Day 21


Day 21 of my Acute Care Placement, my last day on the Mental Health ward and my first exposure to Electro Convulsive Therapy (ECT). It was the first day on the ward that I felt truly in control, I knew what was expected and what to do fully. It is a shame that it has taken the four days t find my groove, but I am glad I found it in the end. I am also intrigued by ECT and TransCranial Magnetic Stimulation (TMS), both of which can be used to treat severe clinical depression, both use electricity but in different ways.

My day on the ward started differently to what it has the past couple of days, as I was tagging along for the ECT round this morning. It began at 0600 and started by meeting with the consumers participating in ECT, gaining their consent for the days treatment, discussing any concerns, completing paperwork and preparing them for the treatment. We then escorted them to Theatre, they where put under a light General Anaesthetic and there treatment was completed. For anyone who hasn’t seen an ECT or is curious click here. The treatment itself was slightly confronting, despite the fact that I knew what to expect, in that you are literally watching someone have an electrical signal pushed into their midbrain to cause a controlled seizure. I knew it was conducted safely, I knew the consumer would feel and remember none of it, but it was still confronting. In the recovery room I chatted to the consumers, both out of curiosity and to ensure they were waking appropriately, about the procedure and how they felt. Of the consumers that completed treatment today, they had no memory of the treatment, didn’t realise they had even gone through the procedure, and felt no ill effects from the treatment. Anecdotally, later in the afternoon the consumers that had completed treatment were the brightest and most conversant I have observed them to date. When asked how their mood was, they responded with Great, better then yesterday or similar. I was intrigued.

I had the opportunity to watch TMS a couple of days earlier, as a sort of precursor to ECT and for exposure, and it was definitely less confronting then ECT. To begin with the consumer that was being treated was awake, and the only thing that was involuntarily moving was their eyebrow, which at the time was directly beneath the magnet. I was able to converse with them while they were being treated, ask if they were uncomfortable, in any pain or felt unusual. Aside from the uncontrollable twitching of the eyebrow, there was no complaints. I was intrigued yet again. In later discussions with  one of the Clinical Nurses (CN) I learnt that ECT has about an 85% success rate versus TMS with a 50% success rate. So despite the gentle nature of TMS and the seeming barbaric nature of ECT, the results speak for themselves. If I were in the shoes of a consumer and being asked to select a treatment option, I think I would start on TMS before jumping into ECT. But, knowing that some of these consumers have fought depression for 30, 40 or even 50 years, I can appreciate and understand why they would jump to ECT, and continue with it.

I am thankful for my time in Mental Health, it has opened my eyes to a world that I didn’t think really existed. I know I entered Mental Health with expectations and assumptions, though to be honest I am still trying to work out exactly what they were. And I have left feeling educated, enlightened and better for it. Could I work in Mental Health, absolutely,  could I make a career out of it, entirely possible. Asked me that 7 days ago, and the answers may have been slightly different. Thank you to all the team, you know who you are.

Maintain the Rage

Luke Sondergeld

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