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.”

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

  1. Deb says:

    I love this. Great job. Only another health care worker can possibly understand.

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