meandering journey

Psychiatry 4: Acute Observations – Poem 61

this one’s a story
about traveling
and never really knowing
until arrival

only to find
that it’s time again
to keep moving on
in a restless way
that’s littered with small
shining gems of meaning
waiting to be stumbled upon
if your eyes
stay fixed
firmly on the ground

pick a day

pick any shining day
you like
you might choose the one
we just had
why not
it was bright
and the sun rose

there was a woman in my hands this morning
I had to tell her
that she was welcome here
but that there really wasn’t much
I could do

her ills and ails
were beyond my reach and ken
but I would do all that I knew how

she smiled

it took away her pain
for the moment that we shared
and my incompetence
was a thing we could both laugh about

the light of truth
was more palatable
than the darkness
of yesterday

sometimes I think
the only thing there is
that keeps us hanging on
and clinging to the shining thread
is the laughter
that emerges from the night
when we speak honestly

I’m sorry
I’ve meandered
but this is still a traveling poem
and I am moving to another place

today it’s true
I stopped awhile
but it was temporary

© Frank Prem, 2016

Next – Psychiatry 5: Hostel Life -Introduction

This is the final poem in the Psychiatry 4: Acute Observations section.

nursing theory

Psychiatry 4: Acute Observations – Poem 60

well alright
if you really want to know
I’ll tell you the theory
my theory

a few eons ago
they stopped making people like me

I’m a relic from another time

I rubbed shoulders
with madness and eccentricity and violence
and plain nuttiness
for three full years before they licensed me
to be a psychiatric nurse

if they give students two or three weeks
it’s a luxury

back then
they figured that
if we could treat really sick people
in their homes or in the community
they wouldn’t need to come to hospital
we could go to them

fair enough

so what happened
was that all the nurses who had a few runs
on the board
skills and experience
went off to work in the community

well you would
wouldn’t you


except that the result
and you don’t need to be a rocket scientist
for this bit
the result
is that we started getting the sickest people
the ones that couldn’t be managed in the community
coming into the inpatient units

bloody near impossible

at the same time
we stopped training people
in the way they’d created nurses like me


no wonder it’s a bloody struggle
for the poor buggers working in the acute units

no wonder it’s hard to find staff
you can’t blame them for not being interested
in learning on-the-job in psychiatry

no wonder the system is stuffed

I don’t know if there’s a place in the game
for an old fart like me

I’m too cynical
jaded maybe
but that’s my theory
some other bugger might tell you different
but one thing’s sure

it isn’t right

© Frank Prem, 2016

Next – Psychiatry 5: Hostel Life Introduction

This piece has appeared on the blog before, but I wanted it to appear here,  in its intended sequence.


Psychiatry 4: Acute Observations – Poem 59

and I give them so much of myself
everything I can
until my head is a spin
of issues and events
of decisions and repairs
plans and predictions
treatment and containment

I give them all I have

and it is not enough

never quite enough



I am

© Frank Prem, 2016

Next – nursing theory

alzheimer’s in the twenty-first century

Psychiatry 4: Acute Observations – Poem 58

didn’t christ say

what you do
to the least among you
you might as well be doing to me

I always thought
he was supposed to have said
something like that
I thought it might have meant
something real


I follow things
that politicians say
I listen through the newspapers

they all sound like such god-fearers
every one of them has faith
sometimes they fight about
who’s got the best

it seems a strange thing
to me
a kind of phenomenon


today I read another hard-luck tale
a follow-on
from the one about the mad-woman
they put in detention
then forgot about for a few months

they were going to send her
I believe
to some other lucky country

turned out she was one of us
all along

oh well
I guess sometimes
shit happens that way

but today I read
there’s another
this time they deported her
four years ago
and nobody’s seen her since

god only knows where she is now
or if she might be dead

she was one of ours too
slipped through
a safety net
meant to protect us
from the dirty unwashed
these boat refugees
who might be some kind of terrorists
except that most terrorists
I hear
arrive by aeroplane these days


when I cast my eye
over the headlines
I feel despair
wonder why I’m battling the odds
to make my small shred of difference
when it hardly seems that anyone cares
about what happens to the least of us

making a difference
is no longer a measure
of what sort of people we are
or of who our parents were
before the alzheimer’s of this
terrorising twenty-first century
drew a veil
across our vision of justice
our sense of right


