Working in a Mental Facility

The following is my “Clinic Diary”. Its pretty much very simple as I had to hand it in as part of my working experience to my nursing lecturer. I suppose I dedicate this to @AngelinAfrica, and anyone else who enjoys my crazy (literally!) patients!

Clinic Diary

The week of the 21 – 25th June was one of the best weeks of my hospital career. We had to work one week at a clinic, and my colleague, Wilke, and I were working together at Gateway village. It’s basically a place for mentally retarded people who were either born genetically abnormal, or were injured due to oxygen deprivation or another problem at birth, or were involved with a traumatic head injury later in life. Depending on the severity they either stay at houses provided at Gateway and more or less manage to look after themselves (the houses do have a house mother), or they stay where I was working – in high care. These people really are not well at all, they would never be able to live a normal life outside of this village, but what they can do and do better than most people in the world is offer love and complete devotion. And they thrive on the love you give them! They flourish, and the looks on their faces and in their eyes is completely priceless!! And each one of them steals a little piece of your heart in their own little ways.

This is a little bit about the patients found at Gateway:

Janet – knits little pieces on her knitting needles and then destroys it and begins again. Always knitting. She is quite fragile physically, very delicate. But she gives the most heartfelt hugs – she pulls you in tight and grabs you close, and she whispered in my ear “Ek is lief vir you” – I love you. And I have never felt more loved!

Korne – Usually in a wheelchair but is able to drag himself on the floor. Carries an auto magazine and flicks through it with you to show you which car he wants and asks if you will buy it for him. When you say he must buy it for himself, he reaches in his jacket pocket and pulls out “money” (his hand clenching imaginary money) and when you tell him its not enough and he is cuckoos he bursts out laughing with abandon, and covers his hand over his eyes and chuckles.

Sammy – Wears glasses thicker than cokebottles. Usually keeps to himself, watching tv while holding a coat hanger. Likes to clean up after eating and always takes his dishes to the sink. When I was close to him he held out his hand to me and took my hand and kissed it twice (sometimes a bit yuck especially if he has food all over his mouth but I can always wash my hand, but never the feeling of love), and then he would grab me close and give me a BEEEEEEEEEEEEEEEEG hug and guffaw and guffaw and guffaw – oh he was so happy!

Daniel – He is strapped in a wheelchair. His whole body seems to have been tortured – completely contorted, and seemingly unreal.  His hands are completely bent at the wrists, so that they touch the underneath of his arm. His legs are always sitting so closely and tightly together that it is sometimes difficult to pry them apart and place a pillow in between them. We place him in front of the television and he watches a variety of things – Dumbo and Barbie and the news. Well, watches as best he can, I suppose, with his head leaning all the way back on his wheelchair so that when you are behind him he looks at you, but he is able to move his head and neck with ease back to the television. But its when you go up to him and call him “Danny-boy” that he truly smiles up at you with this big naughty grin. I always wonder what he is thinking because not one word is ever uttered out of his mouth. Ever. Daniel’s family are so loving – every afternoon they fetch him so that they can have him with them at home, and they return him to Gateway in the morning. I really admire them a lot.

Jacu – In my professional opinion I think he is the worst of the lot. Not behaviourally naughty or anything of the sort, but seemingly without a personality and his own identity. He is like a baby; in a pram, helpless. He does love to be taken for walks, or at least I like to think he does. Wilke had a soft spot for him but I was quite afraid of him at the beginning because I am VERY sensitive to anything related to vomit, and he seems to have something wrong with him that causes him to choke quite badly with practically every spoon of soft food he receives, and even on liquids like tea. I am ashamed to say that I shied away from him at the beginning, but as I got more used to him and the high pitch noise he emitted as his eyes bulged and his hands rushed to his throat, I became more comfortable, and even able to look after him myself.

Shaun – what a character! He seemed to think that he was in charge of all the repairs and construction in Gateway. He walked around absolutely everywhere with his sunglasses on, and holding steadfastly onto an empty blue “suitcase” – a children’s art or book supply hard plastic case – in which he said his “contracts” (papers torn from newspapers or magazines) were held. He also always carried a pen in his mouth.

Lyle – a very happy chappy. Is also in a wheelchair. Struggles to speak properly but loves to talk about everything and anything! He likes to draw pictures and watch the soccer. He also likes to listen to stories. A real sweetheart!

