Tag Archives: hospital

Medical Hospitalization

I promised awhile ago that I would write about my medical hospitalization. This happened after I’d already had 3 psychiatric hospitalizations, so it’s interesting to me the similarities and differences that occurred between the two types.

I experienced a couple of symptoms that came on suddenly, one which was very worrysome and one which I wasn’t too worried about, but was uncomfortable.
The less worrysome symptom started while I was at a place I volunteer at. I’m not very good at listening to when my body tells me to stop something. I kept telling myself I would push through, I didn’t have much longer before I was scheduled to leave. Then the more worrysome symptom appeared and I told the supervisor I wasn’t feeling well. I rested in the break room for a bit hoping I’d feel up to going back to working. A supervisor offered to drive me home, I turned her down. Instead I took public transport.

I called my primary care doctor for an urgent appointment. My doctor wasn’t available, but there was someone else who could see me almost immediately. I saw this doctor and she told me what she strongly suspected the problem was. It was something unpleasant, but at the level I was experiencing it, not life threatening and she expected the symptoms would pass. She told me she’d make a referral for me to see someone the next day to confirm the diagnosis.

I was supposed to get a phone call soon about the exact time and location of the referral.

I went to class. I have to be doing pretty poorly to miss class. The professor noticed before the class that I wasn’t looking great and she kept commenting on how pale I looked. I was very insistent that I wanted to stay even though I wasn’t feeling well (there was no evidence that any of my symptoms were anything contagious). It was a long class though, a lecture followed by a lab. I made it through everything but the final hour. My poor lab parter was pulling most of the weight. I gave up though, I was too miserable to stay, so I left to go home. The professor was understanding.

This is very different from how things are with my psychological problems. I also went to class the day of my first psych hospitalization. There was nothing visibly wrong with me other than that maybe I was possibly quieter than normal. I’d not have been able to excuse myself from the class explaining to the professor that I was experiencing a lot of suicidal ideation, like I explained to my other professor this time about my worrysome symptom.

I hadn’t gotten any call about the so-called urgent referral for the next day. This is pretty similar to how primary care doctors have also treated my psych referrals

I went home and tried to sleep. It didn’t work very well.
I was feeling a lot worse than I had when I’d seen the doctor earlier. I was very stressed, because I had work the next day and no information about a referral (My work that day was flexible enough that if I’d ducked out for an hour to see a doctor no one would have objected) and felt worse.

I called my parents, crying. I feel like I do that too often for someone my age. They kept telling me to go to the emergency room.
I really didn’t want to go. Even though I felt horrible I felt that since I had already seen a doctor that day, who felt my situation was not an emergency, it didn’t make sense for me to go to the emergency room.
I worried that I wasn’t ill enough to go there.
This is pretty similar to how I’ve felt about seeking help for psych emergencys. I go back and forth between, ‘things are pretty bad’ to ‘but I don’t want to bother anyone’.

I agreed to go to the emergency room. The closest emergency room to me is the hospital where my 3rd psych hospitalization was. Nothing went right in that hospitalization There was not a chance I was going there, so instead I took a cab to one a little bit further, but arguably more prestigious.

I told the triage nurse, what was going on. I told her about the diagnosis that the doctor I’d seen had mentioned and how the referral hadn’t come through. I also mentioned how much worse I felt since I’d seen that doctor. On the pain scale I said I was an 8.
I’m a little unclear about the pain scale (and it’s supposed to be so simple!) I had thought that it was based on 10 being the worst pain I can imagine. I’ve since been told by some that 10 is the worst pain you’ve experienced. If I’d answered saying it was the worst I’d experienced then it would have been a 10.
This step was pretty similar to how things worked with triage at a psych hospitalization.

Then I was sent to a little room with a lot of other patients. I’ve been to the emergency room a number of times in my life for things like broken fingers, a broken foot etc. This room reminded me of the types of rooms I’d waited in for those situations. It was the group of people who could theoretically wait forever in the room without dying. I waited for about 3 hours in there. I called my parents again, crying. I told them I was going to leave, because based on how I’d been triaged they didn’t seem to think my problem was that serious. I was in a lot of pain and I figured that if I was in a lot of pain and the doctors didn’t feel it was an emergency then I may as well be in that pain at home in my comfortable bed.
I sat around for a little bit and finally asked the nurse if maybe there was a cot somewhere I could lay down on because, my pain was so much worse when sitting upright.

