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.
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