[NOTE: Much of the information contained herein are of things of which I have no memory. These are eye-witness accounts from friends and family, words I scribbled in notebooks, rudimentary drawings when scribbling was no longer possible, and doctors’ and nurses’ notes from hospital records (which were obtained after years of requests and an Act of Congress). I simply added some adjectives.]
They should have told me years ago when my mind first split open like a rotting melon that as they were trying to “fix” what was broken, they were going to destroy other parts of my psychological makeup in the process. Would I have so willingly handed over my brain if they had told me the truth? But then, I should’ve known. I had seen hundreds of patients soft-shoeing the Thorazine-shuffle across the floors of psych wards for years. They were relieved of their hallucinations and racing thoughts. They were no longer concerned with imminent alien invasions or presidential assassination conspiracies. Unfortunately, they were left with only enough cerebral capacity to signal one foot in front of the other. Painting, poetry and piano were occupations too frivolous to consider when there were only enough precious brain cells to direct walking, eating with a fork, and being polite and appropriate in public.
All those years I had mixed the medicines and forced the injections, charted patient responses and improvements in my nursing notes, and I felt honored in my contribution to society’s mental health. Now, I feel myself an escaped Nazi war criminal and live in fear of imprisonment for crimes against humanity.
I have been the recipient of shock treatments over the years, since my twenties, and I would like to be able to say how many exactly, but I can’t. There are entire episodes of which all memory has been erased. Memory loss is the most common and main side effect of ECT (electroconvulsant shock therapy) and everyone will tell you, and I have told my own patients this as well, that whatever you forget will come back, but that is a lie. Well, lie is a strong word. Unless the doctor or nurse or whoever is telling you this has also had shock treatments and knows the opposite to be true, they are only telling you what they have been told and what they have read and learned in the latest Psychobabble Literature of the day, which is that the memory loss is temporary. It’s not. I am a psych nurse. I have read the literature. I have had the treatments. And some of that shit you forget is never coming back.
For a while I wondered if that was how ECT worked. Did it just erase your memory of why you were depressed? If you couldn’t remember what was causing you to be sad and despondent and sardonic and derogatory and isolative in the first place, wouldn’t you just feel better automatically? Uh, no. Truth is, no one knows how ECT works. Some say it doesn’t work at all. Some say it does more harm than good. The medical field emphatically denies that it causes brain damage while opponents offer up buckets of proof that it does. There are groups and committees in every state in America that are trying to have the practice abolished, and yet, it is happening right now as you read this, right down the street at the local hospital in your friendly outpatient surgical center.
During a particularly boring inpatient admission for ECT, I decided, for whatever tragic or dramatic reason, that I was not going to speak to anyone. It was a silent protest of sorts. I hadn’t wanted the treatments in the first place, and certainly hadn’t wanted them inpatient, but signing the consent forms had been a formality. Had I refused, it would’ve been nothing for them to get a second opinion, and then a commitment, and then guardianship. I had been down that road before.
I awaited the treatments as if under the swish of a razored pendulum. No matter what I was doing, I did it with my head down. At meals, in the med line, during groups, even while sleeping, the sparkling steel of the blade glistened with an air of an impending bloodbath. I had to laugh at the inevitability. I had so often told my patients that it was they who had control over their own lives. I had told them with such dignified belief that ultimately, they made their own choices and they were responsible for the consequences of those choices. And I wondered, who could I apologize to for telling such outrageous lies? I had seen the effects of shock treatments in some of my patients that could only be described as miracles, when they had rallied, when their depression had lifted seemingly overnight and they thanked their doctors on their knees! But there were others who had not received the divine cure, who had gotten worse, who couldn’t find their rooms and were found urinating in the hallways. What of those people? Where was my truth then? “Don’t worry, everything will be fine, unless the treatment obliterates your brain.” Even that would’ve been better than sending them off towards glitter and rainbows, ignorant of the pitfalls and blindly trusting their caregivers.
