Crazy Days at Metropolitan State — Inside Out

Three days.  When a patient was first brought in to the hospital, an analysis was done over 72 hours to determine if the patient is “a danger to themselves or others,” and therefore will be staying indefinitely, or if not, to be released.  It’s also the first thing a new patient, “Jomo,” said to me.

“Three days, man, and I should be out of here.”   He sounded more nervous than confident, probably reassuring himself.  “I swear, man, I just took a lot of acid, and now it’s mostly worn off.  So they’ve got to let me go, right?”

We actually had a lot of patients on the ward who claimed that drugs, particularly hallucinogens, caused their problems.  The scientific belief was that schizophrenics tended to abuse drugs, or that drugs could be contribute to the experience that tips the brain balance in a person with schizophrenic tendencies.  “Let’s hope so,” I said.  “That’s why they’ve got you scheduled for a brain scan today.”

Schizophrenia generally shows up on a brain scan, either as reduced activity in the frontal lobes, or shrinkage in the areas of the brain associated with attention, memory, and social behavior, and sometimes (at that time) used to identify schizophrenics who couldn’t be definitively diagnosed from their behavior — for example, because they tested positive for drug use within their 72-hour observational period.

I took Jomo over for his scan, and waited with him through the procedure.  He was understandably nervous — the results of this scan would determine his fate — possibly even whether he’d spend the rest of his life in an institution.  Perhaps more importantly, it could be an early indication of a progressive disease, of which he’d only experienced the first symptoms.  Jomo was at the age where nearly all schizophrenia first manifests itself — between 18 and 23 — and what he thought was a drug experience could genuinely be his first symptoms of his brain detaching from reality.

I was within that range as well.

The next day, we got back Jomo’s scan results, with the interpretation:  “inconclusive.”  The scan showed some reduced activity and shrinkage, but it was not yet profound.  Jomo would be staying for a while.

Later that night, my roommates and I had been invited over to dinner at our elusive third neighbor’s house, so we walked a few blocks to the local convenience store to pick up some drinks so we didn’t show up empty handed.  (On a side note, I never adopted the local dialect of calling the store a “packy,” short for “package store,” which referred to its ability to sell alcoholic beverages.)

On the way back, a car pulled up alongside us, and a man in the passenger seat shouted, “fuck you, Mickey Mouse!”  I was wearing a Mickey Mouse shirt.

This seemed like an unusual amount of hatred for a cartoon character, and I said, “What?”

The car screeched to a halt, and two big, muscular, prison-tatooed guys jumped out.  They looked typecast for brainlessly violent goons in a movie.  They pushed us around a bit, trying to start a fight.  None of us made any threatening moves, attempting our best to diffuse the situation, but without any idea what any of us had actually done to provoke their ire.   “Do not FUCK with us!  We have a guns in the car and will KILL your asses!” they yelled as they sped off.

“People from your ward?” asked one of my roommates as their car swerved out of sight.

“Heck no,” I said, my heart still pounding.  “I’ve never felt that threatened on the ward.”

We met our neighbor for the first time, who we hadn’t actually seen much. We’d seen his Trans Am, the exact model featured in Smokey and the Bandit, complete with the bird logo on the hood.  It had been out of style for a while even then.  The man himself usually wore mirrored aviator sunglasses, and had a Burt Reynolds-style moustache, but he’d never actually stopped to talk until that day, so when he told us all the neighbors were invited over to his apartment for a cookout, we all agreed that it would be a good opportunity to meet him.

He grilled hamburgers outside, and served us in his kitchen.  None of the other neighbors showed up, but he only had six chairs — and there were five of us and one of him.  We ate burgers and chips and drank the beer we had brought.  About halfway through her burger, one of the girls pulled the other two girls aside, and they all left, leaving me, my roommate “Tom,” (who also worked at Metropolitan State) and my neighbor together.  I had another burger while we talked, eating quickly as usual.

Our neighbor went out back(probably to tend the grill, or grab another beer) and “Nancy,” one of my roommates, stepped back in.  “Something’s not right,” she said.  “I’ve been throwing up.  All of us have.”  Tom and I looked at each other.  None of the girls had eaten all of their burgers, but they seemed fully cooked.  Tom had eaten all of his, and I had managed to eat two.  Nancy left quickly again, clutching her stomach.

“Uh oh,” said Tom, looking a little green.

We felt the heave at the same time.  Tom headed for the front door, barely making it outside.  I headed for the sink.  After heaving, I was rinsing out the sink when Tom came back in, and whispered to me, “I think we’re in a lot of trouble.  I’m hallucinating.”

I looked up at Tom.  I noticed his dilated pupils first, then his face distorted like it was melting.  His face and body pulsed and flowed and changed colors as I stared, fascinated and horrified — and suddenly nauseated again.  Tom fell to the floor, crawling away, as I bent over the sink again.

