ParanoidPrank

     “I want to show you something,” the twelve year-old girl said.
     Lizzie was smiling, but it was more of a smirk. There was no warmth behind it, only a mischievous undertone. She had a secret, and I was the benefactor. Lizzie’s grins always seemed half-frown to me, as if the disapproving lines were carved into her skin and she had to put all her effort into rearranging them. Her eyes betrayed her true feelings, always gleaming with some dark, primal deception.
     It hadn’t been a good day for me. I was starting to hear schizophrenic voices whispering on the periphery, demanding my attention. When I tried to listen, they either receded into the background or shouted something unintelligible. Most of the messages revolved around my co-workers talking behind my back. I knew this was nonsense, but when you hear a lie enough times, you start to believe it.
     Lizzie tugged at my hand. She had straight, honey-blonde hair that hung down to her shoulders. Her cheeks were ruddy, as if basted with fever. Her smile was stiff, insincere; wooden. A smile chiseled into a totem pole.
     “Come on,” she urged.
     “Where are you taking me?”
     “Into the bathroom.”
     I immediately grew suspicious. Kids could lure you into a private place, then claim that you had touched them inappropriately. “Why?”
     “There’s a bug in the shower. I want you to get it out.”
     “Tell Julie. She’ll help you.”
     “No! She’s afraid of bugs.”
     I didn’t feel like arguing. “Okay. But let’s make it quick. And I want you to stay by your bed.”
     She nodded, still grinning.
     Lizzie led me into her bathroom. I could feel my gut grow queasy when she pointed at a cockroach scuttling in the shower stall. The strange thing was, Lizzie showed no fear of the scavenger. She pointed at it with no change in expression. I wondered why she hadn’t stomped it already. She would probably take a perverse joy in crushing the filthy pest.
     I was about to approach the shower when the lights went out. I was surrounded by utter blackness. My chest constricted and my heart pounded. Lizzie had flicked off the light switch, playing a joke on me. She still held my hand, and I could feel her grip tightening. Slowly her fingers curled inward until her sharp nails gouged my palm. They felt like miniature talons.
     I had always been afraid of the dark. Now the bathroom was a fathomless abyss. Childhood fears clawed their way into my mind, hissing that there were monsters lurking in the shadows. Disembodied voices snarled that a demon stood beside me now, and would hurt me if I didn’t defend myself. Before I could even think, I tore myself loose of Lizzie’s grip. I rammed her away and groped across the wall. When I found the switch, I wrenched it up. Yellow light exploded in the bathroom, blinding me.
     Lizzie crouched in a corner, her smile gone. She was used to being the predator, but now she was the prey. She clutched her shoulder, which throbbed from the intensity of my attack. Her face was twisted with fear. This young girl, who terrorized the other kids on the unit and was unaffected by large doses of Haldol (a major tranquilizer), gazed at me as if I would dismember her with my hands.
     I moved forward slowly. The voices were still muttering, but I could push them away.
     For now.
     “Lizzie,” I said. “I’m sorry.”
     She edged away from me.
     “It was an accident. I don’t know what happened.”
     “You hurt me.”
     “Not on purpose.”
     “It doesn’t matter. My arm HURTS!”
     I held up my bleeding hand. “What about this? All fun and games?”
     Lizzie scowled. “You’re a psycho.”
     Something inside snapped. “You know what? It takes one to know one. And you can run out and tell every staff member that I pushed you, but no one will believe it because you're a chronic liar who cries wolf three times a day.”
     She bolted from the room. I could hear her yelling for Mrs. Comston, and I knew I would be reprimanded later. Not for shoving Lizzie, but for being in the bathroom alone with her. That story I could alter to suit my needs. All I cared about now was hushing the voices that were slowly turning me against myself.
     I wasn’t a violent person, but the relentless, accusatory voices were making me see dangerous, conspiring imps when I looked at the children.
     It wouldn’t be long before I injured one of them badly.