One day I was lying on my bed, minding my own business, not talking to anyone, when a resident and a group of interns entered my room (without knocking or announcing themselves) and stopped in a circle around my bed. They looked at me as if I were covered with hundreds of oozing, infected sores. “This is Tracy Schreier, a 45-year-old patient of Dr. Stewart, admitted for bipolar…”
Really? No hello? How are you? My name is and these other people are?
“…history of suicide attempt with ICU hospitalization, several episodes of ECT treatments…”
She also likes orchids, likes to write, and has a beautiful daughter. It pissed me off when doctors rattled off everything that was wrong with a patient but never said anything about what was right with them. I was guilty of doing it myself.
A different voice caught my attention. “But how does ECT work? All the research I’ve done has been inconclusive.”
“Well,” the resident said and looked at his watch. “In very simplistic terms, ECT does to the flatline in the brain, depression, what a shock does to a flatline in the heart.”
Suddenly I was engulfed in flames.
“Okay,” the resident said and made his way towards the door.
“Excuse me?” I said and propped up on my elbows.
He stopped and looked at his watch again. “Yes?”
“You don’t shock a flatline.”
I swung my legs over the bed and sat up. “Asystole is not a shockable rhythm.”
He shrugged. “It was just a simplistic way to…”
“But it’s wrong. Shock a cardiac flatline and serve up roasted heart for dinner. Is that what happens to the brain then?”
He turned to leave and said over his shoulder, “I’ll let you talk to your doctor about this.”
I followed them out of the room into the hallway. “I already know the answer, numb-nuts! The issue I’m having is what you’re telling your students!”
He didn’t respond.
“If you’re going to use the analogy, use it right! You’ve got to put your hands on a cardiac flatline! You’ve gotta do CPR! Hands on! Why wouldn’t you have to do the same for a flatline in the brain? Hands on, one on one, face to face, talking, therapy, digging, crying, spitting, screaming!”
They kept walking.
They entered a room at the end of the hall and closed the door behind them. I stood in front of the door for a few minutes wanting to barge in and be heard, but I had suddenly lost the energy. I leaned into the doorframe and whispered into the crack, “You don’t shock a flatline, asshole.”
The truth is, ECT does work, but it works for the brain much like abortion works for pregnancy. It’s quick, it’s effective, but it’s not something you should be using as a standard form of treatment. There was a doctor in that hospital that we referred to as “The Shock Doc” because all his patients received ECT whether they needed it or not. And I have seen patients getting ECT that were clearly not meeting criteria for the procedure, either because their families wanted them to have it, or their doctors did, or it was just a last-ditch hope to pull the switch to electrocute them back into reality. Surprisingly, the population that seems to benefit the most from ECT are depressed geriatric patients. With every reason in the world to be depressed (having lost their spouses, living in nursing homes, not seeing their children or grandchildren, failing health), they receive two or three treatments and they begin to rally, to smile and talk. It is amazing to behold. Psychotic patients don’t respond well to ECT. Fifteen minutes after the jolt you will find them standing on top of the nurses’ station completely naked and declaring war on Iowa.
In the old days, the preparation for the treatments was intense. There were spinal studies, chest x-rays, EKGs and blood work. If they were lining you up for a series of treatments and you were a hard stick, you might get an easy-assess port in your chest so they wouldn’t have to keep sticking you for an IV each time you had a zap. They don’t do this stuff anymore—at least they don’t do it for me. I am now a drive-by shock patient. Still, it is not something you ever get used to.
