Psychiatry…………painful!

Student nurse in Toronto, 1973

The psyche rotation was another matter!  One month at Queen St Mental Health Center, also known back then in 1973, as 999 Queen Street, or even just nine, ninety-nine !!  A Toronto institution with an ominous reputation, for decades thought of as the ‘loony bin’.

queen street mental health centre back in the 40/50s

queen street mental health centre back in the 40/50s

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dont know the time period of this photo?

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I believe the main entrance looked like this in 1973…….. I could be wrong… of course there definitely were no recycling bins back then!

Interestingly (to myself), I have no clear memories of how the hospital looked when I did my psych rotation there in the 70’s, however this is the one image that did stick in my mind along with these  lyrics of Pink Floyd…

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All in all it was all just bricks in the wall.
All in all you were all just bricks in the wall

My group of about 6 fellow student nurses were assigned to a ‘Day Hospital’ setting.  There were about 12 patients, most indigent, living in ‘half-way houses’, who came in Monday to Friday from 8:00am to 4:00pm.  These poor souls were so dysfunctional, tattered and torn that one wondered if these were day patients, what were the in-patients like!!

The Day Hospital daily routine included group therapy, a social worker who spoke with each patient and would ensure they had transit tickets, dealt with disability funds and residence issues,  psychiatrists who checked in once a day re the condition of the patients and regular consultations at set times,  a rest period, individual counseling, an hour of crafting and the availability of a TV and a record player for social time in the afternoon.  Staff could also refer patients who had medical issues to MDs in the building (social medicine offered more in those days!).

I remember how awkward the group therapy sessions were, as most of the time none of the patients offered any words, and the room would be heavily silent.  One of the patients, a 6Oish woman, who looked more like 8O, and never spoke, sitting all day in an armchair, smoking a cigarette (patients were allowed to smoke in hospitals in the 7Os), well she would take a couple of puffs, and then continue holding the lit cig in her fingers, while it burnt down to her fingers.  She must have done this for many years as she had horrible scars on her knuckles of these 2 fingers.  At least in Day Hospital, we could attend to this issue and put out the cigarette or remind her to either smoke or extinguish it.

Yes, I am sure a lot of these patients were in a state of sonambulance due to the medications they were prescribed.  The alternative to not being medicated I am sure would have been worse and probably negate the essence of the Day Hospital function.  I am not saying that it is good for patients to be too doped up,  but what a conundrum.  I believe that the psychotropic drugs were prescribed in ‘good faith’ in earnest efforts to help these patients function.

the only good things about our psyche rotation were

  • we were allowed to wear our civvies
  • We had the most amazing instructor, Milly B.  She was empathetic, compassionate and had a sense of humour.

There was many a day where you could pass Milly’s assigned office on the day hospital unit and find one of us crying our eyes out.

We of course were each assigned a patient.  Mine was Mary D.  She suffered from a plethora of psychiatric ailments, including paranoid schizophrenia.  Mary was about 35 and alone in the world. She had never been able to keep a job and had often ended up living on the streets.  She had suffered many physical injuries and had been raped more than once.

Mary was of small stature, thin, and pale with stringy, greasy long brown hair.  She looked like she had given up as she paid no mind to her personal appearance, and often smelled of urine, body odour and worse.  She frequently wore the same wrinkled stained clothes from day to day looking like she had slept in them.  It was extremely difficult to talk to Mary.  She would never look me in the eye and often ignored or did not hear my questions.  This was the common scenario and the reason my colleagues and I found this experience so depressing and left us feeling inadequate and hopeless about helping our patients and making a difference in their lives.

One of the obvious functions of the Day Hospital, was that we would administer their medications during the 8 hours they were with us.  It seemed difficult to imagine that most of these patients in various states of lost and fractured minds could regularly remember to take their pills.  Patients were offered hospital meals of breakfast, lunch and an early supper in Day Hospital, for some of them, probably the only good food they had access to for the whole week.  They also had access to showers.  Mary never wanted to take a shower and I often needed Milly’s help to persuade her to wash or take a shower.

I had read in Mary’s chart that one of her phobias was hair.  Apparently once, she had shaved off all her hair, and plucked out every hair on her body, including her eyelashes!

The last day I saw Mary nearing the end of my rotation, she continued to be uncommunicative, but did agree to a full shower, took her meds for me and ate a little from the meals offered to her.  We (the students) left, as always, 30 minutes before the end of the Day Hospital day which closed at 4:30pm.  I said goodbye to Mary, who was sleeping, sitting up, at the end of a couch, not an unusual occurrence in this unit.

The next morning, arriving at Day Hospital for our shift,  I was thunderstruck to hear that Mary was dead!  At the end of  yesterday’s shift, when staff had tried to awaken Mary to go ‘home’,  they discovered that she had no vital signs.

OH MY GOD………………….Mary was my patient!   Was it my fault? Should I have checked that she was breathing, felt for a pulse when I said goodbye to her????  She didn’t look any different snoozing that afternoon than she did snoozing at any other time.  Her lips were not cyanotic, she did not feel cold to the touch, when I patted her hand.

I was relieved when Milly told me it absolutely was not my fault, and that Mary was most likely alive when I last saw her… but still I felt so guilty and inadequate!

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Such was the psychiatric rotation at Queen Street in 1974…

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