SlinkySidewinder

     Julio’s homelife was a mystery.
     It was rumored his mother was a prostitute, and that’s why he ran away from home and sought refuge with strange men in downtown Sacramento. Maybe she pimped him; I’m not sure. It absolutely blew my mind to discover that an eleven year-old boy spent most of the day looking after his four year-old brother (Manuel), acting as his surrogate parent while his mother disappeared for days at a time. Then, at night, when Manuel was asleep, Julio would lock the apartment and pull on his hoodie, wandering the city streets in search of adult male company.
     How did he learn this behavior? Was his mother an inadvertent tutor, schooling him in the dubious art of seduction? Did he watch her every night, selling herself inside a cramped bedroom, trading integrity for cash? After a few weeks did he strike out on his own, soliciting dirtbags for physical attention, his innocence chiseled away by father-figures whose intentions were corrupt?
     Julio was a lean kid with close-cropped black hair, a mischievous smile, and intense brown eyes. In the psychiatric center, he either wore a Raiders jersey or a plaid shirt that he kept unbuttoned to his stomach, showing off his gold chain and six-pack. He did crunches every night, saying that he had to stay “strong and smooth”. When I asked him what he wanted to be for a living, he said, “A pimp. With a crib full of hos. And when they act up, I can bitch-slap them.”
     I replied that he was too intelligent for that profession. He smiled slyly and said he was kidding, he really wanted to be a pro football player. But something in his tone made me realize that being a teenage gigolo was a much more realistic goal for him. He knew nothing about sports, except that staying muscular and athletic (and acting like an All-American kid) made him more attractive to predators.
     Julio vacillated between childish innocence and wanton maturity. One morning a phlebotomist had to draw his blood and he refused. I coaxed him into cooperating, and when the needle entered his vein, he let out a heavy sigh and rested his head on my shoulder, as if a lifetime of stress was being sucked out of him with his blood sample.
     My saddest memory of Julio came one night when three kids were in the dayroom, watching a movie. It was 8 p.m., and we were watching Spy Kids. Julio frowned when the young sister and brother argued with each other. “She wants to screw him,” he said matter-of-factly. “Everyone wants to do it. So they should just get in bed.”
     Mark, a totally humorless, militant staff worker told him to watch his mouth or he would go to the Quiet Room.
     Julio shrugged. “I’m just sayin’. They want to have sex, so why are they hiding it?” A faint smile touched his lips.
     Mark tried to distract him. “Button your shirt, Julio.”
     “Why? You afraid you might see something you like?”
     Mark’s face turned purple. “Just do it. No one wants to see your skinny body.”
     “Plenty people like my body. Like you. I seen you looking at it.”
     “That’s it.” Mark got up, towering over Julio. He was a beanpole, but stood 6’5”. “Get up. You’re taking a time-out.”
     Julio smiled at him. “Make me, stud guy.”
     “If you don’t get up on your own, we’ll escort you into the Quiet Room by the arms.”
     “You wanna touch me, huh? Feel if my skin is silky muscles.”
     “Five seconds, Julio. One…two…three…”
     Julio lunged at Mark’s leg. He wrapped his arms around Mark’s thigh, giving it a passionate embrace.
     “Get off, Julio.”
     “Ten dollars, Mark. That’s how much I charge. You get full night of pleasure, I get two boxes of cereal.”
     Mark tried to wrestle him away. Julio grappled tighter, his smile provocative, his torso squeezed against Mark’s leg.
     Mark pried him loose and Julio bit his hand. Mark recoiled, then shoved Julio flat. He climbed on top of him, giving in to his anger, performing a function that Julio craved. He flipped Julio onto his back and tried to pin his arms down. Julio flailed about, brushing his wrists and forearms against Mark’s mouth, yelling, “See? I knew you wanted to kiss me.”
     Even as Mark pinned Julio’s limbs to the floor, Julio heaved his waist upward, grinding his buttocks against Mark’s groin, simulating something dark and terrible. When a worker appeared in the doorway, Julio bucked for a few more seconds; then his defenses crumbled and he began crying, sobbing that Mark was violating him and “didn’t have the right kind of love”.
     Mark straightened up, shell-shocked. His expression was both appalled and somehow guilty. When Julio saw the fear inscribed on his face, his tears gave way to anger and he scowled as if Mark had delivered an insult that could never be forgiven.

