Holiday Season at the I/DD Group Home

Broken Noses and Broken Families

Iam no Christian, but I’m pretty sure this is not what Jesus had in mind for winter solstice celebrations.

First, some background info. As a Direct Support Professional (DSP), I work the night shift at a 24-hour residential facility licensed by the state of Oregon and run by a non-profit corporation which shall remain nameless for as long as they care to keep me employed. At this facility, we care for three adult men living with moderate intellectual and developmental disabilities, along with the severe emotional and behavioral problems which are so often comorbid with I/DD.

For legal and ethical reasons, all names used henceforth shall be changed to protect the identities and dignity of the gentlemen I serve.

Working with these guys can be rewarding, but also incredibly taxing — so much so, in fact, that we boast an employee turnover rate higher than the fast-food industry. They don’t pay us enough to put up with this shit. Most new hires wash out within three to six months. I’ve been working that house for over four years now, long enough to become lead staff — basically, the house manager’s second-in-command. It came with a 50-cent-per-hour raise, putting me at $11.50 per hour.

The catch is that, along with handling a few extra administrative tasks, I also have to be on call for a couple of weekends a month, and also when my boss takes her much-deserved vacation time.

On December 23rd she took a personal day to go out of town with her family.

Naturally, that would be the day for all hell to break loose.

My phone woke me up just after 3:00 PM on December 23rd. (I work nights, remember.) It’s the house manager. I answered, groggily: “What’s up, boss? I thought you were taking the weekend off.”

“I just got a call from the house. Ralph went into a behavioral crisis. Edgar and Sam took off and staff followed, now Cesar is there alone with Ralph and we need another staff to get things under control — ”

“I’m on my way.” Click. I’m fully awake now as I dress and leave.

My coworker Cesar is a big guy, but Ralph is huge. I’m average height and no lightweight myself, but Ralph has 9 inches and 100 pounds over me. He’s a gentle giant most of the time. Usually he’s the first one up in the morning so we’ll play a round of Pandemic or No Stress Chess while he drinks his morning coffee. I’ve taken him on the road to compete in Special Olympics golf. Ralph’s a lot of fun. We get along great.

Most of the time.

But Ralph also has Fragile X Syndrome, along with the attendant autism and anxiety problems that so often accompany it. He doesn’t process emotions or communicate his needs very well. He’s more anxious around us than we are around him. So he bottles up his nerves and his feelings and his anger, until he blows up — like a human Krakatoa.

As soon as I park my car and get out, I heard Ralph yelling from inside the house:

“SHUT THE FUCK UP DAVE! RRAAAAAAAAAAA-”

THUD. A thirty-pound bar stool connected with the reinforced glass of the French doors leading into the kitchen from the back patio. He’d already shattered the glass of one door and he seemed deadly intent on breaking the other.

In case you were wondering, I had not yet spoken a word to Ralph or any other living soul on the premises.

He’s a gentle giant most of the time… Ralph’s a lot of fun. We get along great.

I walked calmly and deliberately towards the French door, partly because I did not want to slip on the packed snow but mostly because I was not having this shit today. My war face was on. When you wrangle grown men with “retard strength” — for lack of a kinder term — you cannot show fear. It’s like taming lions: if they see you as prey, you’re kitty chow.

I pushed open the French door, which is blocked by some debris on the kitchen floor — then closed it again quickly as I saw Ralph pick up the bar stool for another try. CRASH. The safety glass from the second French door finally shattered too, and I felt a blunt shard graze my cheek. Fortunately the stool was stopped by the wooden lattice frame that held the glass in place, and fell harmlessly to the inside floor.

Cesar chimed in at this point: “Dave, maybe you should try the front door instead.”

Okay, so maybe I wasn’t fully awake yet after all, or I might have thought of that myself.

I loped around the perimeter of the house while Ralph continued wrecking the kitchen. Stepping around the broken glass next to the front door — Ralph’s been busy this afternoon — I entered the house unopposed and warily stalked through a hallway to the open area on the outside of the kitchen counter, where Ralph continued to yell and cuss and toss bits of furniture about. Cesar has wisely placed the kitchen counter between him and Ralph.

Seeing me approach from the rear, Ralph turned and swung his meaty fist at me. I deflected the haymaker punch easily enough — I may be a clown but this ain’t my first rodeo. I circled, keeping my open-palmed guard up. Standard procedure for Ralph requires a two-person standing restraint, where Cesar and I each pin an arm to our chests while standing back-to-back behind Ralph, safely immobilizing him until we can calm him down.