I believe tomorrow
I’ll stay home from work

it’s not that I don’t care
it’s just that
I can’t find the heart
to face it

© Frank Prem, 2016

Next – weary

raising the pride

Psychiatry 4: Acute Observations – Poem 58

today they’re okay
on this day at the start of october
I’m proud

this crew of mine
a random rag-tag of workers
has pulled together
to make it through the shift

it wasn’t without drama
sickness left their numbers down
experience was light on the ground
and there was madness in the air

hallucinated voices insinuating

hooch smoked out of sight of everyone

trouble brewing behind brooding looks

and a young guy rocking non-stop

he’s out the back in the high-dependency
with a head full of trouble
so f____d
that we don’t know what to do
and maybe there’s nothing we can do

I’m not sure what will become of him

but today the shift held up
they worked for each other
for the people they’re here for
and it went okay

I feel proud

© Frank Prem, 2016

Next – alzheimer’s in the twenty-first century

between ridiculous

Psychiatry 4: Acute Observations – Poem 57

it’s a fine line

we’re saving a woman
from killing herself
because her life
is a form of dying

she says if she has to go on
it’s not worth it
she might as well pull out the PICC line
that delivers liquid nutrients
to feed her
and just bleed for a couple of minutes
till it’s over

a very fine line

sometimes it makes sense
to be thinking in terms of
an ending
I can understand that
yes I can

no really
I can
when life is reduced
to never tasting food in your mouth again
never being allowed
to bounce a grandchild on your knees
lest you start bleeding again
and always always having the bloody PICC
to remind that you’re an invalid
I can understand

and the anger too
to have your life destroyed like this
through simple mishap in a routine procedure
in the operating theatre

I know about the anger

it’s just that
before you can decide
it’s not worth it
and that you want
to pull the plug
you have to be sane

and if you’re miserable
because your life seems to be
in a terminal state
of appalling
that’s not sane
it’s a depression we have to treat
before you can do
what you have to do

you can’t be allowed to kill yourself
unless you’re of sound mind

the line doesn’t get any finer


the medication
and the shock treatments
have shaken her memory to the foundations
she’s started making little written notes
just to try to catch up on
the place where she was
before treatment

her husband helps
reminding her of what has gone before

and she may be no better
how can we choose any better
between what’s rational
and what’s mad
even when I might think
that I too would rather die
if I were in the same position

I can’t imagine
never being able to eat real food again
or living the whole of the rest of my life
through an intravenous drip

and in the meantime
the treatment has to go on

I wish she and her husband
would remember that
and not hold us responsible
for shooting her memory
to such very small pieces

or blame us
for not letting them act
on understandings they’ve reached
about what to do
when it becomes intolerable

it’s no good pointing the finger
we’re only trying to help her
to be rational
when deciding

it’s a terribly sublime line


one of the nurses told me
that there was a murder
a double suicide
up in the hills

the details were in the local paper

in the end
sanity prevails

© Frank Prem, 2016

Next – raising the pride

Note: This piece was previously posted on the blog, but I want it to appear in correct context as part of this series.

from long black shoelaces

Psychiatry 4: Acute Observations – Poem 56

Please be aware that this poem is on adult themes (suicide) and may be confronting.

I think they’re going to pull the plug soon

maybe tomorrow

she’s been in intensive care since Thursday
in the afternoon
when we found her
tried to bring her back to life

she started breathing by herself
for a while
but that’s all

today they said her brain has died
everything is being done
by machine
set to automatic

on Friday
we talked among ourselves
told what we thought had happened
what we saw

someone said it looked too late
before we’d even started

and the girl who cut her down
had already lived this once
this was a second one the same

why do they do that

I don’t know
nobody seems able to say
but this one used shoelaces
lost consciousness
then strangled

it seems a stupid empty way to go
and today
we’ve been remembering that suicide
is a fleeting thought
and our job
is to see folk through
to the other side
of nothing left
worth living for

a community-based colleague
said she was thinking of us
as she drove to a home visit

halfway around a bend
she saw a mother cow
licking a baby calf

around the next
a flock of cockatoos
the biggest she’s ever seen

and she thought of us
checking bedrooms and bathrooms
for people suspended
maybe dying
thought she was lucky in her work

I guess she is

I got a call from Intensive Care
family members want the possessions
the diary and phone numbers

I’ll carry it all across the campus
tomorrow morning

but the shoelaces
have gone

© Frank Prem, 2016

Next – between ridiculous

Note: This piece was previously posted on the blog, but I want it to appear in correct context as part of this series.

