A bit of background before I start about day 1.
Worked for a year with adult mental health inpatients on a ward that mostly consisted of personality disorder patients and those with psychosis, acute schizophrenia.
I started working there after completing my degree in Psychology and looking for work, that was the first I stumbled upon. After a year of working there I decided to look back out in the job market, and always having had a keen interest in children and young adults (with no experience) I decided I would need to look for a children’s ward or a mother and baby unit. In addition to work I secured a space to start a Masters in Psychotherapy which would be my year 1 training as a Psychotherapist.
My interest in children specifically doesn’t appear to stem from any real, justifiable reason. I just seem to have told myself, I would quite like to work with kids. I had an upsetting childhood, just like most of us out there, I adore children and I cant wait to have some of my own… I am also small in build, and very much younger than the average Psychotherapist that one finds. I suppose these things combined sort of gave me the ‘logical conclusion’ that children would suit me best.
So here I am now, a year of adult mental health experience behind me, a degree in Psychology, Certificate in Counselling and a Diploma in Psychotherapy… also about to start my formal training in psychotherapy.. And I have just had my first day on a children’s ward.
It was an early shift I started on. The patients appeared asleep as the shift commenced. In handover, I was introduced by the nurse in charge, by name.. each of the sleeping children behind the lock door. I tried to connect and listen in, but without a face and personality to the notes it was difficult to keep my focus. After the briefing we entered the ward… The children’s ward on first glance certainly receiving a lot more funds than my experiences in the adult sector.
I was told that the ward at the moment is unsettled because there is a young lad who is being held as he hasn’t got an appropriate place for him, and for his safety, this unit was the most appropriate interim space for him. In addition, there is another troubled teen going through a difficult time, both these patients requiring their own team of 3-4 workers at any one time. This meant that the rest of the 16 other patients would receive less attention and the procedures of the day were rushed etc… naturally this would mean my first day would be more of a watch and learn, do as I do… without much explanation or walk throughs.
I felt unsettled by this, however I didnt feel that I was in an imminent danger, or vulnerable, as I have just been working on a forensic ward. That was scary.
I found out it was a mixed ward. There are much more females than males. The dominating illnesses are anorexia and bulimia and autism and anxiety. Although it is described as a children’s unit, there was certainly and overwhelmingly dominating feel right from the start.
Young, middle class girls suffering from anorexia was the patient I mostly met with. Through out the shift I began to notice how much of the set up of the day would be centred around this particular patient.
The patients would all be woken up for breakfast, all those patients with eating disorders had to attend breakfast, others could sleep in until school time. I was faced for the fist time with a bunch of people who Just.Couldnt.Take.A.Bite.Of.Food. – it was very interesting watching a 14 year old girl absolutely sobbing because she just couldnt take that first bite or the second or third. given the program, she had to eat. And so the staff had to sit and encourage her to eat her bowl of cereal in front of her. She also had to drink a glass of water and finish absolutely every bit of food in front of her. Some finished in 20 minutes or so, others lasted up to 1.5hrs. After breakfast they then had to sit in the lounge and be supervised, to make sure than they didnt disappear to their bedrooms and purge their food. Whilst they sat under supervision, they werent allowed to move, or tap their legs for instance. This supervision, after the main meal would last an hour. It was rather boring. And I noticed a few of the girls tapping their leg here and there, sitting forward in their seat, trying to hold a pose in order to burn more calories. It was so interesting, but also a bit boring as neither staff nor patient really spoke to me.
After breakfast some would go off to school.
At around 10am I think it was, there was a break at school and so everyone needed to come back down and those with eating disorders had to attend the kitchen and eat a snack. Most of the snacks consisted of an apple, a glass of water and 2 biscuits. Just like at breakfast, they needed to finish everything in front of them. This time more girls were crying over their meal. A few refused to eat, but then because it was compulsory, started picking at the food, tapping their feet… eating a little bit at a time, crying, becoming tearful.. This time the supervision would be 30 mins. We would go to the lounge and sit and supervise the patients so they dont purge.
Before I knew it, it was lunch time! the children came down from school and were waiting outside the kitchen. Some were visibly troubled. As if they were children standing outside the dentists office, and they can over hear a screaming child within.
Lunch was difficult for many. Food was being forced down in tiny bits by most of the patients. At this point I noticed that one anorexic male youth was really having issues with getting his fish and chips down. However, he ate and maintained silence. The girls on the other hand, many of them were tearful and troubled, many took over 20-30 minutes to even take the first bite. It looked tremendously painful. One girl in particular appeared to cry at regular intervals, and as soon as a member of staff approached her a similar response would be illicited. She would skew her face, pull her body in the opposite direction of the person talking and refuse to eat stating her stomach is sore becuase she is full. She doesnt need the food in front of her. She is full. At lunch, some people took over 2 hours to finish their meals. And just like breakfast, we then had to sit for an hour and supervise.
After the hour was up many of the girls sprung up and started doing their daily exercies. This consisted of walking up and down at a rather brisk pace, through the corridors of the unit. It was a pretty surreal experience to witness for the first time. Young, girls, smiles plastered all over their faces, chatting to each other, pacing up and down the corridors at a jogging speed. The staff carried on with their various jobs. It was an odd experience. It reminded me of another patient from my previous ward that was stick thin and paced the corridors every single minute of the day. No one ever questioned if she might be having boy issues. She was perhaps the most psychotic patients on that ward. I wondered if I was looking at those girls happily, skinnily walking up and down and then their future selves of the woman I used to know. It wasn’t pretty.
By the time the shift was ending for me, I could hear staff members collecting the patients around for their afternoon snack. I have to be honest, I was feeling full by this continual fascination with food.
My first day wasnt particularly emotional for me. Nothing compared to my first day on the adult ward. My overriding feeling, funnily enough ended up being feeling filled ot the brim with all the food that was being dished out and compulsory to eat. I felt it quite interesting how there was such a huge focus on eating for people who struggle to eat. I wondered if that was the best way to go about things? What was with the breaks? and why werent there more healthy options available? I didn’t feel particularly taken aback as I was able to recognise that it was of course, only my first day and people were very busy to give the attention the newcomer would need.
I came away from that shift, glad that it was over and not really feeling much about the things I had witnessed and learned. Whilst writing this, it then gives me a sense of puzzlement. I am both bored and interested to know more…