This is very different from my psych emergency room experiences. I’ve gotten a bed right away. Sometimes that bed was just a bed in a hallway, but it’s still a bed. Still a ton of waiting to be seen by a doctor, but they’d never put a psych patient in a room with a lot of other medical patients and only one nurse. In the psych emergency room I’ve always had a “sitter” watching me too. Here I don’t think the nurse even noticed my sobbing phone call. If I’d walked out I doubt anyone would have noticed. At a psych emergency room though you can’t just change your mind. You’re stuck there at least until you see a doctor.

I was seen shortly after the nurse found me a cot set up in the hallway. I’m not sure if this was because I’d made her more aware of how awful I felt or if it was just because I’d already waited 3 hours.

I was wheeled into another room and saw a lot of doctors and had a lot of tests. The original diagnosis the doctor told me at my primary care office was wrong and sent the ER docs on a bit of a wild goose chase while they ruled it out.
This period of time was very scary, because I didn’t know what was wrong with me. As soon as I saw a doctor I was given pain medication, so at least I was more comfortable physically, but I still didn’t know what was wrong. Many diagnoses were thrown at me as possibilities. Some of these were very serious chronic illnesses.
This is very different from a psychiatric hospitalization, where differential diagnoses are rarely discussed and it’s hard enough to even get the doctors to admit the diagnosis they’ve selected for you until maybe the end of the hospitalization. Here, diagnoses were discussed right off the bat and I was informed of reasons why they considered them.
I also saw a lot more doctors here than at any of my psychiatric hospitalizations. The most I’ve ever seen at a psychiatric emergency visit is 2 doctors and that’s only because there was a shift change.
Here I saw 4 or 5. There wasn’t a lot of waiting time in between either. Once I was past that initial 3 hour wait I had a steady stream of events, from doctors, to nurses to tests.

In my psychiatric emergency visits I’ve sat in a room by myself for nearly 24 hours with no form of entertainment, because they take your possessions, and maybe 20 minutes total of conversation with anyone working at the hospital. And this was at a supposed top tier hospital.
Here I had come prepared and brought my laptop. I was able to use the hospital’s wireless during the chunks of time where nothing was happening.

For medication they put an IV in, which is different from my psychiatric hospitalizations where my medication was taken orally.
For one of the tests I needed to drink contrast fluid. I have a bit of an oversensitive gag reflex and tend to vomit a bit too easily.
I vomited right as a doctor was walking in, because I was trying to drink the fluid. The vomiting wasn’t a symptom of the immediate problem. This is something I deal with regularly when trying to take medications. Nonetheless a nurse rushed over and gave me a medication through the IV that she said would help with the nausea.
It’s a scary thing for a person to so easily put a drug into my body, before I can even realize what is happening. I didn’t have a huge objection to it, but if she’d asked me first I’d have told her it was not necessary.

In a psych hospitalization this would be a lot harder to do. Worst case they could give someone a shot (this has never happened to me), but it would be a bigger deal to do and there are more safeties in place when giving something like this without explicit permission from the patient. It’s not done so casually.
During the course of this hospitalization I received all sorts of medications and I have no clue what any of them are, except for the morphine. In a psychiatric hospitalization I know everything I take and refuse anything without significant research ahead of time.

I contacted my work to let them know I was in the hospital. I don’t know what I would do if this had been a psychiatric hospitalization. I’d have probably had to lie. I wouldn’t feel comfortable telling them about that even though my work is in the mental health field. Actually, especially since my work is in the mental health field.
No one was going to judge me for this transient medical problem, but a long term mental health problem is not safe from judgment.

Eventually a diagnosis was found and treatment was planned. I was admitted to the hospital and moved from the ER. I felt a lot better knowing what was wrong.

The problem was something that was life threatening if left untreated, but not a big deal at all with access to modern medical care.

There is a part of me that mourns an opprotunity wasted here. I always have some level of suicidality and have at times wished I’d come down with something life threatening so I could die passively by just avoiding treatment. At the time of this illness, I was doing very well psychologically, but I wonder if I’d have stayed home instead of going to the ER if I’d been more depressed.
The uncertainty though is what drove me to the ER. Not knowing what was wrong freaked me out.
If I’d been more depressed and at home and known with high certainty the diagnosis (If I’d even glanced at Doctor Google I’d probably have come up with this diagnosis) I can’t say for sure that I’d have sought treatment.

