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.