I saw my neighbor come back in through the back door.  “Something’s wrong with the food,” I told him, not quite thinking straight, and trying to think of what kind of food poisoning would cause hallucinations.

“I know, motherfucker.  I didn’t eat any,” he said, staring at me through his mirrored sunglasses.  My reflection in the sunglasses undulated and moved crazily.  In those sunglasses I could see my own soul, twisting.  “That’ll teach you fuckers to narc me out.”

I hadn’t a clue what he meant.  “What?” I said, unable to tear my eyes away from his glasses with my reflection dancing in them.

He pushed me into a chair.  After a moment, I’d realized he’d tied me to it.  My stomach was still heaving, but there was nothing in it.  “Where is everybody?”  I asked.

“Doesn’t matter, Mickey Mouse,” said one of the huge guys from the car who had pushed us around earlier.  He and the other goon from the car were now there, two guns on the table.  “We’ve got your friend in the other room.”

I can’t string any thoughts together; as I watch the room and the three guys in it swirl and pulsate.  Perhaps I have done something horrible to them.  Had I called the police on them?  Perhaps I had informed Starsky and Hutch, or maybe even the Duke boys?  I couldn’t remember.

One of them pulls out a gigantic knife, and I watch the blade bend and twist and reflect painful light through my skull.  “We’re going to give you a choice.  We can either kill your friend, or cut off one of your thumbs.”

I’m now beginning to realize the kind of trouble I’m in.

I hold out my left thumb.  There isn’t really a choice involved.  I’m suddenly fascinated by it, as it squirms and dances, and imagine it gone from my hand.   “You’ll let him go, right?”

“That’ll cost you both thumbs,” said my neighbor with a laugh.  He ties my hand tightly to the end of a chair, and the gleaming, swirling knife comes screaming out of the sky toward my thumb.  It’s terrible and absurd, and I laugh as the knife touches the joint.

Deep red blood appears on a line along my thumb, and I stare at it, giggling like an idiot, as the pain shoots through my entire body.  Not just my body.  The entire room hurts.  My teeth are on fire.  The mirrored glasses hurt, bouncing reflective metallic pain off the corners of my skull.  I’m laughing, or screaming, I can no longer tell which, as I drift out of consciousness.

It’s dark outside when I wake up later.  The room glides and twists about me, and I’m tied to the chair everywhere; my arms, my chest, my legs, my dreams, my soul.  I notice that both my thumbs are still on my hands, and I count them to make sure.  It’s hard work, and it takes a while to complete.  “Two,” I say out loud.  Around my arm, there’s surgical tubing loosely wrapped, and dots of blood on the veins of my arm.  The two guns that were on the table are now two empty syringes, and I ponder this for a while, wondering how such a transformation could have been effected.

The room throbs and pounds, sending waves of pain through my entire body.  Agony comes from all directions, and pierces me everywhere.  My teeth sting, my muscles are jerking everywhere, and electricity shoots through me.  I hurt in places I don’t even have, and the pain doesn’t stop at the boundaries of my body.  The hours and days drag on, and I feel myself … detach.

When I next have a coherent thought, I’m in a hospital bed.  Some memories come back to me, but I don’t know what’s real.  Running through broken glass on the street; climbing rusty metal steps covered with pigeon and bat droppings, running down the streets, scraping against buildings and falling, trying to cram myself under the back seat of my own car, trying to escape the pain, desperately repeating every phrase any patient of mine had ever uttered to anybody who would listen in an attempt to make them understand…   My feet hurt, and I wonder if they’re cut up badly.

I realize that I’m strapped down.  Weirder, I recognize the restraints from some dim corner of my memory.  Ever so slowly, my brain starts to re-engage, and I realize I’m strapped to a bed in my own hospital.  I don’t recognize the ward or the room.  I actually say out loud, “holy shit, I’ve gone insane.”

Into the room steps Tom, “holy shit,” he echoes.  “I was afraid you were gone for good.  It’s been four days.”

“What happened?” I asked weakly, still a little nauseated, and still, I noticed, hallucinating slightly.

Tom took a deep breath, and started to explain.  “Well, turns out our neighbor is a coke dealer, if you hadn’t figured that out.  I guess he thought we’d called the police and turned him in.  Apparently, he put a combination of rat poison and LSD into the hamburgers.  The girls went to the hospital and got their stomachs pumped as soon as they left.  They figured it was food poisoning.”

“Did they let you go?” I asked.  “After they said they would…”

“Well, I crawled out the door, and threw up in our apartment for a while,” Tom said.  “After I finally felt like I could move again, I went back to look for you.  But I was tripping pretty hard, and not thinking too straight.  I walked around to the back door, and you’re in there with three guys and they’ve got guns, so I go to call the police…”  Tom winced, “but I kind of got lost.  I couldn’t think straight at all.”

