Private Sector Guilt

I did it- I qualified as a mental health nurse. Officially on the register as of approx 10 days ago, and my cohort graduates later this week. The past year has been so hectic that blogging has fallen by the wayside; I had a total of two days off during my final, three-month-long placement, but it was all worth it and I'm graduating with the degree classification I wanted. My current post is in a male rehabilitation unit that isn't yet open, so I have very little nursing to report on (I mean, literally none), but I do have a lot of other things. Brace yourselves, this has been building for a while.

Inside the Mind

This time I'll do it. This time I'll go to every lecture and make notes, and when I get home I'll do the recommended reading — no, wait, I'll do even more. I'll be the most well-rounded student nurse anyone has ever seen, because it can't be that hard to learn about everything, can it? There's only three modules, and half of one of those is just clinical skills. There's so many ways of learning, it'll be easy to get into all of them. But, oh, we're never really going to have to do all these things as mental health nurses, are we? It doesn't matter if I can't do it perfectly. Why are we learning about catheterising patients? They'd never let a mental health nurse down there, good lord. And all of this physical stuff — it's handy to know, but how often are we actually going to use it? I just won't bother doing extra reading on the renal system, or the others, there's loads more important stuff to focus on. I'll start learning my drugs early, that's what I'll do. First I'll learn how to pronounce them, that won't take too long, surely? Wait, everyone pronounces everything differently, and it confuses me on the ward. The average doses are different for different disorders too, how am I ever going to remember them all? And don't even get me started on titration. Side effects! Side effects! I'll learn the side effects, they'll be practically the same for everything and they're important to know. Why are there such complicated words for such simple things? Do I need to know them? Surely only pharmacists need to know these. And I could look them up in practice, right? That's what the BNF is for. Nobody knows everything all the time… Or do they? Maybe nursing is like driving, you don't really do it properly til you're qualified and out on your own for a bit. But that's not good enough, is it? You can't muddle your way through things that affect patients' lives. Lives. Lives. What has my life become? I get up early, leave the house, run around all day, come home, go to bed, and do the same thing over and over again. My bursary's been reduced again this year? But the cost of everything is going up. I need to do assignments and manage placement and work for money and see friends and see my family and take time for myself and there'll never be enough hours in the day/week/year. Everything I read is related to nursing or mental health, I should maybe read for pleasure sometimes, too. Or sleep more. Or get some sunlight. And, god, exercise. So many physical health lectures about how we're going to die slow, painful deaths if we don't get regular exercise. But how? HOW?

These are a collection of recurring, stressful thoughts I've had over the past three years. I'm actually at a point where I can see a light at the end of the tunnel; I've completed almost all the academic work (bar for a report and a reflection) required of me and my last placement begins in June. It'll soon be time to start looking for jobs and the reality of how different my life is going to look this time next year is starting to hit home. Cue panic, ahhhh.

PMDD & Me

Preface: trigger warning for suicidal ideation. Also a lot of in-depth discussion about PMS, periods, physical symptoms, and emotionality. In short: if you don't like reading about the wiles of being a woman (to a true extreme), you may want to abandon now.

I've had issues around my menstrual cycle for as long as I've had a menstrual cycle, I would say. Much less around my actual period than before it, where my premenstrual symptoms have ranged from such extreme breast tenderness that to simply move would cause intense pain, to raging mood swings that have, particularly lately, caused me to wonder if I have a serious mental illness. Today I was finally confirmed as suffering with Premenstrual Dysphoric Disorder, the most extreme form of PMS.

Psychology and MH Nursing

Placement looms again. This is our penultimate placement; a mere eight weeks, which pales when compared to the behemoth 15 weeks we had to deal with last year. I've had my 'expression of interest' wish granted, and I'll be spending two months with an Improving Access to Psychological Therapies (IAPT) service.

I've been begging my tutor for this placement since literally my first term of training. I've been begging life for this kind of opportunity since I was a lowly Psychology student, actually. IAPT was established the year that I graduated from my first degree and I'd had high hopes of jumping straight into a PWP training post and the world being my oyster. Unfortunately, despite numerous applications, I never got so much as an interview. I was embittered for a while, but life has a funny way of working out.

