In Liu Wenhui's (pseudonym's) ward, there is a grandfather who is very good at painting.
He had a beautiful picture book of fish, houses, and people. Every time Liu Wenhui went to check the room, the grandfather pulled him and wanted to give him the picture book, saying, "Thank you doctor, thank you for saving your life." ”
There are also patients who write letters to doctors, and although from a psychiatric point of view, letters are a sign of illness, but the words in the letters are "really heartwarming." ”
Since April 1, a mental health center in Shanghai, where Liu Wenhui works, has entered "closed management," with most of the medical staff living in hospitals, sleeping on sofas, bunks, or in corridors. Many of the 90 patients in the psychiatric ward are over 60 years old, most of whom suffer from schizophrenia and are hospitalized for a long time.
Doctors can't go home, patients can't go home, and in difficult times, there is a kind of sympathetic friendship between doctors and patients, "like friends." ”
Over the years, Liu Wenhui has been doing science popularization of mental illness, hoping to break down social prejudices. There are also some more realistic problems in front of patients: property is encroached upon, abandoned by family members, and Liu Wenhui has helped many patients to maintain their rights.
Some time ago, Liu Wenhui took a break to go home and took some twists and turns to enter the house. What is even more tortuous is the last meter of the mentally ill person's return home.
【The following is Liu Wenhui's self-statement】
Psychiatric wards during the pandemic
On April 21st, I told my family that I might take a few days off and go home for a few days.
When the neighborhood committee went to the door to distribute antigen reagents, the family told them. As a result, at noon, I received a call from the neighborhood committee, suggesting that I should not go back and continue to stay in the hospital.
As soon as I listened, the whole person was a little uncomfortable: we had worked on the front line for such a long time, and it was rare to have a chance to rest and go home to take care of the children. There are no documents in the city that require front-line personnel not to go home, but each district has different standards of implementation.
Our neighborhood committee manages several communities, and there are also my colleagues in other communities, and their communities on the other side did not say that they could not go home. A colleague also said that the people at the neighborhood committee told him that he was welcome to go home, as long as he provided a work certificate issued by the unit and proved that he was safe.
In mid-March, our community was sealed, and I was able to come out every day with a certificate of return to work. My colleagues in the same neighborhood as me sometimes can't come out.
My wife is a doctor at a community hospital, and she has colleagues who have had similar situations.
I also have many colleagues who can't come to the hospital because of the community sealing. Our hospital began to be closed on April 1st, and most of the staff lived in the hospital, sleeping on office sofas, camp beds, or building a simple bed, mattress on the floor, and sleeping in the corridor.
Because it is a mental hospital, there are relatively fewer transfers to support, only about 1/5, and other general hospitals may be more.
During this time, the hospital outpatient emergency department was open, and patients were admitted every day.
At the beginning of the epidemic in 2020, our hospital set up an isolation ward to receive patients sent from the isolation point. After the epidemic situation in Shanghai became serious in mid-March, the hospital set up a new sealing ward to receive patients from various sealed and controlled communities for centralized management. The sealed control ward has a building, more than a dozen rooms, and can accommodate thirty or forty patients. There are about 20 medical nurses drawn from various departments.
In the early days, patients came to the hospital to see only the green code, after the epidemic was serious, they began to check the nucleic acid, if there was no nucleic acid, they tested the antigen, did the nucleic acid in the hospital, and then did the hospitalization. Now, regardless of whether there are nucleic acid reports or not, the hospital will admit them.
Nucleic acids can only represent an immediate state, and this risk is difficult to grasp if the patient is in the incubation period or whatever. At the end of February, our hospital had outpatients diagnosed positive the next day, and the hospital became a close connection, and closed-loop management for two days according to the requirements.
After the construction of the sealed ward, the newly admitted patients received the sealed ward. After 14 days of observation, nucleic acids that have been negative are transferred to the general ward, and those who are positive are transferred to the isolation ward.
I have some medical care around me, and after the infection, I have been treated and returned to work after I am ready. During this time, there are fewer patients in the emergency department of our hospital than usual, because mental illness does not directly endanger life, and many can be slowed down.
The family tried to send them to the hospital, all of them were particularly serious: some of them threatened themselves, such as some depressed patients who wanted to commit suicide and were rescued many times; some did not eat and sleep well for several weeks; some were threatening others, emotionally unstable, causing trouble, endangering public safety... There are all kinds of them. More than half of them were hospitalized with episodes of depression.
"This kind of day and night together, let us be like friends"
There are 90 patients in the ward where I am, most of whom are schizophrenic, and there are also Alzheimer's disease, depression and so on.
Their average age is over 60 years old, the oldest is more than 80 years old, the youngest is less than 20 years old, most of them are in long-term hospitalizations, because of illness, family, financial or other reasons, they can't get out of the hospital, they can only stay here. The longest lived for forty or fifty years.
In the past, patients could play cards, play chess, watch TV, move freely, and have a variety of rehabilitation and psychotherapy activities in the activity room.
Now, due to the epidemic situation, since mid-April, the wards have implemented "bubble" management to reduce the gathering of people. Patients can not move around, can only play cards in the ward, chat, read books, they can not understand the outside information, we are when we round the information to bring them.
