When I started out as a nurse, I had no idea where I would land.
I left a career as a college English instructor after more than 10 years pacing around a classroom trying to get freshmen to care about the intricacies of semicolons (or even commas, honestly) with extensive burnout and the desperate desire to do absolutely anything else. I thought that teaching English would teach me to love writing and literature more. Instead, it did the opposite. I needed to step outside the world of academia and try my hand at something that felt… real? Real wasn’t exactly it. Teaching was VERY real – the world of juggling students’ worries with rules and regulations and cramped semesters. Kids who were supposed to be learning about logical fallacies would come to me to ask how to do their laundry, or to tell me about the kid in their dorm who had sexually assaulted them. That was nothing if not real.
Maybe the word is “foreign.” Or “other.” Packed terms, I knew from my academic study. But I wanted to do something that felt different than what I’d been my whole life, what I’d always known. I picked English because I was good at it, because it came easy. But that was what I’d done in my twenties. Now what I wanted was the thing that came hard.
And so I chose nursing – a profession whose 2-year associates certification was harder than all 150 pages of the thesis I had written for my MA, more grueling than any analysis of Dickens or Foucault. I wasn’t perfect at nursing school, but I loved it. All the caretaking I’d learned as a teacher was still present and relevant, but the setting was different. And the science was a revelation; I’d always told myself that I was “bad” at science – that it “wasn’t my thing.” When my brother and I were young, a female scientist who worked with my father once chastised us for following stereotypes; my brother was the kid who could do math in his head and whose brain’s STEM switch was always flipped on. I was the one who swam in the arts and ran at full speed from biology and chemistry, only surviving physics because my dad was a physicist and it felt insulting not to try at least a little.
As soon as I entered nursing, though, I realized there was more poetry and language and depth in the land of caring for bodies and minds.
But that’s not really what I meant to talk about here. I didn’t mean to take you back so far into the past. What I meant to talk about was the second half of that journey – the one that led me from the care of the body to the care of the mind.
When I started working, I kept choosing what I perceived to be the “hard” thing to do. I worked ICUs of all sorts – cardiovascular (the unit with the reputation for the snottiest of mean-girl nurses), trauma (the messiest unit, the one with the pace rivaled only by the ER), and the dreaded Covid ICU from the first days of the pandemic. Human dramas, all of them. But something was missing. In all my days in ICU, I knew there was a place even better suited to my talents.
When I started teaching, I heard over and over again how I must be so patient to work with freshmen, to teach people material they didn’t really want to learn. Now, as a nurse, I was hearing it again. I had become the go-to nurse on my unit for the care of psychiatric patients. In the ICU we often care for patients with acute mental illness who are too sick to go to a psychiatric-only unit. What I didn’t realize at the time is that psych specific units – even though they house nurses with the same training as any clinical RN – aren’t really equipped to care for patients who need IVs and antibiotics – much less those who need hourly vital signs and machines to help them breathe. So when a psychiatric patient becomes extremely ill, the ICU is the best home for them. Nurses in ICU only care for 2-3 patients at a time. So even if the patient’s illness is not officially critical, sometimes those nurses with a lighter lode are better equipped to watch closely for mood swings or lability – to make sure that a patient who is very sick doesn’t suddenly hit a panic spiral and tear out their lines and drains.
After 5 years of being the patient one, I realized it was time to walk towards my real home; I applied to a psychiatric facility and a psychiatric nurse practitioner program.
My work in both - in my clinicals and classes as a PMHNP and in my day to day as a psychiatric RN – feels like the culmination of everything that has ever held my interest. Psychiatric work is about language and personality and behavior and character – about the subtleties of the way people behave and the way they thing – and about the ways that science can open the door (barely) to understanding what drives those subtleties.
Every day I think of something I want to talk about, or write about. I read a book that teaches me something about how we process concepts related to mental illness, or how mental illness can teach us something about how the brain understands language or input or… anything, really.
And so this is a blog about all those thoughts. I can’t promise a specific theme beyond explorations of the intersections of psych and literature. But I do know where I’d like to start: with drugs.
As a PMHNP student, I have to learn about the names and actions of about a billion specific drugs. And honestly, they’re nearly impossible to remember on their face. The names aren’t as well themed as things like cardiac medications, which have convenient suffixes that point you in the direction of their specific action. And their actions themselves are vague and sometimes flat out unknown. Sometimes psychiatric care is about throwing proverbial spaghetti at the wall – and whether or not the spaghetti sticks determines the diagnosis.
But what DOES make these drugs memorable is their history – their story. And so that’s where I want to start. Every medication I learn about, every medication I give to the patients I care for on my unit, has a strange history – a story all its own. So some of this blog is about swimming throw that world of drugs to understand the landscape of psych treatment – and to give myself some tricks for remembering which medications we understand and which ones we don’t.
To study anything psychiatric requires studying something of history; the DSM is a living historical document in and of itself, changing constantly with our changing understanding of how the mind works and what truly counts as “disease” or “abnormality.” But what I’m hoping here is that telling the stories of some of these medications – and the conditions they are used to treat – will help me to remember and understand them better.
To tell a story is to try to understand how something fits into the wider world. And that’s what I’m hoping to do here… along with occasional jaunts into other related subjects.