LabileLobotomy

     Elaine was an elderly woman who still worked on the adult inpatient psychiatric unit. I admired her fortitude; most women in their late sixties would have retired years ago. The problem was, Elaine didn’t feel productive outside the mental ward. She had worked there as an LPT (licensed psychiatric technician) for thirty-five years, and it had consumed her life. Her husband had died ten year ago, and she tolerated his absence by surrounding herself with patients, both lucid and acutely psychotic.
     Elaine shouldn’t have worked in the potentially-dangerous psych ward. She hobbled along with a limp, and was useless during a crisis situation. She had auburn-colored hair that was so poorly-dyed it looked pink. She wore thick bifocals and had a shriveled, red-lipsticked mouth. Often she would grunt when waddling from one end of the unit to the other, her hips waggling, her spine warped with scoliosis from trying to support her obese frame. I also suspected she suffered mild dementia. She forgot simple instructions and asked you to repeat yourself several times, as if her hearing aid had malfunctioned. Honestly, she was a threat to the well-being of her fellow employees. If Elaine was alone on the unit with another nurse, she would not only be helpless during a violent attack, but would also be fair game for several of the sociopath men wandering the halls in search of lambs to fleece and slaughter.
     Still, even though Elaine was a liability, she didn’t deserve what happened to her one terrible night in August.
     Cholo was a 21 year-old paranoid schizophrenic who felt he was always in the FBI’s crosshairs. He saw the world through the distorted lenses of cracked binoculars. He felt helicopters were flying overhead, agents watching him and charting his every move. He also believed nurses would sneak up on him while he showered, injecting sterilizing drugs into his penis with a hypodermic needle so he couldn’t have children. Haldol and Risperdal (anti-psychotic medications) took the edge off his delusions, but he was still labile and occasionally hostile. He couldn’t stand Elaine, who pestered him like a disapproving grandmother.
     Cholo was scheduled for ECT in the morning. ECT (electroconvulsive or shock therapy) was a procedure reserved for severely depressed or catatonic patients. Voltage was applied to the brain with the intent of inducing seizures that would re-align its waves. It was a controversial treatment, and seemed barbaric. The hulking technician who applied the electrodes told me that it was completely safe; the amount of voltage discharged was less than a Duracell AA battery. Unfortunately, even if ECT was successful, it usually wore off in a few months. I had seen patients return from electroshock with artificial smiles, their faces twisted with confusion. They seemed synthetically happy, as if their emotions were manufactured. I often wondered if short-term memory loss took away their depression by making them forget the tragedies that caused their overwhelming sadness.
     One night at 2 a.m., Cholo wandered outside for a drink of water. He wore a white tank-top, a gold cross on a chain, and had a blue/green tattoo of the Virgin Mary inscribed on his shoulder. His lean body rippled with muscle. His head was shaved and he had black stubble on his jaws. Even as he approached the fountain, Elaine tried to intercept him.
     “Mr. Ramirez you can’t have any water,” she scolded. “You have your ECT treatment tomorrow and are nothing-by-mouth.”
     Cholo ignored her, yawning into his palm. The medications left him sedated and mind-numbed.
     “Mr. Ramirez, you can’t have no water,” she repeated, moving out of the nurses’ station through a swinging door. “If you do your ECT will be cancelled and Dr. Drenan will not be happy.”
     “Yeah, yeah, whatever,” Cholo mumbled. He grabbed a Dixie cup from the dispenser and rubbed his chin.
     “MR. RAMIREZ.” Elaine’s voice rose an octave. “YOU CAN’T DRINK ANY WATER. IT IS AGAINST PROTOCOL.”
     “You better back off,” Cholo mumbled, flashing her an irritated glance. “You ain’t my moms and you sure as hell ain’t got my respect. Geritol-snorting, hip-replacement bitch.”
     Elaine grew distraught. She hobbled toward Cholo, her eyes panicked. She believed that if Cholo drank the water, it would be her fault if his ECT was delayed. She was an old-school nurse who stood up and offered her chair when a doctor entered the room, even though her joints were rusty with arthritis.
     Cholo’s face twitched. His lethargy washed away and he became stiff with annoyance. He almost crushed the Dixie cup in his fist as he placed it under the spout.
     “MR. RAMIREZ. YOU ARE NOT LISTENING. YOU ARE GOING AGAINST PROTOCOL. THE DOCTOR WILL NOT BE PLEASED. YOU CAN’T HAVE THE WATER BECAUSE YOUR STOMACH MUST BE EMPTY FOR THE ECT. OTHERWISE YOU MIGHT CHOKE DURING ANESTHESIA.”
     Elaine grabbed his forearm. He jerked away and water splashed his tank-top. His gold crucifix was drenched. Cholo stared at the damp spot and his face flushed with rage.
     “WHAT THE HELL,” he snarled, stalking toward her. “YOU MADE ME WET MYSELF. I DON’T CARE IF YOU IS SOME DINOSAUR WITH A CANE, YOU CAN’T TOUCH ME. BITCH, YOU JUST SPIT ON MY CROSS. NO ONE DOES THAT TO THE SAINTS.”
     Cholo grabbed her hair and wrenched it to the side. A wig popped off, showing milk-white scalp beneath. Later I would wonder if Elaine’s dementia was so prevalent she forgot her hair was fake when dying the auburn strands.
     Elaine scrabbled away. Cholo flung aside the wig and loomed over her. He grabbed a potted plant off the counter and smashed it against Elaine’s head. The pot cracked and wet soil dribbled down her face, blinding her. She wailed, then fell silent. Cholo took a sharp fragment of the pottery and slashed her face from eye to jaw line. Then he tried to stuff the plant’s roots into her mouth.
     A nurse emerged from the break room, yanking the emergency cord. Alarms screamed and the unit was flooded with workers, mostly male. Cholo stooped over Elaine for a moment, mumbling incoherently, then dried off his cross with a napkin. He wandered away, holding his hands up and flattening himself against the wall when he saw the workers swarming around him. He smiled and told the “FBI spooks” he knew they were spying on him, because he had seen the camera they installed in the ceiling behind the light bulb.
     Elaine lay motionless on the floor. Blood trickled from her nose. Her pupils looked fixed and dilated. She didn’t respond to urgent hands shaking her. She was suffering from an intracranial hemorrhage (brain bleed) that would leave her with partial paralysis.
     Elaine loved being in the psychiatric center. She had 30 years of experience working with volatile patients. There had been talk for months about whether she should be coaxed to resign because she was “unfit for duty”. Managers thought they would be doing her a disservice by firing her. They didn’t have any evidence to support her dismissal. Now a paranoid, delusional man who confused her for a nagging parole officer had forced an early retirement in which she would lay in bed most of the day, half her body erased, her mind plagued by seizures, her eyes staring at a dingy grey wall that was as bleak as her future.

