Tag Archives: mental hospital

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.”

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.”

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.”

One day, a new patient was brought to our ward. This is unusual primarily in that most of our patients were long-term, and there wasn’t a whole lot of turnover. People didn’t often get out or leave, so seeing new faces was unusual unless it was for an extremely-rare family visit or new recruits joining the visiting Christians. The new guy was an older man, who looked like an old southern gentleman, with shoulder-length grey hair and a chin-puff beard. I don’t know if he had a southern accent, as he didn’t speak.

Paranoid schizophrenics don’t all appreciate or understand eye contact and a hearty handshake, so I left him alone. He didn’t speak, and mostly paced back and forth along the day hall, a ritual I wasn’t about to interrupt.

Our largely-Haitian custodial staff (and some MHA’s) were in the obnoxious and dangerous habit of speaking French to each other on the ward. A normal person not fluent in French might have suspicions that they are being talked about. To a paranoid schizophrenic, this is not only an absolute certainty, but it provides proof of a conspiracy against them, feeding into any number of delusions and agitating them beyond belief. For this reason, the hospital had a strict English-only policy. The policy was sometimes just ignored, with the predictable result that French-speaking Haitians tended to get attacked at an alarming rate.

On more than one occasion, I found myself rescuing one or more Haitian rejects. It pissed me off and I wrote them up. Knowing the patient was set off unnecessarily may have led me to be even more gentle when I restrained a patient, even though I might want to punch the jerk who should have known better. I never did, of course, though I’ll admit being pretty slow on the draw if the patient wasn’t in danger of getting hurt.

Sometimes, though, a patient would be set off by nothing in particular. More accurately, nothing external, as schizophrenics often had a disjointed internal dialog that could upset them or tell them to do things. This was referred to as “responding to internal stimuli,” and would appear on incident reports where a patient would appear to go off for no discernible reason. Even with medication, some patients were subject to bouts with their internal demons, so on the ward, one’s guard was never entirely down.

As I sat in the day hall chatting to a patient about one of their problems, the new guy walked back-and-forth, back-and-forth in front of us. Nobody paid much attention, though I tried to keep an eye on “the Colonel,” as I thought of him, without it seeming obvious that I was keeping an eye on him, which can be a trigger for an episode. So mostly, I listened to his feet, and didn’t look at all.

The footsteps halted abruptly near enough where I could see his feet, even looking down. A lot happened at once — he reared back, and his foot came up. With a small measure of pride, I can say that my first thought was how I could keep the Colonel from hurting himself. With a larger measure of embarrassment, my second thought was “here comes a foot right for my FACE,” and since I didn’t want to knock the guy onto the concrete, I decided to lean back to minimize the blow and get kicked in the face. Decided is probably far too strong a word, as ruling out more potentially-harmful-to-the-patient options as his leg was in motion left me with very few choices of action, most of which involved a facially-visible shoe print.

Agitation breeds agitation, so a lot of the patients started yelling and getting upset. The Colonel lost his balance with the initial blow, his fists balled with rage, body shaking, face strangely impassive. I grabbed him and we fell to the ground together. “It’s okay,” I said calmly, “I won’t hurt you.”

Other MHA’s showed up and they walked him down to the restraint room. Since I’d been kicked, I was instead sent to the nurse, who looked at the tread on my face and said, “those look like Converse All-Stars.”

As they struggled to restrain him, the MHA’s noticed dollar bills on the floor of the restraint room, which had fallen out of the Colonel’s many pockets as he tried to wrestle free. He’d apparently had nearly $500 in small denominations crumpled and stuffed all over his person, which was inventoried and placed in safekeeping to be returned to him upon his release.

I didn’t see him for a while after that, but while I was sitting on the day porch, he marched out and fixed me with a wild-eyed look. I was wary, but not openly defensive. After a moment, he sat down next to me.

“Sorry about kicking you,” he said with a sigh. “Money just makes me so crazy.”

After a while of seeing the same people in the hospital day after day, they began to trust me more and more. I did what I could to earn that trust, being a patient advocate whenever I could, listening when I could and never being argumentative. When I occasionally did have to restrain a patient (usually because they were in a violent altercation with another patient, or much more rarely, another Mental Health Assistant/MHA) I did so as gently as I could, trying to calm things down, rather than add fuel to the fire.

Nearly every possible psychiatric diagnosis was represented in our ward. The majority were schizophrenic — which, for the layman, is not the same as a “multiple personality disorder” which is actually extremely rare. Schizophrenia is simply a collection of dysfunctional symptoms that include delusions, hallucinations (mostly auditory), and incomprehensible thought, speech, and behavior. Some patients could be quite lucid when taking their anti-psychotic medications, usually only for a few weeks at a time. Others made no sense ever, but still seemed to appreciate somebody to talk to.

