Harvey

Things are heating up here in the Lakeside area. Believe it or not, May is the hottest month of the year down here. According to everyone we know, it should cool off in June once the rainy season starts.

That’ll be nice. I think it’s rained once since November, and there have been a thousand fires in the last month or so. It’s so smoky/hazy now, there are days when you can’t see the other side of the lake.

* * * *

If you’re a classic movie buff, I don’t need to tell you about Harvey. 1950. Jimmy Stewart as Elwood P. Dodd, an eccentric man whose best friend is a pooka named… what else? Harvey is Elwood’s best friend, and he’s a six foot three and an half inch tall invisible rabbit. If you haven’t seen it, I highly recommend it. It’s a darling movie.

I knew a guy named Harvey. He was maybe five foot four. He had kind of a weather-beaten appearance, and he wasn’t invisible. Harvey was an older guy. He was in his seventies when I first met him. I can’t remember if he was bipolar or schizophrenic. He might have been both. If he was bipolar, he was the quietest manic guy I’ve ever met. And if he was schizophrenic, he kept his psychosis to himself.

Harvey was pretty much an enigma. He was more imp than pooka, and was, at least once, like unto a gremlin that had been fed after midnight. That’s how I remember him. One of our patients at the MVAMC was a guy we called Forrest Gump’s Smarter Brother. Harvey was probably their grandfather.

And I should add this: The female nurses loved him. They thought he was cute.

I probably first met Harvey around the year 2000 or so. He came up the nursing station one day and said, “I want to call my mom. My mom. My mom!”

I took a long look at Harvey and seriously wanted to ask if his mother was still alive, but I asked a different question.

“Do you know her phone number?”

“Yeah. Yeahyeahyeah.”

So I set a phone in front of him, and he dialed a number.

“Hi Mom. It’s me. Harvey.”

I decided to look up Harvey’s contact information in the computer. His mother, Olive, was listed. As near as I could discern from his file, his mother was still alive. She had to be in her nineties.

Harvey had a very nice conversation with someone, and a few hours later, a frail little old lady who smelled of cat urine, walked onto the unit with a man whom, I think, was Harvey’s brother.

They brought in a bag of clothes for Harvey, and his glasses. When Harvey was showered and shaved and wearing his own clothing, he looked like he could’ve been a college professor.

All the female nurses wanted to talk to Olive–they might have seventy year old sons to raise someday, and they wanted all the information they could get about Harvey. I can’t remember what he did for a living anymore–if he ever had a job, or if he was on some sort of disability, or if he had a place to live, or much of anything else about him.

There was a lesson for me to be learned. Just because I didn’t think something could be possible, didn’t mean it wasn’t true.

For example, The Guy Who Knew Milton Berle. His name was Steve. He was a local radio personality/comedian who had relapsed on alcohol. His detox was uneventful, and we were getting him set up with follow up care.

For those of you who don’t know who Uncle Miltie was, he was a comedian, and one of the pioneers of early television. He might have been a pooka, but he stood only five feet ten inches tall, and he wasn’t invisible.

Steve was talking on the phone at the nursing station one Saturday morning, and when he hung up, one of the nurses I was working with asked who he was talking to.

“Milton Berle.” he replied, and all of the nurses started laughing. So Steve went to his room and returned with a photo album that contained dozens of pictures of him with none other than Milton Berle.

Yeah, who’s laughing now, nurses?

The sad fact is most psych patients lie about almost everything, so as a psych nurse, you tend not to believe practically anything they say.

“I’m the hair dresser to the stars.”

“No kidding! If you don’t mind me asking, who are some of your clients?”

“Stevie Nicks. Victoria Principal. Morgan Fairchild.”

“Wow. When was the last time you were in Southern California?”

“I’ve never been there.”

“So, they fly here, to Minnesota, so you can do their hair?”

“Yeah. Pretty much.”

“By the way, I love what you do with Stevie’s hair.”

“Yeah, she’s beautiful. Thanks!”

I met at least two guys who were the hair dresser to the stars, and neither of them had ever been to California. And then there were the guys who were mysteriously drugged at their local watering hole.

“Well, I was at the bar, and then I can’t remember anything. I think they ​slipped me a mickey!”

