The Witch Queen of New Orleans

I met the Witch Queen at St Luke’s Behavioral Health. I had just started there after fleeing Banner Del E Webb Medical Center. The Witch Queen had been on my unit–AP 5–for quite some time. She was what we in the business refer to as a ‘placement problem.’

Almost all psychiatric treatment centers are acute care facilities. In places such as these, patients are stabilized as quickly as possible and then discharged back home, or to a halfway house, a group home, a homeless shelter–something/anything like unto that. In essence, all patients have to be discharged to a some where.

Every now and then a patient will be admitted to your facility that finding the where place to send them to is supremely difficult. This is usually the result of said patient being an unimaginable, monstrous pain in the ass, and they have essentially been kicked out of every decent existing placement facility in your area. Even all the roach motel placement dives that will normally accept anyone with a pulse and the money to pay for their care won’t take them either.

What you’re left with is a nightmare because the person no one wants is stuck inside your facility, and you’re trapped inside with them. It’s like being in a horror movie, except it’s not a movie, and no one ever gets to say, “Cut!”

This is where having an amazing social worker comes in handy. In the world of Inpatient psychiatric treatment, the psychiatrist orders medications. The nurse administers the meds and manages any medical issues, as well as as a varied assortment of other duties as required. And the social worker drives the discharge bus. Social workers also perform a thousand and one other miscellaneous duties, much like nurses. Take it from me, a really good social worker is worth twice his or her weight in gold.

My personal favorite social workers based on the fact that I actually worked with them: Tom McClellan, best social worker at the MVAMC. Mike Greeman, second best social worker at the MVAMC. Brian Lockwood, great social worker at the MVAMC. Denise Blackfeet Wagner, really great social worker at the MVAMC. Michelle Zwemke Burns, great social worker at Del E Webb. Amy Bressler, great social worker at Del E Webb. Ray Young, great social worker at Aurora. Karen Rae Goff, my personal favorite greatest social worker at Aurora, ever. For all time.

Oddly, I can’t remember the names of any of the social workers at St Luke’s. I do remember one of the social workers–she dressed like a prostitute, right down to the fishnet stockings and the miniskirts. Maybe social worker was her day job…

Now then, where were we? Oh, yes. The Witch Queen.

Her name was Larue. I think ‘The Diary of a Mad Black Woman’ was written about her. If it wasn’t, it could’ve been. She was from New Orleans, and she ended up in Arizona in the aftermath of Hurricane Katrina, somehow. This is how I imagined it happened: someone, probably a social worker, bought her a bus ticket as far away from the Big Easy as they could afford, and that’s how she ended up in Phoenix.

It didn’t take long for Larue to develop a reputation once she arrived in Phoenix. She was quickly banned from all the nice placement facilities. The placement dumps followed suit quickly. She probably set a record for how quickly no place in Phoenix wanted her at their facility.

Larue was truly psychotic. Even when she was as stabilized as much as modern psychiatric treatment could possibly accomplish, she was still crazier than two Mad Hatters. She would sit quietly in the day room, absorbed by whatever it was that was playing inside her head. And then she’d get up and stroll toward the nursing station…

There are times when a narrative is just not sufficient to portray the quality of something, like Roya’s darlingpreshadorbs Persian accent. Or Larue’s psychotic Witch Queen motormouth, blackmagicmojo ramblings. It’s been probably five years or more since I’ve heard one, and I had to go make sure she wasn’t standing outside my front door before I started writing this.

There were three points of patient access at the AP 5 nursing station. There were Dutch doors on either end, and a window in the middle of the station. Larue would randomly pick one of those three spots, and for lack of a better descriptive term, go off like a motherfucker on the unfortunate nurse sitting at that spot in the nursing station.

Larue didn’t appear to have any preference. She didn’t single out any particular nurse. She just let whomever have it with both barrels at point blank range, and there was no such thing as verbally redirecting Larue once she got started. She was a laser guided, heat seeking missile of psychosis that delivered a payload of unintelligible insanity. Her speech was a combination of English, Creole, spittle and craziness delivered in an extremely loud shriek.

Larue would let her victim have it, and when she had completed her rambling voodoo curse, or whatever it was she was doing, she would take a deep breath, nod her head and walk away. And there was peace once more. Until the next time…

It was inevitable that Larue would pick me for one of her rants. In fact, I can remember a few. The first time, I wanted to die, maybe. I should’ve pretended to have a seizure, that might’ve distracted her–but if you’re going to fake a seizure, you really need to pee your pants or no one will ever take you seriously.

The second time I was better prepared and smiled every now and then, but mostly nodded in agreement a lots of times.

The third time, I actually don’t remember the third time, but my first ex-work wife, Deb Goral does. Larue went all batshit crazy on me, as usual. She’s shrieking at me in Chinese Creole English or something, and spitting all over the plexiglass window separating us. I think she wanted me to discharge her, “…or all your hair will fall out! Great googly-moogly, prolly nolly dictum!!”

I ran my hand over my head and said, “Oh my God, it worked!”

All things must pass. Nothing in this world is permanent. Larue was eventually discharged to a facility near Tucson. The Witch Queen was gone, the memory of her presence would fade. She would be replaced by other nightmare patients, some of whom would make the Witch Queen look like a fairy princess.

Psych nursing is a lots like working in a pawn shop. You never know what’s going to walk through that door. So be careful what you ask for. You just might get it.

Fabulous Roya

One of the most pleasant surprises I would experience working at Aurora was Roya, or as I came to think of her, Fabulous Roya. The photo above was taken at Christmas. Roya might be Iran’s Christmas present to America.

Roya was an RN. She worked full time at an Eye Surgery Clinic in Scottsdale when I first met her. She picked up extra shifts at Aurora on the weekends because, well, you never know what’s going to happen, and you shouldn’t put all your camels in the barn before the peacocks have their pajamas on.

I’ll tell you what. I used to spend a lots of time in Texas, and when it comes to turning a phrase, can’t nobody beat a Texan. They have a way with words, Texans do.

Now I’m gonna tell you damn what–Texans got nothing on Persians when it comes to turning a phrase. And not even a Texan can hold a candle to a Persian when they start waxing philosophic about life, or love, or food, or anything. And maybe it’s not all Persians. Maybe it was Roya. After all, she is fabulous.

I will never forget my first time working with Roya. My wife took one look at me when I got home and started dialing 911. I had to convince her I hadn’t been assaulted and ended up with a traumatic brain injury. I had a dazed look in my eyes.

“I’m fine. I just worked with Roya today.”

“What does that mean? What’s a ‘roya’?”

Roya’s family fled Iran after Mohammad Reza Shah Pahlavi was ousted from the Peacock Throne in 1979. She was the youngest of something like fifty children; the Prophet David would’ve been proud. This was perhaps the only subject Roya wouldn’t expansively talk about, but I think Roya was an honest to Allah, 100% genuinely real princess in Iran.

She came to this country, learned to speak English and got her nursing license. She got a job, divorced her husband, bought a house, and renovated everything inside and outside of it. (Spoiler alert! It was fabulous!) She built a life of her choosing, and continued her education, getting her Master’s degree in Nursing and she’ll be nurse practitioner by the end of the year.

Roya told me she became a nurse because the nurses in Iran wore the cutest outfits back before the overthrow of the Shah. I did a Google search. Iranian fashion was very Western before the Ayatollah took charge and burned all the miniskirts and go-go boots, and I think that’s what Iranian nurses once wore. I encouraged Roya to dress like her nursing idols, but she declined. That doesn’t mean she donned a chador–I didn’t call her Fabulous Roya for nothing.

