Documenting my journey through the mental health system

Day three of orientation for my new job – also the last day. I had clinical content, part of a whole slew of legal regulatory requirements. I wasn’t thinking much of it – it’s all review, I’ve been doing this 15 years – till the instructor got to restraints and whipped them out in front of the class- the types they use, for what reasons, how to apply, etc. I froze. Absolute flight or fright. And I froze. My heart was beating really loud in my ears, and I had a cold sweat all over me.

I knew I was starting to have a panic attack, and I asked to be excused. Choked the words out. So far it was just slides and we hadn’t got to the demonstration of competency yet. But those slides had me fucked up. The restraints lying on the mannequin for practice had me near tears.

I recognized the “violent locking restraints” in which I had been placed, a few times. Once in this very hospital’s psychiatric ED. One time I simply woke up from minor surgery and reacted violently, adrenaline pumping, fists swinging wildly. I was put in locking restraints and sedated and it was terrifying. The doctor later explained the anesthetic drugs can do strange things to people, and they had seen my violent reaction before in other patients.

I left the room. I took a piss, trying to breathe. I sat in some chairs down the hall, waiting while they figured out what to do with me. Eventually the others left for a break after demonstrating their competency and I sat in the room with the teacher and tried to explain.

“I talked to my unit manager after my tour yesterday. I’m asking for reasonable accommodations – I can’t care for a patient in restraints. I have bipolar and PTSD, and I’ve been that patient. I’ve had severe decompensations for different reasons over the years and I’ve had to be put in restraints. Also, one time after a surgery. I have a lot of PTSD and trauma around it. I can’t do it. I feel like a terrible provider, and I hope it’s not asking too much.”

Sounds good written here, in reality I stumbled over my words nervously. It was very hard to try to meet her gaze.

She was very nice about it; said it did not reflect on me as a provider and caregiver. But my heart was racing. She asked if I could demonstrate competency using the arm of a chair and I shook my head no, I could not even look at the slides without feeling panic and despair.

She was very understanding and said “conversations were already happening” around my request for reasonable accommodation. I worry I am asking too much.

Yesterday when I talked to my new unit manager and explained in a little more detail why I need these accommodations – which is always horrible and awkward for me to talk about – she was also very nice about it. I also told her how horrible it is to talk about. She then told me about her late husband who took his own life after a long battle with mental illness, so she took my request for reasonable accommodation seriously. I told her I was so sorry for her loss, and she thanked me for being vulnerable as well.

I’m still thinking about those words. Being vulnerable sucks and I’m scared of it, but I have to talk about this if I want to pursue the accommodations. I’m literally asking to not take care of certain patients as a CNA who takes care of patients. I can look after suicidal patients. I can clean all the poop; I will deal with all the C-diff and spinal precautions and excessive urination. That’s fine, I got that. I can’t have anything to do with restraints and the poor people who get put in them. I just can’t do it.

I forgot this isn’t like the restraint free rehab and hospice unit I work at the VA hospital. This isn’t like the psych residential I did before that, also restraint free. This is a hospital with high acuity, and they are definitely not restraint free. In fact, they’re so focused on staff safety these days that restraints come out quickly as soon as a patient is agitated. I feel like a fool, but I’m also trying to do as Dr Black would do and give myself a little credit for advocating for myself.

So, I don’t know if they will say never mind, and rescind the job offer, or allow the accommodation. I go in for my first shift tomorrow night and there are patients in my unit in restraints right now. Of course, they would not put me with one right away (patients in restraints are continuous 1:1 monitoring, just like I had). They will prioritize orienting me to the unit. I’m looking forward to a new unit, it is like a med/surg floor but with a focus in nephrology. Very different from my rehab vets.

All I can do is wait. I really need this job; I need the money to pay off debt for a furnace and new sewer line at my house. I’m also going to have to move back into my house with my mother. It’s going to be horrible, but I have eight months to prepare and make it the best outcome possible.