Sheet Metal Mirrors
A night shift in a psychiatric ward…
By J Malcolm Anderson
The neon light in the nurses’ station cast a soft glow down the corridor in this world of troubled souls and misshaped psyches.
Sleeping or sitting passively in the lounge nearby were the 18 men and women patients in the A2 ward of the community medical centre.
It is the psych ward — a place where medical science is coupled with the energies and commitment of the staff to somehow contain the afflictions of those therein.
It is a Friday night and that in itself is enough for the staff to know it will be a particularly hectic shift.
The starts of weekends are traditionally times for an increase in activity in such wards, with patients caving in under the prospect of a lonely weekend in their troubled world.
But what makes this Friday even more a cause for trepidation is the full moon looming large outside the mesh-covered window at the far side of the lounge.
Just as the magnetic forces of the moon control the tides, so too do they exert mysterious forces over the soul. Psychiatric patients who have been struggling to keep their emotions in check find themselves at the time of a full moon unable to control the demons inside.
In charge of the ward this night is Judith Smithson, a 32-year-old registered nurse who has been in psychiatrics for the past four years. Recently divorced and struggling to maintain some stability for her and her two children, Judy’s own world is hardly trouble free.
But as she sits at the formica-topped work station looking out at the patients, she has put behind her personal travails for the good of maintaining a semblance of order through what portends to be a rigorous night.
Each of the 18 patients in A2 this weekend has within them the ability to pose a problem. But none more than Billy.
Like the person responsible for him this night, Billy is 32. Since he was 20, his life has been a never ending series of psychotic episodes.
He was admitted to A2 only two days ago after being rushed to the hospital’s emergency room suffering from self-afflicted puncture wounds to the chest.
In what amounted to the eighth suicide attempt in five years, Billy used a serrated knife to stab himself at least a dozen times in the area around his heart.
Only the presence of a physician in the ambulance prevented Billy from accomplishing his goal.
This is the first night Billy has been allowed among the patient population. Until now he had been in bed, a sheepskin-lined restraining harness over his chest, thighs and ankles.
Alternating between periods of drug-induced sleep and fits of hysteria, Billy finally calmed down to the point where the medical staff felt he could mingle with the other patients.
Now as he sat calmly in the overstuffed chair, a hospital blanket draped over his bathrobe, Billy looked like someone at peace with himself.
It was that look of contentment that bothered Judith.
Twelve years of nursing — the past four in psych wards — had taught her that suicidal patients appeared calm for one of two reasons. Either they were truly coming to grips with the self-destructive forces inside them, or more likely they were feigning things in order to gain the smallest amount of freedom needed to once again commit suicide.
On this night, Judith didn’t know what Billy had on his mind. She doubted it was true peace and ordered him to stay close to the nurses’ station.
In his rumpled pyjamas and unkempt greasy hair, he was a young man grown old.
When he was lucid, Billy loved to tell his life story. It came out in one unending, breathless stream.
Sitting next to Billy this night was another young man whose bandaged wrists bore proof to the struggle within.
“Henry can I talk to you?” said Billy.
“Sure Billy, what’s on your mind?”
“Henry when I was 17 I used to work for a restaurant over on Spruce Street. It was right around the corner from the phone company. The operators used to stop there for lunch. I would flirt with them Henry, you know how girls are. I used to give them free lunches. I lost track of what I was doing. It amounted to a lot of free lunches. The owner found out and called the cops. The judge said I wouldn’t have to go to jail if I joined the service.
“So I went into the Air Force. They sent me to basic training in Texas and then sent me to tech school for food service. On June 12, 1970, I was sent to the Air Force Base in Shepherd, Alaska. There were two camps there. There was an upper camp and a lower camp. I worked in the upper camp Henry. There was this guy I used to work with and we lived together in this Quonset hut. One night Henry this guy got up in the middle of the night and tried to force himself on me — you know Henry sexually.
“I reported him Henry and they sent me to work in the lower camp. I don’t know why Henry but they discharged me; it was September 23, 1970. I was shot Henry. It just wrecked me. It was an honourable discharge under Section 213 for moral disturbances.
As Henry sat there listening, it dawned on him that if it took this long for Billy to tell this much of his personal docu-drama, it could be a marathon rap session before the tale was brought up to the present. He was looking for some kind of diversion to rid himself of Billy.
Just such a diversion presented itself directly in the form of Mary R., a 15-year-old runaway whose mother died giving birth to her. Her alcoholic father died two years later and with no family willing to take responsibility, Mary grew up being tossed between foster homes and orphanages.
