I like to say I’ve seen the action of a psych ward from both sides of the nursing station. The perspective is radically different depending on which side I’m viewing it from, and whether that is as a nurse or as a patient, there are things learned either way. The freedom, however, comes from the patient side. Yes, the nurses hold the keys to the outside world, but there are times when those keys are the only thing separating us from them.
One of the most traumatizing things that ever happened to me as a patient wasn’t the result of a shock treatment or an emotional breakthrough in therapy or even realizing that ultimately I was responsible for my own life and that I had to stop blaming everyone for everything that was wrong with it. The trauma was ushered in violently, forcibly, on the wheels of a crash cart…
I had a private room on an in-patient general psych unit and had gotten a treatment that morning (the seventh of nine). The rackety noise of a wheeled cart speeding down the hallway woke me up. Nearly everything traveling down the hall on wheels had its own unique sound. The laundry cart had a pronounced squeak on the far side. I knew the sound of the meal cart, depending on the time, and stretchers and wheelchairs, occupied and unoccupied, made different noises. The slow squeal of the wheelchair coming for me for treatments in the morning rolled with an unrushed familiarity down the hall and then came to an abrupt stop at my door, as if the front wheels had been popped.
This was the sound of a crash cart.
I knew the sound well, having run alongside a few in my day. There was the squeak, of course, but it traveled faster than a laundry cart or a transporter’s gurney, and there was that thunder of stomping feet running with it. Someone shouted, “Is her doctor here?”
“He’s on his way!” came the screams of several voices.
The phone at the nurses’ station rang like a warning bell. I knew there was no one to answer it. I rose slowly from bed and tiptoed in tentative steps to the doorway. I could see Becky, the patient across the hall, throwing off her covers and leaping out of bed. At the door she whispered over, “What’s going on?”
“Someone’s coding,” I whispered back and put a hand to my throat. “Who is it?”
She peered down the hall. “I don’t know. There’s no one out here. I can’t tell what room they’re in.”
“WHAT THE FUCK IS GOING ON?” This came from Loud Girl who had a room at the very end of the opposite hall near the entrance to the unit. Of course, her real name wasn’t Loud Girl, but everyone referred to her as that and I don’t think I ever heard her called another name by staff or anyone else. “YOU COULD WAKE THE DEAD WITH THIS NOISE!”
From deep inside a room at the end of the hall by the nurses’ station a voice yelled out, “C’mon, Wanda!”
Becky and I exchanged looks. Wanda was probably the most psychotic person I had ever seen. And quite rare. She had hebephrenic schizophrenia, which simply means “disorganized schizophrenia,” as if there could be any other kind. Hebephrenics often distinguished themselves from the normal schizophrenic population by their inappropriate emotional responses: laughing, sobbing, cackling, heckling, screaming, knee-slapping, comedic outbursts. Wanda was the only one I had ever seen before, from either side of the station.
The unit doors smashed open and Dr. Wilson barged down the hallway. His quick step spooked me. Being a large man both in height and weight, he was conscious that he intimidated most patients by his size alone and he had a way of moving slowly so as not to startle his patients. That day the pounding of his stride shook the hall and rattled the pictures on the walls. Brad, the charge nurse, met him at the door and gave report as they flew down the hall. “She was more psychotic last night during meds than usual and she got an extra Geodon. Rounds boards shows she slept through the night, which is normal for her. She was up for breakfast but back in bed and unresponsive at 10 during checks. We started CPR and called the code. Code team got here about ten minutes ago. They got a line in and hung fluids. Temp is 105.2. 02 sats are tanked in the low 80’s. They got an airway, pushed some bicarb, and got her on a monitor…”
“What’s the rhythm?”
“Who’s the code doc?” Dr. Wilson asked breathlessly as they passed my door.
“Good,” he answered and they were sucked into Wanda’s room.
Several patients came out of their rooms and met in a tight circle in front of Wanda’s door. Becky followed. I backed up into my room and didn’t stop until my legs met the bed, and then I sat down. Death did not come often to a psych ward. It flew through the emergency room and took gunshot and heart attack victims at random. It flooded through ICU like a virulent sludge and picked off patients one by one. But I always thought insanity was its own type of death and served fittingly a swash of lamb’s blood over the heavy, looked doors of the mental ward. “Continue on that sweeping hand of fate,” I said out loud. “Life is already in suspension here.”