Dating as a Student Nurse

This week I've felt forced to end my second relationship in as many years, and it's led me to one conclusion: dating as a student nurse does not work.

For me, anyway.

Using Evernote for Essays

I'm a sucker for organisation, and I've spent much of the past academic year kicking myself for not getting into using Evernote before now. There's a fair few blogs around on how to use the app to help write essays, but I haven't found any of them particularly helpful, or at least not in a way that I find applicable to writing essays for nursing.

Basics: Evernote is a free application for every platform ever - I currently have it installed on my MacBook, iPad and iPhone. You need to create a free account to use it, which takes mere moments, and if you wish to access your notes offline, you'll need to pay £4 a month for a premium account (I've been doing this for the past two months as I've had chance to work on essays when I'm at placement, which doesn't have wifi). Your account syncs your notes between all your devices, and is incredibly simple to use.

Choices, Choices

Pre-placement thoughts:

"I don't want Crisis/HT, I want to work with people long-term."

"I don't want Crisis/HT, it's all medication."

"I don't want Crisis/HT, it's too far to travel."

Mid-placement actions:

I've submitted my management request for third year, and Crisis/HT is top of the list.

13.3.89-7.4.14

“But how do you even become friends with someone so famous?” was, and I suppose still is, the first question I get in response to disclosing that I was, for a while, a friend to Peaches Geldof. And the only answer I really have is that at a time when the whole world was set against her, I showed her a little respect. What started out as the odd supportive tweet turned into mutual following and DMs, which lead to Facebook contact, and eventually meeting in person a handful of times. My interest in her arose, I am embarrassed to admit now, out of thinking she was beautiful (anyone who knows me will know my weakness for a girl with a nose ring), but quickly turned to intrigue – I’m hardly the first person to be sucked into the tragic world of the Geldofs, but I was perhaps the first random tweeter to reach out to her personally and tell her I cared. There are no words to express how much I did care, or how much I’ve continued to care despite our arguments and falling out, or how much I will always care.

I’ve tried to shrug it off in recent years, but ultimately I held the misguided belief that I could save her. I was twenty-two when we first met, and younger when we initially became friends – this was 2010, 2011, the height of her drug abuse, ‘wild’ behaviour, a strained relationship with her family and fleeting contact with her friends. I was training as a counsellor with ChildLine at the time, and she latched onto it in a big way – I would regularly receive a torrent of FB chat messages closed with “Don’t tell anyone though”, as if I was about to spread it around like gossip. With my unconditional positive regard hat on, I allowed her to pour out anything she wanted and accepted it at face value – even the things I knew couldn’t be true, I allowed her the benefit of the doubt. You see, I knew what would happen if I didn’t – she would drop me instantly, turn nasty, and I was too naïve to realise that this was actually what was best for me all along.

The first time we met, she was recording OMG with Peaches Geldof. As soon as the show had been announced I applied for tickets and told her I was attending to come along to a taping; she told me not to bother with them and put myself and a friend on the guest list. Whilst I was on my way home from this, she messaged me asking me to come back to London in a few weeks so we could hang out properly, and it felt like my dreams were coming true. The day itself was not quite what I expected: she was two hours late to meet me (though did text the whole time), she crunched ice throughout the whole three hour film we saw (Norwegian Wood), and she divulged things that I had suspected of being true but hadn’t wanted to believe. She also lied on several occasions, about the most trivial of things; she was fixed on finding out what my family and friends thought of her (“Do they think I’m a cunt?”); everyone she knew who didn’t agree with her choices was “mental” or “psycho”; and bizarrely tried to discount any other ‘celebrity crush’ she forced me to admit to. I headed back to Birmingham confused and shaken, and not filled with the joy I’d travelled down with.