Roya was one of the best nurses I’ve ever worked with. If there was a code of any color, Roya was always one of the first responders. There was one time I know of that she was the only responder. I used to be a first responder. The longer I worked in Psych, the less likely I was to actually respond to a code, unless it was on my unit. Also, the longer I worked in Psych, the less likely it was that there would be a behavioral code on my unit.

On the second day I worked with Roya, one of her patients started escalating. He probably wanted more meds, or different meds. And by different I mean Ativan, or maybe Subutex. Roya told the guy what she was willing to do for him, and she also told him what she wouldn’t do. She’d check his MAR, talk to his doctor; he was going to have to be patient and wait, but she was going to take care of him. And she called him Sweetheart. I can’t recall if the guy got what he wanted or if he was so stunned he simply walked away, but Roya was impressive.

“When I first saw you, I figured you were just another pretty face, but you’re a damn good nurse.”

“Seriously, you think I am just pretty, and nothing else? Markie! I can’t believe you would think that about me!” See? Fabulous.

Part of Roya’s charm was her voice and her accent. Replicating the sound of someone’s voice isn’t easy to do in a narrative. And in terms of Persians, what do most Americans think of when they hear that term? The Shahs of Sunset? I Dream of Jeannie?

Roya’s voice is what Jeannie’s voice should’ve sounded like. It was lilting, it was lyrical and musical. And it was non-stop.

In an earlier essay, I talked about my friend and mentor, Sondra, and I mentioned that she liked to talk. Sondra was a catatonic mute compared to Roya. Sondra was talkative. Roya was hyperverbal, on steroids. Seriously, I have never met anyone that wasn’t hypermanic, or on methamphetamine that talked as much as Roya. I doubt Roya had much self awareness about this aspect of her personality, and I know she had even less awareness about her volume. She even processed her thoughts out loud.

That part wasn’t so charming. In fact, for myself and almost everyone that ever worked with her, it was exhausting. I have described certain people I know as a force of nature, like, for instance, my wife. After working with Roya, I think Forces of Nature need to be measured on something like unto the Fujita scale for tornadoes. And based on that scale, Roya was an F-5. Maybe an F-6.

We all have our issues, right? Well, you do. As I sometimes tell my daughters, can’t everyone be perfect like me and you. And when it comes to fabulous, well, there’s only one Roya. The rest of us look like the Three Stooges trying to get a cat out of a tree compared to Roya.

I’ve been retired for a little over a month. Do I miss working for a living? I might, if I weren’t living in heaven on earth. Do I miss the people I worked with? Yes. And some of them I miss a lots.

Dooset daram, Fabulous Roya. I miss your koon.

To Sleep, Perchance to Dream

I don’t know what the problem is, but I’ve been having trouble sleeping ever since I retired. It’s not like I have a lots of stuff on my mind. The two most pressing problems in my current life are, Where did I put whatever it is I’m looking for? I just had it! And, where should we eat today?

This may not sound serious to you, but me not sleeping–it’s like Guy Fieri having problems with his appetite. It’s like Hillary Clinton not having problems with integrity, or Donald Trump not saying something stupid.

I don’t usually make political references, but I used to facilitate a lots of groups, and one of the things I used to examine was how people tend to stereotype things. Now, stereotypes rarely stand up to rigorous examination, except this example: Are all politicians crooks? And everyone always said, Yes! It was true every time.

So, now that I’ve retired, I can’t sleep. Well, it couldn’t have happened at a better time. If I failed to sleep and I had to work the next day, it would surely effect my performance. I’d most likely run out of gas sometime in the afternoon, and probably sputter to the finish line.

Now that I’m retired if I can’t sleep, I can take a nap any time during the day I finally feel tired enough to actually doze off. It doesn’t have any impact on my productivity because, well, my entire lifestyle has changed. My boss is…me?

Well, technically, my wife’s the boss, then the cat. But they’re pretty easy to please, especially the cat.

Back in my nursing days, I had a lots of bosses. Administration. Management. Supervisors. Co-workers. And finally, my patients. I used to let some of them think they were my boss. It made life easier for everyone. And not all of my many bosses were easy to please.

One of the most common complaints by unhappy patient/bosses was this: I can’t sleep!

As a nurse, you have options. You can do nothing. Tell them to back to bed, stop trying so hard. Relax, you’ll fall asleep. This is generally seen as an inefficient response by the patient.

“I tried that! I’m still awake! That’s why I came out here to talk to you!!”

I would always ask my patient/bosses what they did when they weren’t in the hospital. Smoke. Drink. Take a pill. Yeah, well, we can’t let you smoke. We sure as hell can’t let you drink. Which pill did you take and what dose?

Benadryl. Ativan. Klonopin. Valium. Xanax. I don’t know. The green pill. You never knew what you were going to hear.

If there was a med order, I would dispense meds. The unhappy customer would take his or her medicine and go back to bed. Most of the time it was as simple as that. If there wasn’t a standing order, I could call the POD, Physician On Call, and usually get an order because I had a teacher that taught me how to get what I needed from almost any doctor.

It probably stands to reason that most of these urgent calls for sleeping pills occurred at night, right? Because that’s when it always happened. And I had a different name for the Physician On Call. In my terminology, POD stood for Prince/Princess of Darkness. As odd as this might sound, most of the docs I called in the middle of the night liked that term. Some of them identified with it. And you can get almost anything you want from the Prince of Darkness.

So, there was this guy at the MVAMC. Edison. He was an older guy, late fifties, early sixties. I can’t remember if he was depressed or schizophrenic, but what I can remember is he was the guy that couldn’t sleep.

I worked a rotating Day/Night shift at the VA. During the time in question, Edison was a patient on my unit, and I was working a stretch of nights. He was generally a quiet guy, kept to himself; makes me think he heard voices now. Because he couldn’t sleep, Edison didn’t even try to pretend to go to bed. He sat up in the lounge listening to whatever it was his voices had to say.

Edison didn’t complain about his insomnia, well, not at first. I offered him meds, but he declined. He said meds didn’t work. He just sat in the lounge every night for maybe four or five nights.

Edison started coming up to the nursing station. He still wasn’t sleeping, but maybe he’d try some meds. And that’s when the problems started. Edison wasn’t lying. Medications did not work.

I called the Prince of Darkness, he gave me an order for Trazodone. It’s an antidepressant, but it has one helluva sedative side effect. We used it for sleep all the time.

Didn’t do a thing.

Next night, get an order for an extra dose.

Didn’t do anything.

Next night, Edison says he hasn’t slept at all during the entire time he’s been in the hospital. I have to admit, I didn’t believe him. No one can stay awake that many days straight and not go crazy, or in his case, crazier, I suppose. I got a higher dose of Trazodone, plus a repeat dose if needed.

Didn’t do a thing.

We tried other meds as the nights progressed into Week Two. Haldol. Benadryl. Combos of Haldol and Benadryl. Add Ativan. It didn’t matter what we did, the meds did nothing. Edison asked me to get a big hammer and hit him over the head with it. I told him we already tried Maxwell’s Silver Hammer, and it didn’t do squat.

At some point in time around here I had a night off. Maybe two. I didn’t have any problems sleeping on my days off. When I went back to work again it was for another stretch of nights.

As for Edison, it was allegedly Night 11 of no sleep at all, day or night. I wasn’t the only skeptical person when it came to believing Edison’s claim of total sleep abstinence. No one did. We all figured he had to have gotten a few minutes of sleep here and there.

I couldn’t stay awake that many days in row. I’d nod off for at least a few minutes, if not more, especially between 3:00-5:00 AM. It wasn’t called the dead of night for nothing. That two hour timespan was a killer for me. If I could make it through those hours, I could make it through the night.

It just so happens there’s a threshold/drop dead timeline when it comes for how many days you can survive without any sleep whatsoever.