Family members can't visit, and video visitors can't get it. If the patient has any requests or something to communicate with the family, we will help them communicate.
I am the person in charge of our ward, there are 4 doctors under my hands, some of them are sealed at home, some go to support the sealing ward, and I am left alone to manage the entire ward. 13 nurses, 3 went out to support, the remaining 10, divided into three shifts, working about the same as usual.
I was "on standby" 24 hours a day, checking rooms in the morning and afternoon, writing medical records, communicating with patients' families, and some paperwork to deal with patients' emergencies.
In psychiatric wards, there are often a variety of emergencies. Especially for elderly patients, there are more physical diseases, such as colds and fevers, high blood pressure, high blood sugar, or myocardial infarction that needs to be rescued, which we can't deal with; if we can't deal with it, contact "120" to transfer to the general hospital for treatment.
In March, there was an old man in the ward who had a sudden heart attack, he had been rescued several times before the heart attack, this time rescued for an hour, did not save it, and then the hospital helped coordinate his family to come and handle the aftermath.
Our psychiatric staff has a "beating fee" - when the new patient first arrives, there may be some intense, impulsive performance, we must go forward to stop, to protect, may be subject to some skin trauma. I get hurt by some patients every year. However, most of the patients were treated and their condition soon remissioned.
During this time, most of the hospitalized patients' emotions are relatively stable and can cooperate with treatment. Those who have been hospitalized for a long time are more indifferent to what is happening outside and do not care much.
Some young patients who have just been admitted to the hospital will be a little anxious, asking when the epidemic will be better and when they will be able to go home. I reassured them that when the epidemic was under control, they could arrange for discharge and let them see hope.
Some fear of being infected. I would tell him that it is safe in the hospital, and we will accompany you, protect you, and reassure them. So far, no one in our ward has been infected, and everyone has a nucleic acid every other day.
When many people talk about mentally ill people, they feel very scary, in fact, they lack understanding of them. There are very few mental patients who cause trouble, and as long as he is stabilized after treatment, he is a normal person, even more lovely than normal people.
Their thinking is very simple, not so many complicated ideas. They were asked to stay in the ward, wear masks, and everyone was like children, not crossing the line at the door, and all of them were surprisingly cooperative.
Some patients also write letters to doctors. Although from a psychiatric point of view, the letter is a manifestation of the disease, indicating that his symptoms are not completely better, but the words of thanks in the letter are really heartwarming.
There was a grandfather in his 70s who lived here for many years. He was not in good health, often had a fever and coughed up phlegm, and was rescued several times. The old man was very good at drawing, and he had a picture book with pictures of fish, houses, and people, and it was very beautiful.
Every time I went to check in, he would say," "Thank you doctor, thank you for saving your life," and would give me the album. I politely declined, and he kept sending it.
"The Carpet of the Immortals", exhibited in "Gallery 600". Infographic, graphics and text have nothing to do with each other.
This kind of day and night togetherness makes us feel like friends with patients.
There was a seventeen or eighteen-year-old child who told me every day that I wanted to eat KFC and McDonald's, and I wanted to eat spicy and hot. I can only laugh and laugh, and we can't solve this.
Recently, two patients in the ward were discharged. They had lived for a month or two and were in stable condition. Before, because of the seriousness of the epidemic, I consulted with them and did not go out for the time being, but now it is slightly better, and the family can also come to pick them up, so arrange for them.
In order to reduce the time that the patient's family stays in the hospital and the time spent in contact with the personnel, we have streamlined some procedures, and the discharge procedures and dispensing of medicines are all done by our staff in advance. The family only needs to pay a fee and sign a letter.
"Doctor, what should I do?"
During this time, many old patients called me or sent me messages every day, asking when the hospital would open the clinic and what to do if the medicine was gone.
Many psychiatric patients need to take medicine for a long time, which used to be dispensed once every two weeks, and once the drug was stopped, there may be reactions such as poor sleep, anxiety, irritability, etc., and the risk of disease recurrence will increase exponentially, so they are very nervous.
I will provide some medical information according to their needs. If it is a patient in Shanghai, most of the hospital outpatient clinics are open, you can go out to the nearest hospital to dispense medicines by yourself, your family or a volunteer from the community. Now some common drugs, hospitals can buy, only a few special restricted drugs, to the designated hospital to dispense. The dispensing clinic of our hospital has also been open, and many family members do not know it, thinking that the hospital is also closed.
In addition, recently there is a courier brother, Jingdong or online pharmacy can also try, dispensing routes are more diversified. If it is a patient from abroad, many hospitals have an Internet consultation platform, which can be consulted and followed up, and most of the drugs can be bought throughout the country, not necessarily in Shanghai.
On April 18, 2022, at a community health service center in Changning District, Shanghai, community volunteers sorted out drug dispensing information. Infographic.
When a patient goes to a community hospital or a general hospital to dispense psychotropic drugs, the doctor can only prescribe for 3 to 5 days. In our psychiatric department, these are routine drugs that can be prescribed for two weeks or even a month at a time, depending on the patient's condition. Therefore, some elderly patients, accustomed to buying drugs for a month or more at a time, are reluctant to go to community hospitals to dispense.
