From the Odds and Ends Department

Have you ever watched something on TV, or read something, and thought, Man, I could do so much better than that! You might even be thinking that right now…  Especially if you’ve read more than one of my blog posts.

I mean, all this guy writes about is getting wasted, his slutty girlfriends, and how all of his relationships fell apart! There was that story about his nympho Russian girlfriend, Ivana Sukyurkokov. And his heartbroken Chinese girlfriend, Wat Wen Wong. Jeez, his blog is dumber than putting wheels on a ball! I liked him more when he wrote about crazy people!

And I hear you. Before I started writing my blog, I thought bloggers were people who needed to get a fucking life, man. They were probably people who thought Paris Hilton and Kim Kardashian were the epitome of American society and they all wanted to be Paris-ites, or biffles, or twat waffles with them or something.

I’ve started reading some of the blogs that are out there on the Interweb, and I was wrong about bloggers. Most of them appear to have lives.

Except me.

I’m retired. If I were to write about my day-to-day life now, my blog would consist of restaurant reviews in the Lakeside area, and stories about how much I love my Sleep Number bed®.

And to be honest, I probably liked me more when I was writing about crazy people, too. But those stories are relatively easy to write, and like everything else in life, it’s only when you step outside of your comfort zone that anything meaningful happens. It’s the stories I didn’t want to write that taught me the most about myself. It was the stories that hurt like hell that showed me how far I’ve come.

And how far I still have to go.

And the other thing about writing about my nursing career is not every person I cared for resulted in a story worth telling.  Knife wielding homicidal maniacs were the exception, not the rule, thank God. Most of my patients were never a problem, unlike medical dramas on TV. I’d probably hate being a TV nurse, unless my work partner was the hot nurse with the big tits…

The majority of my nursing career was pretty ho-hum. Mischief was managed. Shit got done. No one died. And that was that. But there were a lots of snippets and moments and oneliners, and if I could patchwork a lots of them together, I might be able to spin a tale or two…

* * * *

I’ve discovered that time management is still necessary once you retire. I certainly have more time to do things I enjoy now, like reading. And because other bloggers sometimes read my posts, I feel a certain obligation to read some of their posts, too. My favorite blogger is a young woman in New York who writes about her struggle to overcome her eating disorder. Her blog is called Beauty Beyond Bones. And while I love her now, I probably would’ve hated her as a patient.

Back when I was a psych nurse in Arizona, there were a couple of eating disorder treatment facilities in the little town of Wickenburg, about thirty miles northwest of Surprise. Remuda Ranch and Rosewood Ranch. She’s never come out and said if she was a patient at either of them, but I’m going to guess she was at Remuda. I hope she doesn’t mind me saying that. I interviewed at both facilities, but decided not to take a position at either one of them. I absolutely sucked at working with eating disorder patients.

Remuda is a Christian based treatment facility. One of the questions they asked me in the interview was did I think the Bible was the sole source of truth. I said no, it wasn’t, and I wasn’t even sure all of the things written in the Bible were true. After my interview, they told me I wasn’t Christian enough to meet their criteria. I told them that was okay. They weren’t the first Christians to tell me that.

A few weeks later they called me back and told me that they had changed their mind about me, and asked if I was still interested in working there. I wanted to say something like, God, you guys must be fucking desperate! But instead I thanked them for thinking of me, and told them I had found another position and I wasn’t available anymore.

Well, it was the truth…

Like most every psychological/psychiatric disorder, eating disorders are caused by a multitude of complex factors, and as with every psychological/psychiatric disorder–except dementia–the successful treatment of anorexia or bulimia depends completely on the patient. If they don’t want to change their behavior, there ain’t nothin’ anyone can do for them once they’re discharged from the hospital.

It’s like alcoholism or drug addiction, only worse. Just as the drinking and chemical use are usually a symptom of a deeper, darker pathology, eating disorders are about far more than food.

Eating disorders are incredibly difficult to treat, mostly because eating disorder patients are the spawn of Satan. I mean that in a Christian way. They are sneakier than a ninja. They can vomit silently so they can purge without anyone knowing. They stockpile food so they can binge feed when no one is looking. And if their lips are moving, they’re probably lying.

The other thing I remember most clearly about most of these women, and they were all females, is the majority of them were gorgeous. And that is truly one of the great mysteries that used to keep me awake at night when I was learning how to be a psych nurse. How could someone so beautiful be so fucking miserable?

One of my first posts was about one of my patients at the MVAMC. I called him the Piano Man because he liked to play the piano. About the time he walked onto the unit for one of his many admissions, we had just discharged a gal with anorexia. She had been on our unit for a couple of weeks, and none of the staff were sad to see her go.

After we got the Piano Man admitted, he sat down at the piano and started playing, and the piano sounded like a wounded moose. We opened the top to find the eating disorder girl had hid enough food inside of the piano to feed Hannibal’s entire army when he crossed the Alps to attack Rome. Including the elephants.

For someone who has never worked in a psychiatric setting, it would be easy to say that we, as staff members, totally sucked at our job, and I really don’t have much of anything to say in our defense. We were hardly specialists at treating eating disorders, and the fact we were so happy to see that particular patient leave speaks volumes to the level of struggle we all had with her.