Several years ago I once saw a primary care doctor at this hospital. I needed a psychiatrist referral (Don’t I always?) and could only see one at her hospital by going through a primary care doctor first.
I can’t remember exactly what I said, but I believe I gave a fairly thorough psychiatric history to her.

All through this medical hospitalization they had access to those records. I was really pleased with how that knowledge was handled. It probably helped that the records were old, but I don’t feel like I was treated at all like a person with a psych history.
I was asked 1 time how my mood was and once it was clear that I was fine, it was never asked again.

They also knew my current medications, both of which are psych medications. I was asked a number of times if I needed either of them while I was there, but I think that was more due to confusion because it’s unusual for someone to take Ritalin only some days like I do.

I was relieved that my self-injury wasn’t discovered/discussed in the medical hospitalization (It’s probably in the record from the primary care doctor). It helped that I had no fresh injuries. If anyone noticed the scars no one said anything. I was terrified of having a psych consult sent to me.

Everyone was so much more accessible than when I’ve had psychiatric hospitalizations. I had a button to call the nurse. In psychiatric hospitalizations I might walk around looking for a nurse and knock on the nurses station door to be told someone would get to me eventually. Unless it was a huge emergency, anything could wait. With the medical hospitalization, getting help when I needed it was easy.

In my hospital room I had a roommate. Unlike in a psych hospitalization, I have not a clue what she looked like. There was a curtain between us. All I know is that she was an elderly woman and that she had been there for awhile.
She was very disoriented and spent the night talking to herself.
While that might seem like it would be similar to a psychiatric hospitalization, it really wasn’t. In my hospitalizations someone that disoriented was usually given a single room instead of a double.

The largest difference between the two types of hospitalizations was length of stay. For the medical hospitalization I was there two days, counting my time in the ER. That’s shorter than the time you can be held involuntarily without a court order for a psychiatric hospitalization!

My shortest psychiatric hospitalization was one week long. They wanted to keep me longer, but I signed one of the forms requesting they either release me or get a court order. They realized they couldn’t pull off the court order so they backed down and released me.

After two days of the medical hospitalization I was very ready to get out of there and they were very ready to kick me out, so we were all on the same page.
I did spend a week at home recovering more, but at that point the worst was over. I just slept a lot.

Follow-up was also different. I’ve never had a psychiatric hospital discharge plan that didn’t fall apart within a couple of days of leaving. Then I’m left with no one to call and zero follow-up.

With the medical hospitalization they gave me an appointment at the hospital the following week and I could have continued to go to follow-up weekly as long as I felt necessary. Personally, the one follow up was all I needed. I was even able to call a number they gave me for when I had a question or ran into an issue about the treatment plan.

I’m all better now. It was an interesting experience to have a medical hospitalization after all of the psych ones.

Partial Hospitalization #1

A partial hospital program is sometimes also called a day program. You spend the day at the hospital, but then go home to sleep.

My first partial hospital program was right after my first hospitalization. I lasted two days there.
This is the program that I mentioned in my post about how they sent me someone else’s records.

The social worker in my hospitalization set up the intake at the partial hospital program for me.
I told her two requirements I had for it:
1. It needed to be an adolescent program
2. I did not want to do DBT

When the social worker informed me it was set up, she told me my requirements had been met.

When I arrived on the first day, I quickly learned neither request had been fulfilled.

I realize now that avoiding DBT in this type of program is likely an impossibility, but I’d have appreciated her being upfront with me about this. To be fair she probably didn’t know the program contained DBT. But the reason for this is probably because she didn’t put any effort to find out.

My request for an adolescent program was reasonable. I was 19. My inpatient hospitalization had been with adolescents (their cut off was age 21).

There was a group of about 6 others in the program. I was by far the youngest. Most were old enough to be my parents.
I was very uncomfortable. I listened to people complain about their children and spouses. I couldn’t relate.

At my intake meeting a ‘No Harm Contract’ was presented.
‘No way’, I said ‘I will self injure if I want to and forcing me to sign that just will force me to lie. I’d rather not need to lie.’
The contract was pushed aside to be reevaluated in the future.
I left that meeting with the understanding that I had in no way suggested I would refrain from self-injuring.