“Yeah, that’s why I quit going to bars. I got tired of getting drugged, too.”

“See? This guy knows what I’m talking about!”

I always got a kick out of that story. Fictional private detectives from the 1940’s, like Sam Spade and Mike Hammer, were always getting slipped a mickey, but I don’t think it ever consistently happened to anyone in real life. Until Ruffies became popular, and correct me if I’m wrong, but it was mostly girls who were the target of Rohypnol. Even the girls had their tales of misfortune.

“We just discharged you two days ago. Why are you coming back today?”

“Someone on the bus stole all of my meds!”

“Even your Xanax?”

“No, that’s the only thing they didn’t steal!”

“What happened to that?”

“Oh, I accidentally dropped the bottle in the toilet!”

Well, there are a lots of fun filled activities to do on the bus, so it’s easy to see how that could happen…  And toilets clearly can’t be trusted anywhere near controlled substances. But every now and then, you meet someone who actually tells the truth. So, try to remember that.

* * * *

Unfortunately, I don’t have a whole lots of Harvey stories. He was a mostly benign, very quiet guy, who sometimes looked quite professorial.

He did have his Harvey moments. He would randomly bolt down the hallway as fast as could, for no apparent reason. I think that was Harvey. I’m pretty sure it wasn’t me.

He was one of those guys that randomly uttered words of inestimable profundity, most of which I can’t remember, but he did say this:

“Ooh, shiny!”

It became our catchphrase whenever someone went off on a tangent, or for someone with a short attention span who was easily distracted. Like me.

And then there was Harvey’s hallmark admission. And like so many hallmark moments, it happened in the dark of night.

It was probably around 2005. Harvey had been a patient on my unit a couple of times. None of his admissions had been especially remarkable. We stabilized him and sent him home, or somewhere, until the next time.

On this particular night, it just after midnight. Harvey was admitted once more. We got him changed into VA pajamas and settled into his room by the nursing station. There wasn’t much point in trying to do a thorough admission assessment because Harvey wouldn’t answer any questions, so we got all our information from his old charts and our previous knowledge about Harvey.

Most people admitted in the middle of the night just want to go to bed, but that night, for no apparent reason, Harvey decided to demo his room.

I think he started with the baseboard molding, and ripped it all off of the walls. One of the nurses I was working with asked me what we should do. He wasn’t harming anyone, but he was systematically tearing his room apart.

We tried medicating him with Haldol and Ativan. The meds didn’t touch him.

After he removed all of the baseboards, anything that Harvey could disassemble with his bare hands was fair game. We would check on his progress periodically, and remove all the debris from his room from time to time.

When he started to take his bed apart, we rolled the frame out of his room, leaving the mattress and bedding on the floor. By 5:00 AM, the only thing Harvey hadn’t demolished was the light fixture on the wall where the head of his bed had once been.

Around 5:30 AM, we heard a loud crash. Harvey had somehow ripped the monster light fixture out of the wall, leaving behind a few live electrical wires. We were forced to move him across the hall into one of the seclusion rooms. I can’t remember if we locked him in or not, but we probably gave him another cupful of meds, that would have no more effect than an handful of Tic-tacs. Then I entered a whole lots of work orders into the computer so the maintenance guys would start putting the room back together again.

* * * *

It took the VA Corps of Engineers at least five days to repair what Harvey had done in roughly five hours.

I had at least one day off between getting off of Nights and transitioning to Days. I asked the night nurses how Harvey was doing when I returned to work. He hadn’t demolished anything else, but he hadn’t slept since he was admitted.

I have a couple of clear memories of that day. One, I was assigned to do Meds. Two, it was the first time I met Darrell. He was an LPN, and a new hire. He had never worked in a Psych setting before, and my boss asked me to show him the ropes.

“I’ve been doing this job for a long time. I can play this song in any key. I can tell you how you’re supposed to do this job, or I can tell you how I do it. If you do it my way, you’ll work smarter, not harder.”

“I was hoping I’d meet a nurse like you.” Darrell replied. I was going to like working with this guy.