* * * *

To be sure, it’s very easy to be an armchair quarterback or a wheelchair general, and criticize someone doing a job you’ve never attempted. And when you’re in a service oriented occupation like Nursing, you are never going to be able to make everybody happy. No one is that good, and people can be incredibly demanding/entitled. And it is generally the people who were making the least positive contribution to anything who were the most demanding and entitled.

You guys have to be the worst fucking nurses I’ve ever seen! I couldn’t tell you how many times I’ve heard that one. And it was usually a guy that you and your team had spent a month busting your asses trying to arrange housing and follow up for, who had been discharged from your unit forty-eight hours earlier, and was already back because he chose to drink as much alcohol and smoke as much meth as he possibly could before he came crawling back to the hospital.

Most of the time it’s better to just agree with someone like that, and walk away. But there were times when I couldn’t.

“Maybe you should get out more…  That means a lots coming from you…”

I said something like unto that to one of my unhappy frequent flyer guys at the MVAMC who probably spent as much time in the hospital as I did. His name was Ray. I’m going to guess that the total bill for the many, many times we detoxed him off of alcohol, sobered him up and set him up to succeed was in excess of one million dollars, and he had this response, “You used to be a good guy, but you need a new job. You’ve been inpatient too long.”

“So have you.” I replied.

He froze to death one cold December night in Minneapolis. He had gotten drunk and was walking to the hospital so he could be admitted again. His body was found propped up against a tree across the street from the hospital in the morning. He had stopped to rest before making his final stumbling trek to the ED, and had fallen asleep.

You meet a lots of guys like unto that when you’re a psych nurse. There was Charles. He was another MVAMC guy who spent an inordinate amount of time getting drunker than fifty guys combined, and the rest of his time detoxing on my unit.

We had safely detoxed Charles for the umpteenth time, and discharged him at 9:00 AM on a Friday morning. At 2:30 PM that same day, I answered the phone. It was Charles.

“Hey, I don’t think this discharge thing is going to work, man. I’ve been out of the hospital for about six hours, and I’m pretty fuckin’ wasted, man.” he slurred.

“Hey, Charles. Has it ever occurred to you that you need to quit drinking?” I decided to ask. There was a long silence, and then Charles said this,

“Is there anyone else there I can talk to?”

For one of the few times in my life, I had no response. I handed the phone to one of my co-workers. Charles would also die to death as a result of his alcohol abuse.

Sometimes the disease wins.

* * * *

You never know what you’ll see or hear as a psych nurse, and there’s a reason for that. People are capable of an infinite amount of kooky stuff, not that you have to be a psych nurse to experience the full spectrum of kookiness available out there.

All you really need to see that is a family.

But one thing you may not experience unless you’re a psych nurse is the dreaded Dissociative Identity Disorder, or more commonly, Multiple Personality Disorder. In my thirty year career, I met a lots of people who claimed to have multiple personalities, but none of them ever seemed to be legitimate to me, or anyone else I worked with.

Multiple Personality Disorder was virtually unheard of until the 1970’s. That’s when the book Sybil was published, 1973 to be exact. Three years later, the TV movie of the same name was broadcast on NBC, starring Sally Field and Joanne Woodward, and like magic, suddenly everyone had multiple personalities.

For my money, all of the people I met who claimed to have multiple personalities were just assholes looking for an easy excuse for their behavior.

* * * *

I was working nights at the MVAMC fairly early in my career. I was the Med nurse that night, so anyone needing any medications had to see me. Enter Sam. It was around 2:00 AM. We had detoxed Sam off of alcohol with a Valium protocol. Once someone had been safely detoxed, the protocol was discontinued.

Sam had been off the protocol for a day or two, but he wanted more Valium. I explained to him how the protocol worked, and Sam had a five star meltdown. He screamed at me, waking up everyone on the unit. One of the other nurses called the POD and got a one time order of Valium for Sam, and he went back to bed.

At 6:00 AM, Sam came up to the nursing station to get his morning meds. He was quite pleasant, and I remarked that he was much nicer than he had been at 2:00 AM.

“Oh, that. That wasn’t me. That was Samuel.”

“No kidding. He looks just like you.” I said.

Sam gave me, and anyone else willing to listen, a detailed description of his three personalities: Sam, Samuel and Sheryl. A line of patients had formed behind Sam. They were waiting to get their meds so they could go smoke. According to Sam, Samuel was the troublemaker. Sheryl was the lover, and Sam was the drunk. I listened to Sam, and gave him his meds.

“Well, the next time you talk to Samuel, give him a message.” I said. “If he ever talks to me like that again, I’m gonna punch you in the fuckin’ mouth.”

Sam’s jaw dropped. He turned to the guys standing behind him, “Did you hear that! He threatened me!”

“Hey! Take your goddamn meds and get the hell out of the way! And if you ever pull that shit again, if he doesn’t punch you in the fuckin’ mouth, I will.” one of the Nam vets growled.

Yeah, not one of my better moments, but Samuel never made another appearance.

* * * *

I think the last time I met anyone who claimed to have multiple personalities was at Aurora. I walked onto the Canyon Unit, and Nikki was on a 1:1. She was a frequent flyer, and I was usually her nurse.

A 1:1 is a special precaution, usually reserved for patients that are acutely suicidal. In essence, one staff person is assigned to one patient, and that patient is never more than an arm’s length away from the person assigned to watch over them.