Eventually I wandered down the hall and stood with the crowd. From Wanda’s room sounds of destruction echoed into the hallway. Someone had kicked a bedside table through the door, an obstacle they had no time to roll neatly against a wall. I could see that Wanda’s clothes had been cut off and were lying in a tragic pile on the floor at the foot of the bed. I listened to the urgent chorus of voices and closed my eyes. “Anyone call her family? Her aunt’s on the way. Nancy, switch! Wait, clear, clear, everyone clear?” and then the jolt. For a moment, a silence fell and reminded me of the first time I had ever seen snow falling. It had been my first winter in Virginia. Accustomed to the violent precipitation in Florida where hurricanes and tornados splayed forth torrential downpours and banged out sinister orchestras of lightning and thunder, I had not expected that snow would be so quiet. I stood outside that night in the garden at midnight and watched for hours as the flakes cascaded from the blackness like a soundless prayer and whitened the ground with cold, glistening whispers.
“Okay, go! Where is that fucking transport?”
The mental health tech, Susan, poked her head out the door like a turtle and looked down the hall. “Kelly’s at the door,” she reported back to the room. It was something frequently overlooked during a code on a psych ward. With all the excitement, they usually forgot to post staff by the locked doors to let people in and out. Susan noticed us huddled in the hallway and said over her shoulder, “We’ve got gawkers out here!”
Brad nearly shoved her into the wall as he passed and hissed something under his breath about compassion. “Okay guys, let’s take it to the dayroom.”
Michael, a dementia patient having a good day, demanded, “What the hell is going on? This ain’t Marcus Welby!”
We had been corralled in the dayroom for about ten minutes when the gurney backed out of Wanda’s room. A code nurse was on the bed doing compressions and the code team, Dr. Wilson, Dr. Rockwell and a throng of others made its way down the hall like a medicinal sea creatures, its tubes and machines forcing life into its parasite.
After group that afternoon our resident Revelations Expert, Phil, burst into the dayroom and said, “Wanda’s dead.”
“How do you know?” Becky asked.
“I just heard Kelly tell Susan at the nurse’s station. She’s dead!”
No one knew what happened but everyone had a guess. Phil figured it was a heart attack. “You can’t be that happy all the time and not have your heart just explode!”
An alcoholic named Clyde said, “She killed herself. She may have looked happy all the time, but it was just a cover.”
“How the hell did she kill herself?” asked Loud Girl. “They check every fifteen minutes with their stupid flashlights. YOU CAN’T EVEN MASTURBATE IN HERE!”
“You think someone can’t kill himself between checks?” asked Clyde. “I could do it, easy.”
“What do you think happened?” Becky asked me.
They looked at me as if I held the truth like a golden nugget in the palm of my hand. I couldn’t remember anything different about Wanda’s behavior over the past few days. Had she been irritated? Had she been drooling? Had she complained of pain? I tried to remember but my brain was still reeling from shock, both from her death and the treatments, and my brain was nothing but a huge glass chamber with a large silver pinball rolling randomly from side to side. “I don’t know.”
“Or maybe you do know and you’re not saying,” Michael said. “You don’t want to scare us!”
“Well, it’s not like the bitch got killed by some raging green monster that eats lunatics!” Elizabeth shouted. I had been Elizabeth’s nurse a few times over the years at another hospital and twice as a fellow patient at this one. She was the meanest person I ever knew but she was my favorite patient of all time. She was incapable of saying anything nice, to anyone, for any reason, and the words and comments that rolled off her tongue dripped with a poisonous acid that sizzled and burned holes through the floor on contact. Over the years I learned how to speak her language, and though she had once punched me square in the eye and twice threatened to kill me, sometimes she couldn’t keep the smile off her face when she saw me. “What else is there to fear? She was probably just cheeking her meds and took an overdose, the stupid Groucho Marx fucker.” She removed a pill from the front pocket of her robe and popped it in her mouth. “Those punk ass doctors and nurses. They see what they wanna see…and they don’t see what they don’t wanna see.”
