A home visit

Julie had a home visit today.  It was the familiar routine: Joe picked her up in the morning and took her into town for lunch and a quick trip round the shops.  She came home for the afternoon, and spent time with me doing some crafts and catching up on all the television programs we had recorded for her, before I drove her back again to the hospital before dinner.

It sounds routine, but it can be exhausting.  One of the aspects of her illness is that Julie isn't able to communicate her feelings very well at the moment.  She can be sitting beside you on the sofa, feeling desperate and suicidal, and you would have no idea at all, not even knowing her as well as I do.  There have been countless occasions when I have sat with her for a whole afternoon thinking all is well, and she has gone off five minutes later and taken an overdose or cut herself really badly.  When these incidents occur, it always turns out that she has been sitting there feeling as if she is falling into a black hole, and all that I could see was that she seemed a bit tuned out.  There's no point asking: she can't tell you.

The upshot is that you end up watching her like a hawk.  We have no choice - the only way we can anticipate an emergency some times is by picking up on patterns of behaviour.  If she goes off on her own for example it's often a bad sign: but what teenager wants to hang around with their parents all the time?  At the moment, while she is still very fragile, we have to be very alert if she goes up to her room.  The temptation is to relax and go off and do your own thing for a bit (perhaps catching up on the housework, for example), but the odds are quite high that she is going to self-harm and need intervention, so you have to remain on duty.  I think it's important that we don't try to control her, and we don't ban her from going off on her own.  If possible, I discuss it with her before she goes upstairs, talking over the risks, but I'm not sure if it makes much difference.

After I delivered her back to the hospital ward, I had to run the gammut of her primary care worker. Genevieve is a lovely woman - very warm and caring - but I don't think she understands what makes Julie tick at all.  This is difficult, because a primary care worker is supposed to spend a lot of time with an inpatient, talking through their problems.  Genevieve's been trying to have a meeting with me for days, so I spent an hour talking to her, even though it was late on a Sunday afternoon and it was about the last thing I wanted to do.  All I wanted was to drive back home through the sunshine and curl up at home with a book.  The meeting just confirmed me in my conviction that she doesn't understand Julie and they would be better off without each other.  Genevieve is a great woman, and I'm sure she's a fantastic psychiatric nurse, but she and Julie are as different as chalk and cheese.  Julie is really dismissive of Genevieve's advice, and I think she would respond better to someone else. 

As if to confirm this, as soon as I got back home I phoned the ward, only to get a tale of woe from Genevieve: she and Julie had had a row, and Julie had shut herself up in her room.  I asked to talk to Julie and we talked for a while until I was satisfied that she was alright.  She seemed Ok: just angry.  In some ways it is real progress to hear her talk about being angry - at least she knew what she was feeling and was managing it herself.  The row had been about searching her pockets after a walk (in case she had hidden something to self-harm herself with later).  I refuse to take sides on these things, but it is exactly the sort of issue of security and trust that causes problems during recovery. 

Somewhere during this conversation Julie herself asked to change primary care workers and I agreed to see what I could do.  So tomorrow I will have to try and work out how to do this diplomatically without ruffling any feathers.