I spent the first couple of hours explaining my unorthodox philosophy to Darrell, and then I decided to show off a little to the new guy. I pulled Haldol and Ativan from the Pyxis, and told Darrell to follow me. And we went hunting for Harvey. He was standing in the hallway by the dayroom.

“Harvey hasn’t slept since he got here. I’m going to send him to the Land of Nod.” I told Darrell.

“Yeah, the nurses tried like hell to put him down for the count yesterday, but nothing touched him.”

“Hey, little buddy. I’ve got a couple meds for you.” I said, and handed Harvey a med cup with a couple pills, which he readily took. Then we escorted Harvey back ​to his room, and laid him down on his bed.

And I started singing, softly.

“Lullaby, and good night. Go to sleep lit-tle Harvey. Close your eyes, count some sheep, a-and go to fucking sleep…”

I didn’t know many of the actual lyrics, so I kind of made them up on the fly. I sang a few more verses of my impromptu lullaby, and when we tiptoed out of Harvey’s room, he was snoring.

“I don’t know what you just did, but I can’t believe what I just saw.”

“Smarter, not harder.”

“Well, I hope you don’t expect me to sing a lullaby to every one of these guys, because there’s no goddamn way I’m doing that!”

“Nope. It’s probably the only lullaby I’ve ever sung.”

“If you don’t mind me asking, how did you know that would work?”

“I didn’t. It was a gut feeling. Always follow your gut. It’s never wrong.”

* * * *

I know some of the stuff I write is hard to believe, but that actually happened. And as weird as it might sound, I had no doubt my intervention would work. I probably didn’t even need the meds.

However, I didn’t have any qualms about giving them to Harvey. I figured if my lullaby worked, the meds would help him stay asleep, and that’s probably what my little buddy needed more than anything.

Almost every field of Nursing is a science, except Psychiatry. At best, it’s an imprecise science, but it’s mostly an art. Only the really good psych nurses understand this.

The essence of psych nursing is guiding people out of the maze of darkness or whatever else they’ve created inside their minds, and teaching them a few new coping strategies, so they can try to avoid having to repeat it again in the future.

It sounds good in theory, but the reality is the majority of the patients we took care of weren’t all that interested in doing anything different.

You can lead a horse to water…

That part of the job was frustrating, but every now and then, someone would come along, and all they wanted was a second chance. And every now and then, you could sing someone a lullaby.

It was those moments that made the whole thing worthwhile.

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.

The Doctors

You get to work with a lots of different disciplines as a nurse. Social Work. Adjunctive Therapy. Physical Therapy. Laboratory. Dietary. Even Housekeeping.

But the most challenging discipline you’ll likely encounter is the doctor. Well, Dietary can be a real pain sometimes. You know who the sweetest people are? The housekeepers. I loved them, especially the housekeepers at Aurora.

Doctor shows are incredibly popular on TV. I have no idea why. I’ve spent years hanging around doctors, and I never found most of them to be that interesting.

TV doctors have changed a lots over the years. They used to be older, wise, fatherly figures that made house calls and took care of you and your family from birth to death and everything in between. Nowadays they’re young, pill-popping, supersexy smartass mannequins who perform some obscure lifesaving surgery, then go get drunk and have sex with another supersexy doctor or the nurse with the big tits.

From a nurse’s point of view, doctors can either make or break your day, depending on a wide variety of factors and variables. Sometimes the most difficult part of being a nurse is getting what you need from your doctor.

And as a psych nurse, mostly what you need from your doctor is good coffee in the morning, and a shitload of medications to offer your patients.

* * * *

My first psych nurse position was at the Minnesota State Hospital. You had to be certified crazy to be a patient there, and some of them were downright scary.

Vincent was a certified crazy, angry young man, and he often made threats of death and other types of destruction to the staff. I never found those situations to be especially fun, so I asked his doctor to maybe increase his meds, just a little.

Vincent’s doc was a tall guy named Bruce, who spent about five minutes a month meeting with his patients. When I spoke to Doctor Bruce and informed him how his patient had decompensated of late, and was threatening death and destruction to pretty much everyone, Doctor Bruce had this classic response:

“Well, Mark, we all have to die from something.”

* * * *

The next stop in my career was at the MVAMC, and I would stay there for almost twenty years. I would meet a lots of doctors there.