Anyone want to guess how many days that might be?

I returned to work, and there was Edison, still not sleeping. Also there on this night was my nursing bud and all around best friend, Paul Anderson. This was going to be a great night, I thought.

Edison was becoming more vocal in his claim of not sleeping, not even a goddamn five minute catnap, for Christ’s sake! His voice was starting to incorporate a kind of annoying whining tone.

I checked his medication record. He’d already received everything he could for sleep. I gave him a couple Tylenol and a shot of Maalox, and encouraged him to lay down and try to relax. Edison whined as he walked down the hallway, but he didn’t go to bed, he went back to the lounge.

Paul and I had a great time that night. We told jokes and said funny stuff. And we were working with Gail Sebesta, an uniquely talented LPN who could run with the wolves, and by wolves I mean Paul and myself.

The night seemed to fly by. We were having a minor great time inside the nursing station. I looked at the clock. It was almost 3:30 AM already! This was going to be the best night ever. And that’s when Edison came up to the nursing station.

“I still can’t sleep!” he kind of whined.

“Yeah, I know. The problem is, I don’t know what to do about it.”

“Can’t you call the doctor?”

“Sure, I can call him, but then what? Edison, I’ve gotten orders for enough meds for you to put this entire unit to sleep for a week. I’m pretty much out of suggestions. You guys got any ideas?”

“Hey, Edison.” Paul said. He went through the Mark’s a good nurse and he’s done everything he can think of speech. Maybe more medication wasn’t the answer. It hadn’t seemed to have been very effective so far. Paul was a master of redirection, and when that didn’t work, he was a master at setting limits. All I had to do was sit back and relax.

“But I haven’t had ANY sleep in almost two weeks!” Edison cried, his voice was more whiny, and he was getting louder.

“It’s more like eleven days, isn’t it?” I thought that sounded better than two weeks.

“No. That’s not possible.” Paul disagreed. “It’s physically impossible for you to go that many days in a row without any sleep. Your brain will automatically shut down all by itself.”

“Mine just shut down right now,” Gail added. I laughed. Edison did not. He got louder.

“Why won’t anyone believe me?!? I haven’t slept since I came in here! I. Can’t. Sleep!!”

Other patients were coming to their doors to see what was going on. This was suddenly becoming a nightmare. No night shift nurse wants to take care of a bunch of cranky people at 3:45 AM.

“Hey, bud. Can you turn down the volume a bit, you’re starting to wake everyone else up.” I said.

“I DON’T CARE! I CAN’T SLEEP AND IF I DON’T GET SOME SLEEP SOON, I’M GONNA DIE!!”

“Hey, Edison!” Paul jumped back into the fray. He voice was stern. “You’re gonna have to trust me, man. No one has ever died from a lack of sleep.”

There are moments in every life when everything happens in slow motion, right? Have you ever felt that?

Paul finished his pronouncement. Edison started making these strange creepy-croaky noises in the back of his throat. His eyes rolled back inside his head, and he turned a kind of beet red color. He fell to the floor without even a hint of muscle tone or control. He landed face-first with a smacking sound like unto the sound a beaver makes when it smacks its tail on the water.

“Holy shit! Call a code!! Gail said, running for the crash cart.

There was a phone right in front of me. I called the Operator as Paul went flying by me to try to save the life of the man he’d just assured there was no way he was going to die.

And then everything became a blur. We started CPR, the Code Team flooded onto the unit and took over. But despite Paul’s promise, Edison was DRT.

I haven’t been awake eleven straight days, so there’s no chance I’ll die from Terminal Insomnia. My condition is probably a cumulative effect of all the profound changes I’ve gone through lately that have upset my sleep pattern. Life seeks equilibrium. We’re usually the cause of most of our own turmoil. It’ll all balance out again, soon…

I usually try to wrap these vignettes up in a nice, neat bow, and add a moral or something. But what do you say about a guy that was telling the truth, only you didn’t believe him, and then he got dead? My gut had no extrasensory messages for me, and my head was telling me that guy was full of it.

Maybe Gail summed it up best as we were walking off the unit when our shift was over.

“This only goes to show me what my mother told me as a little girl is true.”

“What’s that?” I asked. Paul wasn’t talking.

“Never trust a man that says trust me.”

The Pebble in the Pond

Almost every new nurse had that one incredibly special person that took them under their wing and showed them the ropes–that awesome person became your mentor.

In my case, that person was Sonie Roberts-Johnson. After I endured the easiest job interview ever at AMRTC, I accepted the position and eventually was introduced to Sondra. That’s her real name, but I’m probably the only person that calls her that.

Sondra was an LPN. She was younger than I was. She had shoulder length naturally curly blonde-ish hair that fell into ringlets. I thought she was kinda hot looking.

Sondra ruled the night shift on Cottage 8, the unit that would become my base of operations for roughly the next year. The state of Minnesota had recently changed their regulations, and required all LPN’s to be directly supervised by an RN.

Sondra didn’t accept this change quietly. She is perhaps the most least shyest person I’ve ever met.

“I’ve been running this unit for the last three years and I thought I was doing a pretty good job, but what do I know, I’m just an LPN. So now what? I have to teach you how to do my job, and you’re going to be my boss? Is that right? That doesn’t seem fair to me.”

Fair or not, once Sondra decided to teach me how to be a psych nurse, she put her personal feelings aside and taught up a storm. I learned more from her in a month than I learned from anyone.
She taught me everything she knew about psych patients, and how to manage them without resorting to threats. She taught me about psych meds and which meds worked best, which meds required routine lab monitoring and how often labs needed to be ordered. She taught me what to say to the docs to get them to do what I needed them to do. She taught me which staff members I could trust and who to stay away from.

By the time I had absorbed everything she was willing to share with me, Sondra had become just about the coolest person I had ever met. And I was no longer the fuckin’ new guy who was going to ruin her life.

I’m sure Sondra said something about the change in our relationship because there was nothing she didn’t talk about. Seriously, she never stopped talking. I once bet her ten bucks she couldn’t stop talking for ten minutes.

“That’s just stupid. Of course I can be quiet. If you want me to shut my mouth, all you have to do is say something. Jesus!”

“Okay. I’ll bet you ten bucks you can’t stop talking for ten minutes, starting…now!”

“What? Wait! I’m not ready!”

“Okay, now.”

“No! If you want me to be quiet, you have to leave!”

“What? No! Ten minutes, total silence, starting now.”

“No! Nononono. No. I can’t do that. You have to leave the nursing station.” And then she laughed that Sonie laugh. She has one of the best laughs, ever. I miss that laugh.

As is sometimes the case in nursing, Sondra and I would part ways. She transferred to another unit at AMRTC a few months after I started, and I would transfer to the VA. Despite that, we remained close friends and kept in touch through all the trials, tribulations and celebrations in our lives. The impact she made in my life resonates inside me still.

In a figurative sense, we are all pebbles thrown in a pond. The ripples of our impact, good or bad, flow outward in an infinite pattern, effecting everyone we meet. You never know how something you do or say can make a difference in someone else’s life.

You were a good pebble, Sondra. You still are. I hope you never forget that.

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And by the way, you still owe me ten bucks.

I’m Too Sexy For My Clothes

**This is the post that landed me a three day suspension from Facebook**   

It wasn’t what I wrote so much as it was the accompanying picture (See above) that FB had an issue with. And it was their decision–a process that has no appeal, you’re simply denied access to your account–to block my page that ultimately led me to create this blog. So, if you’ve enjoyed anything you read here, send Mark Zuckerberg a thank you card.

I’m not sure what it is about crazy people and clothes, or rather, the lack of them–but crazy people love to get naked.

