Skipping Down the Psycho Path

"Don't worry about choosing a specialty," said one of my nursing instructors the first week of school. "You will not have to choose it. It will choose you." Throughout school I watched the light of knowledge light up my fellow students' eyes when they realized, during our many rotations, that his or her specialty would be emergency medicine or OB/GYN, geriatrics or pediatrics, med-surg, or O.R. I watched them all become motivated towards a specific goal and I envied their path, so clearly laid out before them.

I went through most of my nursing education having no clue whatsoever. I liked most of the rotations, except for pediatrics, but even that specialty was not off-limits. If offered a position there, I certainly would have accepted it, and I would have done my job well. But I wouldn't be passionate about it. I had always believed that people went into nursing much like others went into the priesthood--that it was a calling motivated by some higher meaning than we mere mortals could not understand--that indeed, we should not question that calling, but follow it to the best of our abilities and give to life what it was so clear we had been chosen to give: our help, our compassion, our steadfast belief in the human spirit.

Okay, it might sound like a crock of shit, but at the time I was all into this Florence Nightengale thing and I was carrying my lamp, baby...I was carrying that light into the darkest crevices of human suffering and misery that you could ever imagine. But while I offered that light and compassion to others, I waited--I prayed--that more would be revealed to me. I hoped that one day I would be tending a wound or assisting with a biopsy or starting an IV and I would feel myself lift up and know that yes, this is where I belonged. This is where I will do the most good.

I had almost lost all hope until the semester before our last term in nursing school. My fellow nursing students and I huddled in a small circle smack dab in the middle of the craziest, loudest, shit-slinging, scream-echoing, pissing on the walls county psychiatric center this side of One Flew Over the Cuckoo’s Nest. While waiting for our instructor that morning, I tried to feel the anxiety they told us to expect. I tried to feel the apprehension that was flowing like a shock treatment current through the circle, but I didn't. I couldn't. I wanted to talk to these people. I wanted to know where they came from and how they ended up here. I wanted to read their charts and find out what meds they were on. I wanted to do care plans and conduct groups and crawl into their minds to nestle up beside their neurons and watch their brains work. I had been, you might say, chosen.

     "Yo, Nurse Person," a voice said.
     I turned around to see a man wearing round eye-glasses and a smirk. "Yes?"
     "Can ya open the laundry room?"
     "Uh, no. We're students."
     He sighed. "Well, can ya open the Day Room?"
     I looked around. "No, we can't open anything. We don't have keys yet."
     He looked me up and down, smirked again and said, "Yeah, you look pretty keyless."

I had been chosen. But why here? Why psychiatric nursing? Was it even real nursing? And how the hell was I going to do any good here? Certainly many would argue that feeling at home on a psychiatric unit does not necessarily mean it's the best place for one to be practicing nursing. What a thin line there....how dangerous could it get if keys ended up being the only thing that separated me from them?

Months later, working that same unit, I watched the early morning patients make their rounds through the ward. They stopped off at the Day Room, circled the nursing station once or twice, made a few trips down the hall to look out the unit door windows, checked the board to see what staff were assigned that shift, who the doc was, and probably made mental notes of what they could and could not get away with that day. Inevitably, no matter how fast and efficiently I worked, a line would form in front of the med room door. A young black woman danced in place. Every once in a while I could see her arm shooting out to the side, see her head bobbing over the crowd, hear her feet tap, tap, tapping in place. She was singing; a song of her own, making up the words as she went along. "I'm hap-hap-happy today, because you're okay, and I love the world today, because I am so gay, but it doesn't really mean, that I'm a lesbian, I just wanna be friends...." She shimmied up to the med window and harnessed her singing into a hum, but shook her hips defiantly, letting me know without words that my medicine would not extinguish her spark. She downed the cup of liquid tranquilizer and danced off in a series of pirouettes, high kicks, and shouts of glee. The next patient stepped up to the window and while we both watched the happy girl dance off he said, "I'll have what she's having."

I did feel a certain affinity for those lost souls. I always wondered if maybe they weren't the sane ones and maybe we were crazy. Or maybe they were the intelligent beings, responding to their own creative way of thinking, and we were the dull drones who didn't understand them. When I met Jesus Christ or Joan of Arc or the latest abducted human recently let go by alien beings, I always kept it in the back of my mind that maybe, just maybe, it was true...that it could be true, even on some alternate level of reality, that what they believed, who they believed they were, what they believed was happening in the world, might actually be true. I think it's what kept me from feeling superior. It kept me from being judgmental. And eventually, it drove me crazy.

"ARE YOU FUCKING CRAZY?" She was 21 years old and I will never forget her for the rest of my life. At first glance she reminded me of a Sunday School teacher. She was pretty and had an innocence about her that made me aware of angels treading nearby. She was thin and held herself folded in, her arms crossed in front of her, her legs drawn up whenever she was seated in the Day Room. She usually spoke very softly, so much that you had to lean in and strain your ears to hear her. "YOU'RE GOING TO AMPUTATE MY FUCKING HAND?" She was a junkie. She had been prostituting herself for three years to buy drugs. She was also a successful artist. She had had several showings in prominent galleries and was considered by the local art community to be the person to watch out for in the coming years. Painting had been her life, before heroin took its place, and she covered her secret by shooting dope into the plump veins between her knuckles and then wearing gloves while she worked and taught art classes so no one could see. It's a pretty sad irony that while the gloves kept her secret hidden, they also became the catalyst for her many abscesses, keeping the sores from the precious air they would need to heal...providing a wet, warm environment for growth. I will never forget the day when I sat down with her and talked to her about her upcoming surgery. I tried to educate her about the infectious process, what the surgery would entail, why surgery was absolutely necessary, and I dove deep into my own empathy and tried to offer my condolences to her once promising career as an artist. It was a darkening of her eyes that made me suck in my breath and hold it. Somewhere in the bottomless pit that was her despair came a voice that chilled me to the bone with its emptiness. She said simply, "I don't give a fuck about my art. I'm worried about how I'm gonna shoot dope with one fucking hand."

