Cabbage Conversation

"Cabbages." 

I stared at Kaseem, wondering if my ears were playing tricks on me. I'd just asked him what he was growing in his gardening group. I had not been expecting an answer, I never did when speaking to Kaseem. But now I had one anyway; cabbages. 

Kaseem is selectively mute. He can talk nearly as well as any other 15 year old, yet he chooses not to. When he first came to us, he refused to communicate in any way at all. He stood by our doors, watching everything that went on, but never responding to any of it. Even a smile was a rare cause for celebration. 

Gradually Kaseem began to be more communicative. He smiled more, and started pulling wonderful faces; eyebrows twitching up and down, nose scrunching, mouth opening and closing. Mostly we had no idea what he was trying to say with these faces, but it was fun to watch anyway. 

After a while, Kaseem started pointing to symbols and words to talk to us. Then he started using thumbs up and thumbs down to tell us if something was good or bad. Sometimes Kaseem would read to us, and we would all smile at the sound of his voice, and wish that we could hear it speaking his own words rather than someone else's. 

From the time that Kaseem came to our ward, my staff and I talked to him as we would anyone else, so my question about gardening was nothing unusual. The answer, on the other hand, was. 

"Cabbages." 

With a huge smile on my face that I could not suppress, I asked him if he was growing anything else. 

"Strawberries. Lettuces. Potatoes." 

At this point I could have hugged him. Emma, the staff member who had been doing the gardening with him came over and asked him what else he did that afternoon. 

"Hammering nails."

What was he making, I wanted to know.

"Boxes for compost." 

By this time we had the attention of everyone in the room, and I was swallowing a lump in my throat. 

Emma pointed out to him that he had hammered something else, and he grinned. 

"Emma's thumb" he told me with a distinctly cheeky tone. 

I wanted to know if that was an accident.

"No"

"Are you winding me up now?" I asked.

"Yes". 

Everybody laughed, slightly delirious with the feeling that six months of frustrating silence might finally be coming to an end. Six months of patiently allowing Kaseem his silence, of providing him with security and stability so that he might one day be confident to speak, was beginning to pay off. 

I'll never be able to look at a cabbage again without remembering my first conversation with Kaseem, six months after meeting him. 

Let Me Introduce You To Danny

Danny will be 17 this year. He has severe learning disabilities, autism and depression. One of those at a time is enough for most people; Danny has to try and cope with all three together.

Danny can talk. I wouldn’t, however, say that he can hold a conversation. He can tell me that he wants a drink, or the toilet, or to go home. He can even tell me that he feels sad, or angry (a word usually followed by a marvelously creepy growl). But he has no idea how to answer questions that start with ‘why’, which makes it nigh-on impossible to identify the reasons for his sadness and anger. A lot of Danny’s speech is echolalic; he repeats things that he has heard without any understanding of what he is saying. Danny likes to repeat statements that he hears in his favourite Postman Pat and Noddy videos; a classic example is when he says, with no apparent reason but lots of feeling: “oh, what a predicament”. 

Danny has been living on my ward for almost a year. He came to us after his parents admitted that they could no longer cope with his behaviour. Certain members of my team are beginning to think that they cannot cope with it for much longer either. For a reason that we have not yet been able to fully identify, Danny wants to hurt himself. Left alone he will punch and slap himself on the face and head; I would guess that if we left him to it, he would carry on until he was unconscious. 

Of course we don’t leave him to it. We step in and hold his arms, sit him down in a restraint so that he can’t move. This is very effective at stopping him from hurting himself, however it leads straight to another problem. When we restrain Danny, he fights back. And he’s strong. I’ve sent staff off to hospital in an ambulance when Danny has really fought back. He kicks, he headbutts, he does everything he can to get us to let him go. And if we do, he goes straight back to hitting himself. This cycle can go on for hours each day. 

The saddest thing is that, on the moments when Danny is calm, he is a lovely boy, friendly and affectionate, but nobody really thinks of him that way. If I say his name, people groan. All they see is the shouting, self-harming, aggressive nightmare that he can be. 