“So they didn’t have you in the other room?” I asked, now wondering if he was ever there.

“Nope,” Tom went on.  “I don’t think they saw me.  Anyway, I wandered around until I ran into Rose around 10 in the morning, at one of the gas stations she works in.  She helped me find my way back, and when we went to the back door, you were in the dark all by yourself, tied to a chair, screaming.  You didn’t recognize either of us.”

“We cut you free, and you kept screaming.  We went to call the police, and you went running out of the place.  By the time the police got there, we had no idea where you had gone.   But they found you that night, apparently you kept hailing taxicabs and then screaming incoherently at the drivers, so they called the police.  They brought you to the hospital and they got you into detox with me.  But I don’t think they know what they shot you up with.”  Tom pointed at the track marks on my arm.

“This isn’t detox,” I pointed out.

“Nah, after a few days of that, they were afraid you’d snapped completely, so you were brought here for your 72 hours of observation.  Every time you woke up, you’d scream and try to run away.”

“So, what happened to those guys?  The neighbor and the goons, I mean,” I asked, wondering if the police had caught them, too.

“After they left you, they headed for the Mexico border.  The police took our statements and told us we might be needed to testify, but yesterday, they told us it wouldn’t be necessary.  They were killed by police when trying to escape.”

Wow.  “Hey, while you’re here,” I asked, “you think you can take me out of these restraints?”

“Sure, man,” said Tom, as he started to unbuckle the straps holding me down.  “Now that you’ve got your shit back together, we can probably move you back to a regular hospital until your feet heal.  Oh, yeah, and somebody else wanted to see you while you’re here, if you want.”

It was Jomo.

“Dude!” said Jomo, shaking the hand that Tom had freed from the restraints moments before.  “They’re letting me out!”

“Awesome,” I responded.  “What changed?”

“Well, man,” said Jomo, “you provided a damned good example of just how fucked up somebody can get on drugs and still have a normal brain.  I think that helped me out.”

“Glad to be of help,” I said weakly.

“Plus,” he added, “I wasn’t never as crazy as you.”


Crazy Days at Metropolitan State — The Night Shift

Second shift was my primary shift — and my favorite one, because I could wake up around noon and wander in to work and still be on time.  There would only be one meal served on second shift, and by the time it was over, most of the patients would be in bed.  On the other hand, I’d pick up any other shifts I could, because we weren’t paid much, and to make ends meet I already had four roommates in a three bedroom apartment.  That generally meant a lot of first shifts, especially double-shifts on weekends.

Occasionally, though, there was an opportunity to pick up a coveted third shift.  Although there’s not a whole lot creepier than a mental ward in the middle of the night, these were highly desirable because there was a minimum of work and patient interaction.  Staff were fewer, but if you happened to be paired with somebody you trusted, you could actually relax and read a book, as you traded off doing rounds and being alert for any trouble.

On the other hand, people either braver or stupider than I took it as an opportunity to sleep.  I can’t imagine doing this unless you’re working with somebody you trust with your life, since you are, after all, in a ward full of people judged to be dangers to themselves or others, generally only with one other MHA and no other backup whatsoever.

One evening, I drew a third shift with an MHA whose standout trait was the fact that he was Haitian.  I say this mainly because he neither greeted nor acknowledged me in any way, but immediately upon the departure of the second shift, chatted briefly with the custodial staff in French, put a book over his face and fell asleep in the day hall.  I checked my watch, almost in disbelief — he’d managed to start snoring exactly five minutes after the shift started.

We had rounds to do and paperwork to fill out, and I was just as happy not to have his help.  There was less to do at night, and I preferred to feel busy.  I contented myself with making sure the custodians were safe (the wards were cleaned at night) and checking on the patients — mostly asleep, or at least dormant.

After a few hours, my rounds through the male bathroom led me to discover one of the patients, stark naked, posing and walking in front of the mirror and watching himself in a manner best described as “prancing.”  He stopped abruptly and exclaimed, “Jesus Christ!” when he saw me.

This wasn’t an expression — it’s what he called me.  Patients called me by a number of names, none of them actually my own, in order to fit their own delusions, worldviews, or generally unfiltered impressions of me.  “Jimmy” was particularly popular, for reasons I cannot fathom, though there was a small cadre who referred to me as “Paul Revere.”  “Cindy” carefully explained that I was Paul Revere from Paul Revere and the Raiders, not the Paul Revere who made his famous ride, because he was obviously long dead and it would be “loopy” to think I were he.  Perhaps it was my long hair and occasional beard.  I was also referred to as “the Captain,” but with one exception, it was used jokingly.

Some people referred to me as “Jesus Christ,” convinced that I was actually the Son of God, probably due to the same vague resemblance that led people to call me “Paul Revere.”  It’s one of the few delusions I attempted to dispel directly, but without any actual results.  “I’m not Jesus,” I’d say, as directly and bluntly as I could.