I was very angry and aggressive (verbally, not physically). Largely because I was stuck at this partial hospital program because I’d been kicked out of school and possibly also in a small part because of a bad reaction I was having to Celexa.

I was under the impression that successful completion of this program was necessary to help my return to school. Despite despising the program, I felt I needed to stick it out.

The first day was a Friday. That weekend I returned to the school to move everything out of my dorm room.
Most was removed Saturday. Sunday morning I came to retrieve the last few items and discovered another person sleeping in what had been my bed and a large bong in the bathroom.

Monday I returned to the partial hospital program. The first day I had left my sharp items at home. I wasn’t sure what I was getting into (would my items be searched?) and decided it was in my best interests to leave them at home. Monday, the second day, I came prepared with a swiss army knife in my pocket. This seemed fine based on my experience the first day.

Inpatient hospitalizations are under-structured. Too much time with nothing to do. Partial hospital programs are over-structured. One group after another. Spending the entire day dwelling on problems, because the structure prevents one from going out and doing anything enjoyable.

I was frustrated with the way the people leading the groups spoke down to us, as if the depression meant we were cognitively challenged.

During the lunch break I made a few little tiny cuts on my leg. Very minimal, close to zero blood draw.

In the afternoon I had a daily check-in meeting with a social worker. As a side note I mentioned cutting a little during lunch. I didn’t think it was a big deal to mention. I’d never agreed to the no harm contract.

I was transported into an office with another woman (someone with a higher level of authority). She demanded to see what I’d used. I handed over the knife.
A lecture proceeded in a disgusted tone, wondering how I could have possibly thought it was acceptable to bring a “weapon” (aka a small swiss army knife) into a hospital.

She demanded to see the cuts.
I refused, explaining they were minimal and did not need medical attention.
She argued that because I had done it “on the premises” she had to see them.
I continued to refuse.
“I’d have to take off my pants to show you”, I protested.
She seemed unconcerned.
I was scared and eventually intimidated into giving in.
I tried rolling up the pant leg to show the cuts, but as I’d suspected the leg wouldn’t push up far enough.
I unzipped, pulled down my pants and showed her the cuts.
I felt very violated.

“Well there’s not too much damage this time“, she huffed.

That was it. The last straw. I announced I was leaving the program.

She bombarded me with questions assessing my current suicidal risk, trying to trick me into saying something to allow them to keep me there.
I didn’t fall for it.

My knife was returned and I went home.

I still didn’t have a therapist. While making phone calls to find one, many therapists refused to see me on the basis that I’d not properly completed the partial hospital program. I only was able to get into therapy (although this was my fake therapy, because anything I said was at risk of being reported back to my school) eventually when I left out the bit about the incomplete partial program.

Confidentiality Struggles on Inpatient Psych Units

I’ve found that during my psychiatric hospitalizations working to maintain my confidentiality has been an issue.

I’ve never been hospitalized for non-psychiatric reasons, so I don’t have a perfect comparison. From observing while visiting family in the hospital I can tell that any hospitalization seems to result in some level of decreased confidentiality. When there’s a shared room it’s near impossible to keep everything private. You might not know details, but there is often at least a vague sense of what your roommate’s problem is. Family members who visit, often speak with the doctor without the presence of the patient, creating a risk that information will be communicated that the patient might have not wanted shared.

At my first hospitalization there was some posturing about confidentiality. Cameras including camera phones were banned and the lack of names on doors was emphasized.
I had a terrifying experience of 24 hours in the ER and was refusing to sign the form to be admitted. I wanted to go to a different hospital, but they wouldn’t let me. I asked if I could maybe see the unit first to see that it wasn’t scary. I was told I couldn’t have a tour because of confidentiality issues. This seemed reasonable. Eventually I gave in a signed the form.

A couple of years later I heard from a friend who was considering going inpatient at a different hospital for medication adjustments. He had been given a tour of the unit he would stay on before making his decision. So it appears this rule is not consistent between hospitals.

It seems the most significant confidentiality difference between general medical hospitalizations and psychiatric ones is that for psychiatric admissions patients are specifically encouraged to interact.
In fact, not interacting with other patients will likely be looked upon as a symptom.
Rather than staying in your room in bed all day there are common areas and group activities.

It might seem like that activity group is purely recreational, designed to break up an otherwise empty day. Wrong! In all of my records there are notes of my behavior during those types of activities.
One form for an arts activity group says simply that I attended and comments, “Very quiet- worked with no discussion with peers”. Never mind that I was focused and enjoying that I was doing. All that mattered as a record for that hour was my silence.