I just hope that we can help him before the person that he really is gets lost forever, buried beneath endless misery. 

What Is This All About?

A little more introduction is perhaps necessary. Five years ago I finished university with a degree in learning disability nursing. I had chosen this little known branch of nursing having previously worked as a nursing assistant in an assessment and treatment unit, working with people with learning disabilities and severe challenging behaviour. Hardly a day went by that I did not finish with at least one bruise, one bite or a handful of hair missing from my head. By the time I needed stitches in my arm following one lady’s attempt to eat me, I knew that this was exactly what I wanted to do with my life. I just didn’t quite know why.

Three years studying, and a few years doing various different jobs both in England and overseas, brings me to this point in my life and career. I’m a deputy ward manager, which is less glamourous and harder work than I had anticipated. The ward that I manage is a ten-bedded unit for boys between the ages of 12 and 18. ‘My boys’, as I generally refer to them. There are various reasons why my boys are on my ward. From the lad who can’t stop hitting himself around the head, to the one who tries to touch up girls on a regular basis, they all have one thing in common; they need a lot, and I mean a lot, of looking after. 

My boys all have some degree of learning disabilities, although for some this means that their reading level is a few years behind what it should be, and for other it means that they are unable to speak, to understand what is being spoken to them, to feed themselves, to take themselves to the toilet. These boys, functioning at a level not much higher than a new-born baby, are the ones I most love to work with. It’s the challenge of teaching a young man how to appropriately respond to his feelings of anger or sadness, rather than lashing out at himself or others, when he hasn’t even learnt how to put his own clothes on, that I find fascinating. Frustrating, most of the time as well, but the satisfaction when he makes a small step in the right direction is worth all the weeks or even months of work. 

So I’m writing this blog to introduce you to this world, which is alien and more than a little intimidating to a lot of people. I’ll tell you more about my boys, the difficulties they have and the way we overcome them. I might even tell you how we fail to overcome them. Sometimes my boys will make you laugh. Sometimes they’ll make you cry. Sometimes you’ll want to cheer them on, sometimes lock them up and throw away the key. But if they have any impact on you at all, then you’ll be a fraction closer to understanding why I do the job that I do. 

What Socks You Got On?

"What socks you got on?"
"What colours your socks today?"
"Lemme see your socks!"
These questions were fired at me daily. Michael, a 16 year old lad recently admitted to the ward, had an obsession with socks; specifically what colour they were. The answer pretty much determined how he would behave on any given day.
White socks were a huge problem. For some unknown reason, he associated white socks with bad people. Now, while I'm the first to admit that white socks are often a fashion faux-pas, I wouldn't actively persecute  wearers of them. Michael, on the other hand, was quite likely to attempt to beat them up. I wore a pair once, as an experiment, and spent most of the day hiding in the office while Michael glared menacingly at me through the window.
Black socks were safe. Michael, upon seeing a pair of black socks, would give a big sigh of relief, as if he knew nothing bad was going to happen to him that day. When I first met Michael, I wore black socks most of the time, and he would happily sit beside me, he believed whatever I told him and was generally happy to do things that I asked of him. Black socks were, apparently, the sign of a trustworthy person. 
After a while, I became bored with always having black socks to show Michael, so I went sock-shopping. I bought socks in bright colours, socks with spots on, socks with stripes on, even socks with monkeys and mice on. I wore a pair of my new socks to work, and proudly displayed them when Michael came to me with the inevitable question; "what socks you got on?" He looked at the bright colour and the funky pattern, shrugged and wandered off to pose the same question to someone else. He then ignored me for the rest of the day. 
I stood looking down at the socks which I'd hunted high and low for, and spent my hard-earned cash on, all to give Michael a more interesting answer to his daily question, and realised that in Michael's world, there are only two options: good or bad, trustworthy or undependable. There is no middle ground. 
In other words, there are no shades of grey. Everything is just black or white.