Well, that’s how it’s supposed to work, but it’s rarely played out that way.

I went over to talk to Nikki. She had scratched her wrist with a plastic spoon on the evening shift. She didn’t even break the integrity of her skin, and her nurse had placed her on the 1:1.

I’m shaking my head while I write this. I don’t usually like to criticize the actions of other nurses, but that was a lazy-ass intervention. If the evening nurse had taken even five minutes to talk to Nikki, that ridiculous waste of manpower and resources wouldn’t have been needed. We barely had enough staff to cover the units, let alone have one staff assigned to watch someone for no good reason.

I asked Nikki to tell me what happened.

“I didn’t do anything! It was Alexandra!”

“And whom might that be?”

“She’s one of my three personalities! She–”

“Stop. Cut the crap, Nikki. You’re on a 1:1. You can’t smoke if you’re on a 1:1.” I said.

“But they let me smoke last night, and this morning!”

“I don’t care what they did last night. This is my unit, my rules. If I can’t trust you to be safe on the unit, I’m sure as hell not going to trust you to be safe off the unit, with a lit cigarette in your hand. What if you decide to burn yourself?”

“It wasn’t me! It was Alexandra!”

“I don’t care who did it. None of you get to smoke.”

“I’ll be safe, I promise! Please!!”

Less than five minutes. Mischief managed. And I never heard another word about Alexandra again. Ever.

* * * *

There was a fairly consistent response whenever I told someone that I had just met that I was a psychiatric nurse. Their eyes would widen, and they would say something like unto, “I bet you’ve seen it all, huh.”

I would reply, “No. I’ve seen a lots of strange stuff, but the kookiness of humans is infinite.”

And that is the fucking truth.

Every time I thought I had seen it all, something I didn’t think was humanly possible walked through the door. I eventually made peace with the fact that I would never see it all, and I was okay with that. My two other personalities are still sulking about that a bit, but they’ll get over it.

Or I’ll punch them in the mouth.

A Rose By Any Other Name

I first met Rose when I started working at MIHS, Maricopa Integrated Healthcare Services, otherwise known as the County. Maricopa Medical Center was the ancient hospital that was its primary treatment facility. And by ancient I mean it was built in the 1970’s. There’s not a lots of historical places in Phoenix.

MIHS also provided psychiatric care, and they had two facilities for that. The first was the Psych Annex. That’s where I worked. It was a nondescript two story building behind the medical center. The second was Desert Vista, a much newer, incredibly secure building in Mesa. It’s the place you’ll end up at if there’s ever a petition for court ordered examination/treatment filed against you.

I’m sure I’ve suppressed some of the memories I have of working there, mostly because I hated the management there so much. I really liked the people I worked with, and the patients I cared for weren’t terribly different than the patients I’d taken care of at the MVAMC.

I left the MVAMC in October of 2007, and started working for MIHS in November. And that’s when I met Rose.

What do you think of when you think of a rose? A beautiful, fragrant flower, right?

Yeah, that wasn’t Rose.

She was loud, intrusive, disruptive and did I mention loud? She was rude and undisciplined. Her hygiene was crude, her manners were random and unpredictable. And watching her eat could ruin your appetite for a few days. On top of that, she was also one of the most profoundly psychotic persons I’ve ever met. I can’t imagine what happened to her to transform her into the person she became.

Rose was possibly cute at one time, but those days were long gone by the time we crossed paths. She always looked disheveled, even after she had just showered. She had no fashion taste. Her outfits could cause seizures. Even if you were blind.

But the most distinctive thing about Rose was her voice. It was harsh, discordant and gravelly. Clint Eastwood sounded almost gay compared to Rose. And after listening to Rose for eight hours, even someone speaking into a megaphone sounded like they were whispering.

Rose could easily be described as a problem patient. She needed a lots of redirection. And there was no such thing as telling Rose something once. It was constant. And exhausting.

“Hey, Rose! Turn down the volume over there, okay!”

“YES, SIR!” I have no idea why, but Rose always called me Sir. She called other staff members by name, but not me. “I’M GONNA TURN DOWN THE VOLUME, ISN’T THAT RIGHT, JEFFREY?” Rose was constantly talking to Jeffrey MacDonald. You might remember him. He was the guy accused of murdering his pregnant wife and two daughters. He was apparently Rose’s imaginary best friend. “YOU HEARD WHAT MISTER SIR SAID! TURN DOWN THE VOLUME OVER THERE, ROSE. WHAT ABOUT YOU, JOHANNES? He was one of the BHT’s at the Psych Annex. DO YOU THINK ROSE NEEDS TO TURN THE VOLUME DOWN? I KNOW JEFFREY THINKS I NEED TO TURN IT DOWN, RIGHT JEFFREY? THATS FUCKING RIGHT!”

And she swore more better gooder than two Portuguese sailors. I purposely deleted about seventeen swear words from Rose’s dialogue. Anyone that knows me knows I don’t have any problem swearing, but even I was shocked by the amount of profanity Rose unleashed in casual conversation. And when she got upset, it was like getting hit by a fucking tsunami.

Rose was rarely violent, but she tended to provoke it in others. I think she wore on the nerves of everyone around her until they just couldn’t take it anymore. And most of the people on the same unit as Rose weren’t all that tightly wrapped either. She made more than one person lose it, and half of them were people I worked with.