“That’s exactly what Jesus would say,” would be the response.

Rather than engage in another fruitless debate as to whether or not I was the embodiment of a Christian deity, I simply said, “I don’t think you should be walking around naked this late at night.  Come to think of it, you probably shouldn’t be walking around naked at all.  Aren’t you tired?”

“Sorry, Jesus,” said Naked Man.  “Is that in the Bible?”

“It must be in there somewhere,” I said.  “At least something about going to bed when it’s dark.”

Naked Man looked momentarily horrified.  “Oh no!  I didn’t realize I was sinning.”

“Well, let’s let God sort that out, all I’m really asking is that you go to bed, get some sleep, and generally avoid being naked when not absolutely necessary,” I told him, trying not to abuse my position as Lord and Savior.

I walked back to the day hall to find “Ed” standing on the MHA’s neck.  The MHA’s chair was lying on its back, and the MHA was lying there with Ed’s foot on his throat, eyes wide, not breathing, unable to move and not getting any air to scream.  Ed was clearly bent on murdering the man.  It was so quiet and dark, it took me a moment to take this in.

“Ed!  What are you doing?” I asked, running closer to rescue the man.

“I’m trying to kill this guy,” Ed stated blandly.

“What for?” I asked, genuinely interested.  Ed wasn’t particularly violent.

“He’s a putz,” said Ed, as if that explained everything.

“Well, yeah,” I agreed.  “But if you kill him, I’m going to get in trouble.”

“Oh shit!” replied Ed, taking his foot off the MHA’s throat.  “I didn’t think of that.  Fuck it, I’m going to bed.”  With that, Ed walked calmly back to the male dorm.

The MHA lying on the ground wheezed with the first breath he’d probably taken in several minutes.  After a moment or two gasping for air, he stood up slowly, set his chair up again, sat down, put the book over his face, and went back to sleep.  Not for a single moment did he acknowledge my presence, or in any way acknowledge the fact that somebody intent on killing him was quite literally standing on his throat minutes before.

I’d like to think that every time I faced death, I could be so incredibly blase that I could go right the hell back to sleep seconds later without giving it another thought.  On the other hand, it’s deeply ingrained in my psyche that when somebody saves my life, even if it’s their job, I at least say an enthusiastic “thank you!” and experience has borne this out.  This was either the coolest man I’d ever met, or, more likely, such an incredible putz that he simply trusted me both to do his work and save his life as the occasion demanded.

At least he was unconcerned that I violated procedure by not restraining Ed, simply letting him go back to bed and not writing up the incident.

Years later, I worked in group homes for the developmentally disabled.  Similarly to my time at Metropolitan State, I’d occasionally pick up an extra shift.

Third shift was a little different. Because there was no custodial staff, third shift was a three-person job that involved cleaning the home from top to bottom.  With three people, you could get the job done in about six hours, which left enough time to deal with any kids who woke up during the night and needed help or attention.

One third shift, I had two co-workers, “Paul” and “John”.  John immediately launched into a cleaning frenzy with an incredible, infectious enthusiasm.  He loved the job and loved the kids, and he was great to be around.  Paul, on the other hand, announced that he was “really tired” since he had worked the shift before (as both John and I had) and proceeded to go to sleep on the couch.

Near the end of the shift, John and I had gotten all the work done for all three of us.  We had briefly talked about waking up Paul to make him help, but decided that he’d probably be pretty useless, and it was kind of a downer to be around people who didn’t really like the work or the kids, and we were better off just letting him sleep.  It seemed unfair, however, that his laziness would go entirely unpunished…  So I took a permanent marker and wrote “PUTZ” on his forehead in large, neat, block letters.

Our supervisor showed up early in the morning, for a rare surprise inspection.  Paul woke up and stood with John and I, taking credit for our excellent work.  The supervisor went through every part of the home, giving us perfect marks, but was obviously distracted by Paul’s forehead, still sporting a gigantic, unmistakable “PUTZ.”  However, he didn’t say a word about it.

Paul started to notice the supervisor looking at his forehead as well, and surreptitiously peeked in a mirror.  In a display of incredible smoothness, the next time he caught the supervisor staring at it, he explained, “I see you’ve noticed my Afrikaan family name.  Our rituals require us to have it written on our heads this time of year.”

Our supervisor, a man of Jewish descent (and well acquainted with the word) raised one eyebrow, but otherwise did not comment.  At the end of his inspection, he announced, “Excellent job, but I want to see each of you individually in my office today.”

At my individual appointment with him, he explained that he had fired Paul for reasons “that you probably understand” and went on to explain that if somebody falls asleep during a third shift there are procedures for dealing with such things. and that it’s incredibly hard to keep a straight face when telling somebody they’re fired and they have PUTZ written on their heads in huge letters.

I had to admit, it hadn’t occurred to me.