Esther – my personal favourite of the lot. She didn’t understand English at all, so it was by complete physical and verbal tone communication. She is the only black person of the group, and liked to sit in the sun on a chair which was away from everyone else. What I love about this environment is that there is no prejudice of any sort. She also liked to help around; putting the chairs away, helping  to take some of the patients who are able to eat normally to the dining room and so forth. What I loved about her best was her smile; her whole face crinkled up into a thousand lines and there was true joy in her eyes. She was found on the road, and a white lady took her in and is now looking after her son. She is what the Jews call a mensch.

Patty – Patty really disturbed me. She reminds me the kind of mentally disturbed person they would use in a horror flick – the way she shuffles around with a vacant look on her face, drool dripping out of her mouth, and carrying two dirt-smeared teddy bears tightly to her chest. She pretty much steered clear of everyone, but was really like a silent little girl.

Sasha – wanted coffee ALL the time which is really unhealthy. She would beg and beg, even after her morning coffee and when we refused she would start bawling. Its hard to say no, but you have to stand your ground because too much coffee causes increased urination and that can lead to dehydration. Eventually they had to lock her up in the “naughty room” for about half an hour and she would cry at the beginning and then go silent, and when we let her out she was much better behaved.

Arthur – Arthur is a very sweet old man. He doesn’t verbalize, but is always smiling and laughing. Sort of always in the background on his own mission.

Kevin – Kevin has an advanced brain tumour, and this causes some leakage to come out of his nostrils. He thus has gauze by his nose which is taped to his nose, and he keeps it on, and it is usually changed in the morning. It smells horrible, and its hard not to blanch your face when a waft of it hits you. He doesn’t say anything. He goes with Esther and Shaun to eat in the dining room, and enjoys walking outside.

Lawrence – was in a traumatic accident that deformed his face and skull and caused him to become mentally instable. He isn’t able to verbalize, but communicates in high-pitched excited squeals and grunts. He can become aggressive and his strength is incredibly surprising. He is also in a wheelchair, and enjoys doing simple puzzles.

Day 1

Wilke and I arrived at Gateway, unsure of what to expect. We entered and greeted everyone and immediately volunteered to assist Charity and the rest of the careworkers with feeding the patients. We were given soft foods and told to feed the 3 patients who are unable to feed themselves – Daniel, Jacu, and Arthur. I was hesitant to feed Jacu as I had already heard the noises associated with vomiting (the one thing I am unable to handle), so Wilke said he would do it while I fed Daniel. Wilke fed him like a champion, although he was also a bit wary at the beginning, and just my luck – Daniel refused to eat. We then helped clear the tables and thanked Sammy and Esther for helping us. We then brush all the patient’s teeth. I was a bit concerned because a lot of them do not spit after their teeth are brushed, but merely swallow the toothpaste and water! All the patients were then moved to the one corridor where there is sunlight. They line up on both sides in their chairs and wheelchairs and bask in the sun, while I was nominated to read them stories. I read them the Lion King and the Busy Bee. After that, we got everyone who wanted to ready to go for a walk. I took Korne and Wilke took Jacu. We walk simply from one side of Gateway to the other and back, but its good for the patients to get out and see some of nature, and a different environment. Along the way we see other people from the other houses walking about. We returned inside, and put Jacu, Daniel, Korne, Sammy and Janet by the television to stimulate them, although Janet always sits by the TV to knit. The rest of the patients we place around the tables and they play with Lego, or do puzzles, or do fine needlework and so forth. We talk to the patients and assist them. At 12, we assist with medication. It was really great because the medication is already pre-prepared by the sister in those Monday-Friday pill boxes with different times of the day. Most of the medications are against seizures and are sedatives. What we do is we get yoghurt and put it on a spoon and then the medication on top. This makes it easier for the patients to swallow, and it also tastes a lot better. None of the patients complain, or argue. Then it is lunch, and we go to the dining room with Esther, Shaun and Kevin, and waited for them to finish eating while the other caretakers took food from the kitchen and took it back to high-care. When we returned we helped the rest of the patients with their food. We were then told that we have lunch, and we were given the same lunch as the patients – fish with vegetables. The veggies were yum, but Wilke and I both do not enjoy fish.  After that the day is pretty quiet – there are about 6 nappies to change. We give love and plenty of hugs to the patients, and listen to them and help them with any problems. I then went with Charity the careworker to get clothes ready for tomorrow for all the patients. And then it was hometime. It was very overwhelming that first day, but we left there content that we were making a difference.

Day 2

Routine follows the same as normal each day, so I will only comment on the extra things that happen.