The problem of communicating with other patients is that all of a sudden your hospitalization is no longer just a relationship between you and medical professionals, now others are added into the mix. These others have no ethical responsibility to uphold confidentiality.
I know that sometimes outpatient group therapy groups discuss that what is said there should stay confidential, but I’ve never heard any sort of similar comment discussed in an inpatient setting.

Despite this, I have found the unstructured social time of inpatient settings to be one of the few helpful things I have gotten out of my hospitalizations.
I’m so secretive in general that it’s nice to be able to talk without the fear that I will be judged for my ‘crazy’.

But information besides what I choose to disclose also gets revealed. If I was in my room crying all morning, people know. There’s no hiding it. If I go back to one-on-one security, people know my suicide risk was deemed increased.

Sometimes check-in meetings with psychiatrists were conducted in the hallways where anyone could hear. I’d whisper everything and usually reveal less information as a result.

This makes visitors a very anxiety provoking experience. On the one hand it’s nice to get a visitor, on the other hand those visitors are generally my parents. I don’t tell my parents much of anything. They receive the most vague information possible. I worry about another patient blurting out something private about me in their presence.

At the first hospitalization visitors were let onto the unit and were allowed to all the same places I had access to. So much for that “No Tours” rule.
There was no private place to meet. They could go in my room, but I also had a roommate. I was on edge during all the visits, trying to steer them away from anyone I’d communicated with.

The second and third hospitalizations had rooms where visitors and patients could meet for more privacy. The second still allowed family access to the rest of the unit thus compromising confidentiality of anyone there. What if a visitor ran into someone they knew there besides the one they’d come to see? In a general medical hospitalization the chances of noticing someone you know are much less likely unless you were peeking your head into each room.
The third hospitalization restricted visitors movement more, only allowing them in that one room.

Some point in the middle of my first hospitalization my doctor asked me to list the top things bothering me at the moment. One of the top items on this list was the distress my hair pulling was causing me. I later learned that this had been relayed to my Dad. He didn’t understand why I was stressed about my hair (the part about pulling it out got lost it appears). I can’t imagine how that doctor believed that it was appropriate to share this information with my Dad. I was so visibly upset upon learning this that I worry my Dad held back telling me more he might know to keep me from getting further upset. I have no idea if he was told more.
I believe him when he says that he didn’t try to get information out of the doctor and that this was shared more spontaneously. The hospital only had my permission to talk about about logistics (such as arranging affordable outpatient care) with my Dad but still information gets shared that shouldn’t once a line of communication is opened.
My Mom is banned from speaking to any mental health professional of mine, because she tries to manipulate people into giving her information.
I banned her from visiting at all during my second hospitalization and unfortunately it wasn’t very effective because they kept allowing her on until I started to scream that she wasn’t allowed there.

Family meetings seem to be encouraged, again creating the risk that something will be said that I wanted private.

My third hospitalization was the worst with regards to confidentiality. The central issue became my efforts to protect my privacy.

First they told me they were going to contact my school to let them know I was there. I strongly refused.
Anyone who’s been reading this blog regularly knows that letting my school know about my psychological issues is a touchy subject.
‘But it’s our policy’, they said. ‘We have an agreement with the local schools’
I called my lawyer and they called theirs.
After creating a huge amount of panic and stress for me they backed down realizing they had no leg to stand on.

While this was still being sorted out I noticed some student nurses were visiting the unit. I spotted a name tag. My college’s name was on it.
I fled the room. Had they seen me, had anyone recognized me?
Student nurses from my school came twice a week. No one had thought to mention this to me.
It happened too fast for me to spot any faces. Did I know any of them?
I spent the morning hiding in my room.
“Isn’t their being here putting my confidentiality at risk? I don’t want them to know I’m here. Can’t they leave?”
I go to a small school. People know each other.
No one seemed concerned.
I spoke to the apathetic Human Rights Officer.
I wasn’t allowed to ban them from the unit, but I could ban them from any activities I wanted to attend.
But I couldn’t attend the activities, I couldn’t walk down the hallway to get to the activities room without risking being seen.
The only way to prevent them from knowing I was there was to hide while they were on the unit.

When got out of the hospital I sent an anonymous email to the heads of the nursing department to let them know what had happened.

