Wednesday, 5 September 2012

All about ECT

A lovely day out today with my oldest best friend, Ginny.  In the meantime - here is chapter 19 - All about ECT:

Chapter Nineteen

It was only a five minute walk to the ECT department but walking along hand in hand with Annie and Millie, each dressed in their slippers and dressing gowns, the journey seemed to drag into infinity.
Annie shuffled along as slowly as possible it seemed. Although she hadn't spoken a word her whole body screamed at Karen to take her back to the safety of the ward. Millie was even worse with her glazed expression seemingly accepting her fate passively as each footstep marched her towards just another day.
The corridor was cool, the sun not reaching in through the windows which were too high to see outside. The blue walls still smelt of new paint, covering the grimy fingerprints of many hands which had trailed along them in misery. They passed the kitchen doors, the inviting aroma of bacon curdling with something else - disinfectant and a taint of stale urine. Two cleaning women were mopping the floor outside the locked door of Milton ward. Raised voices seeped through the keyhole and floated into the air in the corridor.
Eventually they reached the entrance to the newly built ECT department. Shiny and bright, it was incongruously attached to the end of the dinghy Victorian corridor. Linda had been right about the dentist. It certainly looked like a dentist's waiting room with chairs along each wall and a pile of magazines stacked untidily on the low table in the middle of the room.
Karen clutched their notes under her arm. She settled the two ladies in chairs before turning to the office where the staff nurse was waiting.
'Millie Thomas and Annie Crook,' she said as she handed the notes to the nurse. 'From Camberley ward.'
'Thanks. You must be Karen.' The nurse took the notes and placed them on a pile. 'Are you going to watch? Mike phoned and said you were doing your training soon.'
'Is that alright?' Karen asked.
'Of course. My name's Ruth, by the way. Come with me, and I’ll show you the treatment room.' She swept from the room, clutching the pile of notes. Karen followed quickly behind. They marched the length of the waiting room and through the open double doors into a large clinical area.
The room was empty apart from a row of trolleys along one wall, each one covered in a sheet with a folded blanket neatly placed on the end. Oxygen cylinders complete with masks were lined like sentries beside the work surfaces, ready to be used in case of emergency.
Ruth pushed open a door at the far end with her backside and they entered the next room. The smell of disinfectant clung to the air - the surfaces were gleaming white. A tray of syringes and small phials of medication was laid out on one side. She placed the notes on the work surface and turned to Karen.
'These are the anaesthetics we use to put the patient under,' she explained, as she pointed to the tray. 'This phial is the muscle relaxant. Once the patient is unconscious, we inject the muscle relaxant so that they're not so rigid and don't damage their limbs when they convulse. Unfortunately the muscle relaxant also stops them breathing naturally so we have to do it for them with this.' She indicated the oxygen with a large balloon and mask attached. 'We put this over the patient's face and breathe for them until the drug wears off. It only last for a short while. Just long enough to do the ECT.'
'What exactly does ECT stand for?' Karen asked.
'Electro-convulsive therapy. It's just a way to make the patient have a convulsion, you know, like an epileptic fit.'
'What's the point of it?' Karen asked.
'It's supposed to lift their depression,' Ruth replied. 'It's very effective in most cases but it's only used for people who are deeply depressed and all other treatments have failed. It's the last resort, I suppose you could say.'
'Sounds a bit barbaric.'
'Well, not everyone believes in using it,' Ruth agreed. 'But I've seen people get better with this when nothing else has worked and it's better than watching someone suffer to the point where they want to take their life, isn't it?'
'Of course.' Karen was unsure.
'This is the ECT machine.' Ruth indicated a small box, fitted with dials and switches. 'These are the electrodes.' She held up a headpiece complete with pads which was attached to a cord plugged into the machine. 'They're placed on the patient's temples, one on each side of the head then a charge is sent through which causes the patient to fit.'
'Does it hurt?' Karen asked.
'No. They're asleep through the whole thing, and the muscle relaxant stops them doing any damage to themselves.' Ruth smiled. 'Once the treatment is over we take them on the trolley into the recovery room next door and leave them to sleep it off. It only takes half an hour, if that, to come round again. As soon as they're awake, we help them into the waiting room and give them a cup of tea and a biscuit.'
'Are there any problems with it?' Karen couldn't let go of the feeling of unease she felt. 'I've heard that it causes memory loss.'
'There's usually confusion when they wake up and some short term loss of memory, but it is only short term. By the end of the day they'll remember everything again.' She paused. 'Well, mostly anyway.'
'What do you mean?' Karen asked.
'Sometimes people do have longer term memory loss.' Ruth moved towards the door. 'And some patients complain that they're not the same person after a course of treatment. But that's probably to do with their illness, not the treatment.'
'It sounds a bit scary to me,' Karen admitted.
'You get used to it,' Ruth assured her. 'And believe me, it helps more people than it hurts.' She opened the door. 'Right, the doctors will be here in a bit. Are you ready to start?'
'Yes,' said Karen, her reluctance churning inside. She took a breath and followed the nurse through to collect the first patient.
'We'll have Annie first,' Ruth said. 'Sometimes she gets a bit restless.'
She ushered Annie into the recovery room and helped her onto the first trolley.
'I hope you haven't had any breakfast today, Annie,' she said. 'No teeth in?'
Annie showed her bright pink gums before laying down. Ruth pulled the blanket over her lower half and wheeled the trolley through into the treatment room.
'Hold the door open, Karen,' she called.