I spent a lots of time with Rose. I may have even begged her to quiet down, I’m not sure anymore, but it’s not out of the question.

Rose was at the Psych Annex when I started working there. I’m pretty sure she was still there when I quit six months later. Rose was one of those people no one wanted within fifty feet of their facility, let alone inside it.

I worked Gero/Psych and did a stint in management at Banner Del E Webb for a few years, then moved on to St Luke’s Behavioral Health–straight psych–I was back in familiar territory. I hadn’t been there long, maybe a couple months, when I did something stupid. I started wondering what had happened to Rose.

There’s a rule when you work in Psychiatry: you never, ever mention the name of a discharged patient. You know, I wonder how So and so is doing? If you do, the person you invoked will invariably get admitted. The only way you’re safe doing this is if the person got dead, except if they had gotten dead, you wouldn’t have to wonder how they were doing…  For chronically frequent flying psych patients, the only way you can totally get rid of them is death. I know that sounds terribly callous, but it’s also true. You can ask around, if you so desire.

I never said Rose’s name aloud, not even to myself or any of my imaginary friends, nor to any of my co-workers–none of the people I worked with at St Luke’s knew Rose.

But they would.

Never underestimate the craftiness of a psych patient, especially the really crazy ones. They are spooky beyond belief. And like any other organism, they evolve. When I first started working as a psych nurse, a name had to be spoken out loud. By the time I was getting ready to retire, a simple thought would suffice.

I was walking into work at St Luke’s from the parking lot one day, and I ran into someone from the day shift.

“How was your day?” I asked. What happened on the day shift rarely had anything to do with how the evening shift would go, but it was always nice to ask.

“Oh. My. God. Turn around and leave now! We got a new admit today, wait until you meet Rose!”

I stopped in my tracks, and slowly turned toward my co-worker. I briefly described the Rose I knew, knowing there could be only one Rose that could effect that kind of reaction.

“Oh. I see you already know her.”

Yep. That was my Rose.

AP 5 was my home unit at St Luke’s. It was the court ordered unit. You didn’t have to be court ordered to be admitted to my unit, but if you were court ordered, it was the only unit you could be admitted to.

Rose was permanently court ordered. She was usually admitted to the Psych Annex, or Desert Vista. But the staff at those facilities were burned out by Rose. She was sent to St Luke’s purely out of desperation.

AP 5 was a chaotic place. It was two large dayrooms with the nursing station in-between. The patient rooms were dotted around the perimeter of the dayrooms. The unit was a giant echo chamber, it was concrete and linoleum. The other units had artwork. Some of them had carpeting. AP 5 was like the basement where your family locked up your crazy aunt, and no one ever talked about it. There was no no artwork, nothing for noise abatement. It was almost as loud as the artillery firing range at Fort Sill, way back when I was in the Army.

Added to the abnormally normal pandemonium, was Rose.

“WELL, HELLO, SIR! HOW ARE YOU! I HAVEN’T SEEN YOU IN THREE AND A HALF YEARS!”

I had to stop and think about it, but she was correct, almost to the day.

“Hi Rose. Say, could you do me a favor, and turn down the volume a few hundred decibels.”

“TURN DOWN THE VOLUME! YES, SIR! WHAT DID I TELL YOU, JEFFREY! MISTER SIR STILL WANTS ME TO TURN DOWN THE MOTHERFUCKIN’ VOLUME! YES, SIR! I’LL TURN THE MOTHERFUCKIN’ VOLUME DOWN!!”

I hadn’t even started my shift, and I already had a motherfuckin’ headache.

I filled my fellow evening shift staff members in on Rose. This was perhaps the best crew I would work with in my career. Deb Goral. Luis Hinojosa. Anthony Tafoya. Rachelle Carson. I loved those guys. We were a well oiled machine. And Rose had all of them pulling their hair out within the first hour.

I started herding Rose to her room to remove her from the mileau. She started peeing on the floor. I think Rachelle was ready to kill her.

I spent a lots of time talking to Rose once more. It didn’t happen right away, nor did it happen overnight. I didn’t even notice it at first, probably because it was always so noisy on AP 5, but Rose actually did turn down the motherfuckin’ volume of her voice. She didn’t swear anywhere near as much as she normally did, and she stopped peeing on the floor altogether. I think she actually became one of the better patients on the unit.

I have no reasonable explanation for it.

And then something really weird happened. Rose came up to the nursing station one evening and actually whispered something.

My name.

“Maaaaaaark!”

It was, like, the spookiest thing I’ve ever heard.

Deb could do a perfect imitation of it, and she did it often. But only because she loved me. She became my first work wife, ever. And then she became my first ex-work wife.

I’m in a lots of relationships, and they’re all complicated.

Unlike my first encounter with Rose at the County, her stay on AP 5 was relatively short. Maybe three weeks, maybe a month. She came back again almost immediately, but was discharged later that same week. We had to have set a record for her shortest hospitalization, ever.

I never saw her again, not that that’s a bad thing. There are people you meet in your life that you’ll never forget, but you don’t miss them when they’re gone.

I know a lots of people like that.

I like to think Rose was able to gain a measure of control of her insanity, and she’s doing better.