I think it was at this point that I knew I was getting into something deeper and darker than I could handle, but didn’t quite give up on her. We maintained intermittent contact, but I found myself getting frustrated with her hypocrisy and fickle nature. We argued over one of her Twitter tirades about the Daily Mail reporting that she was engaged as she was wearing a ring – she was fighting for her privacy despite baiting them (oh, and the fact that she had been engaged for six months at this point). In fairness to her, she managed a better debate than she usually does (for every bit as smart as she was, she was irritatingly closed minded), but we stormed off from one another in as spectacular a way as you can manage in 140 characters. A few weeks later, she tweeted a photo of The Handmaid’s Tale to me – a book I’d insisted she read when we had spent the day together – and I took this as a peace offering. We spoke intermittently again for several months, until we parted ways following an argument over an interview with Tom being printed in the Daily Mail. This was a situation I was very definitely in the wrong in (the interview was sold to them from a Jewish newspaper), but I think it would have happened anyway. She had changed in ways I couldn’t reconcile with the girl I’d first started talking to, and it didn’t seem that she was going to be coming back.

A friend encompassed my precise feelings in 2013: “Everything she’s doing now – the perfect life, the interviews, the weight loss – is a thousand times more scary than any of the times she fucked up in the past”. And it was. Peaches had never made a secret of feeling that having children would be the only thing to save her, to give her a reason to sort out her life and take care of herself. She seemed to want to be, if anything, the reverse of her mother, who Peaches disclosed to me she felt hated her because she had not been enough to make her want to live. This wasn’t a hatred she felt was aimed at her sisters, only at herself. I was proud and moved when her feelings around this started to change when she fell pregnant, and she managed to talk about her feelings in interviews – I had always believed she’d have gotten a lot less stick if she’d just talked about this years ago, but can understand why she didn’t. But then, it all got a bit much. She started sharing absolutely everything, and I felt she became obsessed with portraying that she had everything she wanted, that the babies had fixed her, that she had the life she’d wanted for so long. I don’t believe that anything could resolve the trauma she’d experienced, or at least not in the instantly healing way she believed it had. I don’t doubt that she was happier, that she had a purpose, but had twenty five years of heartbreak been wiped away in one fell swoop? No, I do not believe so. And her obsession with pretending that it had, ultimately, might have made her feel worse. There was something unsettlingly soulless about how she abandoned her convictions about privacy for the sake of earning cash to provide for her family. Put like that, it doesn't really sound that bad, does it? But it seemed to me she'd pushed the real her aside in favour of a woman who existed solely for the media - her worst nightmare.

The mystery surrounding the circumstances of her death is the hardest thing to deal with. My initial thought was heroin (whose wasn’t?) but after more consideration, I just can’t see it as an option. She might not have been as happy as she wanted everyone to believe (and this in itself is my own conjecture), but to intentionally risk everything? There’s just no way. Right now I’m holding out for a conclusion of SADS, because I do not want to entertain the notion that the toxicology report will have an answer.

People are mourning for Peaches as a mother, a daughter, a sister, but so few for Peaches as a person. I am. The first night we met, we stood chatting in a corridor of a television studio, and we talked about books (we always did). I told her she’d completely revolutionised what literature I’d been interested in – that she’d introduced me to science fiction and this had ultimately transformed how I viewed the world. She was confused, as if she couldn’t believe she could have had a positive influence on another person. I had the opportunity to read some of her short stories over the years we were friends, and they were barely fictional – most of her stories were largely biographical with a supernatural twist at the end, to throw people off the scent, I can only assume. I had always maintained that, had she ever reached the point of having her stories published, I would have been first in line to buy them, regardless of the bad blood between us. Nobody would have been more proud than I would have been. If there was one thing she taught me (beyond the perfection of J G Ballard and Philip K Dick) it was how to turn pain into beauty, to write your way out of the prison of your mind. If her stories are published posthumously, I will, as promised, be first in line to buy, and I will remain forever proud.