There was Duane. He was a frequent flyer at the MVAMC. No Brain Duane would start disrobing in the parking lot. By the time he reached the front door, he was doing the Full Monty.

I called him No Brain because it rhymed, and because he just looked…gone. It was usually a time consuming process to get admitted. Duane got a police escort straight to my unit, completely bypassing the Admission Office. Now that I think about it, the guy was a frickin’ genius. When Duane could keep his clothes on for 48 consecutive hours, we knew he was ready to go home.

Old Joe didn’t come into the hospital naked, but once inside, Joe must’ve thought he was at a nudist camp. He rarely wore clothes.

I was working a double shift one evening. Old Joe had been admitted earlier that day. I was on the phone, taking report on another admission.

“Well, goodbye.” I heard Old Joe’s voice with half an ear while I took notes on the patient we were going to get. When I finished, I looked up and saw a wrinkled ass and scrotum swinging in the breeze as Old Joe walked off the unit in the general direction of the front of the hospital. Our units were ‘open’ back then. Our patients could come and go as they pleased, as long as they signed out at the nursing station and checked in with the staff when they returned.

That would change when a former patient walked onto one of the units carrying a knife.

“Hey, Joe!” I called out. He stopped and turned around. “I used to think you were crazy, but now I see your nuts. Don’t you think you should get dressed before you leave?”

Old Joe looked down, and almost seemed surprised to see his penis. He nodded, said, “Oh, that’s a good idea,” and returned to the unit. He must’ve forgotten he was leaving when he got back to his room because he didn’t try to streak to freedom again. Old Joe was another guy we knew was ready to go when he could keep his clothes on for two days straight.

There was another semi-naked guy. He was a young guy at St Luke’s, and he was actually kind of handsome. He crapped on the floor one day, then picked up his turd and ate it.

“EEWWW!” all the female staff howled in unison, then looked at me and asked what they should do, like this happened to me all the time.

“Whatever you do, don’t kiss him. His breath probably smells like shit.” was the only advice I had to offer.

Crazy guys are far more likely to strip and go naked in public than crazy girls are. Men are also far more likely to masturbate in public than women. I called it ‘playing the skin flute.’ I’ve lost track of the number of guys in the Skin Flute Band, but there were a lots of them.

If you want to play an imaginary instrument, what happened to air guitar? But it’s not as bad as playing the rusty trombone, I suppose…

I can only recall one girl that masturbated in front of me. She was a cute-ish young Korean American girl at Aurora, I called her K-Pop. She rang her joy buzzer, a lots. I went to her room to give her her meds one morning, and she was…busy.

“Just leave them on the table, I’ll take them when I’m done.” she said without missing a beat. She was laying in bed under the covers, but there was no confusion about what she was doing. She didn’t seem to be embarrassed in the least by my presence. I can’t do that, I replied. “Well, you don’t expect me to stop now, do you?” she asked. I’ll close the door on my way out.

There was another Asian girl, from China. She was acting weird in the community and running around outside naked, of course. Most Asian families will try make it through a situation like this without seeking professional help, but once the clothes come off, all bets are off.

From report, I learned she didn’t speak English. So I went to the Babblefish Translation site and printed some greetings and instructions in Chinese and English.

You’re at the County Hospital. 你在縣醫院
We will take good care of you. 我們會照顧好你
Are you hungry? 你餓了嗎?
Please keep your clothes on. 請保持你的衣服

My niece, Amber Rowen, could verify this because she knows Ung Fu Chinese.

China Doll read each page, then looked at me and smiled sweetly. She nodded her head in what I guessed was understanding. I went to the kitchen to find her something to eat. When I returned, China Doll was standing in the hallway where I’d left her, wearing nothing but a smile. She was probably the only psych patient I’ve had that I didn’t mind seeing naked. She was really quite lovely.

Rondi, on the other hand, was not. She had been my patient at the VA many times, and her main problem with all of her previous admissions was her Borderline Personality Disorder.

Da Do Ron Ron was a tough-looking, heavy set lesbian. In regards to her nudiditity, all I will say is if Samson had been female…

On her last admission as my patient, she went off the deep end and started flashing her boobs at me, then my co-workers. She eventually went full throttle stripper. All she needed was pole.
You might wonder why a lesbian would disrobe in front of a guy. I can’t explain it, but one of the ward clerks I used to work with, Justine Henley, once told me I was very ladylike, so it might be that.

I tried to talk Da Do Ron Ron back to Earth. Hell, we all did. I almost begged her to stop.

“When you come out of this and you’re on the other side,” I said. “You are going to be sooo embarrassed. Do yourself a favor and stop doing this now.”

Rondi eventually did get better, but she was mostly naked for almost a month, I think. And she was incredibly embarrassed by what she had done. She got so much better she actually got a job in the Billing Office at the VA after she cleared. I’d see her in the hallway occasionally. She couldn’t look me in the eyes. She couldn’t speak to me. I felt so bad for her.

Rondi is the only person I can think of that improved after a series of Full Frontal Nudity therapy, or I might be inclined to recommend it. Oh, and the guy at St Luke’s got better too, but he was on a specialized diet.

Send me a private message and a picture if you’re curious about this, I’ll let you know on an individual basis. If you’re a guy, let me save you some time. Keep your damn clothes on.

Creepy clowns and zombies are bad enough. We don’t need a Skin Flute Marching Band and the Joy Buzzer Corps added to the mix in our society at this point in time.

When I tell people what I did for a living, they give me a certain look most of the time. They nod knowingly, and say, “I’ll bet you’ve seen it all.”

I reply that I’ve seen a lot, but there were a couple times when I saw it all.

Alcoholics Anonymous

Hi, my name is Mark, and I’m an alcoholic. I’ve been sober for ten years. Prior to that I drank for probably thirty-five years. When people ask if I was always an alcoholic, I used to say yes. It’s not easy to defend my former drinking habits. But while we’re on the subject, let’s take a look at them.

I started drinking when I was fifteen or sixteen years old. A beer here, a sip of whiskey there. The legal drinking age back then was eighteen. I went to high school in Montana in the 1970’s, when the legal age was more of a suggestion than a law. Things were very different then.

I joined the Army after high school. The Vietnam War was winding down, and I was stationed in Oklahoma. There was no chance I would fight in ‘Nam. And there were no more Indians to fight in Oklahoma, so me and the boys sat around the barracks drinking beer and smoking joints, and talked about what we’d do if there was ever another Indian uprising, or if the Vietcong decided to invade Oklahoma.

And for the record, there was never a successful Vietnamese invasion of Oklahoma while I was stationed there. You could look it up if you like…

I discovered the Wide World of Drugs while I was in the Army. Weed, pills, powders, liquids. I never met a drug or drink I didn’t like, except tequila. Yeah, that was a night to remember, if only I could remember it. I’ve heard stories though…

I liked to drink back then. It was fun. Lots of good times. Was I an alcoholic then? No, and yes. I say no only because I need to have a end game, but I had all the hallmarks of someone who would become an addict. I drank, I smoked, I took pills. I was the embodiment of the sex, drugs and rock ‘n roll lifestyle. It was the 70’s, man! All the cool kids were doing it.

When I got out of the Army, I quit popping pills. I no longer had access to the pipeline of drugs that were so readily available on base or in an Army town.

One down, two to go.

I think I liked smoking pot more than I liked drinking at this stage in my life. I seriously loved weed. I’m still not sure why I stopped smoking it. I woke up one morning and I didn’t feel like getting high. I’ve never actually quit smoking pot, I’ve simply never lit up again. Oddly enough, given my affinity for it, not smoking weed again was probably the easiest thing I’ve ever done in my life.

Two down, one to go.

