of the time, there would be some sort of remorse or guilt after a suicide attempt. Lots of crying and wondering why. Lots of apologies. Emily on the other hand, never shed a tear. I had seen her self-harm from the first day she arrived at the facility. She would cut herself with anything she could find. She would swallow whatever she could get her hands on. Quite honestly, some of the things she did to self-harm were kind of amazing. She was so creative and if she could find a new way to hurt herself, she would surely do it without thinking twice.
I will never forget the day when they called me to the unit to assess her because she had “done something interesting.” I arrived on the unit and couldn’t help but to laugh.
“How in the world did you do that?” I asked her in shock.
“I just did it,” she answered and was laughing her head off.
This girl had removed the underwire from her bra and weaved it through the skin in her arm. Yep. You read that right! She pushed the dull metal underwire in one side of her forearm and pulled it out of the other! She was so proud of herself and all the other girls on the unit of course wanted to see it. She was smiling from ear to ear the whole time.
I brought her up to the nursing office with me to figure out what we were going to do. Before I could say anything, she grabbed both ends and pushed them together and asked, “what would happen if I just pulled it up like this? Would all my veins bleed everywhere?” At that point, I knew that she needed to go to the ER to have it removed. She would have pulled it out like that, damaging muscles and tendons and nerves. She would not have cared and I knew that she would have done it if I didn’t call for help. I had to have two staff members come to the nursing office and hold her arms until the medics arrived to keep her from pulling the underwire up and out through her entire forearm. They were able to take it out at the ER without surgery and only a few stitches. She was mad that more damage hadn’t been done.
No more underwire bras for her!
I never knew what she was going to do. Every day with her was always a surprise. One day she drank four bottles of shampoo and ate some deodorant. It wasn’t toxic and she was mad that I didn’t send her to the emergency room. She was begging for surgery. She loved having to go to the emergency room and loved having surgery, which was why she would swallow things all the time. She obviously didn’t love to swallow things. She told me one day that she liked to cut herself so that she could feel something. She said that she constantly felt numb and like the world wasn’t real. She told me once after returning from the ER to get stitches for a deep self-harm to her arm that she felt like “a zombie.” She laughed when she said it and honestly, I believed her. She was looking for something or someone that made her feel alive.
And she thought she had found him.
We’ll call him Tyler.
When girls self-harm, it’s often not for suicidal reasons. They want to feel something. They want to have a sense of control. They often have unresolved pain and cannot figure out how to express it appropriately. It becomes a maladaptive coping skill during times of intense emotion. And afterwards, they feel better. A sense of relief. A little bit of control over their emotions.
It was something different with Emily.
When Emily met Tyler, she was immediately in love. She went out of her way frequently to make sure she was able to see him. It didn’t take long for him to realize that he thought he was in love too. He started leaving the unit and running over to hers to try and see her. They would often try to AWOL together and were successful at it a few times, hiding in the woods behind her unit. The staff, after multiple tries, could not get them to stop and eventually moved her to a different locked unit that was farther away from his. Now they weren’t able to see each other.
But of course, when there’s a will, there’s a way!
Once a month, all of the units got together for a celebration and recognized the kids who were doing well in school and on their units. It had been a month or so since Emily and Tyler had seen each other so no one gave it a second thought that maybe they still were thinking about each other.
They obviously were.
They sat beside each other at the meeting, or at least tried to. Staff had to prompt them to switch seats but not before they had passed a note that no one had seen.
Shortly after dinner that same evening, I was sitting in the nursing station doing some documentation and getting medicines packed for kids who had home visits on the weekends. The phone rang and it was Emily’s unit. I answered with my usual, “nursing, it’s Brandy.”
“We have a problem.” The voice on the line was full of worry.
I very rarely panicked. The longer I worked as a nurse in residential, the more I realized that a medical emergency did not mean the same thing to everyone, especially to those who do not work in the medical field.
I’d been called to medical emergencies that have been has simple as a scraped knee, so I learned to stay calm but ready for whatever I was about to walk into whenever the staff called for me.
If you’ve never worked in mental health, hearing about people swallowing objects may sound totally bizarre, and sometimes it is. But in reality there is always a reason for why. We will talk more about this later when we get to another favorite patient of mine. So for now just know that this was not my first rodeo dealing with random objects being swallowed. But it was my first time dealing with someone swallowing a razor blade.
“Emily is spitting up blood. I think she swallowed something again,” the staff said as I stood up to leave the nursing office. I hung up the phone and headed out to her unit. As soon as I closed the nursing office door behind me, I had a call on my walkie.
“We need a nurse,” one of the units called. I was the only nurse working that evening so unfortunately they were going to have to wait.
“I’m in the middle of a crisis. I’ll be there as soon as I can,” I answered back but within seconds they called me on the walkie again.
“We need you now.” It was a newer staff making the call. Nothing against the newer staff members, but like I said before, a lot of times they would call me for something that was nothing.
