Empathy learned through violance

Have you ever had someone around you that you had to keep your guard up and ready for anything to happen every time they were around you? The kind of person you almost dread to see coming. In the 22 years of nursing in mental health there has always been a few patients that you were not so excited to work with. However, in time they became one of your favorite people.

In mental health you have empathy for patients who arrive in the hospital very sick and out of control from their normal behavior. However, out of control is some people's normal.

Over the years I have been spit on, scratched with long nails, peed and pooped on, cursed at, threatened, fired over and over in a shift, apologized too, my shoulders cried on, request to confine in, rolled in the floor with a physically violent person, chairs through at, water thrown on me, doors slammed on me. When I stop to think about who would fit that criteria one person pops in my mind who has done it all.

She walked in the door as a young slim, and very attractive women. She was well dressed, sassy and full of sarcasms. As her stay lengthened from out of control behavior – so did the buttons she pushed to test her boundaries.  She broke every rule that was ever made and the new ones that were developed just for her. She holds the record for hurting the most staff in the building from scratches to broken wrist.

At one point in her stay she was too violent to stay in a community area and was placed in a unit where it was only her and two staff. She challenged each staff – every shift – it was like clockwork for 30 days. Over those 30 days – she hurt 17 people in one form or another.

Over time she had spikes of good behavior and she can be such a sweet person. At the same time – in the blink of an eye she can be the most unpredictable.

One Christmas around 18 years ago – she overheard me talking about a Christmas gift I had gotten. They were striped socks with toes – I liked them but it was not something I had planned to wear a lot and she mentioned they sounded cute. I brought them to her the next shift I worked wrapped in a package. She smiled from ear to ear as if I had given her a very expensive gift. She wore them until they literally had holes in them.

Over the years of working with her, and with no success of being able to find a place that would accept her for very long at a time due to her attacking other people, hurting staff and walking away from the facilities. She remained in our care for several years to come. Her family had stopped visiting because she would be so aggressive and rude to them – no phone calls came in or very few – no boxes arrived with any outside supplies. We had become her family.

The unsolved mystery of a patient that had drowned on the same unit she was living at the time – was suspected she had held her head under water in the tub the other patient was soaking in. She had made several comments over the years that she had done it – and then laughed "I am just kidding." If the phrase "she got away with murder" could possible fit a person…it would probably be her.

Each staff that has ever worked with her could fill a book of stories and events that have taken place with this one person. The sad thing about her was she showed no emotion – her good behavior face looked almost the same as her out of control behavior face. The only human contact for her for many years were in moments of correction, because she would strike out, bite, pinch anyone she got close too.

Fast forward to a time the doctor was successfully able to try a medication that worked for her, Lithium. Within a few days she began showing signs of more good behavior than disruptive. She began following the rules, attending groups and eating downstairs in the main cafeteria with the other clients. She began caring for her appearance again and interacting with staff appropriately.

As I passed through her area one day I stopped and talked with her. She smiled at me from the corner table where she was sitting. I told her I had heard great things about her and was so tickled to hear how well she was doing. She said, "Really, you have been hearing good things about me?" I smiled at her, "Yes I really have." With no expression she said, "Angie, do you remember one Christmas when you gave me a pair of toe socks?" I laughed, "Yes I do!" She shook her head, "I want ever forget that. I wore those things out" She ask me if I had heard she was possibly leaving. I shook my head and ask "What do you think about that?" She said, "Well, I guess I am suppose to be excited – but I am nervous and a little scared. I have lived her so long that those people want know anything about me and how I act sometimes. They may not like me. I feel funny inside Ang. I have never felt like this before." I told her I understood her being nervous and actually inside…I was nervous for her.

Later that day as I returned from lunch I met her coming down the outside steps. Two staff were walking with her headed to a car that was waiting. I stood and watched excited for her and amazed at her calm character that got in the car. The male staff leaned in to fasten her seat belt and got in with her.

It is funny to me how we as staff have struggled with her violence, were attacked by her out rages, cursed by her words, spewed on with liquids, bitten by her mouth,  pitched by her fingers, kicked with her feet, challenged by her behavior. We watched for years as the tornado inside her body held her prisoner, and the many medications that filled her body did not calm the demon.

When she was able to walk outside the boundaries to possibly a new place to live the staff find themselves surprised at the emotions of concern. Will they be good to her? Will they understand what she is saying is not always true or meant for harm? Will she be able to handle her new surroundings?  Will she be good to the new residence?

Time will be the test for her success. In the meantime, she has changed a lot of people – she has been a teacher for professionalism. She has taught the people around her how internal suffering looks like and how long it can eat at you on the inside. Who knows what happen to her when she was younger to make her this way for over 20 years. Was it mental illness…or demons?

Angela Brooks is a mental health nurse educator who spent the last 22 years working in a state funded mental hospital. She is the author of "The Nurses Voice" who exposes raw truth as a nurse. She is transitioning from nursing to one of the top positions in a health company changing life's one oil at a time.