She came into A2 after being rushed to the emergency room after a miscarriage in the stairwell of a teenage group home. The physician on duty in the ER admitted her to A2 after she became hysterical; screaming that one of the ambulance attendants was her father.
She had been in A2 for two weeks and had just received the news that she was being transferred to a more intensive diagnostic centre in the western part of the state.
Mary had taken the news calmly and had told anyone who asked that she was going home to see her sister — a sister that existed only in her mind.
The staff had become concerned over how Mary would react when the personnel from the centre came to get her.
When it was time for her to leave that evening, the hope was that Mary would give up clinging to the hope of an imaginary sister. And yet the power of having someone who could break the cycle of institutions refused to die; it actually got stronger.
At the sight of the state attendants, Mary ran to Judith. “They can’t take me. My sister’s coming,” she said in a voice on the upward climb to hysteria.
“Please Mary you know you don’t have a sister. You’ve been fooling yourself. These people are going to help you. You want to get well don’t you?”
“Where’s my sister,” she shot back, her voice now in a high-pitched frantic cadence.
As the attendants moved toward her, Mary pulled out a pair of scissors she had snuck out of the occupational therapy room earlier in the morning. Before anyone could get to her Mary rammed the not very sharp knife into the thigh of the state attendant.
Within seconds, the entire night shift of A2 was involved in either restraining Mary or tending to the wounded attendant.
Judith had to secure emergency permission from an attending physician in ER to sedate Mary. The attendant would only need a tetanus shot and a butterfly bandage.
With the situation under control, Judith and her colleagues allowed themselves a minute to relax.
“Nobody ever said it would be easy,” she joked to her team.
“Yea, but if I knew it was going to be this hard I would have come here as a patient,” said one of the younger therapists.
Judith thought how ironic it was that the night’s trouble came from Mary and not Billy.
“Where is Billy by the way,” she asked.
“I don’t know. He was sitting over there when all the fun started,” said one of the team.
Anyone who works in a psychiatric ward comes to realize that attention paid to one incident can’t come at the expense of being vigilant elsewhere. For when things heat up with one patient, there is a greater tendency for other patients to become enflamed.
An appropriate analogy can be found by imagining a room full of mousetraps each with a ping pong ball on top of it. Throw a ping pong ball into the room and eventually all the traps will be tripped in a display of random but methodical disorder.
Accordingly, every effort is made to shield patients from the more dramatic disturbances that occur around them.
With Billy nowhere in sight, Judith ordered her team to conduct a thorough but low-key search of the ward.
That search was just beginning when Paul M., a 63-year-old steelworker who was being treated for his third nervous breakdown in two years, got up from his seat to go to the men’s room.
When he opened the door, he was greeted by the sight of Billy crouching on top of the commode with one end of a blanket wrapped around his neck; the other end tied around a light fixture.
Paul was not particularly bright but sometimes what he said could be construed as witty. “Come on Billy, don’t take it so hard. Notre Dame will come back next week.”
“Fuck off you moron. Get out of my way.”
Billy realized he was in a bind. If Paul stayed where he was, there was no place for him to jump in order to accomplish the hanging.
He decided instead to just jump directly at Paul, hoping he would just run away.
But when Bill did jump, right into Paul’s burly arms, his weight on the light fixture brought the entire fiberglass panel ceiling down on both of them.
Judith came into the bathroom just as Billy was picking himself off Paul.
With the blanket scarf still hanging around his neck and sheds of the fluorescent light still stuck to his hair, Billy just sat their screaming. “Why can’t I do anything right.”
“All right Billy. Settle down. Are you hurt? How’s your head.”
“Who cares how my head feels. It’s going to explode if I can’t turn it off.”
Paul was still sitting on the floor. “I hurt my back. That dumbshit loser kid hurt my back.”
By now, two of the bigger attendants were on the scene. Billy was placed in his room, under restraints, while permission was sought for a powerful sedative.
The entire episode last only a few minutes, but it was more than enough to set the other patients on the edge of high anxiety.
The ping pong balls hard started flying.
The next three hours were then spent fighting one brush fire after another, none of which erupted into a full conflagration.
Shortly before midnight, Judith walked into the cool night air of a different world.
The shift had drained her as so many had before. And yet as she drove home she knew that the cumulative process of this exhausting job had, in some unexplainable way, left her richer not lighter.