This doesn’t begin to communicate how broken my heart is that she’s gone, or how incomprehensible it is that I won’t have the privilege of being irritated by her again. There are no words, no inspiration, to get me through. But I have some of the happiest memories to hold onto, and these are the ways I want to remember her:

Waiting in the crowd at the taping of her TV show, she catches my eye and waves a little too enthusiastically, with the biggest grin I’ve ever seen. I tell my friend it was probably at someone else; I wasn’t sure she would even recognise me. The taping ends, and teenage girls gather around the stage to get autographs and photos, and she pushes through them all, rushes over to me, picks me up, and spins me around. “I can’t believe we’re finally meeting,” she says, kissing my cheek and wiping lipstick away. “It’s been so long.” Her manager, inexplicably, makes us all stand together for a photo, then I’m taken backstage to wait for her. It’s a clusterfuck. Janice Dickinson is obsessed with my friend’s pink hair, Tom is impossibly tall and insulting Coca Cola, people interrupt us to ask for photos. She asks what I’m reading and I take The Unit out of my bag – dystopian to the core – and she flicks through it, before we run over the last few books I’ve read, most of which have been her recommendations. Rather than passing the book back, she opens my bag and puts it in for me, kisses me on the cheek again. On the train journey home, I get a DM asking me to come back soon so we can hang out properly, and my heart explodes.

I overestimate how warm London will be when this finally happens a month later. Cinemas are cold as it is, but in my thin t-shirt and blazer, I’m positively shivering. She gives me her coat, covered in horse hair and smelling like a farm, but it’s warm and I’m grateful. We get outside and head to McDonald’s, and in the middle of her attempting to order a “large Big Mac” (not a meal, a non-existent larger burger) she turns to me and inexplicably shows me all of the forms of ID she has on her: provisional licence, 16-25 travelcard, passport. We sit down and, honestly, I’m too nervous to eat; she takes the opportunity to zone in on my food and finish it off. We sit and talk for two hours, and she comes out with the most hilarious unfiltered comments and questions: Why are you so short? Why don’t you have a Birmingham accent? Why don’t you have a girlfriend? It’s so hard to be a bisexual person. You could totally move to London on £900 a month, you should definitely move down here. Never before had I been so conscious of the fact that she was on an entirely different planet to the rest of us. We head back to the tube station and I’m still cold on the way; she takes off her scarf and wraps it around my neck. Heading in different directions at Euston, I give her everything back, and we hug before we depart. She seems so impossibly tall. This is how I remember her: so big, so much more than anyone ever wanted to acknowledge, and as Bob perfectly put it, so completely bonkers.

A Week in the Life...

I'd say it seems impossible that I haven't managed to blog since August, but it isn't really that surprising. Between placement, uni and work I barely get a minute to myself, and any time that I do get I tend to spend in bed pretending I don't exist. Since August I've finished my rehab placement, had my older age placement changed to Early Intervention, done a term at uni, and this week started my fourth placement - originally planned, again, to be older age, but changed to crisis/home treatment. I'm two shifts in, and the team is lovely, so the next three months (I'm on this placement until literally the day before my birthday in June) will hopefully be enjoyable.

I've been wanting to do a 'week in the life' of blog for a while, but as you might have guessed, I never have any time! But this week I sort of do.

First Year Lessons

First year is as good as over! I have four weeks of placement left, then (presuming I pass) we're thrust into second year. Given how for most of us there's no long summer break, it's bizarre to think of how much things will change practically overnight. No longer will we be "just first years". People on placement might not look down on us! Shocking.

I was saying to my mom a few weeks ago, I feel like so much more of a nurse now than I did a year ago. Mental health nursing is almost nothing like I'd anticipated, and I'm still not wholly convinced it's what I want to do (my heart belongs to psychology and therapy), but I feel reasonably confident that I can do it. I may not be feeling this confident at the end of second year, but we'll see.

In the spirit of bidding first year adieu and saying hello to second year, here are the most important lessons I've learned in the past twelve months...

Here, have some placement word-vomit.

The placement we're currently on is split into two parts: four weeks in a community setting, and eight weeks in a related inpatient setting. Tomorrow I begin the inpatient stint in a rehabilitation unit, but my community experience has been such a whirlwind that I need to take the time to blog about it. It's quite possible I've reached the high point of my nursing training, as I can't imagine any other placement quite matching up.