For a psych nurse, there is no way to plan your day. You have no routine, no absolute way of doing something, no tried-and-true method for dealing with an angry or combative patient. You might find yourself on the floor trying to coax a paranoid patient out from underneath his bed one minute and the next be responding to a patient throwing furniture in the Day Room. It is never mundane. It is never boring. And woe be it for you if it gets too quiet and someone says, "Boy it sure is quiet in here." Seconds later the alcoholic you've been medicating to stave off DTs will go into DTs. The paranoid patient you coaxed out of his room will begin to eye you suspiciously. A doctor will barge into the unit and demand your full attention. The lab will call to report a dangerous Lithium level. A scream will echo down the hallway, bounce off the windows and walls, and cause other patients to become jumpy. Your patient suffering from Alzheimer's will again step behind the nursing station and refuse to leave. You will see a male patient entering a female patient's room. The unit doors will barge open and the lunch cart will squeak down the hall. It will suddenly be time for meds and the fire alarm will go off. And all the while, day after day, week after week, your own crazy alarm may be going off like an endless warning bell with no snooze button.

And yet, I could never be happy doing any other kind of nursing. I've worked med-surg (and hated it). I've worked PCU (and hated it). I've worked in Cardiology (and tolerated it). The only place I've been truly happy is in psych and detox...and yet, it is the very place that eventually wins the arm wrestling match between sane and insane. That's the tragedy. The one specialty that makes me truly happy also drives me completely insane.

I wonder sometimes if the tap I got while in rotation wasn't actually a tap to say, "Hey, crazy bitch. Sign in, pick a room. You're in for a long stay." Indeed I was. But what did I get out of practicing nursing in the psychiatric field? Did I get some cosmic subliminal therapy by osmosis? In my first two years of psychiatric nursing I would be punched, spit at, stabbed with a pen, puked on, made fun of, insulted, challenged, threatened, stalked, manipulated, conned, jumped, slapped, and teased. On really bad days I would be at the breaking point and very nearly un-therapeutic, punchy, tired, and beaten. One day I came out of report to find a new patient stalking the nurses' station, pacing before it like a psychotic panther. I sat down wearily and readied myself for the first battle of the day. It wasn't even 7 a.m. He approached me immediately, leaned over the nurses' station and growled, "Hey, do you suck d*ck?" With a sigh I merely looked at my watch and replied, "Not this early I don't."

The patient had been standing in front of the large Day Room window for hours. He had become catatonic several times in the few weeks he had been a patient at County and I was worried about him. He was paranoid, a patient with a long history of schizophrenia. He was well-known in the community. Most people called him the Judo Guy because he was always karate-chopping pieces of branches, thin wood, and anything else that might break easily without crushing his hand. He wore colorful scarves around his forehead and told people he was part of the Catahoula Tribe of Cabbage Beasts. Most people thought he was stupid, but he wasn't. He was just....outlandish, and sweet, and very talented on the piano. But he checked out sometimes too. Sometimes for days and days he became like a piece of Day Room furniture, propping himself against the wall like a tipped hat-rack. I would stare into his eyes for some spark, some light or evidence that would prove he was still alive, but often, he was lost to me...lost to everyone. I had made it a habit to stand next to him for a few minutes several times a day and was doing thus on the day he taught me a valuable lesson. The Day Room window overlooked the side parking lot. Three industrial-sized garbage bins lined the back lot and were usually overflowing with garbage. Birds, stray cats, and mangey dogs took up residence in the lot for this reason and often there were fights, feathers flying, sickly kittens limping across the empty field. A rusted broken down car had been abandoned in the lot months earlier and had been stripped to its hull. Everywhere you looked you could see dog feces, bird droppings, clumps of dirt, garbage, discarded diapers and broken bottles. I was staring out the window and wondering if I should apologize to the patient for the disgusting view when he turned to me and said, "The world is a multi-colored place." Of course, he was insane. You'd have to be crazy to think.....but on second glance, through his eyes, I saw that it was, indeed, multi-colored. The parking lot was like a palette of every conceivable color and hue imaginable. Reds were sharp, blues were soothing, white was bright and clean, black was dark and strong...trash had fashioned itself into a papier-mâché Mona Lisa and the animals, all characters in some woodland play, devastatingly real in their dramatic performances....

You can probably see now why it's so easy to go insane in an insane world. Every time you see the logic in their insanity, you stand a chance of losing a piece of your own. But I believe that small opening into this alternate, albeit insane, reality widens the horizon a bit....widens it so that you may see colors that weren't there before, that you may see human disintegration so raw and unforgiving that you appreciate the light in your own mind, and that you become conscious of considering another person's view, however twisted or real that view is, and that you give it merit for its cause, for its voice....for its freaking courage in being.

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