Toke*Anhedonia

The teenage boy despised me.

     You could see it in his scowl every time he confronted an authority figure on the inpatient psych unit. He had scraggly blonde hair, glasses, and a perpetual sneer that exuded contempt for anyone who tried to help him.

     Antony was here because he had an unhealthy addiction to smoking pot. His father had practically disowned him, saying that Antony had thrown away his future for a few cannabis leaves. His grades had dropped, his school performance was lackluster, and (once a promising athlete) he had lost interest in sports.

     According to Antony, he didn’t have a problem. He maintained control over his recreational use of marijuana. He could stop at any time. Besides, his father was a f-ing hypocrite. He condemned marijuana to hell but used it himself. The only reason he disapproved of Antony smoking joints was because he was a kid and couldn’t handle drugs like an adult.

     So Antony got thrown into the psychiatric center. For what? Substance abuse? Oppositional defiant disorder? Depression masked by the mellow euphoria of smoldering THC? What would the doctor prescribe for him? Prozac? Mellaril to tame his raging pubescent hormones? Counseling sessions that would probably leave Antony with an even more intense suspicion of adults?

     I was the only aide on the adolescent unit that morning. There were three boys and one girl. The census was uncharacteristically low for spring break. I went from room to room, reminding the teenagers that breakfast was at eight, and if they chose to hibernate they wouldn’t get a meal until lunch. They scowled at me and pulled blankets over their heads, preferring to sleep until noon. I reminded them that part of gaining privileges on the unit involved cooperating with staff and participating in activities. This earned me a few derisive snorts. My last caveat: I knew the boys liked sports, so I told them that if they chose to sleep, we wouldn’t go to the gym later. They responded by cursing under their breath and stumbling into the bathrooms to take a quick shower.

     When they were ready, we had community meeting. This allowed them to voice pent-up grievances and discuss their progress in the psychiatric center. The conversation went like this:

Me: “How are you feeling today, Antony ?”

Antony : “Like shit.”

“Why?”

“Because I didn’t get any sleep. One of the kids was yelling in the Quiet Room all night. What a joke. It’s more like the Screaming Room.”

“What’s your number today?”

“Four.”

“Well, that’s one better than yesterday. Or are you just saying that to get discharged faster?”

     “Nah, I feel better, dude. Really really great. I think the evil cannabis has been cleansed from my system.”

     All this was generic psych center bantering. I decided to press the issue a bit further.

     “Your dad says he doesn’t want you back home unless you agree to stop smoking pot.”

     “Dude, I get the pot from his stash.”

     “We’re talking about you, not him.”

     “The pot isn’t taking over my life. I just use it to chill a little. Is that a crime?”

     “Yes, according to your probation officer.”

     “Screw him. You can’t tell me he never smoked weed.”

     “Antony, look at yourself. You do everything you can to defend your habit. That’s addictive behavior. If it’s so easy to quit, why don’t you?”

     “Because I like it. It serves a purpose. If I didn’t have pot to help me relax, I would probably strangle my dad.”

     “Then we need to work on your dad’s attitude as well.”

     He laughed. “You guys are so full of it. It’s always the kid’s fault. My dad could be beating me with a club, and the psychiatrist would say, ‘ Antony , what could you do to stop stressing out your dad’?”

     “Well, you could stop smoking pot. That drives him crazy, right?”

     “A few joints aren’t the problem.”

     “I disagree. Marijuana has screwed up your life. It’s the root of all your troubles. You defend a drug that takes away your motivation, makes you eat junk food all day, and precipitates arguments with your dad. Seems like a high price to pay.”

     He responded by yelling, “You don’t understand. Pot should be legal. It’s legalized by the government for some people. It doesn’t hurt me. My father hurts me. He’s the one that should go away.”

     “You’d choose pot over him?”

     “Hell, yes. And over jerks like you, too.”