In the hospital I had anxiety around the clock. I had crying spells that I could neither predict nor control, and the tears gushed through like a raging river at breakfast, while taking medicine, during groups and while on the phone with anyone. Anxiety slashed through the perimeter of my personal space and left me with arms outstretched and begging to die or stuffed low into a dark corner of my room preparing for the onslaught of the approaching army. Between denial and inevitability, my moods fluctuated sometimes in midsentence and oftentimes changed from the time someone asked me the question in that tiny pause where I took a breath to formulate an answer. I wished mood swings were really like swinging…that I could swing effortlessly through the air while seated on a sturdy wooden plank. I wished that the plank was attached to trusty metal chain links that were fastened to a heavy, unbending bar inspected twenty times over by licensed professionals from the parks department. My mood swings would go back and forth with the same effort and force each time, controlled by the movement of my legs, faster or slower by the force of my stomach muscles. I would let the breeze blow into my face and close my eyes to it. I would lean back and smile up to God. I would stretch my legs out and give myself to that backwards flight like nothing else in the world matter…like nothing mattered but knowing I was flying away from any grounding force, challenging appropriate mood and behavior, and all the while, feeling the safety of those code-inspected mechanisms.
My moods were nothing like that. They were not timed. They were not smooth and even. I could not tell from one second to the next what emotional outburst the next moment would bring. What was most maddening were the trivial components that flipped my switches. Were the drawers in the kitchen not shut all the way? Was the clock ticking too loudly? Was there a dog barking far off in the distance? Did my mother ever love me?
There was a French nurse on the unit who used to give me encouraging words when they were carting me off for treatments. One morning she ran down the hall and caught me right before the unit doors closed. “La vérité vaut bien qu’on passe quelques années sans la trouver.” She kneeled beside me and squeezed my hand. “Truth is more valuable if it takes you a few years to find it.”
I kept my eyes closed on the way to the surgical unit. I didn’t want to see anything. I didn’t want anyone to see me. I wanted to be invisible. They parked me in the lobby close to the receptionist’s desk and I would look around and try to guess who else was about to have their brains fried. It was easy to tell. Patients awaiting varicose vein stripping or pacemaker placement were jubilantly called by their first and last names. When calling patients back for shock treatments the staff simply waited to catch your eye and then beckoned you forth with a come-hither finger. I watched those broken souls stumble through, all of them slow, tragic, washed out, unseeing and beaten…all of them dead already. I was a mirror image. I hadn’t combed my hair in so long it was just a mass of knots. I couldn’t remember when I had last showered. My hands were cold and unmoving in my lap and for a moment I thought that they weren’t even real hands but two white balloons filled with water. When they motioned for me I went gratefully, wanting either to get better or be killed.
The preparation and procedure were all conducted like a well-rehearsed play. There seemed to be no down time between the tasks, questions were asked all while syringes were filled, gowns and caps removed from drawers, hair checked for clips or pins, vital signs measured, and in between, answers noted and documented on a form on a clipboard, all carried out as if practiced a hundred times over. In a curtained room, I undressed quickly and slipped into a gown. I was given a thin, blue paper cap to put on my head and a pair of hospital socks with the thick-grip material on the bottom. “Our ECT patients call these ‘shock socks,’” the nurse said easily.
“On my unit they call them Detox Rebox,” I answered.
Suddenly the room filled up with people and there were hands everywhere. Someone started an IV. A blood pressure cuff was placed around my arm and around my lower right leg.
I flinched when a pair of hands came too close to my face.
“Sorry,” someone said. “I just need to swab your temples.”
There was a quick injection in the IV port and my mouth immediately went dry. I smacked my lips together and moved my tongue around in my mouth but there was only the feel of sandpaper. Somewhere a voice behind me said, “That’s the Robinol, Tracy.”
A metal strap was fastened across my forehead with a click. My doctor leaned over at the point and said, “You okay?” For some reason, I was surprised to see him. He fired up the machine and I watched him fiddle with the settings. I wondered idly how they determined how much juice to give their patients. Was it measured in symptoms? How does one measure crazy?
I had observed the procedure so many times over the years and was always surprised at how boring it was. It wasn’t anything like they did it in the early days of psychiatric electrocution. And it certainly wasn’t done how it was portrayed on TV. Gone were the days when they shocked patients without drugs and the body seized and splattered all over the table while seven or eight people tried to hold the patient down. And it didn’t last for more than two minutes. I remembered taking a group of nursing students down to the surgical unit to see the procedure. Right before the switch was pulled an OR tech dropped a huge tray of sterilized tools on the floor behind us and we all jumped and spun around. When we turned back, the procedure was over and the only clue that it had been done at all was the fingers on the patient’s right hand were flared out, separated and petrified, as if reaching desperately for salvation. “That’s it?” one of the students had asked. “Yes,” I said. “I’m sorry.”