Here’s the email I sent:

“I am writing to inform you about an issue I had recently relating to the *college* nursing department. I do not believe that anyone at *college* was at fault in this problem, but I hope that by bringing this to your attention perhaps something can be done to fix it.
I am a student at *college* and I was recently a patient on the inpatient psychiatric unit at *hospital*.
My confidentiality is very important to me, as I have previously had my confidentiality broken and suffered discrimination as a result of this. I understand that not everyone will react the same way others have, but because of these problems, keeping my psychological issues separate from my education is very important to me.
One day while on the unit I spotted someone wearing an ID saying ‘*college*’. I bolted from the room to speak with a staff member and learned that a number of nursing students from *college* would be there that morning. The staff knew where I go to school, no one thought to warn me of their arrival. I didn’t want to be seen by them. The staff informed me that they couldn’t be kicked off the unit or restricted to a less central location and that my only option was to hide in my room(or the isolation room) all morning. So I was stuck doing that. The stress of hiding there and the isolation it involved were not things I needed piled on top of the reasons why I was already a patient there.
The staff I spoke with (including the human rights officer) were fairly apathetic towards this problem, citing that they have an agreement with the school to allow the students on the unit. I argued that allowing peers of mine to see that I am there is a breach of my confidentiality because them seeing me there involves receiving information that I don’t want disclosed.
I understand that the students themselves are sworn to confidentiality. (Though from my experience when people break confidentiality it is hard to prove and they end up getting away with it), Were I to run into one of these students in a social or academic situation at *college* the interaction would be colored by their knowledge, knowledge that I didn’t want them to have in the first place.
I feel that as a patient my needs, particularly my rights to privacy, should be taking priority over the educational needs of the nursing students, because there is the option for the school to find an alternate assignment for the students in this sort of situation, but I don’t have the option of being in an alternate psych ward for the morning.
I can’t imagine that I’m the first person to run into this problem. And I understand that having the students not be there when someone from their school is a patient there who objects may not be a reasonable option.
I understand that the teaching hospital is a very successful concept, but that doesn’t mean it can not be improved. The current way that it is being implemented at *hospital* is taking too casual of an attitude towards privacy. I do not know if this experience is representative of other hospitals.
At the very least, if you could help me out by giving me a list of all hospitals where *college* students are on the psychiatric units, I would appreciate it. So I can know to avoid them. Because at this point I feel that if I am in need of inpatient psych care I am unable to get it because I fear a confidentiality violation.
Thank you for taking the time to read this. ”

I now have a note behind my ID in my wallet listing 8 hospitals I can’t go to because my confidentiality would be at risk. Basically I would have to travel fairly far to get to a hospital free of my school’s nursing students. Even further if I wanted to get to a reputable hospital.

I got a couple of more sympathetic, “We’re taking this seriously” emails in reply, but basically the end result is still that I can’t go to those hospitals.

Confidentiality should not need be one of my primary worries when hospitalized, but it has to be because I have to protect myself.

Hidden Self-Injury Tools

I should preface this post by mentioning that I don’t feel self-injury is inherently bad, it can be helpful so I find efforts of others to prevent me from doing it frustrating. You might with to read my other post about self injury first.

When I began self-injuring I also began hiding tools to accomplish it. This way I would always have access should I feel the need. Safety pins were hidden in most articles of my clothing. I had a pencil case filled with razor blades and bloody gauze.

In my first hospitalization I secretly brought in a safety pin. A small item I impulsively decided to hide when I realized what was happening. Turned out this was unnecessary.

They did an awful job of searching my things. When my searched bag was handed to me the first thing I did was open a compartment and pull out a brand new razor blade. My roommate had packed the bag and handed it to my parents. The razor blade had been left in the bag previously.

To make it seem I was healthier than I was I promptly handed the razor to the mental health worker who had given me the bag. My manipulation was wasted. This interaction was never entered into my records and I don’t believe he told anyone because it was him who had missed the blade in the search.
Upon later inspection I realized all of my buttons (the kind with little sayings on them and pins on the back) had been left on my bag. I had accumulated a very large assortment of sharp items.