     My session was a complete and resounding failure. But what did I expect? I wasn’t a board-certified counselor. I was a college student earning minimum wage while taking classes. I had no training in the psych field. I cared deeply about the patients, but could easily say or do something that traumatized them for life.

      We went to the cafeteria and the teens ate together while I remained on the periphery, an outsider. They whispered to each other and chortled when glancing in my direction. I decided to take them to the gym afterward. We all liked basketball, so we decided to play 2-on-2. I had been playing since second grade, so had a firm command of the fundamentals. I chose a goofy kid named Mike to be on my team. He was obviously uncomfortable holding the ball, passing it back to me like a live grenade every time it dropped into his hands.

     Antony was a surprisingly agile player. He drove to the basket well, had a nice pull-up jump shot, and could dribble with both hands. The games were intense and hard-fought. I guarded Antony , and he scored despite my smothering presence. I didn’t back down, playing tough defense and often blocking his shot. To my delight, he didn’t give up, but played harder than ever, gleaning joy from competition itself. He truly seemed to enjoy the sport and smiled when I patted his shoulder and told him he was the next Stephen Curry.

     After an hour of sweat and hyperventilation, we returned to the adolescent unit. I asked the teens to get ready for lunch, and they mumbled “okay”. As Antony drifted toward his room, I stopped him in the hall. I told him he was a talented player and he could be a starting point guard on his high school team if he practiced hard enough. I expressed admiration for his skills and was glad he had given me an offensive whipping on the court.

     He returned to his room without comment. Maybe my words seemed manipulative. It’s possible he had been screwed over by adults so many times he viewed me as a smooth deceiver. Behind my compliments lay some underlying moral or self-righteous sermon.

     At lunch, one of the teens was effusive. He boasted about his skills and how he had kicked me and Mike’s asses. Mike was too shy to argue. I simply ignored the braggart.

     Antony shocked me. He told the kid to shut up, that he was a ball-hog, and that I could shut him down with one arm tied behind my back. Antony politely asked me if I wanted dessert, then gave me his pumpkin pie. He didn’t bring up the subject of marijuana, but he was kind and treated me with respect.

     That day changed my perspective forever. Forget medications and counseling sessions. Being good at a sport was what made me an equal in Antony ’s eyes. He may keep smoking joints, but at least he was more receptive to my opinion. And who knows, if his dad took an interest in what he liked and spent quality time with him, maybe Antony would realize that drugs were not a substitute for human emotion, and a natural high was more satisfying and enduring than the artificial stimulation of pleasure centers in an undernourished brain.

ScrewLoose

     Josh was a shy 8 year-old from a group home. He was reclusive, preferring to sit alone and build cars with Leggos while other kids played sports. He spoke with a rasp, as if he had a hoarse voice from a Strep infection. Eye contact was painful for him, so he kept his gaze locked on the ground when he spoke to you.
     Josh was admitted to the latency unit for acute psychosis. He scanned the ward with spooked eyes, seeing bizarre hallucinations. He batted at the air with his fists, warding off some unseen predator. He could hardly stand, his brain buzzing with interference. When I tried to talk to him, he looked at me as if I was the Grim Reaper, my scythe poised over his neck.
     This was all unexpected, because Josh wasn’t schizophrenic. He was diagnosed with attention deficit disorder and ODD a few months ago. After being stabilized on Ritalin and Mellaril, he was sent back to the group home. His single mother found him too difficult to deal with, and didn‘t feel he was worth investing time in, so she dumped him into the system. Instead of becoming more social, he regressed and interacted only with himself and his stuffed bear.
     This psychotic episode was a mystery to the psychiatrist. He had no clue why Josh was seeing “bad people reaching for him” and hearing “voices talking underwater”. I eaves-dropped on Dr. Copeland’s conversation with his mother, who seemed not to care that Josh was acting crazy. “I don’t know what’s going on, but he’s nutty as a fruitcake,” Dr. Copeland said, and that is a direct quote.
     It took a few hours of investigation to find out what had happened. Two days ago, Josh had suffered an EPS reaction (stiff neck, rolled-up eyes) to Mellaril, and required Cogentin. Later, he had another reaction, and needed a second dose. Then, during a routine pediatrician visit, he complained of seasonal allergies and the doctor prescribed Benadryl. He took two doses of Benadryl, then needed more Cogentin later at night when his neck stiffened up again. In a nutshell, he received more than seven doses of Benadryl/Cogentin due to psychiatrist non-communication.
     An anti-cholinergic psychosis was the result.
     Doctors had made Josh crazy. They theorized about what had gone wrong in his brain; how a screw had “popped loose” and his cerebral motors were misfiring. They even joked about it, as if a lonely little kid that nobody wanted was an object of ridicule. Josh couldn’t sleep for three days, having night terrors and frightening delusions until the medicine cleared itself from his system. He even soaked in the damn stuff, so disoriented and confused he wet the bed twice a night. The doctors blamed serotonin and dopamine and rampant neurotransmitters, but they were the culprits. They had taken a timid, vulnerable kid and put him through two days of hell.
     I wanted to reach into their brains and pull the wiring loose so they knew how Josh felt. Maybe I would get my chance sometime soon.