Placement 2, already!

I've been awful at keeping up with blogging. I've been awful at everything in the past few months, really. I became quite depressed earlier this year - the result of the combined impact of losing A and my old job, my awful placement, not working for several weeks and then starting a job I ultimately didn't enjoy - but I'm now back on Citalopram and feeling much better, though I'd venture I feel better because my life is better, not because of the SSRI. But that's something I don't have the energy to go into today.

I can't believe how quickly it's come around, but tomorrow I start placement 2! It's really more two placements, as four weeks are spent in the community then eight in an in-patient setting, but there you go. I was excited to see I'd been allocated a rehabilitation placement this time - the exact placement I wanted - so apparently accidentally showing off Daisy Lowe's boobs to your placement allocator really works in your favour (a tip for anyone getting into nursing there). In all seriousness, I had little idea of what MH rehab involved - or even that it existed - until some friends had units as their first placement, and it sounded like a dream. My main care experience comes from LD and MH supported living, and rehab seems to fit in well with the skills utilised in those sorts of settings. Not that I want an easy placement per se, but I definitely feel in need of something to restore my self-confidence after the horrors of the last one. Honestly, the more I think about it, the worse it feels. I was left with no idea whether I showed any promise as a nurse, no idea of my development, no idea of whether I was getting into the right career at all. And yet I'm feeling surprisingly positive about starting tomorrow - rather than being nervous, I'm excited to go in and prove to my new team that I'm good at things, that I want to learn, and get on with everything.

And naturally, the nerd in me is excited for the academic side of this placement. We're required to give a presentation, potentially to an MDT (or at the very least our mentors), which is something I've always enjoyed doing. We also have a reflective essay to write and our portfolios to sort out... I feel incredibly motivated right now, and I hope it lasts.

The past few months, though rough emotionally, have been excellent academically. I got firsts for both my exam paper and my research essay, which I'm over the moon with. I got a first for one essay in the first term and a 2:1 for the second, and because I'm far too demanding of myself (I admit it), the latter grade really knocked me. Apparently there's less academic work in second year (how? HOW?) so fingers crossed I'll be keeping up with these marks!

So many things I want to blog about, so many things to prepare for tomorrow... Suffice to say, I'm very into critical psychiatry again, and as excited as I am about nursing, I'm equally as sceptical about the negative impact some interventions have on people's lives, to the point that I wonder if my conscience can handle being a part of the machine. More, one day, maybe...

Goodbye, placement 1!

So, I have officially survived (and passed!) my first placement.

Stigma and PD

My present placement is an all female acute ward in an inner-city area. We've been having a lot of new admissions on the ward after what the regular workers tell us is several weeks of consistency; people are currently playing musical beds and a lot of people are moving on, which is really nice to see. Yesterday, I had the opportunity to sit in on another ward round, and was quite surprised by the attitudes I came across, particular regarding a new patient with a personality disorder.

First week reflections...

So, I've completed my first week on placement! Admittedly, this has only been three days due to uni and training things, but I think I'm starting to find my feet.

I'm wary of posting too much detail, but a few observations:

1) I'm surprised at the lack of contact between nurses and patients. There seems to be very little; support workers sit with patients while nurses complete paperwork and make countless phone calls to other agencies locked away in the office.

2) There seems to be very little for patients to actually do. There's two televisions, a jigsaw room, a "library", and an art room, but I struggle to consider any of these things "meaningful" or "therapeutic" activities - apart from reading, which no one does. They're temporary distractions from boredom.

3) Coming from a person-centred, non-clinical perspective, I'm really, really uncomfortable with things like environment checks and how so many things are out of the reach of patients. I understand why it's necessary, but it really startled me.

4) I don't think any patients on the ward are over medicated, but the way medication is used as a first line response to behaviours upsets me. These patients have been in and out of the ward for years so they're well known to staff, and it might just be the best response, but I was horrified to see an antipsychotic administered the very instant one patient started "acting out", so to speak.

