Crazy Days at Metropolitan State Hospital – The Intake Ward

Like most people subsisting on the lowest rung of the hospital ladder, I’d often try to pick up extra shifts in order to make more money. Interested people would head down to the assignment office, where they’d have lists of openings, and if you qualified, you could sign up and take the shift, subject to a few restrictions. You couldn’t take more than two extra in a row, that sort of thing. The choicest assignments went to those with seniority, preference was given to people actually assigned to the ward they were picking up an extra shift for, and so when I picked up extra shifts, they were often first or third shift on my own ward, or wards that were incredibly unpopular for some reason.

As it turns out, it may not have mattered whether I was given preferential treatment on my own ward; it was immensely unpopular due to the higher-than-usual number of violent patients. So I was pretty surprised when I got a second shift on an “intake ward.” For some reason, nearly everything else was chosen first.

There was a good reason for this. The intake ward was the first landing place for people who were picked up by the police and given to the hospital instead of running through the court systems because of some obvious reason that they belonged here. I had wrongly imagined that the intake ward would be populated by gently eccentric people brought in by concerned families — not so, those people went to private institutions. In our hospital, the two major paths in were being brought in by the police, or on a stretcher, often to go through the most brutal phases of substance withdrawal. Many were homeless, picked up by the police for something as minor as vagrancy, but managing to clearly demonstrate that they were “a danger to themselves or others.” More than a few homeless wanted to get in to the hospital, checking themselves in, and living out their days with food, shelter, and medical care.

Though the greatest reason for its unpopularity among the staff was the sheer unpredictability of the place. After settling in on a ward, you got to know the patients well — what might set them off, what they like, who needs company. While everybody has their good and bad days, they are within parameters well established by their particular afflictions and medications. Not so on the intake ward. Anything could happen, so you had to constantly keep on your toes, and since everybody is virtually unknown, you can’t tell the difference between the truly docile and those preparing to spring into violent action. To make things just a little worse, most of the people there are quite convinced they don’t belong there at all — and a few actually don’t.

Within a few minutes of my arrival on the ward, I was waved over by a patient sitting in the day hall. He looked around to make sure nobody was listening, and said, “hey, want to know how to make a silver watch out of a nickel?”

“Sure,” I said. While you never want to buy into anybody’s delusions, it never hurt just to listen to anybody.

“Do you have a nickel?”

I searched my pockets, and came up with a dime and a penny, and nothing else. We didn’t carry much, and our keys were required to be firmly attached to our belts. In many cases, the keys dangling from the belt were the only way you could tell staff from patients. “No,” I said, showing him the two coins.

“Well, those won’t work, but I’ll at least tell you how to do it. You’ll have to just imagine the nickel. Now pay close attention,” he said, holding his palm flat, and pointing to the center. “First, you put the nickel in the center of your palm. Right in the middle, right about here.” He traced a nickel-sized circle on his palm.

He paused, looking around to see if anybody was paying attention. They weren’t. “Okay, now make sure you get it in the exact center of your palm. Right in the middle. Have you got that so far?”

“Yes,” I said earnestly, holding out my palm and pointing. “Right here.”

“Exactly,” he said, triumphantly. “You get that just right, and the rest is easy.”

I waited.

“Okay, the next thing you do,” he glanced around again, as if he were about to divulge a tremendous secret. “Is you get some tools, you make all the parts, and you put them together.” He beamed, having conveyed his miracle system to somebody who understood. “Next time I see you, make sure you have a nickel, and I’ll make sure you do it right.”

There was no telling what might happen with an actual nickel. Would he be profoundly disappointed in our inability to make his technique work? Would he become violent, now viewing me as an enemy, unable to use his closely held secret? Or would his delusion simply shift, always chasing what wasn’t around?

A call for help left me for little time to contemplate, and I ran to the source of the call. Another MHA blithely watched me run by (as was the case, more often than not) either on an assignment that takes priority, or simply profoundly lazy or risk-averse. I usually made an effort to believe the former.

I got to a room where a patient was up on a desk, waving a lamp, still plugged in and brightly glowing, and yelling “I’m not crazy!” which was doing surprisingly little to convince anybody. A staff member — an MHA, by the looks of him — sat on the ground by the desk, bleeding from the head, and looking slightly dazed. I had a little more sympathy for the man on the desk than the man under it, for some reason.

“Hi,” I said, as brightly as I could.

“Don’t touch me,” he said, fairly calmly, still brandishing his lamp.

“No problem,” I said, stepping out of the doorway. “Mind if I touch him?” I pointed to the dazed MHA.

I walked over and got him to his feet. To the man with the lamp, I said, “I’m just going to get him out of here and hand him over to the nurse. He seems to be upsetting you.”

“Uh. Okay,” he relaxed a bit, finally seeming to notice that the lamp in his hand. And that he was on the desk. He climbed down sheepishly and set the lamp down as I dragged the MHA outside the room. Aside from being dazed, he seemed okay, so I dumped him in a chair by the door and went back in.

I was followed by something I hadn’t seen on any ward during my entire tenure at the hospital — a psychiatrist. He stepped in, looked at the man now sitting at the desk, and said, “are you more angry or frightened right now?”

He gave this some thought, and said slowly, “frightened.”

The psychiatrist turned to me and said, “I think we’re okay here, I don’t want you to frighten him.”

The MHA was still sitting outside the room. Still rather dazed. Maybe a concussion. I half led, half dragged him to the nurse’s station, where I left him.

I returned to the day hall to find a man with a white headband and wristbands, neatly groomed moustache, clean, expensive tennis shoes, and an incongrously ratty-looking oversized t-shirt and shorts. “You there,” he addressed me as if I were his waiter, “I could use a hand here.”

I walked over and asked what I could do. “Any chance I can make a phone call?”

“Sure,” I said, pointing him to the pay phone.

He looked dejected. “I don’t suppose you’d loan me a quarter, would you?”

Because I had checked earlier, I knew for a fact I had a grand total of eleven cents in my pockets. “Just a minute,” I told him.

I walked back to the nurse’s station, where the MHA with the head would was lying on a bed behind the nurse… snoring. The nurse sat by the window, reading a magazine, and looked up at me.

“Hey, does that guy have a quarter in his pocket?” I asked.

Without a word, the nurse walked over and fished around in the snoring man’s pockets. In a moment, he produced a quarter, and handed it to me without a word. He went back to reading his magazine.

I went back to find the guy with the headbands talking to the guy who knows how to make silver watches out of nickels, nodding absently as he explained that “apparently, the police don’t like it when you try to play tennis naked.” He brightened when I handed him a quarter.

“Thank god,” he said. “My wife is going to kill me.”

“Yeah,” his friend agreed. “It’s too bad you didn’t get a nickel.”

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The man with the lamp found me in the day hall next. “I just wanted to say thanks,” he said awkwardly. “You know, for not punching me or anything.”

“No problem,” I said brightly. “Hey, how did it go with the psychiatrist?”

“Well,” he said sadly, “he’s kind of a dick. I think I’m going to be stuck here for a while.”

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A couple of weeks later, I got another shift in the intake ward. All the faces were new, as I should have expected, every patient who was there before either discharged or moved to a more permanent ward. Lamp guy and naked tennis guy had been discharged; nickel guy was committed to one of the long term wards, and I did see him now and again. He’d recognize me right away.

“Hey!” he’d call as soon as he saw me. “Did you ever find a nickel?”

Once, I actually had a nickel, which I handed to him. He examined it carefully, shook his head, and handed it back. “This one won’t work,” he told me. “It’s the wrong year. Keep looking, though, chief, I know you’ll do it.”