AlterEgo

     The teenager sat in front of me, a wary smile on his face. He looked both amused and incredulous that he had suffered a psychotic break. Seth had milk-white skin, a shock of black hair, and unfocused green eyes. His stare would pin me and then skitter away, as if I was enemy and friend, and he wasn’t sure which way his trust should bend.

     Seth had the misfortune of searing his brain cells with methamphetamines. Often street drugs are mixed with a contaminant that can cause permanent brain damage. One hit of an impure drug could make an adolescent irrevocably schizophrenic within minutes. Recently Seth complained of audio hallucinations. He heard “glass breaking”, “voices shouting”, and “mind-juices sizzling”. Occasionally he saw hypodermic needles stabbing into his eyeballs.

     Before, he had been a normal kid. Maybe a bit of a rebel, dressed in a Metallica concert shirt with rusty metal loops piercing his ears. He bragged about the girls he scored with, and the joints he shared freely with his dad. Now his fried brain would earn him a recurring nightmare in the Sacramento county mental health system.

     Seth was already showing signs of antipsychotic delirium. He slept 18 hours a day, pummeled into a near-comatose state by Haldol, a major tranquilizer. His lips smacked like a goldfish and he had to struggle to keep his writhing tongue in his mouth. His fingers rubbed against each other until he got calluses, and his eyes blinked involuntarily, suggesting a perpetual state of bewilderment.

     When he initially started Haldol, his head wrenched violently to the side due to spasming neck muscles, and he couldn’t straighten it until he received an oral dose of Cogentin. He wandered into the psych center with a smile, looking like his ear had been super-glued to his shoulder. Slowly the dose of medication was tapered until the side effects were somewhat controlled.

     I sat across from Seth, feeling sorry for him. But I also felt a sense of guilt about my dubious line of questioning.

     I held a chart in which I documented his progress on a flowsheet.

     “Any audio hallucinations, Seth?”

     “No. Not since Monday.”

     Are you hearing voices or seeing things that aren’t there?”

     “Negative.”

     “Good, sounds like the meds are working. What about side-effects?”

     “Still a pain, but doc says I’ll get used to them. Something about my dopamine being super-sensitive. Anyway, I’d rather live with the side-effects than feel like a nutball.”

     I nodded, smiling approvingly. Took notes on a scrap of memo paper that had no relation to his written record. When I was done “assessing” him, I patted him on the back and slipped into the med room.

     The nurse was elsewhere, helping with a crisis on the adult ward. I approached the patient cassettes and found one with Seth’s name. Quickly I yanked it open and scrabbled through a handful of pills. Haldol. Cogentin. Depakote. Lorazepam. I stuffed them in my pocket and hurried out of the claustrophobic room.

     Working in a psych hospital has certain benefits. If you suspect you’re becoming floridly psychotic, you can gauge the progress of others to formulate your own treatment plan. If a neuroleptic works for one patient, it might work for others.

     Lately I’d been noticing weird things. Shadows on the edge of my vision. Discombobulated voices like the whisperings of apparitions. Strange messages on license plates. I had a growing feeling of dread, as if strangers were conspiring against me.

     I often felt that I was an orphan; an unwanted child, and my parents had removed my brain and replaced it with that of a preferred embryological twin. When I lacerated my thigh during a bike ride, I later feared that the slash marks were caused by a demon trying to rip out my soul. I could control the menace for now, but the signs were there in glowing blood-red neon.

     Something was taking over my subconscious.

     Sneaking into the staff restroom when the intruders weren’t watching, I tore open three packages and stuffed the pills into my mouth.

    