As soon as we walked through the door, Shaun rushed to up in his gangster-swagger holding his briefcase and a bible in his hand and a pen in his mouth, and blurted out “He’s dead. My father’s dead!”. He then proceeded to tell us how he had just arrived from the funeral. Shaun’s father has been dead for quite some time. We told Shaun we were very sorry to hear this news, and he repeated continually how he is back from the funeral. He then asked us to sign some contract, and tore a page out of a magazine.

Lunch was lamb chops and vegetables – they were amazing! So delicious! We fed the cats outside the leftovers.

Janet was given new wool today and she was so overjoyed! She nearly cried with happiness and told the lady how much she loved her and gave her a great big hug.

The patients began trusting us more, and included us in what they were doing, and it is an incredibly satisfying feeling!

As I was leaving that day – Janet grabbed me tight in a big bear hug, so much that my breath was knocked from me, asking if I am returning tomorrow and when I said yes she told me “Ek is life vir jou  (I love you)”. My heart never felt as warm as it did that day, bursting with joy and pride.

Day 3

We were told that a lot of the patients who are usually violent, have been much better behaved since we arrived! How cool is that?

Today I read the patients Sleeping Beauty and James and the Giant Peach.

Wilke and I managed to get Lyle to sing for us, and he is like a child of 3 singing, but its very cute. He sang Silent Night and Jingle Bells for us, and we played him some music from our cellphones which he really enjoyed.

Everything went on as normal except today I really clicked with Sammy and he couldn’t stop hugging me and kissing my hand and laughing. At one point I actually had to ask Wilke to help me get Sammy off me!

Wilke and I prepared to give health education. Of course, these patients are like children and don’t really understand. So we told them that after going to the toilet they must wash their hands, and not to put dirty objects in their mouths. We kept it really simple. We then gave Family Planning education to Charity because she wanted to have another baby sometime but had still not accepted the death of her previous baby. We advised her to try and see a psychologist because she had not gone through the proper grieving process, and also advised her to make sure she was financially stable with her husband, and to make sure they were both healthy and HIV negative.

Some of the family members came to visit, and we also gave them some health education; to make sure they brushed the patients’ teeth, how to ensure they do not hurt themselves, to make sure they are massaged if they are in their wheelchairs and their muscles are going into atrophy, and stressed the importance of stimulating them and allowing them to be as independent as possible.

Lunch today was chicken with a crackly fried skin, and potato chips, and it was so good!

We left exhausted.

Day 4

Shaun told me that while we were swinging on the swings outside that under no circumstances would he marry Charity, but when I asked him if he would marry me, he looks at me, shyly mutters “Yes”, and turns away. He then told us he went to his father’s funeral again today. When asked why he went twice to his dad’s funeral, he told us that his dad did not arrive to his funeral the first time.

Lunch today was burgers and veggies, mmmmmm.

Sasha today spilt her 3rd cup of coffee all over herself and the floor, and threw a fit when  we refused to give her another cup. They put her in the naughty room for a bit, and she returned calm.

Day 5

Today is our last day, and it is bittersweet because I can’t wait to go on holiday, but as well as that its hard to leave these people. I wonder if I leave, that when I return if they will remember me, or if they will forget me as soon as I am gone?

We have now had to encourage Shaun to give his “nightshift” to someone else to do because he stayed up the whole  night screaming of intruders, and he kept everyone awake, and would not let them return to sleep. Shaun told me that to get married I must sign a contract stating that he would pay me R1 million every month.

Lunch was chicken schnitzel with mash. Their food is really fantastic – really balanced and healthy.

Today, I leave. I feel really glad knowing that the patients are in such good hands and will be taken of really well. They have each other to communicate with, they are stimulated, they are exposed to nature and they are really and truly loved. I look forward to returning, and we have even agreed to come back some weekends when we are available. These people have stolen a part of our hearts, but in fact – we have given it to them willingly.

 – I really miss that place, but I will be going back for my second week in the clinic later in August. I wonder if they will remember me at all?

What was really special to me, is the haunting way in which they have impacted on my life – teaching me that the one single most important thing to give and receive, is love.



One response to this post.

  1. Posted by AngelinAfrica on July 27, 2010 at 14:05

    Awww, a post dedicated to little old me! 🙂 Thank you!
    A very interesting and special read, and it’s awesome you get to take something out of this working experience.
    Not sure I would be able to make changing adult nappies and brushing someone else’s teeth sound so easy. 🙂
    Nice work Cybelle.
    M xxx


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