I wondered if it was true. How many of my own patients had cheeked their meds and then administered them at their own convenience? I had caught a few now and then sliding pills under their tongues or trying to slip meds into their pockets, but how many had I not caught? I looked around at the patients standing near me. Michael was always selling his medication to the patients on the detox unit. Clyde regularly smoked cigarettes in his bathroom. Max, an Alzheimer’s patient, occasionally took a swig of window cleaner off the laundry cart. I had a razor in my bathroom since the day before, which was considered high contraband, but had not been removed even after several room checks, two safety checks, and two housekeeping calls. I had always told my patients they were safe. I preached it like gospel. And I had turned a blind eye to all the sharp edges. Was this what happened to Wanda? Had she been happily running with scissors and the staff ignored her because she wasn’t being loud or demanding or taking off her clothes in the social worker’s office?
That night a special group was held, facilitated by the nurse, Kelly, Dr. Stewart (the director of the unit), and a grief counselor named Elaine. They explained that they weren’t sure of the actual cause of Wanda’s death because an autopsy had not been performed, but they had a suspicion that it was neuroleptic malignant syndrome.
“What is that?” Clyde asked.
“Neuroleptic malignant syndrome is a life-threatening neurological disorder most often caused by an adverse reaction to antipsychotic medication,” Dr. Stewart said. “It is very rare.”
“I knew it!” Phil shouted. “It’s poison you’re giving us!”
“Not poison, Phil,” Dr. Stewart said slowly. “Anti-psychotic medication is used to help millions of people with problematic psychiatric symptoms that would otherwise by uncontrolled…”
“What are the symptoms?” Becky asked. “I mean, how do you know if your neurons are becoming malignant?”
“There is usually a very high fever and rigid muscles…”
Everyone looked at me. Shock treatments can cause several physical symptoms but during this round in the hospital they made me stiff. They were dosing me around the clock with muscle relaxers and benzos, but I could not bend my knees and my arms were frozen at my sides, stock and wooden, like two boomerangs.
“You’re screwed, Warden,” Elizabeth hissed at my neck. This was a pet name she had given me the first time we were admitted together. She had laughed hysterically and said I was a warden sentenced to life in my own prison.
Everyone started talking at once.
“…wait, wait!” Dr. Stewart shouted over the outburst. “It is also associated with behavioral changes, certain labs are elevated…”
“What about Tracy?” Becky shouted. “She’s been rigid for a week!”
“I will not discuss Tracy’s treatment in an open forum. If she, or anyone else, wants to see me after the meeting, I will gladly go over any particulars you have about your own specific treatment.”
“How do you cure this?” Clyde asked. “I mean, can you catch it in time or does it just kill you?”
“Usually, if the symptoms are noticed in time, simple discontinuation of the medication…”
“So what you’re saying, pole-licker,” Elizabeth said from the back of the room, “is that Wanda was walking around here hot and hard and none of you weasel faggots noticed it?”
“I’m not saying that at all,” he replied with the coolness of an expert witness.
“No, I get it,” said Andrew, a new patient and a veteran of the state hospital system for over ten years. I hadn’t had time to figure him out. He had personality disorder tendencies, some mood symptoms, random anger issues—probably a sociopath. Word on the ward was that he had killed his grandmother’s boyfriend with a horse shoe. “It’s like what happens to cancer patients. They’re getting all that fucking chemo and radiation and it’s the treatment for their cancer that actually kills them! You’re killing them with your cure, man! You guys don’t want people to get better anyway! The money’s in the sickness, not the cure!”
“Andrew…” Dr. Stewart began.
“No, you listen,” he shouted back and jumped out of his chair. “My brother died from leukemia when he was 17 and I did my research, man. You got people curing cancer all the time. You got the Essiac and Hoxey treatments in Mexico. They got run out of the country because the AMA couldn’t patent their herbs and make the big bucks off it. So they discredited them and ran ‘em out and now they’re in Mexico curing everything that walks in the door! What about Vitamin B17? It’s fucking illegal in this country! Know why? Because it’s curing cancer in Europe! There’s a special place in hell for those douche bag mother fuckers in the AMA and those asswipes in the FDA can go there too and eat their shit!”
“Not all cancer patients die from their treatment, Andrew,” Dr. Stewart replied. “Many of them get well and recover. There is that risk, yes, but to withhold treatment because of the risk is usually not an option.”