SuicideDouble

     The boy was chunky, freckled, and pugnacious. He had dirty orange hair that looked crew-cut with a weed-whacker. I didn’t like him. Neither did the other kids. His name was Nick Wong, which was weird because he wasn’t Asian, and neither were parents--if any parent would claim him. He beat up his mom once and then gave his grandma a black eye when she restrained him. Grandma Wong fell down and broke her hip, but Nick didn’t care. He looked down at her with an animal gleam in his eyes, hating her for her weakness.
     His mom thought discipline would cure him of his antisocial tendencies. So what did she do? Signed him up for martial arts. Maybe a Mr. Miyagi clone would render Nick docile. No such luck--this just added weapons to his arsenal. It was like giving a suicide terrorist a nuclear bomb, or strapping brass knuckles onto the fists of an extreme fighter.
     Now when Nick is cornered in the psych center, he assumes a classic ninja pose. Except Nick would bludgeon your groin instead of kicking you in the head. And when you went down, he would keep kicking, oblivious of the blood and suffering flaying open at his feet. Sometimes I wonder if he even sees human degradation. It’s my theory that those who are violent and cruel are unable to grasp that others feel pain.
     I found Nick in his closet that morning. I was making my morning rounds, checking each room to make sure the kids were safe in their beds. Nick’s was made up perfectly. You could bounce Jell-O on its crisp, tense surface. Usually he was up doing yoga in his own narcissistic way, stretching and flexing his body, savoring the feel of his muscles contracting. I looked past the bathroom and saw his closet door open. 
     Nick had confiscated a belt. Belts were contraband, taken by staff on patient admission. Nick had looped the belt around his neck and created his own gallows pole with the closet handle. He was slumping on the floor, trying to use his weight to strangle himself. He kept scooting up and then ramming himself down, as if this would wrench apart his cervical spine. When he saw me looking, he stopped. Turned and stared at me with casual malice. I was too shocked to move.  
     “What are you doing?” I whispered stupidly.
     He slipped the noose over his head, ignoring the chafe marks on his neck. Tossed it to the side, as if it was an amputated limb. He wouldn’t allow me the luxury of ‘rescuing him’.
     “What the hell does it look like?” he sneered. “Don’t tell me you don’t know what a suicide attempt is.”
     “Why?” I had no control over what I was saying. My brain had gone numb, like flesh deprived of circulation that can no longer feel. 
     “Because it feels good, idiot. Why are you here, anyway?”
     “I’m checking up on you.” It sounded lame even to my own ears.
     “Well you’re a shitty aide. I can count the minutes between your rounding. I know exactly when your dumb ass is going to pop his ugly face into my room. Fifteen minutes. Just enough time to hang myself. Don’t you know that? Anyone with a brain keeps it unpredictable. If every kid in this place was suicidal, you’d have a litter of dead bodies to send to the morgue.”
     His scorn was lacerating. But he was right. I was a horrible worker. Why? Not because I couldn’t keep a punk like Nick Wong from throttling himself. It was because I didn’t care about him, and despised his wanton cruelty, and felt the world could do with one less serial killer in the making. So maybe I waited an extra ten minutes, hoping the belt would tighten and Nick’s pathetic attempt at gaining attention would be successful, his legs kicking helplessly as oxygen was cut off from his darkening brainstem.
     I wasn’t always this insensitive, but something is changing in me. The more I see aberrant behavior, the more it becomes normal, and jaded cynicism creeps in, adding layers of dead skin to the callus that protects my conscience from feeling too much.

---

BoyWithABomb

     I met a really cool kid the other day. His name is Kyle, and he’s the epitome of an all-American boy. Bowl-cut brown hair, intelligent blue eyes, mischievous smile; Quicksilver shirt. Socially he’s advanced for a twelve year-old, approaching me with a confident smirk and telling me he hears I’m good at basketball. When I try to be humble, deflecting his compliments, he shakes his head and says, “Dude, being a sports stud is a GOOD thing. It’s not like you should be ashamed of it.”
     Kyle excels as an athlete. He can smash a perfect volleyball serve, catch dizzying flyballs, nail a three-pointer, and throw a perfect spiral. So why then do I get a strange feeling around him? He was admitted to the psychiatric center for oppositional defiant disorder, Tourette’s syndrome, and attention deficit hyper-activity disorder. All self-diagnosed by his overbearing, domineering mother. I never saw any hints of ODD; he’s always been extremely cooperative. Which in itself can be troubling. Many kids get to the psych center and become angels, either because they’re adept at fooling strangers or because they simply enjoy being in a structured environment and have no need to act out. Kyle’s mom says he challenges her at every opportunity, even becoming physically aggressive at times. Kyle’s dad is a pushover. He doesn’t discipline, and simply believes Kyle’s behavior is “typical boy stuff.” The Tourette’s diagnosis is legitimate--sometimes when Kyle gets stressed, his face scrunches up into a feral sneer and he starts grunting and snorting, as if he’s possessed by a demonic pig.
     One night I was tossing the football with Kyle. Every time I made a catch, he’d say, “nice grab”, or “sweet reflexes!” But something bothered me, and I decided to let it play out.
     Seven year-old Suzie was crouching near the latency unit patio door, playing with her dolls. Kyle’s throws kept pushing me toward her, and I had to yell, “Be careful.” He acted like he didn’t hear me. Quickly he hurled the ball toward the opposite end of the playground, so I have to run after it in the bushes. When I fling it back, he snatches it out of the air and pretends to “overthrow” so the football thumps Suzie’s head. She clutches her skull with a shocked expression, then starts wailing.
     I put Kyle on time-out. He acted contrite, but I don’t think he cared. His action was cruel and calculated. Later, a psych nurse told me that Kyle said, “____ likes me so much I can fool him whenever I want.” I was amused by this, but also a bit angry. I confronted him, saying, “So you can fool me, eh Kyle? That’s fine. But the question is, why would you want to?”
     I sat down with him that night and we had a talk. He asked me what I do on weekends. I explained that I liked movies and eating out. He talked about how he spent the weekends with his friend Josh, who liked to build pipe bombs. Kyle could list every ingredient that went into a pipe bomb, and even how to increase collateral damage by stuffing ball bearings into the metal cylinder. I asked if they had ever hurt anyone with a bomb, and Kyle smiled.
     “Not yet. No one’s pissed me off enough.”
     “Why are you spending time making bombs, Kyle? You’re an incredible athlete. You could get a scholarship with your talent. I would be using all my free time to practice sports.”
     He nodded, trying to placate me. I told him to speak his mind.
     “You know the feeling you get when you make a shot over someone? Like an adrenaline rush? It’s the same when you plant a bomb somewhere, only ten times stronger.” Kyle was finally being honest with me, and it was frightening. “Seeing someone bleed is more exciting than seeing them sweat.”
     I simply stared at him. He got up, elbowed me in the ribs, and said, “Gotcha, dude. See, I can fool you big time.”
     But I knew the truth. He had let me glimpse a tiny dark sliver of his soul, and it had snagged in my brain, remaining there for days, inflaming the tissue and causing damage that would never heal.