The tough part is that we have to seize both his arms at the same time. I jumped in a little before Cesar was ready, and Ralph used his free left arm to take a free swing at my head. Luckily I was to Ralph’s right side and a little behind him, so he couldn’t square up and plant his feet to put any real power into the blow. I ducked and his fist glanced off my skull without ringing my bell too hard. I yell for Cesar to grab the left arm but he says he can’t get to it. I release and back off, fending off another swing.

They don’t pay us enough to put up with this shit.

Now I’m a little pissed and impatient with Cesar. “GRAB HIM ALREADY!” Professional teamwork at its finest.

Cesar saw an opening when Ralph squared up to face me directly, came in from behind, and pinned both of Ralph’s arms to his side briefly. Normally Ralph is too big for a one-person standing restraint to work, but Cesar is big enough to hold him for a few precious moments. I re-positioned myself to take the right arm once more, transitioning smoothly into the two-person restraint. Ralph struggled a bit longer, but his heart ain’t in the fight anymore. He knew from experience that we were not going to hurt him, and that he would not get out of our hold until he was good and calm.

Right about this time the local sheriff and three of his deputies arrived on the scene.

The lawmen crunch their way through the broken glass to speak with us. They know all about this house; they have come here before. Cesar and I reassured the sheriff that we had Ralph and the situation well under control now. We were not about to hand Ralph over to people who aren’t trained specifically to deal with the kind of challenges posed by a man like him.

I have seen what can happen when American law enforcement feels the least bit threatened by the mentally ill, and it is not pretty. Too many officers have been conditioned to react with force at the slightest provocation. On a good day they just slam somebody against a wall or the pavement before cuffing them. On a bad day they draw a pistol.

We were not about to hand Ralph over to people who aren’t trained specifically to deal with the kind of challenges posed by a man like him.

Instead of handing Ralph over, I directed the sheriff to call the local company director by phone so she can help look for Edgar, who is still at large with DSP Greg. I also asked one of the deputies to tell Sam and DSP Kyle, who are standing out in the front yard, that they could come inside from the cold.

Shortly thereafter we convinced the sheriff’s posse that they could leave the situation to us — which is good, since Ralph calms down faster when he has less of an audience. Cesar and I stand there, holding Ralph’s arms back for several more minutes, going through some breathing exercises until he regained enough executive function to speak rather than yell profanities. Once Ralph calmed down enough to tell us he’s calm, we released the hold and stepped away.

Then I got my first real chance to survey the wreckage.

First I had to get Ralph himself patched up. He generally wears gloves or wraps athletic bandages around his hands since he has this habit of biting the back of his left hand when he goes into crisis. (This sort of self-injurious behavior is common among the I/DD population as a maladaptive coping mechanism.) I saw that his hands were naked and bleeding: his left puffy from being chewed on, and his right from punching people and objects. I instructed Ralph to wash his hands while I fetched the antibiotic ointment, gauze dressing, and clean bandages from the office.

After treating Ralph’s hands I turned my attention to the kitchen. Ralph’s bedroom door faces an open area adjacent to the kitchen, and he had thrown his nightstand and several drawers out there, scattering his possessions among the bits of broken wood and glass shards from the French doors. The new kettle and a few dishes were broken. An artificial white Christmas tree had been toppled over, with ornaments (whole and shattered) strewn nearby.

The heavy plastic lid from a black lock-box lay near those doors, along with sheets of half-crushed blister packs from the pharmacy — Ralph has been responsible for taking his own medications for several months now, part of an ongoing campaign to teach our residents independent living skills so they can someday, theoretically, live on their own with less intrusive oversights. He has done an excellent job for most of that time. But later Cesar would discover that Ralph had forgotten to take his evening psychotropic meds for the past two consecutive nights, which almost certainly contributed to today’s blowout. Those long post-solstice nights often see Ralph falling asleep early — right after dinner, I would learn, during those two nights.

I placed and fielded a few phone calls while Cesar and Kyle started cleaning up the wreckage. Tom, the contractor we hire for building maintenance, brought a shop-vac for the broken glass and boarded up the French doors and the front window with plywood so our lads wouldn’t freeze tonight. I joined Cesar and Kyle between phone calls, reassembling the Christmas tree, salvaging what ornaments I could and sweeping up those that had been broken. Among the ornaments I saved was one with a framed wallet-sized photo of Ralph as a young boy — a contribution from his grandmother.