On my next shift (after the night shift where Ed tried to kill the MHA), Ed located me in the day hall.

“Hey, man, I just wanted to say sorry for trying to kill that putz,” said Ed.  “I didn’t know you’d get in trouble.”

“Well, even putzes have a right to live, Ed,” I tried to explain.

“That’s just the kind of thing Jesus would say.” said Ed.  “And all this time, I thought your name was Jimmy.”


Windows Mobile and ActiveSync

ActiveSync is a wonderful thing — unless something goes wrong.  In the maddening manner of most Microsoft error messages, you get the functional equivalent of “something went wrong” with no other detail — and worse, an error message that appears to be telling you something:

“Critical communications services have failed to start.  Try resetting the mobile device, and then connect again.”

This might lead you to conclude that the issue is on your mobile device, when in fact, it appears to mean nothing of the sort:  it appears to actually mean, “ActiveSync didn’t receive any communications from the device” which is just as likely, if not more likely, to be a problem on the PC side.

ActiveSync communicates on these ports:

TCP from Mobile Device to PC:  990, 999, 5678, 5721, 26675
UDP from PC to Mobile Device:  5679

So you can start troubleshooting by making sure these are open and available on the PC.  (If you have a “personal firewall” on the PC, start there.)

In my case, I finally traced it to Winsock2 corruption, as explained here.  Something I’d installed or deinstalled apparently managed to leave a wake of destruction.

The solution was to open a command window and execute “netsh winsock reset”, then reboot.


Replacing Google Browser Sync with Weave

Google Browser Sync was one of the handiest things for people who use Firefox 2.0.  For those who are unfamiliar, it synchronizes bookmarks, passwords, history and persistent cookies across installations of Firefox, using Google’s own servers.  Google announced that they are dropping support for Google Browser Sync effective in 2008.

Weave picks up where Google Browser Sync left off, and then some, effective today.  Unfortunately, Firefox has closed registration to their own synchronization server, which appears to be one of the few ways to install the extension.  However, you don’t actually need to use their server to store and synchronize your browsers — you can use your own WebDAV server.  Doing so requires a little finagling, but it’s well worth it.

On a side note, if you don’t have your own WebDAV server, you can get one from GoDaddy.  They have an “online file folder” which fits the bill nicely.  The 50MB edition should be enough for most people; my probably-normal use of Firefox puts a little over 4MB on a WebDAV server.

Since you can’t register right now, the first thing to do is to acquire the file weave-0.2.4.xpi.  This is the extension itself; if you download it within Firefox, you call install it directly.  Alternatively, save it to a file, and from within Firefox, File->Open will allow you to install the xpi file.

For it to be useful, you’ll need your own WebDAV server with https installed.  I assume you either have one set up, or can set it up yourself — note that if you use a self-signed certificate, be sure to browse there first, and make sure you create an exception so that you can utilize the server with Weave.  (An exception is a way of loading a cert into Firefox so that it can trust a site that’s not chained to a root certificate.  You can set one up at Tools->Options->Advanced->Encryption tab->View Certificates->Server tab->Add Exception.)

On the server, create a directory called user/[username] where [username] is a valid WebDAV account.  This is the directory where everything will be placed, so make sure it’s writable from the WebDAV account.  (Test this with any WebDAV client if you’re not sure, like cadaver.)

Once you’ve installed the xpi and restarted Firefox, Weave will come up with a screen where you can create an account.  Hit [cancel], since there’s no way to specify your own server at this point.  It will also try to navigate a browser window to, which may or may not work, depending on how their servers are holding up.

There should now be a Weave submenu under the Tools menu.  Tools->Weave->Preferences->Advanced tab will take you to “Server Location,” where you can fill in the URL of your WebDAV server.  Change the server location, and hit [OK] to close the preferences.  (Until you do so, it won’t pay any attention to the location of your new server.)

Tools->Weave->Sign In will now take you to the registration window, but it will be using your WebDAV server.  Select “Set Up Another Computer” (even if it’s your first one.)  Weave will look on your WebDAV server for api/register/regopen, but if it’s not there, it will assume everything’s fine, and let you enter a username, password, and encryption passphrase.  Password is your webdav password, and “passphrase” can be anything, as long as it’s consistent across machines.

That’s it! It will take a while to synchronize initially, so some patience is warranted at this point.

In addition to synchronizing everything Google Browser Sync did, it also adds the ability to synchronize tabs, which is just nifty.


Crazy Days at Metropolitan State Hospital — Walking the Line as Captain Kirk

On the ward, we had a color television that received a few broadcast channels, suspended from the ceiling in the day hall. On the CTG Wards (“Continued Treatment Group” — shorthand for “expected to be here forever”) very few patients actually paid attention to the television, though a handful of the more lucid ones would occasionally watch for a while. Almost nobody except visitors had the skills and inclination to actually watch it for an entire show, though occasionally, whatever happened to be on would feature prominently in somebody’s delusion.