But that’s doubtful at best. More likely she’s standing on a sidewalk somewhere in Phoenix, saying, “Maaaaaaark!” Very softly.

Wild and Crazy Guys

When you’re a psych nurse, you get to meet a lots of crazy people. Even if you’re not a psych nurse, you get to meet a lots of crazy people. But they’re your friends, or your parents, and they don’t count.

I’ve met so many kooky people, I can’t keep them all straight anymore. But these are some that stick out in my mind.

The Tin Man. He was a patient at the MVAMC. I would meet him only once, which was actually quite rare at the VA.  He was an incredibly muscular young man, which probably explained all the people that escorted him to the unit. Almost all of the Outpatient staff had walked him over. You could tell right away he was going to be interesting. For starters, he drew a crowd.  For another, he was wearing a hat made of aluminum foil.

“What’s with the hat?” I asked.

“Aliens.”

“Like, from Outer Space? Those kind of aliens?”

“Yessir.”

“What does the hat do?”

“Mind control.”

“Ah! It…prevents…mind control?”

“Yessir.”

We did skin assessments on all of our patients when they were admitted. We needed to know if they had any open wounds, or lice. Stuff like that. We also wanted to make sure they weren’t concealing any contraband items, like guns. Or knives. Or drugs.

When we did our initial skin assessment on the Tin Man, we discovered he wasn’t wearing just a hat made of aluminum foil, he was wearing a suit made of aluminum foil. Hence, the nickname.

“That has to be incredibly uncomfortable.” I observed.

“Yessir, but you get used to it.”

I was able to convince the Tin Man to surrender his special suit to us with the assistance of my good friend, Paul Anderson. I told the Tin Man he was in a government facility, and all government buildings have a secret layer of lead added when the building is constructed.

“For real?” the Tin Man asked. I am apparently quite a convincing liar. I’ve had many people tell me they couldn’t tell if I was telling the truth or not. Even when I said something ridiculous. And those were people I worked with.

“Oh yeah,” Paul said. “We have a lot of politicians and high powered dignitaries that visit here, and the last thing they want is space aliens taking over their minds.”

“Definitely.” I added. “They might do something unthinkable, like their jobs.”

* * * *

Wally World. He was also a patient at the MVAMC, and he would check in every few years or so. Wally was homeless. Well, he said he lived in a dumpster, so he wasn’t technically homeless in his mind. You wouldn’t believe how awful he smelled when he was admitted. Be that as it may, he was quite kooky, and he collected things.

That’s what he called it. His roommates called it stealing, and threatened to beat the shit out of him. We had two private rooms right by the nursing station, but we generally filled those rooms with old confused guys. I moved Wally into a seclusion room for his safety. Then I ended up locking him in it to keep him from getting killed to death. He couldn’t stop collecting things.

Some of the guys on the unit were combat veterans, guys who had fought in wars, and had killed other human beings in the service of their country. And some of them were the last person you’d want to piss off because they probably would kill you.

Being homeless, well, living in a dumpster, Wally probably didn’t have a lots of stuff. I doubt any of the stuff he had could be classified as nice. I’m sure the temptation to have nice stuff was overpowering to Wally. If he saw anything he liked, he simply took it. Being crazy as a loon probably didn’t make it any easier…

The rules and regulations for seclusion and restraints were the parts of my job that changed the most during my nursing career. When I started in Psychiatry, patients were secluded and restrained for almost any reason. Locking Wally in his room because he couldn’t stop stealing may seem punitive today, but it was acceptable back then. My boss had no problem with my decision, as long as I tried setting Wally free every day.

Nowadays, you need overwhelming evidence of a clear and present danger to self or others before you even think about using S & R. Especially in the private sector.

I worked for the VA. Technically, each VA hospital is supposed to follow the statutes of the state it’s in, but the VA is a Federal institution, and the Federal government doesn’t like the States telling it what to do. We pretty much did whatever we wanted to when it came to controlling the unit and managing the behavior of our patients.

I met with Wally every day that I worked while he was there during that admission. I thoroughly explained my expectations about his behavior to him. Don’t take anything that doesn’t belong to you. If it’s not already in your room, it doesn’t belong to you!

I’m not sure if Wally didn’t listen, or if he couldn’t process what I was saying. I stepped between him and a very pissed off person more than once to prevent bloodshed. I’d return whatever he had taken, and then I’d lead Wally back to his room and lock the door.

“I don’t like you,” Wally told me one day as I was locking him back up again, after I saved his life and returned the item or items he had collected while he was free. “You’re mean, and icky. The only reason you’re doing this is because I can rap better than you!”

See what I mean?

Wally eventually came back to earth. He stopped collecting things, and we discharged him back to his dumpster until the next time.

* * * *

National Security. The Secret Service would bring people to the MVAMC from time to time because they had threatened to kill the President. It was always in conjunction with a Presidential visit to Minnesota.

If you’ve never met a Secret Service agent, they’re intimidating. They’re all tall, and their muscles have muscles. They all wear black suits and sunglasses. And they never, ever smile.

“Lock this man up in that room until we tell you to let him go.” a non-smiling agent would say, and point to a seclusion room.

“This is a locked unit. He’s already locked up.” I said, once.

“Locked up, in that room. Or you can join him. It’s a matter of national security.” When the President’s visit was over, the Secret Service would call and give us the green light, and we could discharge the person they had delivered into our custody.