Initially I had decided I would respect the rules of the hospital and not self injure while there, but after a series of frustrations with the hospital I decided there was no reason for that.
I scratched up my arm a bit one day. Hardly any damage, it’s tough to do much with a pin. I didn’t hide it but also didn’t show it off. It was noticed and I handed over some of the pins.
A threat was made, “Is this everything? We can search all your things again if you want”
“Search if you want too”, I said
I made good eye contact. They bought my pretend confidence.
Later, feeling manipulative again I walked to the nurses station with a pin and said, “Here, I found this in my room”
The nurse made a big fuss about how proud of me she was, not knowing I still had my original safety pin. This was entered in my notes.
I scratched a bit at times following and was not caught.

In the weeks preceding my second hospitalization I knew I was feeling unstable. I had destructive plans running through my head with no specific time set.
In the event that I needed to be hospitalized I decided I should ensure I would have materials to self-injure with in the hospital. I hid razor blades in many items that are always on my person.
Sure enough when I was rushed to the ER I had a nice assortment of sharp new blades. None were found during the search. No one expects the lengths I went to conceal them.
I had quite the stash of blades. I cut a lot during that hospitalization and was not caught.
The closest I came was when I was cutting and punching a wall in the shower. The wall punching made more noise than I anticipated and nurses came barging into the bathroom. Fortunately through feigned modesty and angling my body in ways to hide the cuts, I was able to get enough privacy to get clothing on without being caught. I admitted to the wall punching but the cutting and razor blade were not discovered.

On the day I was being discharged, minutes before I left, I passed a clean new blade to a friend I’d met there. She’d mentioned wanting to cut and being friendly I decided to help her out. It’s a fuzzy moral area for me. It’s one thing for me to cut. I know I won’t go too deep, but other people are uncontrolled variables.
Later I heard she cut up her arm pretty badly and was discovered. She wouldn’t give up my name though when the psychiatrist was demanding the information from her.

At my third hospitalization I also arrived well armed with razor blades. The ER room I sat in had a spare unused blood draw kit. I was bored with making balloons out of latex gloves so I took it and hid it for later.
An accomplishment I shouldn’t be proud of but am is that during this hospitalization I cut in the shower while on one to one security. Meaning, I had a person who’s sole job was to babysit me and make sure I didn’t do these sorts of things and still managed to not get caught.
I tried to draw blood with the blood kit. I thought it would be neat to try and bleed until I passed out. I was doing it wrong. It didn’t work. I tried calling a friend with a history of heroin abuse (the same one who I gave the blade to the previous hospitalization) I thought maybe she would have advice regarding sticking a needle in an arm. She didn’t answer the phone.
I later learned those kits are set up to only work when the blood tube is attached. I didn’t have any tubes.

I was trying to express to the doctors how not okay I was. I gave them useless the blood kit and some of the razors that had become rusty from the shower. I wanted them to know what I’d been up to. It didn’t work. I was discharged the next day despite still being very suicidal. First thing I did upon arriving home was OD on a bunch of pills.

Having so many sharp things hidden in my possession makes airplane travel very stressful. I’m fine with sneaking sharps into a hospital, but not fine with sneaking them onto a plane. The consequences of being caught in the hospital are very low, but being caught with it at an airport is serious business. Before a trip I have to carefully comb through every single possible hiding spot and remove the blades. There are so many I don’t remember them all. I’m incredibly anxious while going through security. I worry if i missed one.
To make matters worse I nearly always have my bag searched additionally. I travel with at least three cameras on the average trip, along with assorted other electronic devices. No matter how I pack these items, my bag appears suspicious under X-ray.
Fortunately it appears I’ve never accidentally left a razor blade behind in my bag, but it continues to be a source of worry every time.

If you are someone who works at a hospital I hope you don’t take out of this post that security needs to be drastically upped for everyone. I think a better message is that if a person wants to do something badly enough they will find a way to do it. Also it is important to note, that most of the in hospital self injury I did was directly following attempts to reach out to staff for help verbally that were unsuccessful.

Trichotillomania

Trichotillomania. I can’t spell the words “schedule“, “definitely” or “regularly” without the help of spellcheck, but I can spell “trichotillomania“. It’s a good thing, because wordpress’s spellcheck doesn’t recognize trichotillomania as a word.

Trichotillomania (compulsive hair pulling) is the one diagnosis I have that all mental health professionals I’ve met with are in agreement about. I, however, feel very out of place in internet communities for those who share my diagnosis. I don’t pull from my scalp, so my problem is more easily hidden. As a result, I don’t suffer from the social consequences that many people have to deal with.