I was in the day hall when Star Trek: The Next Generation came on, which I’d never seen before (not having a VCR, and always working when it aired.) I recognized the words in the introduction from the classic series… and pandemonium ensued. “Donna” ran to the television, screaming at the top of her lungs, “you’re not Captain Kirk!” over and over. She’s so agitated, I reach up and change the channel.

“Was that Star Trek?” yelled “Rob” from the porch.

“No!” shot back Donna, still shaking with rage. “The real Captain just turned it off!”

Uh oh.

She saluted me, adding, “Captain Kirk, you have the bridge. Shall I set a course, sir?”

Again, one walks a fine line between buying into a delusion, and denying it outright. Both paths are fraught with peril. But human interaction is a good thing, and generally people don’t like being ignored, and deflection isn’t always easy.

“Well, I don’t see a need to set a course right now,” I said, walking the line. “I think it’s best if we stay here for a while.”

“Understood,” she saluted, and marched off.

Rob sat on the porch with his new boom box and a pile of tapes, purchased with a social security check he got for disability benefits, listening to heavy metal at reasonably low volumes. Long-haired Rob looked like a heavy-metal weightlifter, and was usually lucid enough for conversations.

“Hey, Captain,” he greeted me with a smirk, having overheard Donna. “Have you seen my sweet boom box?”

“It’s great, Rob.” I was genuinely enthusiastic; it sounded great, and Rob didn’t insist on playing it too loudly or after hours. He’d bought some headphones, too, but during the day, he’d just play it quietly. He had decent taste in music, and the boom box was more expensive than any I’d ever own.

“I need you to get me something,” Rob said, in a conspiratorial aside. “It’s something I couldn’t get myself while I was out on my pass.”

At this point, I was rather assuming it would be drugs.

“I need you to get me a t-shirt. One with writing on it.” Well, that didn’t seem so bad after all.

“What writing?”

“It should say, ‘I murdered your children when you were at work,'” he said, “you know, something to wear around for my next day pass so nobody fucks with me.”

“Do they?” Rob was as big as I was, and heavily muscled. Aside from our giant hallucinating Vietnam veteran, he’s one I’d have concerns if I needed to take him down.

“Well, my dad fucked with me. ‘You need to feed the cat,’ he said. I said, ‘I’m not feeding the fucking cat.’ and a took a shotgun and BLEW IT ALL OVER THE FLOOR. ‘THERE, DAD, NOW NOBODY NEEDS TO FEED THE CAT.'”

“Uh. I’ll see what I can do, Rob,” I told him, walking the line again.

A commotion broke out; I hear female screaming in one of the dormitories, and I ran toward the sound. On the way, I passed Donna, standing at attention. “One of the crew has been possessed, Captain. There’s blood everywhere.” She salutes and steps aside.

I see the blood everywhere first, then I see one of the female patients, “Lanelle,” waving her bleeding wrists and chasing around everybody she sees. She is shouting, “I HAVE AIDS. I’M GOING TO DIE. WE’RE ALL GOING TO DIE.”

She very well could have AIDS, or it could be a delusion. Due to patient confidentiality, we wouldn’t routinely be told. I notice that the other MHA’s are nowhere to be found. Regardless, she needed to be calmed down and helped.

I grab Lanelle from behind and wrap my arms around her arms, being careful not to slip in the blood. The problem with our usual restraints is that they cover the whole arm, so I wrestle with her as I ponder what to do, talking calmly and keeping her off balance.

Donna appears before me. “Orders, Captain?”

“Go to the nurse’s station, tell him we need a gurney and we have a patient with bleeding wrists.”

“Aye, aye,” Donna salutes and runs off.

Moments later, two MHA’s arrive with a gurney. We strap down Lanelle while the nurse puts gauze over her wounds. “Does she really have AIDS?” one of the MHA’s asks the nurse, trying to avoid the blood Lanelle and I are covered in.

“I don’t know,” says the nurse. “Try not to drink any blood.”

The wounds don’t look too bad, but per procedure, the MHA’s take her away to be examined by a doctor, and the nurse follows. This leaves me alone in the ward. “Orders, Captain?” says Donna, standing at attention nearby.

Screaming breaks out in the day hall, male and female shouting. Oh, shit. There’s still blood all over the dormitory. “Well, Donna, maybe you could see what you can do about cleaning this up, I’ll be back,” as I run to the day hall.

One of the women on our ward, “Clara,” is a very large woman. By that, I mean she’s both quite tall (probably around 6″ 3″) and has a lot of non-fat bulk to her. She never says anything coherent, but generally lurches about the ward, swinging both arms together in unison.

