Liu Wenhui is a psychiatrist, and in the ward he is in charge of, there is a grandfather who can draw very well.
Grandpa has a beautiful album, every time Liu Wenhui goes to check the room, Grandpa pulls him and wants to give him the album, "Thank you for saving your life."
Since April 1, a mental health center in Shanghai, where Liu Wenhui works, has entered "closed management", and most of the medical staff live in the hospital, sleeping on sofas and making bunks.
Many of the 90 patients in the ward are over the age of 60, most of whom suffer from schizophrenia and are hospitalized for long periods of 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 helps 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. Even more tortuous is the last meter of mental illness when people return home.
Here's what Liu Wenhui said:
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.
When I listened, I was a little uncomfortable: we had worked on the front line for such a long time, and we had a rare opportunity 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, who did not say that they could not go home.
In mid-March, our community was sealed, and I was able to come out every day with a return to work certificate. My colleagues in the same neighborhood as me sometimes can't come out.
We started "closed management" on April 1st, and most of the staff lived in the hospital, sleeping on office sofas, camp beds, or bedding on the floor, and some in the hallway.
Because it is a jingwei center, there are relatively fewer supports, only about one-fifth, and other general hospitals may be more.
The emergency door of a hospital in Shanghai.
Image source: IC photo
During this time, the hospital outpatient emergency department has been open, and patients are admitted to the hospital every day.
Since the beginning of the epidemic in 2020, our hospital has set up an isolation ward to receive patients sent from isolation points. After the epidemic in Shanghai was serious in mid-March this year, the hospital set up a new sealing ward to receive patients from various sealing and control communities for centralized management. The sealed control ward has a building, more than a dozen rooms, can accommodate thirty or forty patients, and there are more than twenty medical care 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 contact, and closed-loop management for two days according to the requirements.
After the construction of the sealed control ward, 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.
During this time, there are fewer patients in the emergency department of our hospital than usual, and if there is a mental illness, it is not directly life-threatening, and many can be slowed down.
The family tried to send to the hospital, all of them were particularly serious: some of them threatened themselves, such as some depressed patients who wanted to commit suicide, rescued many times, and did not eat and sleep well for several weeks; some threatened others, caused accidents, and endangered 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 my ward, mostly schizophrenia, but also Alzheimer's disease, depression and so on.
Their average age is over 60 years old, with the oldest being in their 80s and the youngest being less than 20 years old. Most of them are long-term hospitalizations, because of illness, family, financial or other reasons, can not get out of the hospital, can only stay here, the longest live for forty or fifty years.
Previously, they could play cards, chess, watch TV, move freely in the activity room, and have a variety of rehabilitation and psychotherapy activities.
Now, due to the epidemic, since mid-April, the wards have been "bubble management" to reduce the gathering of people. Patients cannot move around freely, but can only chat, play cards, and read books in the ward. They also have no way of understanding the information outside, and they bring this information to them when we check the room.
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 head 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 my room in the morning and afternoon, and spending most of the rest of my time writing medical records, communicating with patients' families, and some paperwork.
Patient emergencies are also addressed. Especially for elderly patients, there are more physical diseases, such as cold fever, high blood pressure, high blood sugar, or myocardial infarction needs to be rescued, which we can't deal with; if we can't deal with it, contact 120 and transfer it 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 deal with the aftermath.
When new patients first arrive, there may be some intense, impulsive manifestations, we must come forward to stop, protect, may be subjected to some skin trauma. I get hurt by some patients every year. However, most of the patients were treated and their condition soon eased.
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 newly admitted young patients will be a little anxious and ask 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 patients are concerned about 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 people with mental illness, they feel very scary, in fact, they lack understanding of them. Very few patients are involved in the accident. As long as they are treated and their condition is stable, they are 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 cooperating surprisingly.
There was a grandfather in his 70s who lived here for many years. His health was not very good, he often had a fever, 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 the round, he would say, "Thank you doctor, thank you for saving your life," and he would give me the album. I politely declined, and he kept sending it.
This kind of day and night together makes us feel like friends with patients.
A seventeen or eighteen-year-old child said to me every day, "I want to eat KFC, McDonald's, I want 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 family members spend in the hospital, we have streamlined some processes, and we have done the discharge procedures and dispensing medicines for 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 messages every day, asking when the hospital would open the clinic and what to do if the medicine was gone.
Many patients with mental illness need to take medicine for a long time, which used to be dispensed once every two weeks, and once the drug was stopped, it may be 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 find volunteers from the community. Now some common drugs, hospitals can buy, 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.
If it is a patient from abroad, you can consult and follow up on the Internet consultation platform, and most drugs can be bought throughout the country, not necessarily in Shanghai.
At a community health service center in Changning District, Shanghai, community volunteers sort out drug dispensing information.
Image source: IC photo
When a patient goes to a community hospital or general hospital to dispense psychiatric drugs, the doctor can only prescribe a prescription for 3 to 5 days. In our hospital, 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 one month at a time, are reluctant to go to community hospitals to dispense.
There are also some sleep aids that the elderly take, such as 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 their symptoms.
Most people come to me, make a phone call or two, and the problem is 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 her child might have secretly spit 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. She is a doctor at a community hospital, where the outbreak first occurred in Shanghai, and since the end of February, almost all of her community hospitals, except for the 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.
A nucleic acid sampling site in Shanghai.
Image source: IC photo
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 worried about being infected, joking that "what if I can'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 complains, "I can't hold on, I'm too tired." Once she said, "My son is no longer wanted," I felt very uncomfortable.
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, "Daddy, when are you coming back?"
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 advised me not to go home, I found the leader of the neighborhood committee, and the other party later 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 he could go back.
On April 29th, the doctors who went out to support our ward returned, so 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 the 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 our love, and 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, such as some people's wages and houses being occupied. The family members did not care about them, and the problem of arrears in medical bills, I also helped to solve them.
After the epidemic, I will continue to do some science popularization to let everyone understand that not all patients are terrible. It is hoped that the last meter of the mentally ill people's homecoming will 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. Based on previous experience, the peak of medical treatment is still to come.
(At the request of the interviewee, Liu Wenhui is a pseudonym.) ）
Author: Zhu Ying
Editor: Huang Fang
First image source: IC photo
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