And we would comply. Once we even put a man in four point restraints and locked the door because the Secret Service ordered us to. Several hours later we cut him loose, again, at the direction of the Secret Service. It was the only time I ever released someone that had been restrained and secluded directly to the street.

I have to admit, I’m not sure who was kookier now. The people that hated the President, the Secret Service, or us.

* * * *

The Mad Crapper. He was one of the kooky guys that liked to strip and go naked at the MVAMC. Truly crazy people emit an aroma or pheromone or something. I could tell how psychotic someone was simply from their smell.

That was true with the Mad Crapper, but he had a little something extra in his mix. That guy had a seemingly endless supply of shit inside him. He would crap like a moose. Nay, he would crap like a herd of moose. Yea, verily, he crapped like unto a veritable elephant.

The Mad Crapper crapped like no one you had ever seen. Or smelled. You would think after taking a dump like that, the guy wouldn’t need to poop again for a month.

After he downloaded enough crap to fill the halls of Congress, he would paint himself and the walls of the seclusion room with fecal matter. We would clean him up, and his room. And he would shit all over everything again with the same incredible amount of crap.

There’s something they never showed the nurses having to do on Days of Our Lives.

* * * *

The Piss Guzzler. His name was Patrick. I met him at the Minnesota State Hospital. You can probably guess why I gave him his nickname.

Patrick used to drink water by the gallon, and then he’d go crazier than hell. We’d have to lock him up with a few urinals and empty them as soon as he filled one, or he’d guzzle his piss like it was a bucket of beer.

Patrick was generally a pretty nice guy, unless he was intoxicated on water. He once charged my friend and mentor, Sondra, with deadly intent in his eyes. She had to lock herself in the report room. She later told me she was sure Patrick would have killed her if he had caught her.

Patrick climbed the flagpole one day. I’m not sure if I was there when it happened or not, but I have a vague memory of someone telling me I had to get him down from there. That was a very tall flagpole, and Patrick had climbed all the way to the top.

“The hell I do. Haven’t you heard of gravity?” I think I responded, if I was there.

Patrick eventually came down from the flagpole, all by himself, whether I was there or not.

* * * *

The Stalker. I met this guy at the County Hospital in Arizona. He looked to be a kind of a sweet, benign kooky guy. He mostly sat on the couch in the lounge, staring off into the distance at nothing, smiling to himself. I called him The Stalker because he had convinced himself one of local news anchors, Beverly Kidd, had fallen in love with him. He wrote her love letters, and started hanging around her TV station. He gave her flowers and candy. She filed a restraining order against him, which he ignored. He was arrested, and then he started writing letters to Beverly telling her how he was going to kill her and her children. The next thing he knew, he was locked up in a psych hospital.

He had two warnings taped to his chart. One, we were supposed to notify Beverly Kidd immediately upon his release. And two, we weren’t supposed to let him watch the news on Channel 3. That was Beverly’s network.

I think I left the County before he did, so I don’t know how his story ended.

* * * *

When it comes to my personal wild and crazy guys, this is but the tip of the tip of the iceberg. I’m sure I’ll visit this neighborhood again.

Sometimes the memories are still so real I’m not sure I ever left.

The Jawbone of an Ass

My jaw has been bothering me quite a bit lately. It’s been a little over eight months since I was assaulted, resulting in the nondisplaced mandibular fracture that certainly doesn’t feel all that nondisplaced to me.

My dentist at Surprise Smiles 😆 told me it could take up to a year for my jaw muscles to realign to the new profile of my bite. This wasn’t what I wanted to hear back then, but if it will truly take that long, the good news is I have a mere four months to go.

I have sustained several physical injuries during my career as a psychiatric nurse. I also sustained several more injuries during my career as a drunken moron. These two careers overlapped each other for at least ten years, so it’s hard for me to separate them sometimes. The net result is pain, and for anyone that lives with daily chronic pain, it really doesn’t matter where or how it originated. You simply have to learn to live with it.

I was physically assaulted on three separate occasions during my nursing career. That averages out to one assault roughly every ten years. Somewhat oddly, I was struck in the face each time.

The first time, I never saw the punch coming. I was working at the MVAMC. My back was turned to the guy that hit me. Merrill came up behind me and suckerpunched the right side of my face because he wanted to go smoke, but I had taken away his smoking privileges because he was being an asshole.

It took me a moment to figure out what the hell got happened, and then it hit me, so to speak. That sonuvabitch punched me! My first response was to immediately punch him back. Yeah, guy logic, if there is such a thing.

My co-workers intervened. Merrill was quickly whisked into a seclusion room. I was sent to Employee Health be evaluated. I sustained no serious injury, but the doctor gave me the rest of the day off, just because.

The second assault occurred at Aurora. It was my second year there. I remember it as The Year of the Borderlines. My unit was generally designated as the  Marginally Functional Psychotic Unit, but that year we got hit with a tsunami of patients with Borderline Personality Disorder.

One Borderline can be enough to stand your unit on its head. A gaggle of Borderlines (?) A gossip of Borderlines…  I like that! A lots of Borderlines gathered together is rarely a good thing, particularly if you’re a psych nurse. And especially if the gossip is gaggling on your unit.

