Hurricane Lisa

Nursing care of a person with Borderline Personality Disorder can feel like being in the eye of a hurricane.

Lisa was in her early thirties and had been living in a group home run by the Department of Mental Health. She disclosed to group home staff that she was going to throw herself in front of a train.  Since there were train tracks nearby, Lisa’s plan was viable and she was sent to the ER. From there, she was sectioned to our inpatient psych unit for stabilization.

 From the moment she was admitted, Lisa was demanding and belligerent.  Upon arrival to the unit, she became irate that she had to remain quarantined in her room until her Covid-19 results were pending.  She screamed, yelled, and belittled the staff.  Her voice carried throughout the hallways and triggered other patients.  Some felt sorry for her.  Others believed the staff were mistreating her.  Lisa’s presence created an uproar on the unit.  Both staff and patients were exhausted and on edge for the duration of Lisa’s hospital stay.

Heavyset with thick, dark hair and brown eyes, Lisa had been hospitalized multiple times.  Her ability to tolerate frustration was on par with that of an overtired toddler. She was an emotional pressure cooker, exploding over seemingly trivial incidents.  Attempts to set limits were met with fits of rage followed by dissociative episodes.

  Until she was placed on one to one observation, Lisa’s outbursts episodes escalated to self-injury and/or assaults on others. She was creative and skilled in finding ways to injure herself, given the limited access afforded on the psych unit. The scars on her forearms spoke to Lisa’s expertise in the art of self-injury.  Her weapons of self-destruction included the wire in her face mask, a hairbrush bristle, and a shard of hard plastic from the trash can she smashed. 

I  witnessed one of Lisa’s dissociative episodes one morning while I was coaxing her to take meds to ease her anxiety.  She was yelling and ranting about not wanting to feel sedated.  It took a monumental effort to keep my own anxiety at bay as I worked to modulate my voice and still my jangling nerves.  At some point during our interaction, Lisa’s ranting morphed into the hyperventilation and sobbing of a panic attack.  There was a visible shift in her eyes,  as if a cloud were passing across the sun.  Lisa was no longer present in the same time or space as everyone around her.  In her mind, Lisa was somewhere else.  She began to scream and tried to bang her head against the counter.  I took her hands, repeatedly reassured her that she was safe and that I wouldn’t let anyone hurt her, and led her to her room.  She eventually calmed down and was able to take her meds.  By that point, I felt like I needed a prn for anxiety as well.

Lisa was an incredibly damaged woman with no capacity to regulate the emotional storms that raged in her mind.  She erupted at the slightest provocation and dissociated when her emotional distress was more than she could tolerate.  Lisa had given birth to a child she had no ability to raise.  She had a photo album  full of pictures of the ten-month-old. He was adorable, with a gummy smile, chubby cheeks, and Lisa’s eyes.  In her calmer moments, Lisa spoke about her guilt over filing assault charges against the baby’s father.  His court date was approaching, which partially explained her mental health crisis.  He faced jail time for assaulting Lisa, yet she felt somehow responsible. Caring for her was like walking through a minefield in an emotional swamp.  You had to tiptoe around the landmines while simultaneously finding solid footing.

The night before she finally discharged back to her group home, Lisa banged her head against the wall in her room repeatedly then attempted to swallow a screw she’d removed from the window casing. The next morning, she sat in the hallway crying and yelling that her head hurt and she felt nauseated.  She’d given herself a concussion from headbanging.  Lisa refused to take Tylenol or ibuprofen, insisting she was allergic to both. Trying to work with Lisa made me want to bang my had against a wall.

The day Lisa was discharged back to her group home, a deep silence permeated the unit. It was the kind of silence that a violent storm leaves in its wake.  I felt like we’d all been holding our breath and could finally exhale.  Staff and patients alike appeared shell shocked as we attempted clean up the emotional wreckage Lisa had left in her wake. I haven’t seen her back in our hospital since then. I can only hope this is because she’s either being better-managed in the outpatient setting or she’s been admitted to a different hospital. If Lisa ever comes back to our hospital, it will be exhausting, to say the least. But I’ll know she’s still alive.

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