I round the corner in time to see Rob punch her, hard, in the face, while she swings her arms, clubbing him in the head. “Don’t fucking touch me!” Rob yells, and she’s shrieking incoherently. I hope that if I restrain Rob, she’ll calm down, so I encircle him in our take-down hold, dragging him backwards, as fast as I can get him out of range of her fists. Rob struggles, hard, and we’re too close. ”

“Listen,” I said in Rob’s ear. “If you let me get you to the restraint room, I promise I’ll get you the shirt.”

“Really?” he says, relaxing in my grip. I pull backwards hard to get him out of Clara’s range. She’s still swinging, but not at anything in particular.

Rob walks with me back to the restraint room, and I’ve got him strapped down, sitting outside the room, filling out incident paperwork for Clara’s black eyes. Meanwhile, Donna has managed to clean up all the blood; the ward is spotless. When the nurse and MHA’s return about 10 minutes after they left, they are amazed.

“How the fuck did you restrain Rob by yourself?” asks one of the MHA’s.

“How did you manage to clean up all the blood?” asks the nurse, inspecting the dormitory. “I don’t think it’s ever been this clean in here.”

Donna gives them a smug look. “He did it because he’s the real Captain Kirk. There’s only one, and the sooner you understand that, the better off you’ll be.”

A week later, I handed Rob a paper bag containing a t-shirt silk-screened in capital letters, “I MURDERED YOUR CHILDREN WHILE YOU WERE AT WORK.” Despite the possibility of it being a terrific lapse in judgment, I keep my promises, and I printed it myself, in my apartment.

“Just promise me you won’t wear it around the ward, and especially not around the Christians,” I asked.

“No problem,” said Rob. “I’m going to visit my dad in a couple of weeks and I’m going to wear it. I can’t wait to see his face when he reads I’ve murdered his children while he was at work!”

He seemed so happy, I didn’t have the heart to point out that Rob is an only child. “Are you sure?” was all I could think of saying.

Rob seemed to have second thoughts, “Hmm, you’re right, he might think I meant his cat.” He thought a moment, then brightened. “I’ll wear it when I visit my mom.”


Crazy Days at Metropolitan State Hospital — The Art of One on One

One gets used to patients thinking they have talents or pasts they don’t, so when “Mike” told me he wanted to play the piano, at first I wasn’t sure he actually meant it, or even meant it literally. I found out the hospital had a piano a few floors down, so I got permission to take him off the ward, down to the piano.

He sat at the piano wringing his hands for a few moments, and I was fully prepared for him to either suddenly realize he couldn’t play, plink out “Chopsticks,” or whale on the piano until I had to restrain him. I was pleasantly surprised when he launched into Bach’s Keyboard Concerto Number 1 in D Minor, beautifully. He then played a few classical pieces from Chopin and Mozart, and I was content to sit and listen for a while. In the middle of a piece, he stood up violently, flinging the bench backward, his fingers, clawlike, extended skyward. “Shit!” he yelled. “Shit is coming out of my fingers! Nothing but shit!”

I picked up the bench and hurried after him; he went straight up to the ward, and then back to the male dormitory to sit on his bed, gently rocking back and forth. I left him and walked back to the day hall, running into “Danny,” a schizophrenic hypochondriac. “I think I’m dying,” he said, which was his customary greeting.

As with any delusion, you neither want to feed it by agreeing, nor become argumentative by denying it, so I usually ignored or deflected. Danny continued, pointing to the center of his chest, “I think it’s my heart this time. I think it stopped.”

“Want me to check it?” I offered. One of our duties included taking vital signs — blood pressure and pulse, and sometimes temperature if it seemed necessary and it seemed likely the patient could handle a glass thermometer.

He held out his arm, looking the other way as if afraid to look. I didn’t have a pressure cuff or a thermometer, so I checked his pulse. His heart rate was a little high, probably from anxiety, but in the normal range.

“You have a pulse,” I told him.

“That’s terrible!” said Danny. “My heart stopped and I still have a pulse! It must be something really bad. I’d better go lie down. And maybe die.”

I left him to his room and was assigned to one-on-one duty with “Donna.” One-on-ones were patients at high risk of one sort or another, usually violent toward themselves or others. When on a one-on-one, you’re never supposed to be more than arm’s length away from a patient, for any reason. For example, if a fight started elsewhere, you’re supposed to let it go and call for help. This included the bathroom, which is why female MHA’s were normally assigned to female patients. Donna, however, was a big, strong woman. If she needed to use the facilities, I was supposed to either maintain the short distance, or temporarily hand her off to a female MHA (in short supply) and wait just outside.

Donna was on one-on-one due to “extreme suicide risk.” She was psychotically depressed, which is either terrible combination of schizophrenia and depression, or depression so severe it’s indistinguishable from schizophrenia. A few weeks earlier had managed to fashion a plastic utensil into a weapon, carving deep gashes along her veins in both arms, and bleeding enough that she had to be removed from the ward for surgery, and later, electroshock. Her arms and throat were criss-crossed with long white scars from previous attempts, and the stitches from her recent surgery were still visible down her forearms.