There are also some sleep aids that the elderly take, such as one called clonazepam, which is one of the most common drugs in psychiatry and is very cheap. Most of the hospitals this year are out of stock, and our hospitals cannot enter through various channels. Many patients who have been using it for a long time complain that they can't buy it, and we are also helpless.
There are also some patients who are sealed at home who call and say that they have repeated their illness and want to be hospitalized. I had to give them a simple consultation on the phone.
I usually recommend that they try to adjust the drugs as much as possible, if they really want to be hospitalized, they will contact the hospital through the epidemic prevention department, and see the outpatient clinic after arriving at the hospital, so that the doctor can assess the condition. Patients who can generally cooperate with outpatient visits can still control most of the symptoms.
Most of the patients came to me, made one or two phone calls, and the problem was solved. There was also a patient's mother who called me dozens of times. Her son, who was eighteen or nineteen years old and had suffered from schizophrenia for several years, had visited my clinic before. During this time at home, the child did not take good medicine, and his condition worsened and he hallucinated, injuring his parents.
His parents were at home worried, crying and calling me, "Doctor, what should I do?" ”
In early March, I told her that the child might have secretly vomited out the medicine. She said no, she must have taken the medicine. Later, it was found that the medicine was indeed vomited, and then the child became more and more serious.
In normal times, this situation is very well solved. As long as they take the child to the hospital, there is a certain doctor-patient trust in it, and face-to-face communication will be better. If the condition does recur, I can also help coordinate admission. Now because of the pandemic, I can only give her some advice.
When children are violent, they must first be reassured and try to avoid intensifying contradictions. If it is very serious, you need to take measures to force the medical treatment, usually, you can also find relatives and friends to help, now even the neighbors can not help, can only reflect the situation with the neighborhood committee, and then find the police for help.
"The last meter home"
In fact, not only patients, but also our medical staff have been in the ward for such a long time, and there are some anxieties and worries in our hearts. However, everyone has studied psychological counseling and can quickly adjust their state.
For me, the difficulties in work and life can be overcome, and the only thing I worry about is my family. My son is 9 years old and is cared for by my grandmother in her 60s. Before the sealing, the family stockpiled a lot of supplies, and I also helped grab the dishes several times, and the volunteers delivered them to the house.
My wife is busier than I am. Her neighborhood was the first place in Shanghai to see the outbreak, and since the end of February, almost all of their community hospitals, except for administrative staff, have been sampling outside. Before the outpatient clinics were stopped, then residents had needs to dispense drugs, so they opened one or two sites to dispense drugs.
At first, she went out at five or six o'clock every morning and came back at one or two o'clock in the morning, and this state lasted for a week or so, and then it became every few days, and then there was no time to go back, sleeping in the office. In the past two months, she has been able to count the number of times she has returned home.
On the morning of April 4, 2022, medical staff sampled nucleic acids for volunteers. Infographic.
She sampled positives every day. She fainted once while climbing the stairs, rested only one night, and went out again the next day.
At first, she was also worried about being infected, joking about what if I couldn't do it. I comforted her, not so seriously, and did my best to protect myself and let myself fall as last as possible.
I feel sorry for her, but we are doctors, and we have chosen this profession, so we should take on this responsibility and this pressure.
Sometimes she also complains, "Can't hold on, too tired." ”
My most sad thing is that once she said, "My son is no one wants", I was very uncomfortable when I heard it.
My son never left his parents for so long since he was a child. Everyone has a father and mother to accompany the online class, and he is alone. Now as soon as I called, he asked me, "Dad, when are you coming back?" Ask his mom, and his mom does every time, "I'll be back in two weeks." ”
Usually, I brought a little more homework with him, but now no one cares, and the children are more naughty, and I estimate that I have learned very poorly.
After the No. 21 neighborhood committee did not let me go home, I later found the leader of the neighborhood committee, and the other party said that he only needed to provide the medical staff's work certificate and the proof of going to and from the hospital to work, and then I could go back.
On April 29th, the doctors who went out to support our ward returned, and I could go home and rest and spend May Day with my children. The wife (still) did not rest.
I worked in psychiatry for 13 years. Many years ago, during an interview, the interviewer asked me why I came to the psychiatric department, and I said, I think these patients are sometimes cute like a child and need us to be very loving; sometimes they are weak like an old man and need our patience to take care of. I love this profession.
Over the years, I have helped many mentally ill people to maintain their rights, and their wages and houses have been encroached upon and their rights have been deprived; I have also helped solve the problems of family members ignoring them and defaulting on medical bills.
After the epidemic, I will continue to do some science popularization to let everyone understand what a real mental patient is: not all mentally ill people are terrible. It is hoped that the last meter of the mentally ill will be opened up and help them return to society.
After the epidemic improves, (possibly) many anxious and depressed patients will come to the hospital for psychological counseling and dispensing. According to previous experience, the peak of psychiatric patients seeking medical treatment is still to come.
(At the request of the interviewee, Liu Wenhui is a pseudonym)