Journal Entry #1: MirrorMe

     He was sitting in his wheelchair. Both his feet were amputated because he had diabetes. Psychosis made him neglect to take his insulin properly, and his toes had blackened into charred stubs from oxygen deprivation. He had stepped on rusty nails in his garage, and because his nerves were damaged from glucose plaques like sugar slurry clogging his arteries, he couldn't feel anything. His feet were as numb as wooden blocks. The small puncture wounds allowed bacteria to enter and devour his flesh. He didn't notice until his socks were soaked in green pus and smelled like a gangrenous ulcer. By then it was too late. The infection couldn't be controlled and the surgeons hacked off his feet with scalpels and a bone saw.
     The man was Southern. His black-grey hair was thinning and his expression hostile. He had lost an eye to shrapnel during the Vietnam war and had a prosthetic. When he was psychotic, like now, he tried to rip it from the socket, thinking it was a VC land mine implanted by enemies while he slept.
     I had to get his 5150 renewed. I wandered into the room, ignoring his suspicious frown, thinking my good manners and charm could win his trust. New psych aides are so naive they believe a friendly disposition can tame the beast inside a paranoid schizophrenic. He would sense I was nice and his delusions would be temporarily quelled.
     This type of thinking could have gotten me killed.
     "Mr. Burke, I'm _____," I said with a smile. My eyes didn't quite meet his. One was dislocated, the prosthetic not properly set, staring at the ceiling. The other was focused on me with savage intensity, as if I had Asian features and a red bandanna knotted around my head. "I'm here to renew your 5150."
     He glared at me as if I held a written confession that would implicate him as a traitor.
     "Sir, your legal hold's expired." My voice quavered. "The doctor needs you to sign in on a voluntary basis."
     Burke's face twisted into a scowl. "You're nothing but a f--ing coward," he snarled. He could see fear imprinted on my face.
     I ignored this, holding out the legal document. "It's simple. You just sign it and I give it to the secretary."
     He snatched the form from my hand. Crumpled it into a ball and tossed it in a garbage can. "I'll do no such thing," he bellowed. "The secretary's a scheming bitch and you're in the sack with her."
     I was at a loss. An uncertain smile touched my lips.
     Mistake.
     He rolled his wheelchair forward so it bumped my leg. His face bristled with gleeful hatred. "You're the one who set the bomb. I can see it in your bloodthirsty eyes. You yellow bastard. You put it in the bushes and when I took a piss, it blew off both my feet. It rained blood for days. The jungle is stained with my insides and it will remain there for an eternity. Not even the monsoons will wash it away because it is evidence of your guilt..."
     I backed away.
     "That's it, run, snitch, because I just called in a report and they're going to napalm your ass. You will melt, I repeat, melt, because you have done such harm you will burn on earth as if it is a hell of your own making..."
     Outside, I felt shaken by violent hands. I told myself over and over that the insults weren't personal, it was his psychosis speaking, spewing malice that had slumbered in his subcoscious for decades. Is that what psychosis is? The ability to sense what lies hidden in the brain, without a filter? My God, I thought, shaking my head. His stare pierced my soul. His mad prophet ranting tapped a motherlode of truth. He's crazy and I'm just like him. I can keep a lid on it now, but soon it will boil over.
     I'm just like him.