When Donna was handed off to me, she was examining her arms. “These stitches are so goddamned ugly,” she said. “It’s depressing.”

If there was a hint of irony in her voice, I didn’t detect it.

We talked pleasantly for a while, and in the middle of speaking, she suddenly launched herself at an end table, trying to pull out the drawers. I’m not sure what she had in mind, but I restrained her and tried unsuccessfully to calm her down, eventually having to strap her down in isolation, where she was sedated. This effectively ended her one-on-one, until she was released from the restraints.

One-on-ones were usually dreaded by MHA’s, as I’m sure they were dreaded by patients. A one-on-one was usually characterized by hours upon hours of doing absolutely nothing (one-on-ones actually sat by the patient’s bed while they sleep, if they sleep) punctuated by the occasional fierce battle with a patient, usually as soon as you looked away or let your guard down.

I was sent down to a different ward for a one-on-one with a schizophrenic patient with pica. Pica is an affliction where a person is compelled to eat things that aren’t food — like dirt. When coupled with schizophrenia, the compulsion was magnified and enhanced with irrational behavior and thinking patterns.

My patient was sitting at a table, his MHA carefully positioning himself between the patient and the day hall as he handed off responsibility to me. “Careful,” he warned me, “he eats cigarettes. Don’t give him any, or let him anywhere near ashtrays.”

The patient glanced up at me, and returned his attention to the blank sheet of paper in front of him. He had a ball point pen, and over the course of the next hour or so, sketched an elaborate scene of hell entirely in blue ball point, entirely with dark, cramped strokes. It was both gorgeous and horrifying, the work of a unique and talented artist, with an impossibly detailed and realistic scene of supernatural torture and suffering. He had worked slowly from one corner of the page to the other; rather than sketching complete figures or backgrounds, he worked his way in a narrow stripe across the page, and back again.

Another patient walked up behind me, looked at the drawing, and said in a low whisper, “watch out, man, you’re almost on deck.”

As the artist put the last stroke of blue ball point in the corner, he crumpled up his creation… and tried to eat it. I was quicker, and stopped his arm before it reached his mouth. The artist looked at me with a forlorn expression. “At least let me throw it away. It’s Hell. I need to destroy it.”

“Fine,” I said, with some empathy for the compulsion.

The artist lunged toward the day hall. “I’ll put it in the ashtray,” he said, reaching for it with both hands.

I blocked him gently and pulled him away from the ash tray. “There’s a trash can near the door,” I said.

The artist studied the ash tray behind me, shrugged, and said, “yeah, okay, you win.”

He accelerated toward the trash can, reaching it just before me, pulling out a paper bag that was on top. Again I caught his hands, and pulled him away from the can as gently as I could, taking away the bag and throwing it back in the can. With a sigh, he threw his drawing into the trash can, and sauntered back to the table.

He started another drawing on a new sheet of paper, again starting at the corner. He was halfway through an equally intricate, but quite different scene from Hell when I handed him off to another MHA. “Why doesn’t he eat the pen?” he asked me.

The artist stopped drawing, having overheard. “Because,” he said, waving the pen at us, “eating a pen would be nuts.” He pointed to the pen, and to his drawing. “There are demons in the ink, I’m trying to get them all out.”

When I returned to my own ward, Danny, the hypochondriac, was shuffling around, clutching his chest. As I watched, he lay down on the floor. He was right below a poster on administering CPR. and had managed to position himself just like the “victim” on the poster.

One of our quieter old ladies was walking by, and stopped at his prone body. She looked down at Danny, and up at the CPR poster with comic exaggeration several times. She bent down over his body, listening for a breath, listening for a heartbeat, and referring to a poster. When she got to the step on mouth-to-mouth, I thought perhaps I’d better intervene, but instead of starting mouth-to-mouth, she held up a carton of milk from the cafeteria and shouted, “WANT SOME MILK?!?”

“No,” said Danny, not moving. “Thank you.”

I left him to his own devices and went back to the male dormitory, where Mike was sitting on his bed, feet drawn up, a look of horror on his face.

“Mike, what’s wrong?” I asked.

“A tse tse fly appears to have invaded,” he said, pointing.

Near the bed was an enormous cockroach, the kind that lived in the tunnels. It was not making an effort to skitter away or hide, but instead was rearing up on its hindmost legs, waving its antennae. It was surprisingly creepy.

“I’ll choose you for it,” I said. “Evens or odds?”

Mike lost with evens, and grabbed a shoe. He danced over to the cockroach, then hammered it with the shoe repeatedly with a tremendous sound that echoed through the ward. A big cockroach makes a big mess.

“I’ll get some paper towels,” I said.

“Better get a bucket,” said Mike. “Cockroach shit is a lot worse than piano shit.”