Someone put an oxygen mask over my face. “Breathe in deep, Tracy.”
“Deeply,” I muffled back.
As loving and empathetic as it ever was, intoxication made all my problems dissolve. I cared not that it was induced by whatever drug they had pushed into the IV port. The dry, stagnate years of my sobriety floated up as soft as a bubble and popped with a splash against the ceiling. I fought the point of oblivion for as long as I could. Before I lost the fight and started circling the room like a blowup doll filled with helium, I closed my eyes and said out loud for everyone to hear, “I’ve missed you.”
In a fraction of what could be considered a component of time on some sphere that is not of this world, someone was asking me the date. I didn’t know. They asked me what day it was. I didn’t know that either. I did not know, no matter how I tried to piece it together, how one moment I could be cold and alone on a gurney in the outpatient department and in the blink of an eye be on a bed in the recovery room surrounded by other patients wondering the same thing. Had I traveled through time? Had time stopped? I thought about telling them that I hadn’t know the day or date before the procedure but it didn’t matter. It was just another box to be checked. A gooey sensation on the top of my head made me reach up and crawl my fingers through my hair. At the very apex of my head was a small blob of conduction gel. It wiggled under my fingers like a puny jelly fish. I closed my eyes and did not open them again until they were helping me into bed back on the unit.
After each treatment, it got more and more difficult to recognize the world. The faces of my nurses were familiar, but not from the hospital. I had gone to school with one. I had worked with another. One was my cousin, Molly. Each time the loss of memory became more profound. I last remembered the OR. I last remembered being in the lobby. I was being prepped. I was getting ready for bed. I would just wake up in the middle of the hallway on the unit and one of the nurses would say, “Tracy, you’re on the unit, you’re okay. What do you remember last?” And then I couldn’t remember how to play the game. I didn’t know where I was or what I was doing. Simple words became hard to decipher and following a conversation for any length of time became exhausting and futile. I felt connected to the world only through my body…where I walked, where I sat, where my body displaced matter with the space it occupied.
More than forgetting and stumbling to find my way, the worst part was that moment right after the procedure, when they rolled the gurney to the recovery room, hooked up all the monitoring devices and then began to wander around to check on all the other scared and fragile patients spiking temps, sitting small and unsure without a shred of memory, knees to chest, chin to knees, looking side to side for anything at all familiar. It couldn’t be compared to anything really—maybe that you were reading the Bible at church one moment and when you looked up, you found yourself sitting on top of the Empire State Building. Maybe that.
One night I was at the med window getting my night meds and the next thing I knew, I was surrounded by people wearing scrubs. “You with us?” someone asked. “Get her on five liters of oxygen.” I felt a neuron in my brain sloshing through a syrupy much inside a sappy, synaptic underworld. It crawled through tentacles caked by a goop that sucked it back by some sadistic reversal of the process, pulling it away from its natural forward course. There was a search for an idea, a thought, an ah-ha resting place, but it would not come. It stopped, suspended in an amber bubble of hollowed out impotence, hovering somewhere between the brightening of an idea and the expression of a single word. It sat there and frowned. It wrinkled the skin that encased the frontal lobe and stopped all movement of my neurotransmitters. “Tracy? You’re okay. You just had a treatment.”
When I opened my eyes again I was on the unit, in the middle of the hallway, holding one of the patient phones, with no idea how I had gotten there. My brain scrambled and clicked like black and red numbers on a roulette wheel, flying in circles before my face until the wheel slowed and I could make out specific details: hallway, phones, people, uniforms, food cart. A stranger approached and asked in a far-away voice, “Tracy, are you okay?”