I discovered microbrews and craft beer. Oh. My. God. Grey Goose vodka and the Famous Grouse scotch. And I discovered that my nursing career enabled me to purchase mass quantities of all of the above. I didn’t hang out in bars. When I drank alone, I preferred to be by myself.

You have to be especially inspired to engage in a behavior this destructive against your better judgment. Almost all alcoholics have some major traumatic issues they’re avoiding. I’m no exception to this. I have some serious demons.

Mark Twain’s saying (illustration above) is no doubt true, but when you’re an addict, there’s also a B side to that record that is equally true. I embarrassed my wife. I embarrassed my daughters. If I hadn’t been so out of it, I would’ve realized I was embarrassing myself as well.

I have very few regrets from this stage in my life that are related to the things I didn’t say or do.

Drinking was still fun, most of the time, I think. I certainly told myself it was, but it was also starting to become less and less so. And then I turned forty. I don’t know what it was about forty, but the brakes on the bus started to fade. When I turned forty-five, the brakes failed altogether. Looking back, I’d say I wasted at least half of my life getting wasted. I can’t change that, but I don’t have to perpetuate that behavior any more.

And that brings us back to the beginning and the answer to the question, Were you always an alcoholic? Here’s my vague differentiation regarding my early and late drinking habits.

Early: Was it fun to drink? Yes. Did I drink a lots? Yes. Was I drunk all the time? No.

Late: Was it fun to drink? No. Did I drink a lots? Yes. Was I drunk all the time? Oh hell yes.

That’s where the whole alcoholic thing set in as I see it now. Any time you have to get drunk to feel ‘normal,’ you have a serious problem. For ten years I persisted in a behavior I really didn’t enjoy all that much, but getting drunk was the only thing that mattered to me. It makes no sense, but logic and rational thought don’t apply when it comes to addiction.

The end to my drinking career came in late 2005. I went on an epic binge drunk and almost killed myself to death. When I came to, I knew I had to do something, or I might not survive the next one. I talked to my lovely wife, and she helped me decide what to do. She told me she would support me, and added if I didn’t quit drinking, I had to leave our home. She had had enough.

I reluctantly started going to AA. As I was driving to my first meeting, which just happened to be held at Fairview Medical Center, the hospital that saved my wife, I was praying for the road to open up and swallow me before I got there. I think I cried tears of relief all the way home afterwards. To the members of Squad 46, the bestest squad in all the land, you all contributed to saving my life, and I want to take this time to say,

Thank you.

I had one relapse about one year into my first year of sobriety–in September of 2006–picked up right where I left off. I don’t need to go down that road again to find where it might lead. That was ten years, one month and eight days ago. It took me a long time to come to this realization, but sobriety is the coolest drug I’ve ever tried. If I’d only been willing to try it sooner…

Horrible Bosses

When I was a manager for BannerHealth, I went to classes on how to be a good manager. Did you know seventy-five per cent of employees that leave a job do so because of poor management?

I’ve left at least three nursing positions because of my manager, including BannerHealth. As it turns out, Banner wasn’t as interested in being a good employer as they claimed to be.

My first horrible boss was Marj. She was my manager during the years Lea was so very ill, and I was working at the Minneapolis VAMC. Lea and I learned an interesting thing during that time period. During a time of crisis, you find out who your friends are. During a time of extended crisis, you find out who your real friends are.

Marj was understanding with our situation at first, and she was even very supportive. Then she became less understanding, then she became a bitch.

There were two In-patient psych units at the MVAMC. 1K &1L. Marj managed 1L. Kevin, the guy that would eventually make a baby with Sue Severson, was the manager of 1K. Marj called me into her office around the time of Lea’s fourth, and worst, major surgery to talk to me about my attendance.

“You’ve been missing a lot of work lately.”

“My wife is in the hospital fighting for her life. I think I’d almost be expected to be missing a lot of work under those circumstances.”

“Well, this has been going on for quite a while…”

“And you think I somehow missed that?” I asked.

“No, that’s not what I’m saying. I’ve had to cover for you, a lot. I’ve had to use float nurses and PRN staff when you’re not here.”

“Yeah, well, you know, that’s your job.” I replied. “Right now, my job is to be with my wife, but if it’s any consolation to you, she may not survive this time, and you won’t have to cover for me anymore.”

That’s when Marj started crying. If there’s anyone in this office that should be crying, it’s me, I thought. But I gave Marj a hug and told her to hang in there, she was doing a good job.

She had her boss, Mary Erdman, talk to me after that. I would end up writing them both up and pissing them off forever in the process. I would eventually transfer to 1K and live long and prosper under Kevin’s management. Mary Erdman was also Kevin’s boss, but he never asked her for help in managing me, so she became a non-factor in my life after that.

There’s a lot more to this story. We’ll be back.

Lea and I moved to Arizona in October of 2007. My first job in Phoenix was working for Maricopa Integrated Healthcare Services, or as it’s commonly called, the County. My boss at the County was Karen Swine, I mean Stein. She was an unpleasant woman that wore clothes about two sizes too small for her, which may have had a lot to do with her unpleasantness.

Karen and I never got along. She thought I was the Know-It-All new guy, so… Hey, we did agree on something after all! Who knew?

Karen didn’t like my methods, not that she would’ve known anything about them if it weren’t for the day shift nurses. The day shift nurses spent what seemed to me to be an inordinate amount of time tattling to Karen about me instead of actually doing their jobs.

I worked the evening shift at the County, and my crew would spend the first two hours of every shift getting the unit settled down and establishing a semblance of peace. The patients on our unit used to give the evening shift crew a standing ovation when we walked in. The day shift nurses hated us.

Karen and I had brief chats in passing, until the day she called me into her office. I had been at the County roughly six months. She asked me to explain why I did whatever it was I had done–something related to de-escalating a patient, I think. I started to explain —

“That’s not what I heard.” she interrupted.

“Yeah, well, that’s why I’m telling you what really happened.”

“That’s not what I heard.” she said once more. You know, she did kind of look like a pig that had learned to stand on its hind legs and wear makeup.

“You’re not interested in what I have to say, are you?”

“Not really,” she kind of oinked. I got up and opened the door of her pen, I mean office. “I’m not done–”

“I am.” I handed in my two week notice, and moved on. Next stop, Banner Del E Webb Medical Center.

I loved my boss at Del Webb. Jane Stevenson, you’re the sweetest boss I ever had. BannerHealth had just acquired the Boswell and Del Webb hospitals in Sun City and Sun City West. FYI: BannerHealth is the second largest employer in Arizona. Walmart is Number One.

I started out as a staff nurse at Del Webb, but Banner wanted a lot of middle management people. Jane asked me if was would be interested in one of the clinical manager positions. I pulled a quarter out of my pocket, flipped it in the air, and said, “Yep.”

All was well at Del Webb until the second year of Banner’s ownership, and then Banner showed its ugly side. In something like unto a Nazi blitzkrieg, Banner started firing all the managers that had been in place before they bought the Boswell and Del Webb hospitals.

My darling boss had lost her husband about a month before this happened. He had a heart attack and died quite suddenly and totally unexpectedly. Jane was probably still in the Denial Stage of the Grief/Loss process, when the Banner Nazis attacked.

What they did to her is a sin in every organized religion, including Atheism. All they had to do was terminate her–bullet to the head, get it over with. They didn’t need to eviscerate her and eat her liver in front of her before she bled out.

I knew I was next after Jane’s departure. My new manager was very cordial, and assured me I was welcome to stay as long as I wanted. Would I like some Kool-Aid?

I goddamn near jumped out of her window, and her office was on the fourth floor.