It takes an awesome skill set to effectively manage that.

The patient in question was Melissa, maybe. I used to remember everything about every one of my patients, but they eventually melded into one multi-headed mutant patient. Mel was having a difficult day obtaining the level of attention she desired, so she decided to go full on Drama Llama and had a VPM–Very Public Meltdown. Mel was good for usually one of these a day. She would set off a chain reaction with the rest of her Borderline buddies, and chaos would ensue.

On this particular day, I didn’t respond the way she wanted me to (I didn’t call the doctor to get injectable meds), so she stormed off to her room to slam the door and scream.

Karen Rae Goff, social worker extraordinaire, happened to be on the unit at the time. Karen also happened to be Melissa’s social worker, so we went to her room to see what Mel had planned for her next move.

“Get out of here!” Mel screamed at us as I opened the door.

“I need to know that you’re going to be safe.” I said, from the doorway.

“Leave me alone, or I’ll kick your fucking ass!” she screamed. And then I did something stupid:

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Melissa launched herself at me and started swinging. I blocked her first punch or two, but then she caught me with a left jab that knocked my glasses askew on my face.

That stirred something inside Karen, and she let loose on Melissa with her Mom Voice, and Mel was so stunned she stopped acting like a temper tantrum toddler.

“I can’t fucking believe you did that.” I said, and calmly readjusted my glasses.

“You asked for it.” Melissa replied.

“Are you going to press charges?” Karen asked me. It’s a felony to physically assault a healthcare worker in Arizona. Melissa let a momentary look of panic escape, and that’s when I fell in love with Karen. We never had another problem with Melissa. She was a little angel for the remainder of her stay.

And that brings us to Assault #3, which also happened at Aurora.

That day started out like any other day. Dr Sbiliris, the psychiatrist assigned to the Canyon Unit, came onto the unit to meet with his patients. One of them, a young kid named Desean asked to be discharged. Dr Sbiliris kind of laughed and said, “No, probably Friday. Maybe Wednesday.”

Desean seemed to accept that, even if it wasn’t the answer he wanted to hear.

And then something happened that should’ve sent my Spidey senses tingling. A patient on the Canyon Unit started loudly acting out, and when the staff from other units rushed over to aid and assist, Desean bolted out the unit doors and made a break for freedom.

We took care of the Yelling Guy. Desean fell short in his sprint to escape. He returned to the unit with an escort, and went to his room. And there was peace in the Canyon once more. Until 2:00 PM.

That’s when Desean entered the dayroom and started yelling and throwing stuff.

My boss of bosses, Lori Milus, must’ve been having a rare quiet day because she had come down to chat. I went into the day room. One of the BHT’s was trying to verbally redirect Desean, and I provided back up. But Desean wasn’t having any of that shit.

“Come on, man.” I said. “You know how this works. Sbiliris says that to everyone. He wants to see how you’ll respond. You know acting like this isn’t going to get you out of here. If anything, it’ll extend your stay, and you clearly don’t want that. Use your head, think about this!”

Desean and I were standing in the doorway of the dayroom. The nursing station and the unit doors were behind me. The hallway leading to the patient rooms was behind Desean.

He didn’t say anything, as if he were contemplating the veracity of my words. He appeared to me to start turning to his right, and I thought he would keep on going and go back to his room. I also started turning to my right, thinking my work was done. But Desean was merely loading up. He stopped turning to his right and reversed direction. His right fist came flying at me at about the speed of light, catching me squarely on the jaw.

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I was launched into space, much like that. I landed by the unit doors, seven or eight feet away. Desean may have howled in triumph. He ripped off his shirt, daring me to get up and fight him.

Like that was going to happen.

I didn’t lose consciousness. I even kept my head elevated so it wouldn’t hit the floor. But I don’t think I could’ve gotten off the floor just then if my life had depended on it.

One of the darling nurses I worked with, Lindsey Stirling, picked up my glasses and protectively leaned over me as I lay on the floor, trying to out figure out what I should do next. Another nurse, Brea Bils, one of my darlingpreshadorbs work daughters, tried to check my blood pressure. She later told me she no idea what she was doing. She thought I had gotten dead.

I knew I didn’t got dead, so I think I even said that.

“I’m not dead. I didn’t lose consciousness. My jaw…is really sore, but other than that, I’m okay.”

A group of BHT’s had escorted Desean into one of the Overflow rooms. Aurora was the only psychiatric facility I worked at that didn’t allow the use of seclusion and/or restraints to manage a behavioral crisis. Desean got several injections. And he was kept under close observation by several large men.

Once Desean was medicated and no longer actively assaultive, my boss asked me if I wanted to press charges. I did.

If Desean had been psychotic and responding to internal stimuli, that might’ve changed my decision. But Desean wasn’t psychotic. He didn’t get what he wanted, and he decided to act like a thug. That definitely was a factor in determining my decision.

The police took my statement. They took Desean into custody. Thankfully, Frankie Baby wasn’t there, or the police would’ve had to arrest him for murder. And there was peace in the Canyon once more.

I didn’t find out my jaw was broken until the following day when I had a CT scan. Because my fracture was nondisplaced, there wasn’t much of a treatment. I was on a soft diet for six to eight weeks; nothing but soups, smoothies and ice cream.