“Well, why not?” Elizabeth asked. “You got your schizophrenia, the cancer of mental illness, and you drown your patients in elixirs and potions and pills and injections and shock treatments and lobotomies and they keep getting sicker and sicker and then after you’ve turned them into flesh-eating zombies, guess what? They’re still schizophrenic!”
“Schizophrenia is not a curable disease,” Kelly said. “The treatment is to ease the symptoms.”
“Oh, BULLSHIT!” Andrew screamed and jumped from his chair again. “You might take away a symptom but you replace it with a side-effect! These psycho drugs cause liver damage, kidney failure, hypertension, anorexia…”
“Andrew…” Dr. Stewart said calmly
“…diabetes, obesity, Parkinson’s, oculogyric crisis, alopecia, blindness, birth defects…”
“Andrew, if you can’t lower your voice, you’ll need to leave the room.”
“Well, what about the other option?” asked Phil. “The one no one ever talks about?”
“Yeah,” Elizabeth said with gusto and clapped. “The cides! Homicide, suicide, genocide, insecticide…”
“No, not suicide,” Phil sneered. “I’m talking about no treatment. Who are you to say we need to take drugs because we’re not ‘normal’? You aren’t the judge! You haven’t been given the job by God to determine who’s sane and who’s not. And even if we’re not sane, and let’s face it, there are plenty of people in this room who aren’t, who gave you the authority to fix us? So, a person walks around naked in his backyard at night, or sends a detailed letter to the pentagon warning about UFO soundwaves, or eats flowers or clay sometimes, but only because he has a vitamin deficiency…”
“What’s your point, Phil?” Clyde asked with a groan.
“WHY CAN’T WE JUST BE CRAZY?”
The room was suddenly as quiet as a funeral home. I blessed Dr. Stewart for allowing us the moment to consider the option. Why should we quell the flamboyancy of our madness? We were colorful people. We were dancing outside the boxes. We were singing as loudly as we could even in rush hour traffic. We searched for meaning in everything we did and often found beauty in pain and heartache. We communed daily with god and preached the gospel of ourselves from our guts. We were honest and forthright. We offered up humor and self-deprecation even when lost and hungry. Why not blaze trails through our lives in grand, sweeping brush strokes?
Dr. Stewart leaned forward in his chair. He rested his elbows on his knees and templed his fingertips. He looked around the room and made eye contact with anyone who would meet his gaze. “Mental illness affects about sixty million people in the United States. About two million of those people suffer from schizophrenia. And about 15 million suffer from debilitating depression. It’s estimated that 90 percent of people who commit suicide have a diagnosable and treatable psychiatric disorder at the time of their death. Untreated mental illness destroys lives, marriages, careers, personal relationships, finances, physical health…across the board, mental illness is a psychological, mental, emotional, physical and spiritual cancer. It is a deadly disease and in one way or another, it can kill you. For most of you this will be a battle you will fight for the rest of your lives. But you must fight. As human beings, there should be no other option.”
We were all quiet again.
“If there are no other questions, I’m going to turn the meeting over to Elaine. She’s a specialist in grief counseling and can help you process what happened here today.”
Elaine answered all the questions that were asked of her. Clyde asked if she was married. Phil asked if she had been properly debriefed to receive highly sensitive military intelligence. Linda asked her where she bought her shoes. And Michael asked if she knew how to give a proper blowjob. No one asked what they were all thinking. “Could this happen to us?”
Later that night I watched Elizabeth at the nursing station bartering her soul for more sleep medication. Staff shooed her away several times, but she would not give in. Finally, her pleas set in motion a call to the doctor, an order for another dose of ambien and relieved nurses as she finally turned to walk away. Suddenly she stopped and spun on one socked heel. “Oh, I forgot,” she said and snapped her fingers. “Since y’all killed Wanda, can I have her snacks?”
In the shower that night, I held my face under the water and felt myself disappearing. I imagined the representation of my life a small, black dot on infinity’s radar screen. The water mixed with my tears and I squeezed my eyes shut against the sting. Maybe they weren’t even tears. Maybe it was just the trickle of water, hot and fluid, slithering over my eyes and down my face, and then into the drain to rush without care towards a destiny only to mingle with other water, and then greater rivers, and then home, finally, as invisible and ignored as one solid drop of saline in a bottomless ocean of sorrow.