Once inside, Karen stood by the door, reluctant to be any closer. Two doctors waited inside, leaning against a cabinet. They looked up as the nurses entered.
‘This is Karen,’ Ruth nodded towards Karen. ‘She’s just about to start her training. She’s watching us this morning.’ She turned to Karen who was standing just inside the door, as far away from the treatment area as possible.
'Come over here,' Ruth called. 'You won't see anything from there, and we might need you to help hold her down.'
Karen edged forward until she was standing next to the trolley. The doctor looked up at her.
'Right you can hold the left leg nurse.' He turned back to Annie. 'Now, we're just going to give you a small injection, then when you wake up, you'll be back in the recovery room.'
Annie's response was to lay there, staring at the ceiling.
The anaesthetist took the syringe and injected her with the two drugs, then, as Annie slipped into unconsciousness, held the mask over her face, squeezing the bag to help her breathe whilst the other doctor set the dials on the ECT machine.
'Ready, stand back.' He placed the electrodes on Annie's temples. A shock passed through her as she clenched her gums. Her body suddenly became rigid as her back arched into the air.
'Hold her legs.' Ruth gripped one leg whilst Karen held the other. She felt Annie's body convulsing under her hands.
Karen felt sick with horror at what was happening to this helpless woman but before she could form her feelings into words it was all over. Annie was relaxed, her body seemingly at rest.
'Now we need to turn her on her side,' Ruth said as she moved to the side of the trolley next to Karen. She pulled the blanket from Annie's body. 'It's called the recovery position. Just get a hold of her leg here, take her shoulder and turn her towards you, like this.' She turned Annie expertly. 'Then you put a pillow here, to stop her from rolling on to her back again.' She placed the pillow behind Annie's back and covered her with the blanket again.
'Come on, we've got another dozen to get through this morning.'
She wheeled Annie back to the recovery room where another nurse was waiting to take over.
'You can help me with the next one if you like,' Ruth suggested.
Karen was actually feeling quite queasy at the though of more of the same, but pushed down her hesitation as she nodded and followed her through to the waiting room again.
'We'll do Millie first,' Ruth decided. 'Then you can take them both back to the ward when they're ready.'
The waiting room had filled with patients, men and women, most of whom were dressed in slippers and dressing gowns. Some were sitting passively, staring out of the windows. Others were standing, moving restlessly from side to side. A man dressed in dungarees was pacing the length of the room, a male nurse walking beside him. Ruth nodded to him as she passed.
'Be with you in a minute,' she said. 'We're just going to do Millie first.'
Millie was sat at the end of the row, her face a blank page.
'Come on Millie,' Karen began. 'It's your turn now.'
'Have they done Annie?' Millie asked. 'Is she gone?'
'She's had her treatment,' answered Karen. 'She's sleeping it off now.'
'She's dead,' Millie announced.
'No, Annie's not dead,' replied Karen. 'She's only asleep.'
'You're going to kill me now,' insisted Millie. 'You want to kill me, don't you.'
'Of course not,' assured Karen. 'This is just your treatment. You've had it before and didn't die.'
'You don't know anything,' Millie replied. 'They killed me before. That's what they're doing. I know.'
'Stop it Millie.' Karen tried to find something encouraging to say . 'Come on, you'll feel better after it's done.'
'Alright.' Millie got to her feet. 'I'll come, but you know I'll be dead.' She reached for Karen's hand and walked through the door into the recovery room.
'Hello Millie,' Ruth smiled at her as she came into the room. 'Let's get you up on the trolley. Good girl.'
Millie was soon lying on her back being wheeled through to the treatment room and Karen assisted with the same process as she had with Annie.
'Two down, ten to go,' said the doctor as they pushed her back through the double doors to recover.
'You can stay out here now, love,' Ruth instructed Karen. 'When they wake up take them into the waiting room and get them a cup of tea. There's some biscuits in the kitchen too. But make sure no one waiting for treatment has any. You have to watch them like hawks.' She looked at Karen's face. 'Don't worry, you're not on your own.' She indicated the other nurse who was sitting reading a magazine and who looked across at them before going back to her reading.
Karen waited, watching Annie's and Millie's sleeping faces, each one seemingly oblivious of the busy clattering world that they were in. She wondered what their dreams could be, and whether the ECT made you forget everything in your dreams as well.
Annie was stirring. The recovery nurse dragged herself away from her reading and came over to help her off the trolley.
'Hello, Annie.' Her voice was too loud. 'You're in ECT. You've had your treatment and now we're going to get you a nice cup of tea.'
'I'll take her now, if you like,' Karen said as she took Annie's arm.
'Alright, thanks,' said the nurse. 'Millie will be awake in a minute. You get Annie settled and come back for her.'
Soon they were trailing back along the corridors towards the ward and plodding up the narrow dark staircase together.
Karen remembered her first day.
'The things I've got myself into,' she thought. It was all still strange, but she felt she wouldn't have missed it for the world.
This ECT though was another matter altogether.
Poor Annie and Millie - neither of them seemed to know where they were going or where they'd been that morning.
'Come along Millie.' Karen noticed she'd lagged behind.
Millie gazed blankly at Karen.
'Here, take my hand,' Karen suggested. Millie took her hand and they continued up the stairs.
Being a party to this morning's events weighed heavily on Karen's conscience, taking her mind off her own troubles for a while. There were so many things about this work that made her feel uncomfortable.
'What am I doing here?' she thought, not for the first time.
Fumbling with her keys, she unlocked the door and let them back into the ward.

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