My favorite hairs to pull are ingrown ones. They don’t belong. They’re already defective, they are guilt free pulling.

First I notice the irritation of the skin. Sometimes I can see the hair sometimes I can’t. When the area is more inflamed I poke it with a pin to release the fluid. Digging with tweezers, pins and fingernails I search for the hidden hair. Sometimes blood obstructs my work. I have to allow a day of rest before resuming.

I question the existence of the hair. Maybe I already pulled this one out and forgot? Maybe the skin was irritated from something other than a hair? Was that a shadow or a hair?

After some healing, I recommence my hair retrieval mission. When finally I free the hair from my , then mutilated, skin, I feel immense satisfaction. The greater the length of the hair the greater the satisfaction. The visual is very important to me. I study it wondering how long it had been hiding in my body. Sometimes dead skin is firmly attached to the strand. I slide it off carefully, examine both hair and skin individually and dispose of them.

I replay the scene over and over in my head, eagerly awaiting my next opportunity to repeat it.

Nose hairs are my second most favorite type of hair to pull. They are also the most uncomfortable to discuss. There’s such social stigma about putting fingers up a nose, pulling out a hair there is even worse. I can comfortably tell therapists I pull pubic hair, but often omit the nose hair.

Using tweezers makes me sneeze, so fingers are the way to go. I wonder about the risks of pulling a hair with such an obvious purpose (filtration of the air). I justify it by pointing out to myself, ‘I can’t reach all of them to pull. The ones farther up are still in place functioning.’ I don’t seem to get sick more than average so I suppose it’s fine.

Eyebrows and eyelashes are the source of the most post-pulling-guilt. I start with light tugs. The hairs coming out in my hands are ones that were about to fall out anyway, right? If I’m not careful this quickly escalates into harder tugs. Now it’s uneven. I have to keep pulling to even things out, right? I have to finish the job. It’s all or nothing. Fortunately, I’ve had this more under control in recent years. I started wearing makeup more often. Mascara makes it easier to accidentally pull more hairs in one tug, but seeing the mascara on my hands helps to remind me to stop. Seeing eyeshadow on my hands when pulling eyebrows helps the same way. Wouldn’t want smudgy makeup, would I?

I also pull arm, leg and underarm hair. These are the socially accepted places for hair removal, but I take it to an extreme. Shaving feels like cheating. The hair is still there. I want it gone. I am in a constant struggle to remove it all. There is always that one hair I missed. I remove that and then there’s another.

I use an epilator (basically electronic tweezers) to remove it. I advocate epilators as aggressively as some women advocate diva cups (diva cups freak me out by the way. I bought one and it sits in my desk unused). Epilating is a very soothing experience for me. Unfortunately is as a noisy device. I try to minimize the time I use it when others are home. I don’t want people realizing how much time I spend removing hair.

At times when I don’t have access to an epilator I will eventually begin pulling out the hairs individually. I can tolerate a certain amount of hair, but I have a limit. That limit is lower when stressed. At my first hospitalization I reach that limit. The staff didn’t understand my situation and wouldn’t let me use my epilator because it had a cord (no wires allowed. I could strangle myself -_-). They also misunderstood my trichotillomania as a type of self-injury. I was individually pulling out my hairs, gripping them with my finger nails. I reached the point where I was wiling to compromise with shaving. I couldn’t have a razor to shave either, because I cut. My roommate, who was allowed to shave, took pity on me and allowed me to use her razor on the condition that she supervised to see I didn’t cut. It was very much appreciated. I was eventually allowed access to the epilator under supervision from staff.

Let me elaborate on that point I just made. Trichotillomania is not self-injury. Some people might pull their hair as self-injury, but that is not trichotillomania.

When I self-injure I want to see destruction. When I pull I aim for perfection.

I self-injure as a direct response to stress. I know I will release that stress by self-injuring.

I often start pulling without even noticing. While stress may play a role, it is not the entire explanation. I pull at times I am bored or have inactive hands as well as in reaction to stress.

What they do have in common for me is the importance of visuals. I have to see the hair I pull out, just like I need to see the damage from my self-injury.

I tend to pull more with my right hand than left, which is interesting as it is my non-dominant hand. Pulling with my left hand feels strange.

I have some ideas regarding environmental root * causes for my hair pulling, but I’ll save that for another post.

*ahah poor word choice