The rest of my Arizona bosses have been okay, though I probably would’ve left Aurora if I hadn’t retired. That place was getting kind of kooky…

Management. It can make or break a place. And even if their expressed purpose isn’t to make your work life miserable, that’s probably what they’ll end up doing anyway. It’s the people you work with on a day in, day out basis that truly make the most difference in the workplace environment. They will likely be the greatest factor in whether you stay or leave at any job you have.

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…

You’re a Nurse

Being a nurse has been the best accidental career decision I’ve ever kind of made, and most of the things that I did in my life have been accidents. And by accident I mean something that happened without much, or even any, prior thought or planning.

I know people that have planned their life out, complete with goals and objectives, like where they wanted to be in five years, ten years, and so on. I’m pretty sure the only things I’ve ever given any serious thought to before I did them was get married and quit drinking. Everything else more or less unfolded in front of me. I took a lots of roads less traveled than…

Nursing is not a job. Being a dishwasher or being the President is a job. Nursing is a career. It’s like the difference between having clothes and having a wardrobe.

Nursing also offers a wide variety of specialty areas, so if you don’t like the specialty area you’re in, you can try a different one. That’s how I ended up Psychiatry. My first nursing position was in Cardiac Care, but my heart wasn’t in it, so I left after six months. Once I started working in Psych, I could never convince the doctors I was better, and none of them would discharge me…

Being a nurse made me a better person. Nurses adhere to a high moral and ethical standard. I sometimes marvel at this because I was somewhat blithe of scruple prior to becoming a nurse. I don’t think I had any morals or ethics, but I kind of admired people that did.

Nursing helped define the things that were important to not just my professional life, but my personal life as well. I became grounded on a firm foundation for the first time in my life.
People started seeing me differently. I had become someone worthy of respect. I will never forget the first time my daughters told me I was wise. It’s not the kind of thing I was used to hearing. It was both gratifying and humbling.

Yeah, being a nurse was mostly cool, except for the parts that sucked. Working short staffed. Picking up an extra shift so your relief teams aren’t working short staffed. Problem patients. Asshole managers. Lousy healthcare benefits. It’s not as glamorous as they make it look on TV. And I never even got to have sex in the exam room! Where’s my agent?!? Get his ass in here, STAT!

That’s probably the coolest thing about being a nurse. You get to say that word. Only two or three types of people can use that word. Doctors and nurses, we can say it ever we want. I need a crash cart, STAT! I need that medication, STAT! Social workers can also use that word, but only if they’re ordering a drink.

However, there was one aspect of being a nurse, and all my nurse friends will vouch for this–the one thing that totally bites ass. You’re off duty. You’re at a party or something, and someone will come up to you and say, “You’re a nurse. What do you think this is?”

The first time it happened I was so excited! It was also the last time I was excited.

Do you ask your friends that are hair stylists if they brought their scissors to the party? Maybe you could just trim this up for me. Thanks.

Do you ask your mechanic friends if they could listen to your engine, and maybe give your car a tune up and an oil change? It won’t take long. This party’s gonna last awhile, bro. I’ll hold your drink.

You’re a nurse. What do think this is? Once I got over my initial thrill, it was all over. Hmm, let me see… I started throwing out vague illnesses and diseases. Cholera. Prader-Willi Syndrome. Jakob Creutzfeldt disease. Pika. Beri beri. Yeah, could be that.

Sometimes I made stuff up: cerebrolithiasis. Let’s see if anyone besides me knows what that is.

And people STILL asked me, What do you think this is?

And then it came to me. The perfect answer to that annoying question. “You’re a nurse. What do you think this is?”

“That? I can’t be sure, but that looks like cancer. You should probably go see your doctor, just to be safe.”

I’m a nurse. Do I know what’s wrong with you? Yes, I probably do. But I’m a psych nurse. I also know what’s REALLY wrong with you. You should see your doctor if you want an answer to that question. She probably has kids she’s putting through college, and she could use the money.

Fear, Phobias, Hypochondria and More

If you’ve never experienced any of these sensations, become a nurse. That’ll do it. Let’s start with fear. The only student nurses that don’t feel fear are serial killers, or potential serial killers.

Let’s face it, if you want to kill people, you’re given ample opportunity to do so as a nurse. And as a non-serial killing student nurse, your deepest fear is that you will accidentally kill one of your patients. Or in a worst case scenario, all of them.

And it is real.

Honestly, it’s almost impossible to kill your patient as a nursing student. Any medication you give is verified by yourself and your clinical instructor, probably twice. And then you verify it again, like, a thousand times before you actually give it. After you do this a few times and you don’t kill anyone, you relax and move on to your next fear. There will always be another. However, if fear continues or persists after your first year of employment, you are in the wrong profession.

Some of the things nurses do are incredibly unglamorous, and even gross. All nurses will tell you there’s that one thing they have to do that makes their skin crawl. We develop phobias.

For some, it’s suctioning a trach patient. Wound care on decubitus ulcers. Cleaning dentures. Removing or placing contact lenses in your patient’s eyes. C-diff. Vomit. Borderline Personality Disorder. Seriously, it can be anything, but whatever it is for you, you would almost rather die than have to deal with it.

For me, it was clocking in at the beginning of my shift.

You are exposed to all sorts of illnesses and diseases as a nursing student that you had no idea even existed before you decided to do something this foolish. But the moment you walk into the room to care for your first patient, you’re pretty sure you just came down with whatever it is they’ve got.

Nowadays you can Google stuff, or go to WebMD. In my day, it meant a lot of painstaking research, and flipping through piles of textbooks to verify all the symptoms you just came down with, or are about to come down with, now that you know what to be looking for. Like you had time for such frivolous ventures such as that. Or having a social life. Or anything that resembled a life.

Even things that aren’t contagious, like diabetes, are suddenly and inexplicably at work inside you, destroying your body. And the next thing you know, you’re calling all your friends at 2:00 AM, asking if any of them have a glucometer.

I can’t explain how this phenomena happens, I can only tell you that it does. When I was going through my OB/GYN rotation, I was pretty sure I was pregnant. Man, I wonder how Sister Mary Hitler would’ve reacted to that! And you have never seen a happier guy than I was when I got my period the following week.

More Stuff: Bedbugs. All my nurse friends just stopped reading and went to take a shower. Lice. And, they just went to take another. That’s all it takes! The Joint Commission. That’ll pucker a lots of buttholes for months.

Well, that’s about it from here. FYI, for those of you that have become avid readers of this series, I’d like to extend my sincere gratitude to each of you. I’d even give you a hug, as long as you don’t have diabetes or anything like that. It means more to me than I can say. Thank you from the depths of my heart. In addition, I’m starting a two day trek deep into the wilds of Mexico, and I have no idea if I’ll have Wifi access anywhere on the road. Now that I think about it, I don’t know when that stuff will be set up in my house.

Fear not, and be of good faith. I have a lots of stories to tell, and I have every intention of telling them all.

God Save the Queen

My favorite patient of all time has to be Fiona. I met her at Aurora. She started out as a patient on another unit, but was transferred to my unit because her behavior was too disruptive. She needed to spend some quality time on the Canyon. My unit had a reputation for taking care of ‘problem’ patients.

Fiona’s reputation had preceded her arrival. We had all heard stories about her. She was bipolar, totally manic, and pretty much a hot mess. In fact, the day I met her she was screaming at the top of her lungs when I walked onto the unit. I walked in her room, sat down on her roommate’s bed, and waited for her to come up for air. She screamed for about another forty-five seconds.

“Who the hell are you?” she demanded, once she caught her breath.

“My name is Mark. I’ll be your nurse today.”

“Excellent. I suppose you have some shots to shoot in my ass, don’t you, Mr. Maark?” And she showed me her ass. She had a funny way of saying my name.