I bought the world’s most expensive smoothie. I lost ten pounds. I gained all of them back once I could eat real food again. And now I’m learning to live with my new occlusion pattern. It’s a process. Some days are better than others. Today, it hasn’t been too bad. Yesterday fucking sucked.

And as Forrest Gump said, That’s all I have to say about that.

Get out and vote.

The Muppet Woman

Sue Severson gave Ailene her nickname. Ailene was one of our patients at the Minneapolis VAMC. I had been working there a little over a year, I think. I had been an RN for about three years or so. Sue was one of the nurses I worked with. She was younger than me, taller, attractive, long blonde hair. She had been at the VA longer than I had, so she was teaching me how to be a psych nurse.

“Doesn’t she look like a muppet? I mean, it looks like someone has their hand inside her head, making her jaw move, doesn’t it?” Sue said. She was getting kind of obsessed with the whole muppet theory thing.

Well, yeah, I suppose. I thought. Ailene did kind of look like a muppet. She was an older African American woman that stood about four and a half feet tall. I think she was around fifty years old when I first met her, but she looked to be closer to seventy. Her eyes were overly wide, so she had the appearance that her eyeballs were trying to jump out of their sockets. And she had one of the weirdest voices of any of my patients ever, like Elmo on helium, maybe. Ailene became the Muppet Woman that night.

The Muppet Woman was a relatively benign crazy woman most of the time. Sometimes she’d get all worked up about something, but she was easily redirected, and rarely a problem. She had never been violent or assaultive before, and therefore not a serious problem.

I was working the night shift. It had a been an uneventful night. Sue and I had been talking at the nursing station. There was one more nurse working the unit with us, a hulking taciturn woman who rarely spoke to anyone.

Sue had been telling me she had to pee for the last hour. I got up to do rounds on the unit, and had just checked on Ailene. She was in bed and appeared to be asleep. I filled in the blanks on the Rounds sheet. I was standing in the hallway facing Ailene’s room, which was about halfway down the hallway from the nursing station, when I heard the sound of a Helium Elmo being possessed by the devil. I looked up to see the Muppet Woman charging me like a fullback headed for the end zone, screaming as she ran.

I dropped the clipboard I was holding to the floor, and caught one of the Muppet Woman’s arms before she hit me. Her free hand grabbed my shirt and pulled. Hard.

Pop pop pop pop pop went the buttons, flying off my shirt and bouncing off down the hallway.

“Hey!” the other nurse we were working with said. I remember being more surprised by that nurse speaking than I was by being charged by a possessed muppet.

“Help! We need help over here!” the nurse called out toward the nursing station, then proceeded to envelope the Muppet Woman in the steam shovel maneuver. She essentially scooped the Muppet Woman into her arms and carried her down the hallway.

The only thing not perfect about her intervention was the Muppet Woman was still firmly gripping my shirt, and I was being forcefully pulled down the hallway by a possessed muppet in the arms of a big nurse moving like a bulldozer.

“We need help over here!” I said loudly, looking back over my shoulder. I saw Sue Severson fly around the corner, then fall to floor laughing when she saw me being dragged down the hall by the Muppet Woman and the Bulldozer Nurse.

Bulldozer carried the Muppet Woman, and dragged me, into a seclusion room, where we waited for a moment until back up arrived in the form of Sue, who was laughing so hard she almost peed her pants.

Bulldozer saw help arrive, and dropped her load. The Muppet Woman fell to the mattress on the bedframe, and because she still had a death grip on the front of my shirt, I fell on top of her. Sue gave out a little scream because this time she did pee her pants, a little, but that didn’t stop her from laughing.

I don’t know who Bulldozer was more irritated with by this time, the Muppet Woman, me or Sue.

“Oh! That’s enough of this nonsense!” Bulldozer snapped, and pulled me off of the Muppet Woman, who apparently had no intention of ever letting go of my shirt. And it was right about then I started wondering what I had done that had enraged the Muppet Woman in the first place. “I said enough!” Bulldozer snapped at the Muppet Woman. “Let go of him!!” she ordered, and grabbed the Muppet Woman’s arm.

“Get your fat hands off me, you gray haired old whore!” demon-possessed Helium Elmo Muppet Woman shrieked back at the Bulldozer nurse. Her crazy eyes were popping in and out of her head simultaneously.

“My hair isn’t gray,” Bulldozer replied meekly.

Sue let out a higher pitched scream, because she peed her pants again. This time, a lot.

I never did find out what I did to the Muppet Woman that made her react the way she did that night. She died not long after getting out of the hospital.

Bulldozer retired and moved to Arkansas a couple years after that incident. I loved to tell that story to my co-workers. Bulldozer never thought it was as funny as I did. And she never forgave Sue for acting so unprofessionally, and for pissing all over the floor.

Sue Severson transferred to the Outpatient Department. She was only nurse I ever worked with that laughed herself incontinent while responding to a behavioral management situation. She would eventually marry my boss and make at least one baby with him before I left the VA. She forgave herself for pissing all over the floor. So did I.

“It’s not like the Muppet Woman was actually hurting you, and you should’ve seen how funny you three looked…”

All true. I was probably in more danger when I was being dragged down the hall by Bulldozer.

But I learned some important things that night. Never, ever, let your guard down at work. Always know your crew. And take bathroom breaks. You just never know…