One older gentleman, “Bill,” who had been in the ward for more than fifty years, was often lucid enough to work in a program outside the ward. For much of the day, he’d be gone, but he’d always greet me cheerily with, “I’m an ugly man, Jimmy.” (Jimmy isn’t my name, but he always called me Jimmy.) “I’m an ugly son of a bitch.” One day, he came back from “work” early, clearly frightened.

“What’s wrong?” I asked.

“Well, I was working, and then I saw Jesus outside, following me in his black limousines. That bastard has it in for me, Jimmy.” He paused, and explained, “that’s really why I’m here. You see, when I was a young man, a witch turned to smoke, and flew up my butt. She made me say ‘bugger off!’ to God.”

I’m not quite following this, of course.

“God forgave me, he’s a pretty good guy, but Jesus didn’t. So now he follows me around in his black limousines. So when I see him, I know it’s time to hide out here until he gives up for a while.” Then, with a wink, “I’m an ugly man, Jimmy. An ugly man.”

“I’m here,” piped up “Terrence,” from the day hall, tapping his empty pipe on the chair, “because I spent far too much time in the orient languishing about in opium dens. I fear it has affected my cognition. So my advice to you, Jimmy, is that if an oriental sorceress speaks to you through your teeth and tells you to smoke opium, try to ignore her! I wish I had.” He continued speaking, but his words sounded less and less like English (or any language.)

“Sarah” called me over to where she was sitting in the day hall. She had also been there for the better part of 50 years. “Do you think,” she said, in a low voice, “they put Spanish Fly in the Kool-Aid to make us horny?”

“I don’t think so,” I mused. “Seems like that would be an expensive thing to do. Want me to try the Kool-Aid?”

“Yes I do,” she said enthusiastically. “you should probably stay right here, just in case it works.”

“Gary” was diagnosed with schizophrenia as well as extreme borderline personality disorder. Borderline personality disorder, is not somebody “on the borderline of having a personality disorder or not,” it’s actually a personality disorder that involves borderlines — often perceiving things in black and white, all or nothing. It was colloquially referred to as “AD,” or “asshole disorder,” because they were some of the most difficult patients to relate to.

I’d often find Gary sweeping, and make an effort to talk to him. “How are you doing, Gary?”

“I don’t think anybody likes me,” Gary answered. “I think they hate me. You like me, don’t you? You probably hate me. Why do you always leave me? Why can’t you just stay here and talk to me all day? I hate you.”

“Well, you’re doing a pretty good job with the sweeping, there, Gary.”

“Yeah, I like to sweep because it’s the only thing I’m good at. Sweeping. I suck at everything else. That’s why everybody hates me. Except you. You like me. Because I sweep. Except I suck at sweeping. That’s why you hate me.” Gary continued sweeping, not looking at me once.

“Right, well, I’ll see you later, Gary.” We had a lot of similar conversations.

“Male help!” was called, so I ran back out to the day hall. Everybody was leaving the porch area, and my supervisor explained what was going on.

“Eugene” was a 350 pound, six foot six Vietnam veteran. Although huge, my general impression of him was as a nice, gentle man, although I never actually heard him say anything coherent. When he spoke, his words were hopelessly jumbled, but he’d speak as if you understood, then fold his hands together, and stare for hours at a time. At the moment, he had barricaded himself behind an upturned table and a few couches, and would occasionally shout something. I think I could make out “Viet Cong,” but not much else. Eugene had a pile of chairs, and when somebody peeked through the doorway, he’d throw them with devastating force.

Five MHA’s gathered, including my supervisor. “One thing we could do, is keep peeking in until he runs out of chairs, or tires himself out, and then we all charge him, and take him down. He’s very strong, so we’ll have to hold his arms and legs and head, as hard as we can, and drag him out.”

“I don’t think we want to be perceived as the enemy,” I pointed out.

“Fine,” he said, “you figure out how to get him out of there. But do it fast, before he hurts himself.”

“Eugene?” I called from around the corner.

He answered with some incomprehensible shouting.

“I’m coming in! COVER ME!” I shouted, and ran onto the porch. As I ran toward him, I saw his head pop up, and he made a frantic “come here” gesture. I vaulted the pile of tables and chairs and landed beside him in the makeshift fort. He wrapped his huge arm around me, then gave me a hug. Another string of incomprehensible words, but he seemed relieved, and peeked out of the fort.

“I didn’t see any more out there,” I said, “I think they may have moved off to the north.”

Eugene thought about this, and nodded, his eyes still on the length of the porch. He stood up slowly, and helped me to my feet. He spoke again, and I could barely decipher the words, “I took way too much acid.”

Together, we walked off the porch and into the day hall as calmly as could be. The other MHA’s had retreated to the far end of the day hall, and I waved as Eugene and I walked to the dorms. I dropped him off at his bed, and walked back.

“We should probably go and restrain him,” said one of the MHA’s. “He’s just had an episode.”

“You go ahead and try that,” said my supervisor. “And Jimmy” (pointing at me) “and Eugene will both beat you to death with chairs.”