So far, the ward isn't at all what I expected, but I like it, minus the boredom and sitting around. There's only so much talking you can do to patients before you start to think you're just irritating them! I've sat in on two ward rounds which were both interesting and overwhelming, and next week I endeavour to take in my notebook and learn about all the different meds our patients are on. I'd also like to get more involved in hourly checks and the drug round, and I like he fact that I actually want to do things. I just wish there was more. Ah well, seven weeks to go...

Placement looms!

So, tomorrow is my first ever day on placement -- I'll be working on a female acute ward for the next 8 weeks. Somehow, I felt more prepared before I started training. Six months ago I could have told you about all the jobs a mental health nurse does, but now that I'm going to be expected to engage in parts of it, it seems bizarrely mythical. Having to write a reflective essay on therapeutic relationships has hindered rather than enhanced my understanding it seems -- all of a sudden I can't comprehend how communication can help people in distress. Good to see all that money I paid out to do counselling courses has been worth it!

I think it's just a case of nerves. I'm the sort of person who thrives on routine and familiarity (not to say I can't respond well in an emergency, but give me comfort any day of the week) and it always takes me a few days to find my feet. Once I do, I'm away, it's just a case of having the patience to stick out the first two days or so. I'm also much more confident with academic tasks than practical ones, so I tend to start out as something as a wallflower. I think simply having the opportunity to get involved in things will be good for me though; as much as I loved my LD job, it was the perfect excuse to laze around a lot. I'm braced for a culture shock and a steep learning curve, but hopefully one that ultimately feels worth it.

The placement launch day at university today didn't do much to allay my anxieties, unfortunately -- I think I really downplayed to myself how big a commitment these blocks in practice are, and I'm finding it overwhelming. Practice grids, reflections, essential skills inventories... It's so much to take in. I'm hoping everything just falls into place (and I have a supportive mentor!) and I won't end up too stressed by it all. Hoping being the operative word, of course.

Redundancy is still threatening at work, which is a bit of a pain. In some ways I'd rather just take it, because it'll lift a lot of stress whilst I'm on placement, but when I finish, I'll be sort of stuck. Rota depending, I've been offered the opportunity to keep my 15 hour contract and do late/sleep/early shifts once a week in Burton Upon Trent. Travel expenses would be paid and I could do more hours when I finish placement, but I'm torn because of the distance -- a 60 mile round trip is a pain, but they're doing all they can to reduce it (hence the sleep-ins). Financially I still think I'd be better off taking redundancy, at least in the short term, because I'd be paid owing holiday which it seems unlikely I'll receive at the moment, plus I'd get 6 weeks salary (hopefully not based on my current contract, rather on my 2.5 years of full time work), but like I said, I'd be stuck when placement ended. We shall see, we shall see...

Rest In Peace

I've never had anyone particularly close to me die; a few years ago, an old friend passed away, but it had been years since we'd been in contact, so any upset I felt was minimal.

Yesterday, I worked an early shift at my supported living job, and finished at 3.15pm. By 5pm, the man I've cared for for over two years had passed away.

Four weeks in...

So, I'm into my fourth week at uni and thus far, haven't really had anything at all to blog about. We're doing three modules this term -- Anatomy & Physiology, Introduction to MH Nursing, and Inequalities in Health & Social Care. I'm LOVING Inequalities, which is essentially Sociology, and am very much looking forward to using feminism in my assignment for the module (a dream come true!). A&P I find quite boring, but also the most work, so I'm making an effort to actually try to make extra notes and understand it all, even though most of the time it feels slightly irrelevant to MH nursing. The actual MH module we're studying has felt like a rehash of my old counselling courses -- a lot about self-awareness and taking a person-centred approach -- and training for my job -- the importance of autonomy and the like -- and I'll be honest: I've been finding it all pretty underwhelming. I've not actually thought, "Oh god, I've made a mistake", but I have been wondering when the excitement would kick in. When I'd be reminded of exactly why I decided to take this path. When I'd feel the flare that engulfed me through applying and telling people about my aspirations.

Today was that day.

Pt II

Preparation begins