Halfway through the cleanup process, Greg returned with Edgar, safe and sound. Edgar had been preparing to deliver newspapers when Ralph went berserk and sent Edgar running scared. He had dropped his satchel of folded and bagged newspapers when that happened; now he collected them and left with Cesar to deliver them in the fading twilight while Greg and I spoke in the office.

Greg wanted me to look at his nose. Ralph had punched Greg square in the nose when the latter had first tried to intervene. Greg had only been with us for about a month, and had just finished his Oregon Intervention System (OIS) training a couple of weeks ago. This was the first real crisis he had to deal with. The nose had stopped bleeding but the septum was slightly off-center. Kyle observed that this often indicates a broken nose, so I sent Greg to get that checked out at the clinic downtown while I continued cleaning.

Kyle and I were finishing the cleanup when Cesar returned with Edgar around 6:00 PM. After catching up with Cesar, I left him to finish filing the internal incident report while I clocked out. This episode put me into overtime for the week, I had nothing to eat yet, and I was scheduled to work at a job coaching program with another of our company’s clients in less than three hours before returning to work a night shift at this house after midnight. Cesar could damn well handle the paperwork on his own.

On the way out I called Greg on my mobile to check in with him, find out what condition his nose was in, and ask whether he could cover a night shift for another coworker who could not make it into town through the snow. (Our bench was not nearly deep enough for this holiday weekend; everybody who could take vacation time had already split.) Greg confirmed that the nose was broken and also informed me that he was resigning, effective immediately, at his wife’s behest.

They don’t pay us enough to put up with this shit.

I gave the rest of Greg’s shift to Kyle. He needed the hours anyway.

Sadly, this kind of story is hardly unusual for this time of year. Christmastime sucks hard for our guys. And when it sucks for them, it sucks for the Direct Support Professionals who work with them.

Adults who end up in programs like mine usually have families, but those families can no longer care for them adequately. In nearly all cases they have tried to do so, but either failed utterly from the beginning or burnt out after years or even decades of stress. Many times one or both of the parents struggle with a developmental disability of their own.

I live on the autism spectrum myself, although I am definitely on the higher-functioning end of that spectrum. If I didn’t receive the quality of parental care I was lucky enough to get, I’d probably be living in one of these programs today instead of working for them. My wife has several relatives with autism spectrum disorders in her family, including a younger sister.

That’s the reason my wife and I don’t have children of our own — we know the risks, and we know full well that we’re not prepared to deal with them adequately. Of course, not all individuals with I/DD take the time to make such deliberations for themselves before fucking, so here we are.

Systematic forced sterilization of the sort that persisted in Oregon until 1981 is completely unconscionable and rightly considered a crime against humanity. Nobody should be compelled to relinquish their reproductive rights. But after meeting some of my clients’ parents, I think there’s an argument to be made for making such procedures available on a voluntary basis, and perhaps even providing incentives for doing so. At the very least, adults with I/DD should be enrolled in comprehensive sex education programs and given free access to contraceptives.

But I digress. I originally started this section talking about why Christmas sucks so hard for the guys I serve.

Ralph relives that trauma every year.

Their parents were overburdened and under-supplied to deal with the special needs of their children on a normal day. Consider, then, how much worse that situation gets when you pile the demands of American Christmas — with its financial pressures and the strained extended-family relationships that get brought into these children's lives to satisfy unrealistic cultural expectations of Rockwellian good cheer — on top of that everyday burden.

It’s no wonder to me, then, that Ralph was removed from his home by Child Protective Services around Christmas Day after a domestic abuse incident between his parents, and that Ralph relives that trauma every year. Nor is it any wonder that 42-year-old Sam gets moody whenever Christmas music comes on the radio, reminding him of his own displaced childhood and rekindling the desires of his own arrested development. Edgar, too, thinks of his own broken family more often at this time of year, with much pain and longing for what he might have had.

Small wonder that Edgar and Sam got in a fist-fight with each other the very next day, on Christmas Eve. I wasn’t there for that one, at least, so I don’t know all the details yet. But I can guess why their nerves were so raw to begin with.

Fuck Christmas, and may you all have a Happier New Year. Unless you voted for Donald Trump, of course, and his Cabinet that appears hellbent on shredding the Medicare and Social Security Disability benefits that pay for my guys to have a somewhat better life than they had in overcrowded mental facilities like Oregon’s Fairview Training Center. Then fuck you too.

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