“No,” I answered in a voice that was tiny and unconnected with my throat, its sound coming instead from the phone receiver.
“You had your sixth treatment this morning, do you remember?”
“What day is it?”
“Today is Wednesday.”
“Okay,” I said slowly. “What day was it?”
They walked me to my room as if delivering a half-dead soul into annihilation. They helped me into bed where I sunk into a soft, velvet blackness. When I opened my eyes again, there were people everywhere and voices flapping around my head like seagulls. “Blood pressure is 140/100, pulse is 100, sats are…she’s cogwheeling…let’s get some Cogentin, sats are 98 percent…y’know, she may not have gotten enough Succs…”
None of it made any sense to me, though I knew it should. My brow wrinkled with intensity as I tried to remember. Cogwheeling was rigid, clicking, wheel spokes. It was muscular. My muscles were cogwheeling. I tried to feel it for myself in my forearm but became exhausted and fell asleep from the effort. I was awakened by more hands and more voices. “Just a little shot, Tracy” and then a sharp bite in the hip. And then later, a man’s voice, “Hold her meds, get vitals every two hours…let’s get her on a one-to-one for tonight. I don’t want her getting up and falling.” I woke up again minutes later, days later, months or years later, to the sound of muffled voices. There was a woman sitting in a chair at my door with a clipboard and a small flashlight in her lap talking to someone I couldn’t see. They were talking about some poor girl who probably didn’t have a brain cell left in her head, “…and can you believe they’re going to keep doing the treatments? She’s pissed the bed twice tonight. I’ll tell ya, these doctors are sadistic mother fuckers.”
And then there was the chair. It was one of the big overstuffed chairs in the dayroom, the “good chair,” aptly named because when you sat in it you could watch TV, see everything happening on the unit and hear everything that was being said in the nurses’ station at the same time. I only remember that I sat in this chair for a very long time. There were voices and laughter and screaming and commercials. There were arguments and debates and people coming in and out of view, nothing staying for very long, no words settling long enough to be understood. There was nothing outstanding or colorful, no whimsical hummingbirds flitting in and out of the picture, no fairies or kaleidoscopes or images of madness playing out in stark colors and romantic foreign languages. Everything had become dull and lifeless and was covered with a gray soot that puffed out like a virulent cloud with every movement. I sat very still for a long time.
And then there was TD’s face. “Hey,” she said and smiled.
“Hey,” I said.
“Can you get up? Can you walk?” She helped me stand. “Why are your arms so stiff? Tracy, can you put your arms down?”
“Put them down where?”
“Jesus,” she said. “C’mon, we’re gonna walk.”
It was a short trip to the nurses’ station but each step was a painful, concentrated process. TD shouted across the hallway, “Who’s her nurse today?”
Everyone behind the counter looked up. Brad stepped forward. He was a good nurse. He was funny and honest and had an integrity for his work that so many others lacked.
“What the fuck happened to her?” TD demanded. “I came to visit her last night and they said she was ‘asleep.’”
“She was asleep,” he answered. “What’s the problem?”
TD stared at him incredulously. “Look at her! She’s a fucking zombie!”
“Okay,” he said and put his hands up. “Keep your voice down, and please choose your words carefully…she’s standing right there.”
“Like she knows what I’m saying!” TD said and looked at me. She attempted once again to lower my arms. “And trust me, she’d rather we gave her the hard truth that pussy-foot around to spare her feelings.”
“Listen,” Brad said. “It looks a lot worse than it is. She had some problems with ECT and was medicated for that. She had some side-effects from her medicine…”
“And was medicated for that, too?” TD interrupted. “What the fuck is she on? She can’t even make eye contact!”
While they discussed the complications of ECT and side-effects from certain medications, I became enchanted by the philosophy of a very obese black woman sitting in a chair at the end of the nurse’s station. She was talking to no one in particular, yet the message seemed to be meant for everyone. “Diabetes don’t hurt!” she said and shook her head slowly. “High blood pressure? That don’t hurt neither! They’ll kill you dead and you won’t feel a thing. A toothache? Now that hurts!”