“Nope.”

“Then what the hell do you want!”

“I want to know what you’re so afraid of.”

Fiona ran a hand through her tangled hair, and sat down on her bed. “What am I NOT afraid of! People are trying to KILL ME!!”

“Why?”

“Because…I’m the QUEEN OF THE BLOODY WORLD!”

Fiona was from England, so she had that whole British royalty accent thing going on.

“Your Majesty,” I said, and bowed to her. “I am here to protect you. I am here to keep you safe. I will not allow any harm to befall you while you’re under my care.”

“Really. Would you take a bullet for me, Mr. Maark?”

“Only one?” I gave her a little smile.

“Oh, thank God!” Fiona sighed. “It’s about time I get some decent help in this dump.”

I wish I could say that’s all it took. Fiona was a handful. Team Canyon had to scramble to keep the peace. I ended up giving her shots in her ass, probably more than once.

“Man, that gal’s a trip! She thinks she’s a queen!” one of my techs said, laughing.

“I know.”

“What do you do with someone like that?”

“Treat her like one.” I said.

“For reals?” he asked, and he stopped laughing.

“Yep, for reals.”

So, Fiona got the royal treatment while she was on my unit. We changed the name on her door to Queen Fiona. One of the evening shift staff brought in a plastic tiara for her to wear. She steadily settled down; her mania wasn’t as tenacious as some I’d encountered, and she was a whole lot better by Day Three.

The Queen also liked to hang out near the nursing station and chat, but she didn’t monopolize the counter. She had other subjects, and they needed to see her, too. However, she was quite taken with me, and even offered to make me her personal Beefeater.

“Do I get a hat? I like those hats.”

“We shall see. You have to earn it.”

Once the Queen was stabilized, we discharged her. It was a sad day for me. However, she did return to Aurora at least once afterwards, maybe twice. But she had graduated with honors from the Canyon, and she would never be my patient again. She’d stop by and chat briefly as she walked past my unit.

“Mr. Maark,” she would say, and extend her hand.

“Your Majesty,” I held her hand, and she would flash her crooked smile. Half of her teeth were missing, but she still managed to look regal somehow.

“I haven’t forgotten about the hat!” And she’d have to dash. “Ta ta for now, Mr. Maark!”

I wasn’t present on the day she died, but the story goes something like this: She went to a Psychiatric Urgent Care, begging for help. There was something wrong, she claimed. The staff at the Urgent Care disagreed, gave her a bus pass and more or less pushed her out the door.

I can imagine her, distraught and crying, walking to the bus stop, then screaming for help as she collapsed. Someone on the scene called 911, but by the time the ambulance arrived, Fiona, the Queen of the World was dead.

She always said people were trying to kill her, maybe she was assassinated. More likely, she had a heart attack. Either way, part of me felt like I had failed in my duty as Queen Fiona’s personal Beefeater.

But the other part of me felt God had taken her out of her imagined kingdom, and had welcomed her with open arms into his Eternal Kingdom.

It’s only fitting. After all, she was a queen.

Risky Business

There are a couple of iconic things about this movie. Tom Cruise dancing in his underwear, and this line: Sometimes you gotta say, what the fuck.

Spoiler alert! If profuse profanity offends you, stop reading now.

One of my all time favorite patients at the Minneapolis VAMC was Harold. He looked like the Muppet Professor guy, minus the lab coat. And he was more…round.

Harold was bipolar, and he often came into the hospital extremely manic. His mania was med resistant; it took a looong time to get him stabilized. When I worked nights, we would talk for hours. Well, Harold did most of the talking. I nodded a lot. Harold had a kind of old guy cartoon voice. I loved to hear him speak.

The same thing would happen when I worked the day shift. Harold would shuffle up to the nursing station and ramble on and on and on about anything that popped into his head. Some of the nurses I worked with found Harold to be very annoying, and they wanted me to tell Harold to go away.

“Well, I see it this way,” I said to my annoyed co-workers. “I can either let Harold come to me, or we can move the entire nursing station into his room. This seems like the easiest thing to do.”

But we discuss private information! Harold could overhear something about the other patients!

“When have you ever seen Harold actually listen to anyone?” I replied. Some of my co-workers started thinking I was pretty annoying, too.

All things must pass, and even Harold’s mania eventually lost its grip. We set a date and prepared him for discharge. I tended to be Harold’s nurse most of the time, for good or bad, so I was helping him get dressed after he had showered. I had him sit on his bed while I tied his shoes, and then Harold started crying. And by crying I mean he sobbed like a toddler that had just dropped his ice cream cone.

“What’s going on, bud. Aren’t you happy to be going home?”

“Yes, but you guys have been so nice to me, and I’ve been such a pain in the ass!” More sobs.

I had been a psych nurse for 13 years or so by this time, and I had learned to read people pretty well. And by read I don’t mean read like reading a book. I mean read in the same way a blind person reads Braille. It’s a feeling. It’s a touch.

“Harold, have I ever lied to you?” I asked. I was sure I’d never lied to him, mostly because I rarely got to speak to him.

“N-no,” he stammered through his tears.

“Well, I’m gonna tell you the truth. You were never a pain in my ass.”

“Really?” he stopped sobbing. “I’ll bet you’re gonna say, Man, I sure am glad that son of bitch is out of here after I leave.”

“Harold, I would never say that about you.”

“Oh yeah, I’ll bet you say I sure am glad that bastard’s out of here.”

It was at this precise moment I decided to say what the fuck.

“I would never say that about you, you son of a bitch.”

“Ha!” Harold snorted. He had stopped crying. “I’ll bet you say I sure am glad that motherfucker’s out of here!” I resumed tieing Harold’s shoes.

“I would never say that about you, you bastard.”

“Hahaha!” Harold giggled. “I’ll bet you say I sure am glad that cocksucker’s out of here!” I finished tieing his shoes, and looked him in the eye.

“I would never say anything like that about you, you motherfucker.”

“Hahahahahahahahaha!” Harold laughed. He looked like he was going to do a cartwheel across the room. “Godammit, Mark! I like you! I’m gonna buy you…a new refrigerator!”

Home run.

I don’t recommend using this technique with patients to anyone. Ever. If I were anyone other than myself, I doubt I would’ve tried it. But I do lead a blessed life, or so I’ve been told of late, and right now that appears to be an indisputable truth.

I wonder if any of my former co-workers are saying, I sure am glad that son of a bitch is out of here…

The Power of Prayer

I’m not a religious man. I’m certainly not a righteous man, you can ask anyone that knows me. Even my pastor knows this. But I am a believer in the power of prayer.

I married my lovely wife in 1988. In 1991, I think, she needed to have an endoscopy and a biopsy to rule out a gastric ulcer or some otherwise vague, unknown process that was busily at work inside her GI tract. Well, that’s what the Urgent Care doc guessed what the problem was.

Lea met with a gastroenterologist, and he suggested the procedure because he had no clear idea of what was going on inside of her either. We went to the Same Day Surgery clinic at Fairview Medical Center, a place we would spend a considerable amount of time at in the very near future. What we would eventually discover was Crohn’s disease, three years of misery, a year and half of time spent in the hospital for Lea, five surgeries, four near death experiences and roughly $1.5 million in medical expenses.

On this blissfully ignorant day, the procedure was unremarkable. The results were ambiguous. We were waiting for Lea to be released as the nurse went through the post-op instructions.

“As soon as you can pee, you can go home!” The nurse smiled. My wife did not. “I always have trouble with that after general anesthesia. This could take fifteen minutes, or fifteen hours.” The nurse smiled again and handed Lea a cup of water. And that’s when I decided to say something stupid.