what happened

Psychiatry 4: Acute Observations – Poem 55

she said

I wasn’t planning to throw a Sickie
halfway through the day

what happened is
I was going home for lunch
and I saw my son
I told you yesterday
about him having that chronic thing
that might turn out to be Cancer in his gut

the poor little bugger is only seventeen

anyway I saw him sitting on the fence
around the corner from home
and he was howling his eyes out

he’s tried so hard to be brave
but he just couldn’t hold it in
so I gave work away for the day
I’m sorry
I just knew that had to be my priority

I knew he was pretty sick
but I’ve tried to sort of protect him
from the facts of it
until I was sure just how bad it was
and could explain it all to him

but that f___ing Surgical Registrar
excuse my French
oh they’re such clever Doctors
but absolute fools as people

he just blurted it out
as though he was talking to an adult

there’s a hell of a difference
between seventeen years and fifty
when you’re being informed
you might have a Cancer

I’d be grateful if you’d tell the other Shift Leaders
that I might need time off at short notice
if I speak to them myself
I’ll just start crying again
and that wouldn’t be any help to anyone

I don’t know what’s going to happen

I’ll let you know

© Frank Prem, 2016

Next – from long black shoelaces

and the hell with the papers

Psychiatry 4: Acute Observations – Poem 54

and in an illusion of sanity
I made piles of paper
out of the piles of paper

I picked up stack after stack
flicked through them
as quickly as I dared
to determine which had the potential
to bite me
which were likely to be benign

separated those that were personal

and I threw them
bundle by bedraggled bundle
behind the swivel
on which my working world turns

let them rot there for a day
a week
until I tire of their un-filed clutter
safe in the knowledge that there is no prospect
of lingering importance
in their yellowing ink-lines

it is not a great system
I know
but this is the first time
the first day
in many months
that I have seen the green inlay of my desk

and it makes me grin
with foolish pleasure

I don’t care
what I’ve not yet responded to
nor who I may be causing to wait
or to have to re-write a request

this has been
for me

© Frank Prem, 2016

Next – what happened

the Carer Meeting

Psychiatry 4: Acute Observations – Poem 53

they are mainly older people

making tea
getting the biscuits
familiar with one another
from months or years of Meetings
like the Lion’s Club
or Rotary

one or two
look a little startled
half afraid

new to the game


I am meeting with a group of Carers
have been asked to seek their views
about service provision
and they are ready to tell me
have rehearsed and repeated their stories
many many times

no longer expect to get a response
but are happy to speak anyway
being listened to is cathartic
even if nothing happens

the stages of a career in Caring
for the mentally ill
are transparently on show


the Newbies

look stunned
haven’t come to terms with what it means
this intrusion of Mental Illness
into previously unsuspecting lives
not yet comprehending the future that awaits them
only wanting to know
what is wrong
how to fix it
that help will be there for them

does anyone know what this is
this Schizophrenia
why has it happened
why now
did we do something wrong

will it happen again


the Middle Stagers are angry
but to say that doesn’t do them justice
rope-able is better
they know they won’t get service
when they need it
that no beds are available
unless a life is at stake
that you have to be half beaten up
or expecting to die before anyone gives a shit

the only way to get a response
only way mind you
is to park your car
in front of the Ambulance Entrance
at the Emergency Department
and not shift it
if you want to get them to do anything for you
you have to inconvenience them

those people are supposed to be Professionals
to help those that need them
but they just don’t care

not until it’s too late


the Old Hands have seen it all

they’re angry too
but they have gotten to know the system
over the years
understand that the staff do their best
some better than others
but generally they do what they can
to make it work

when you’ve been around
twenty or thirty years
as some of us have
you learn things
like that you’ll be managing and untangling
this bloody sickness for the rest of your life
the rest of your loved one’s life anyway
so you better adjust to that

you learn where to put your finger
to get at the pulse of influence
the Senior Doctor
the Executive Officer
the local Member of Parliament
you keep at them to change
but you plan it out
brace yourself for the long haul

you have to make sure you keep enough strength
to manage your own ups and downs
look after the Newbies
hose down the others
and keep the pressure on

be sure they don’t add any policies
or make stupid changes
they haven’t asked you about first

we rely on each other in the group
to keep going on

but never mind that
would you like a cup of tea
before we start

so young man
what is it that you
want to ask us about

© Frank Prem, 2016

Next – and the hell with the papers