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.