“I’m a nurse. If anything goes wrong, I can take care of her.” I figured if we decreased Lea’s stress by taking her home, she’d relax and peeing on her own would be much easier. Psych nurse logic.

The clinic nurse thought about it, had us sign a release form, and home we went. Alas, my plan didn’t work. Hours later, Lea informed me she really, really had to pee, but couldn’t.

Simple solution. I needed to cath my wife. So I jumped in the car, got a cath kit, and talked my wife through what she had to do. Using sterile technique, I prepped the area, laid out the drapes–I had done this a few hundred times as a surgical technician–but those women were laying on an OR table, their legs were in stirrups, and they were unconscious. Their crotches were essentially at my eye level, and while this might sound like trivial detail, it is not.

Lea was laying on our water bed, about two feet lower than where I stood. She was perpendicular to me, and I was going to have to do this thing left handed, which is not my dominant hand. There’s an added degree of difficulty for you.

Now, for those of you that have never attempted this, when you’re going to cath a woman, you really need to visualize world peace, if you know what I mean. In order to do that in this situation, I almost needed to stand on my head. No problem, I’m a nurse, I got this. I took a deep breath, and essentially started jabbing the catheter in the general direction of my wife’s crotch, hoping the catheter would know where it was supposed to go and slide into her urethra.

My wife is a really sweet person. Pretty much everyone that meets her falls in love with her. Her smile lights up half the world. But she fired off a look at me that, to this day, will make my heart skip two beats when I think about it. She spoke in a low growl, about one timbre below demonic possession.

“What…in the HELL…do think you’re doing?”

Seriously, I almost started crying. Honey, please! my mind responded. I was raised by nuns! They never told us about this! I didn’t even know women had vaginas!!

“For the love of God, take me back to the hospital! ” Lea snapped at me. She. Was. Pissed!

Dear God, I prayed, please don’t let her head spin around! Pleasepleaseplease!! I was pretty sure Lea had started levitating off the bed.

I prayed one of the most fervent prayers for divine intervention ever uttered, and, bam! The catheter miraculously found the opening of her urethra, and I struck gold. I may have fallen to my knees in relief.

There were a lot of weird things that converged in this situation, but they weren’t over. The next morning, Lea STILL couldn’t pee on her own. I got another cath kit, but I had no problem with the procedure on Round Two. And she didn’t develop an UTI either.

Take that, real nurses. Who’s your daddy, now?

At the time I looked at it as a really great story to tell all my friends. It’s still a great story. But now I see it like this: that was the day my training in prayer began. I would pray a lot over the next three years, and also into the years that followed. And I can testify to this: God answered every one of my prayers. He has been faithful to us more times than I can count.

In an earlier post, one of my friends responded that I was blessed. Blessings evidently come in a wide variety of flavors, and often come disguised as a crisis. Something to ponder for all of us there…

So, fear not, and be of good faith. If God can hit a woman’s urethra without looking, He can do anything.

What is a Real Nurse

There’s a long standing issue in Nursing. Are psych nurses ‘real’ nurses. If you need a nurse to start an IV, or place an NG tube, you’re better off with anyone but me. I probably won’t kill you, but you’ll likely wish you were dead by the time I was done with you.

Many nurses look at us as highly paid babysitters. Not very flattering, but I think it’s a bit more complex than that. Psych nursing requires a completely different skill set, and, at times, the courage and bravery of an infantryman charging a machine gun nest.

I had finished my shift. It was about 7:00 PM when the phone rang. It was the VA calling, so I thought they were looking for someone to come in.

“A former patient with a knife walked on to the unit and stabbed five nurses.” my boss said. One nurse was critically injured, and might not survive. One was seriously injured, but was expected to be okay. The other three were injured, but none of their wounds were life threatening.

Those nurses didn’t think twice in the face of danger. They literally put their lives on the line to save the lives of others, and would probably do it all over again if they had to.

Most nurses don’t go to work wondering if this will be the day they die. Even psych nurses don’t contemplate this every day, but there are days, and it’s more than a singular experience. Sometimes the people in our care are not very nice, and more than one career has come to an unexpected end as a result of an assault.

Are psych nurses ‘real’ nurses? No, we are not. We are un-fucking-real nurses. When you are at the bottom of the abyss where nothing can survive, not even hope, we are there to catch you and help you find your way to the surface. When mania expands your mind to encompass the universe, turns your blood to electricity and your thoughts into lightning, we are there to get you back to earth and safety. When dementia has stolen everything from your mind, we will still be there to be the only word of solace, the last touch of comfort.

I’ve had a lots of people, even other nurses, tell me there’s no way they could do what I do. I’ve never had an answer for that, though it just occurred to me that if this isn’t an answer I don’t know what else it could be…

As I pass the torch to the next generation of nurses to follow in my footsteps, I would urge them to remember this. What you do cannot be measured in normal or ordinary terms. You are paranormal, you are metaphysical. You are an artist. You are beyond brave and beautiful.

You. Are. Un-fucking-real.

The Piano Man

We had a piano in one of the day rooms at the Minneapolis VAMC. And we had a patient that played it whenever he was in the hospital. He was an old guy, so he played songs from the 40’s and 50’s, and he even sang the lyrics. He was really good! Everyone loved him.

The last time he was admitted, there was something distinctly different about the Piano Man. For one thing, he repeated everything I said, really loud.

“THE PACKERS ARE GOING TO LOSE ON SUNDAY!”

And it wasn’t just me. He repeated everything anyone else said.

“NO! THE VIKINGS ARE GOING TO LOSE ON SUNDAY!!”

I figured the guy had had a stroke, so we ordered a Neuro consult, and he was transferred to a medical unit. And he stayed there.

A couple weeks later, my gut asked me whatever happened to the Piano Man? I looked him up in the computer and found the unit he’d been transferred to. My shift would end in about half an hour, it was ‘pink’ on the unit–nurses never use the Q word–so I went upstairs to see him.

The Piano Man did not look good. He was shiny and sweating. He breathing was labored and irregular. And he looked terrified!

“I’M SCARED!!” he gasped. I reached out and took his hand.

“It’s okay. I’ll stay here with you.” I said. His breathing calmed down a bit, but he still looked afraid. His eyes darted all around the room, as if he were trying to locate the source of a spooky noise.

“Maybe we could sing a song,” I suggested.

“NO! I DON’T WANT TO SING!” he said. But I started singing.

“Every time it rains, it rains…” I started.

“Pennies from Heaven…” the Piano Man chimed in, his voice returning to a normal volume. It was the only song I remembered from the songs he used to sing. Despite his reluctance, the Piano Man and I sang two verses of the song. He relaxed a bit with each word of the song.

“There’ll be pennies from Heaven for you and me…” We finished the song. I smiled at the Piano Man. He smiled back. He wasn’t afraid anymore. He closed his eyes…and he died.

I went back to my unit. I didn’t tell anyone what had happened. The Piano Man had left this world, but he had done so unafraid, with a song in his heart.

AMRTC

The Anoka Metro Regional Treatment Center. It was a fancy name for the Minnesota State Hospital. It would be my first position as a psych nurse.

I sent my resume, they called me to schedule an interview with the Program Director and the Head Nurse. I was escorted to a room with a huge table and lots of chairs arranged around the table. I took a seat at the nearest end of the table, and waited a few minutes.

The director walked in the room. He looked like he had just gotten out of bed after sleeping in his clothes for a week. He sat down at the far end of the table, looked up from a pile of papers he had dumped on the table as he sat down and asked, “Why did you apply for this position?” I’m not sure he even looked at me. He might have been staring at the ceiling.

“I saw an ad in the newspaper.” I replied.

“Okay! Works for me!” he said, scooped up his paperwork, and walked out.

Easiest. Interview. Ever.