So I grabbed my cellphone out of my back pocket and called their unit as I continued to head to where Emily was. “I’m in the middle of something. What is going on?” I asked when they answered on the first ring.
“Tyler swallowed a razor blade. There’s no blood anywhere but he is saying his throat is hurting really bad.”
I instantly knew what was going on. Emily and Tyler had planned this together. That must have been what was on the note they passed to each other earlier that morning. I should have known something was up when they were being sneaky with their conversation but unfortunately we can’t predict the future. I had a staff member take Tyler to the closest emergency room because I knew I couldn’t be in two places at one time. When I got to the unit to check on Emily she was in the bathroom spitting blood into the sink. She was laughing when I walked in.
“Did Tyler do it!? He said he was going to do it too!” Her curly blonde hair was in her face and it looked like she hadn’t showered in weeks, which she probably hadn’t. Her pale hands were covered with blood splatters as well as her pink shirt. She smiled at me and her pale-yellow front teeth were red with blood.
“We need to focus on you right now. I need you to tell me what happened,” I told her as I grabbed a washcloth and tried to wipe the spot of blood from her cheek.
“I stole a razor from someone,” she laughed. “I took it apart and gave him a blade and hid one for me in my room. He is supposed to swallow it too so we can go to the hospital together.” She continued to laugh as she spit blood into the sink.
I had a staff member take her to a different hospital.
“You’re a bitch!” She yelled when she found out I wasn’t sending them to the same location for further treatment.
Two days later, I was back to work after the weekend, and I went to go talk to Emily. “Stop talking to me! You are ruining everything! He loves me,” she screamed at me as I walked into her room to see how she was doing since the incident.
I always did my best to validate my patient’s feelings. Who am I to say what someone is truly feeling? Sometimes, in situations like this, when I have a hard time understanding the why, I try to put myself back a few years into my teenage mind. If someone would have tried to tell me who I did and didn’t love, I would have gone crazy (and I kind of did). I try to understand how I would react in the situation they’re in before speaking to help me construct exactly what I want to say. This doesn’t always work in my favor but sometimes it does.
“I’m sorry you feel like I’m keeping you from your boyfriend,” I told her as I stood in the doorway to her room and she sat on her bed with her back towards me. She was surprised that I called him her boyfriend. We always tried to keep them from being in relationships while in residential but like I said before, sometimes they just want to feel like normal teenagers. Relationships are a normal part of being a teenager. I had to take a step back and remind myself of that.
She started crying which she honestly didn’t do very often. “I have a secret,” she told me. I tried to get her to tell me what it was, but she wouldn’t. “You’ll find out tonight,” she smirked.
I told all of the staff and supervisors to keep an eye on both her and Tyler. I had a bad feeling.
“We have a medical emergency! We need a nurse right now!”
Of course. Right at ten o’clock at night when it’s time for me to clock out and go home.
I was pissed. I had waited the whole night for something bad to happen and it hadn’t. I had my purse on my shoulder and was heading to the window to put my walkie on the charger. As soon as I picked it up to turn it off, I could hear the panic in the voice on the other side.
I dropped my purse on the ground and grabbed a pair of gloves and slid them on as I grabbed the emergency bag and took off running.
Like in one of the previous stories, there was a lot of blood. But this time I was used to seeing it. Over time, you become mentally numb to the site of blood, the site of someone intentionally harming themselves. It becomes a normal thing that you see on a daily basis and at some point it stops making your heart ache. It stops making your sympathetic nervous system go into overdrive. You stop reacting with such emotion and worry and fear. It becomes something that just is.
It was one cut. One deep, gruesome cut on his left forearm. He had managed to find a razor blade and he dug it so deep into his arm that I’m not sure how he missed his artery. One cut up and down his forearm lead to a puddle of blood at his feet.
He was pale to the point where he was almost an ashy color. He couldn’t keep his eyes open as I tried to hold pressure to his arm. Blood continued to grow at his feet, dripping quickly from his wound. He refused to sit down.
“You’re really pale. I don’t want you to fall. I need you to have a seat on the floor for me,” I told him as I filled his cut with gauze and applied a wrap as tightly as I possibly could as we waited for the squad to arrive.
“Tell her that I tried. If you bastards wouldn’t have walked in I would have probably succeeded,” he said as he leaned his back against the wall in the bathroom. His hair was a dark black and he looked like a vampire as his skin continued to lose color. Housekeeping was trying to help clean up the blood at his feet. His shoes were covered in red as were mine. I took them off on the way home and threw them in the trash outside before I walked in the door.
He was seventeen, about to be eighteen in a few months. He had his whole life ahead of him and he didn’t even know it. He was so smart and always made others around him laugh. He needed something to live for; not a girl who encouraged him die.
I can’t remember how many stitches he ended up receiving but I know it was an insanely large amount. He discharged shortly after this because he was turning eighteen and could no longer be at the facility. Emily cried and cried when she heard he was leaving. She discharged shortly thereafter he did.
I always wondered if they ever found each other after that.
Or if they were even alive to do so.