Matua and Joseph Smith Junior, a night at the Psychiatric Ward

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    Matua was one of the patients referred to as "well-known to mental health services" i.e. in and out very often indeed. He is a very clever man - years ago, he worked as a psychiatric nurse, he has a BSc in Psychology, and has completed several computer courses. But he is very, very delusional, and has been for a very long time - first admission was in the July of 1984, and he's been in at least two or three times a year ever since.

    Matua is not his real name, it is a Maori term meaning father, used for a Maori gentleman who is 50+ and respected in the eyes of the community. A lot of the staff call him that, whether they are Maori or New Zealand Europeans.

    Matua believes that I am the resurrected Joseph Smith Junior, founder of the Church of Jesus Christ of Latter Day Saints, and that my colleague Rod is King Arthur of the Knights of the Square and Round Tables. And together with my colleague Justine (a.k.a. Justine Just-In-Time Ziggy Stardust), we all have to get into a yellow pink and blue Learjet, and set off to save the world, with of course a stop-over on the Isle of Patmos, as Matua is Saint John The Redeemer, Saint John The Divine, Saint John the son of Zebedee and of Salomne, but not Salome because she was the hussy that danced naked before her father and got John The Baptist's head chopped off.
    On top of all this - (mental health diagnosis of Bi-Polar Disorder), he has plenty of medical co-morbidities. He has diabetes mellitus (adult onset, insulin dependent), hypertension, congestive heart failure, and has had several myocardial infarctions. He is also extremely overweight - (height 180cm, weight 160kg, BMI 49.38).
    He is literally eating himself to death - despite all this, he takes off down to the shop every time he has leave from the ward, buys a ton of fizzy drink, chips, lollies, and chocolate, carts it all back to the psychiatric unit, and eats the lot. Despite his mental illness, he knows what he is doing - as with a lot of my patients, in most ways he is very delusional, but in some ways he is surprisingly logical and knowledgeable, and knows exactly how things are.

    One night in particular, he was very ill, demanding to have the Learjet summonsed and readied for an immediate departure for Salt Lake City and on to Patmos. After picking me up, giving me a cuddle, and crying about me being tarred and feathered and then murdered in jail, and telling me I was his poor little Joseph Smith Junior, he then became very, very angry. He set me down and banged and crashed on the doors, using his considerable weight, desperately trying to escape, and demanding that I come as well to help save the world.
    He would not take any direction, and to keep everyone safe a restraint team was formed. For most people, three is enough to wrist-lock them and take them down to the locked ward, but for Matua, we needed eight. He kicked. He punched. He screamed at the top of his lungs. "You wicked people! You evil nurses! You... you... SATANISTS!"
    Even when we got down there and got him on a mattress in the seclusion room, with me on his feet and four heavy - and determined - nurses holding him down, I was still being raised three feet into the air...
    Finally, we injected him with clonazepam and haloperidol and made a run for it, the door bolts being shot just as he threw himself at the door, howling, banging, and threatening murder, mayhem, and blood running down the walls once he got his hands on us...

    Seclusion is not great for anyone, patient or nurse, but particularly not for Maori patients as they find it particularly disgusting to have a bedpan and food in the same room. However, there is no help for it and we can only put those two things as far apart as possible.

    The drugs took hold and he fell asleep for an hour or so, but soon enough he was up again - and he'd put a mattress against the door - knowing full well that would mean we had to come in as we have to be able to see secluded patients at all times. But our Lois was on duty, and she knew him very well over many years, as she went to the Latter Day Saints Church too. "I think he's up to something," she said. "Let's take a look outside."
    So, at 2am, the nurses were creeping around in the bushes outside the Psychiatric Unit. Three pairs of eyes rose slowly over the windowsill - to find Matua stomping around, and a full urine bottle balanced precariously on top of the mattress, ready to douse the staff...

    For the next hour or so, we continued to do our checks via the outside window, wondering if we were going to get an agitated telephone call from the hospital operators, warning us that the security guards had seen people sneaking around outside our ward, and the Police were on their way. Thankfully, that didn't happen.
    Matua then took the mattress and urine bottle down in disgust, sat on the floor, and sulked.
    As the staff do not have to do room entries if it is too unsafe and we only have four available staff during night shift, we had to leave him in there until 7am.

    Then it was all on again - he sat on his bed as asked, in we went with breakfast, drinks, and a fresh cardboard bedpan and urine bottle - and the shrieks for Learjets, King Arthur, Joseph Smith Junior, and Justine Just-In-Time Ziggy Stardust started up yet again. Just as we were about to hold him down and get another lot of injections out, he slumped to the floor, wailed, and then the poor man sat and cried about my horrible fate.

    Thankfully, all this had a happy ending. It took many months, but eventually he stabilised on his medication, the doctors were able to trust him to take his tablets, and we sent him off to a supported flat complex, where nurses on-site keep an eye on them. He walks every day, is starting to lose some weight, and eats rather more healthily. Better still, we haven't seen him in at the ward for eight months, which is a record.
    He's still one of my favourites - I like people with florid delusions as you never know what will happen next, and the things they come out with are highly original and often rather entertaining :wink2:
    Looking after Matua when unwell is very hard work, but rewarding in the end. He also reminds me that even if you are totally delusional, you can still be respected in the eyes of the community, even if that community extends no further than the boundaries of the Mental Health Service.
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    About NZPN

    Joined: Jan '09; Posts: 7; Likes: 80
    Psychiatric Nurse; from NZ
    Specialty: 5 year(s) of experience in Psychiatric

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