Hard truths. I wondered if the truth was the same for any two people. Was it like art, its true meaning left up to an individual perception? I looked around. Was this place like an eye, beholding and exposing the ugly underside of beauty as it saw fit? How was it that here was where poetry was born, where it was dissected, where its words could fall on deafness, soundlessly and meaningless like beads slipping from a knotless string? Later that night while I was waiting for meds, I overheard two doctors talking together in the nurses’ station, both upping doses and scheduling shock treatments, talking casually about people’s symptoms as if rattling off items on a grocery list. “So he told me that he kept having the same dream over and over, and he was waking up in a cold sweat, screaming,” said the first doctor.
“That’s not so unusual,” said the second.
“Yeah, but get this,” said the first and leaned in. “He keeps dreaming that he is four Russian verbs.”
“Wow,” said the second. “You’d think at the very least he would’ve been a noun.”
And they laughed and laughed and laughed.
I looked away and wondered, “Is this where poetry comes to die?”
It was not long after this that I got my first clue that ECT was working. As is par for the course for most patients, you start off having treatments and do really well, then you are hammered by the fifth or sixth treatment, and by the seventh or eighth treatment you’re starting to string sentences together again and can dress yourself with very little assistance. I was sitting in the group room and we had just finished with goals group. An elderly patient named Michael had stated that his goal for the day was to “get Douglas Fairbank’s autograph when we all went to the commissary.” He then informed everyone that his shoes were on display in the National Archives. I watched him leave the room and make a few trips up and down the hallway. He stopped in front of the med window and tapped on the glass. Inside the nurse waved him away and continued to pour. He pounded again. “Hello? Can you help me please?”
“I’m not your nurse today, Michael,” she said as she slid the window open. “Check the assignment sheet.”
“I checked it already!” he said.
“Okay,” she said, already sliding the window closed. “Find your nurse and she’ll be able to help you.”
“She won’t!” he yelled to the closed window. “She’s too busy extolling the virtues of power!”
A rolling noise escaped my throat. I stopped short, sat bolt upright and grabbed the arms of the chair as if I might be pitched forward. It had been an abbreviation, really, a comical hiccup of sorts, but yes, it had most definitely exerted itself through the months of crud and gloom and despondency. I smiled with satisfaction and informed the empty room, “It was laughter!”
Later that day a patient approached me and said, “We all want something better. We’re never satisfied. Maybe that’s what perfect is. Maybe perfect is always wanting more. Maybe it is trying harder and harder to get more and more. Maybe that’s why we never achieve perfection. Maybe perfect is not being perfect, but striving to be perfect.”
“I don’t give a fuck about perfection,” I said without thinking. “Right now I’d be satisfied with half-way to mediocre.”
It’s the little things: getting the joke, having a come-back, putting on your own pants. Before I knew it, a family meeting was scheduled, discharge plans were being finalized…I was inching closer and closer to the door. What you don’t realize when you are getting well and getting out is that you are going to take all of it with you. They may as well tattoo SHOCK PATIENT on your forehead, because you will never escape it. It will follow you through life like a persistent stalker. You will second guess yourself in many situations because the slightest thing you do that veers off the normal mainstream is going to be held under the microscope and checked for symptoms. I remember coming home from the hospital after this admission to a yard full of bushes that appeared to be covered in spun silk. I looked closer. They were spider webs, but the morning sun was shining a gossamer radiance through them that nearly stopped me cold. I was so captivated I felt myself being pulled in, sucked in and down, closer to those incandescent crowns that seemed to coronet the entire front estate as if they were the Official Royal Gardens of the Carolinas—but I resisted the temptation. I barely slowed my steps. I was a psych patient currently in treatment. I was a shock patient. Everything I did could be considered an aberration.
I was a psychiatric suspect.
I still am.
Well, at the very least, I am a Person of Interest.