Crazy Days at Metropolitan State Hospital – Getting Out

We didn’t wear uniforms or special clothes as Mental Health Assistants — aside from a general guideline about wearing comfortable clothing without accessories that could be stolen or used to strangle somebody, we dressed however we liked — for me, this generally meant jeans and a shirt that wasn’t too loose — which is what most of the patients wore. Most MHA’s were indistinguishable from patients, except sometimes they did slightly more work, and always had keys attached to their belt loops.

Therefore, the general assumption when walking around the grounds is that the people you see are staff. As a huge hospital, there were always people outside on the grounds here and there, and little reason to pay attention to them.

As I parked my car in the lot, I noticed a large man on a Harley cruise by. I looked up to see his back as he thundered by. Nothing remarkable in that. However, as I walked from my car to the front door, there he was again, cruising along in the same direction. That struck me as slightly odd. Just as I got to the front door, I heard the familiar engine noise of an approaching Harley, and this time caught a glimpse of the driver as he sped by. It was “Eugene,” a patient on my ward — a 350 pound, 6 foot 6, hallucinating Vietnam veteran.

I hurried upstairs, and located the nurse in charge of the ward. “Hey, I just saw…” I started.

“Eugene?” he finished for me.

“Yeah. I just saw him go by on a motorcycle. Does he have a day pass?”

“Nah,” the nurse said prosaically. “One of the Christians let him out. Apparently he just scared the Hell out of her, and she held the door open for him.”

“The Christians” is how we referred to a church group who would visit the ward. Their hearts were certainly in the right place, and they offered company to any of the ward’s residents who were interested. They’d play games or read Bible verses, and were generally well received. On the other hand, they were often woefully unprepared to deal with our tougher cases, sometimes mistakenly fed delusions, and were often a focus of attacks. When they were around, I usually kept an eye on them, as there were at least a few patients they’d agitate. Occasionally, there would be a new face, and sometimes they’d simply freak out, and beg to be let out of the ward.

The week before, I’d been on duty when one of the Christians ventured from their usual table to offer to read the Bible with “Ed,” who was generally quiet on his daily dose of thorazine. She took his lack of response as assent, so she sat down and started reading. Ed listened for about five minutes before screaming “Jesus killed my parents!” and launching himself at the poor woman. I was nearby, and caught his elbow before he punched her in the face, taking him down; even immobile in my grip, he refused to calm down, so I tied him down to a restraint bed.

By the time I got back out to the Christian table, she was gone, but one of her friends thanked me on her behalf, and offered to pray for me. I hadn’t expected her to be back.

However, she had been back, and Eugene, a huge and gentle man, had startled and frightened her so much, she had let him out. He’d never shown any sign of wanting to get out, nor ever asked for a day pass, or to go out to work.

“So, where’d Eugene get the motorcycle?” I asked the nurse.

“As far as anybody can tell, he stole it. He was a mechanic in Vietnam, apparently,” explained the nurse.

“So… Are we supposed to go get him? Or call the police?” Nobody was chasing him when I saw him, or, for that matter, appeared to be paying attention at all.

The nurse shrugged. “Well, you know Eugene. Unless he’s having an episode, he won’t hurt anybody or himself, and he’s really not capable of living on his own. Besides, he’s a volunteer, and he’s on the DNR list.”

Surprisingly, most of our patients were technically volunteers. It was more rare to encounter a patient who had actually gone through the legal process of being committed. Being a volunteer didn’t mean you could come and go as you pleased — you could fill out some paperwork, and you’d be released in 48 hours if there were no objections. The trick was that an objection was automatic, and the process of commitment would begin — so there was a class of patients who would apply to get out, then withdraw their request when threatened with commitment, often assured that they’d be released when they were truly ready.

Another class of patient included people who didn’t seem very dangerous, and for whom the hospital was a sort of home — people who would otherwise be mildly deranged homeless, living on the streets. Many of these people were on a “do not report” list, which meant that if they escaped or left the hospital, nobody made a fuss. They’d be granted a day pass and wander off, and nobody would look for them or report their loss to the police. Usually they’d be back some time after their medication wore off, a week to six months later, usually on their own, and occasionally brought by the police.

The nurse continued, “he’ll probably put the motorcycle back and come in when he gets tired. Hopefully whoever owns it won’t call the police, that would just mean more paperwork for us. Hey, why don’t you take a patient outside who hasn’t been in a while, and you can kind of keep an eye on Eugene, just in case?”

“Sure,” I said, and got about ten feet from the nurse’s station before “Melvin” drew me aside. Melvin was shy and quiet, slight of build and older, and I hadn’t talked to him much before.

“Do you think I can go outside?” he said hopefully. “I haven’t been outside in fifteen years.”

“Really? Wow. Sure, of course,” I said. “Let’s go.”

Melvin and I walked out and sat on the lawn. We watched Eugene buzz by several times, while Melvin smiled contentedly and picked blades of grass.

“So, Melvin,” I said, conversationally. “How come you haven’t been outside in so long?”

“I can’t get a pass to go out by myself,” said Melvin sadly. “And nobody will ever take me.”

“That’s … well, that’s too bad,” I replied. “How come?”

“Well,” he began, and hesitated. “I killed an MHA. Buried him in the woods over there.”

“Uh. Really?” I was a little surprised that nobody had mentioned this to me, but then again, I didn’t tell the nurse who I was taking outside, and we did have a number of dangerous patients on the ward. It could be true.  It might be that the hospital never even found out what actually happened. It could also be a delusion, but even then, if he thought he’d done it before, he might try something “again.”

“Yeah,” he said, a trace of regret in his voice.

I briefly assessed his small stature and thorazine-dimmed reflexes, and decided I wasn’t any worse off with him one-on-one than I was when vastly outnumbered in the ward. Eugene buzzed by a few times before Melvin spoke again. “Don’t worry,” he said, “I like you.”

Eugene went by a few more times. “It’s good to be outside,” Melvin said, standing up. “Do you think you’ll ever take me out again?”

I thought for a moment. “I don’t see why not,” I said honestly, “I’ll check with the nurse next week to see if we can head outside for a while again.”

“Even five minutes would be great,” said Melvin, as we went inside.

About an hour later, I looked up to see Eugene looming through the glass on the other side of the door. I walked over and unlocked the door for him, and stepped aside as he came in.

“Ran out of gas,” said Eugene.