Doctor Bob was an older, wise, father figure guy who had been at the VA for eons. He was an alcoholic, but had quit drinking some years before we met. But that was all he did, and he was a mixed bag of moods most of the time.

We had a guy on our unit named Duane. Duane was a was what we called a non-compliant patient. He refused to take any medications. He refused to take part in any programming. Duane just wanted to eat and sleep and he was rather rude in his interactions with the staff.

Doctor Bob walked onto the unit one morning, and walked into Duane’s room. They had a brief, loud interaction, then Duane started screaming. Two seconds later, Doctor Bob emerged from Duane’s room with Duane in tow. He had grabbed Duane by the ankle, pulled him out of bed, dragged him down the hallway to the nearest dayroom, and told him to stay there.

Doctor Bob was investigated by the hospital for alleged patient abuse, and ended up getting a three day suspension. Anyone other than Doctor Bob would’ve been terminated immediately and most likely would’ve lost any professional licensing they had.

* * * *

Lori Suvalsky was my favorite doctor at the MVAMC, and my personal favorite doctor of all time. She knew her stuff, and was a very good doc, and she was hotter than July in Phoenix.

I’m very serious about that.

We took care of a lots of crazy people together, and she was the first doc I worked with that seriously listened not just to me, but all the nurses. As hard to believe as that might seem, a lots of doctors weren’t all that interested in what the nurses had to say. Doctor Lori absolutely loved the nursing notes I wrote. It was so refreshing working with her.

Doctor Lori spent a lots of time talking to her patients, and she almost always took the nurse caring for a patient with her to get input from the patient and the nurses. She was the only doc I worked with that consistently did that.

Doctor Lori wasn’t just the first doc I formed a professional relationship with, she was the first doc that I counted as a friend. We went out for drinks and dinner after work. We talked about the problems we had in our personal lives. She threw elegant parties and invited me and my lovely supermodel wife.

She told me I needed to quit smoking. I told her she had a nice ass. She helped me survive the traumatic aftermath when one of our patients committed suicide on our unit. When the VA decided to create an assistant head nurse position, she lobbied for me to get the job, and she had my back when I quit finally drinking.

She cried when I left Minneapolis and moved to Phoenix. Of all the people I would miss when I left the MVAMC, I missed her the most.

* * * *

I worked at several psych facilities in the Phoenix area, but it wasn’t until my third job that I found a doc I really liked. I worked with some decent doctors at the County and Del Webb, but there were some real losers, too. Especially at the County.

Hey, Dr Loser. We have a guy starting to escalate here. He’s hyperventilating and pacing. He just punched a hole in the solid concrete wall, and he’s threatening to kill everyone. What kind of injections would you like us to give him. Immediately!

No injections. Offer him Haldol 2 mg by mouth, and a half a milligram of Ativan.

Seriously? This guy is six foot five, and weighs about four bills. With all due respect, we’ve had four Code Blacks with this guy in the last three days. Yesterday we gave him ten of Haldol, two of Ativan and a hundred of Benadryl. And it finally caught up with him after we gave him a repeat dose!

Are you a doctor? Do you think you know more about this than I do? You don’t give me orders, I give orders to you! Do what I say!!

That might be an extreme illustration, but shit like that happened occasionally. The big badass guy would inevitably go off. Fifty staff members would come running, and there would be an huge wrestling match. We’d shoot the guy up with what we knew would work, and then get orders. If Dr Loser still refused to give us orders for what we needed, we’d call the Medical Director, and he’d sign off on them, then he’d call Dr Loser and chew him a new asshole.

* * * *

My favorite doctor at St Luke’s was Naveen Cherukuri. My favoritest thing about Naveen was listening to him tell a funny story. He would start laughing so hard I couldn’t understand a thing he said, but was still thoroughly entertained listening to it.

Naveen was also a really good doc, and he took care of the nurses. St Luke’s could be a really scary place to work at times, and Naveen wasn’t afraid to lock and load. I really liked working with him.

He married one of my favorite St Luke’s nurses, Stacey Supermodel. They have a couple kids now. Hopefully, they look like their mom…  Just kidding, Naveen. I don’t know if I’ll ever see him again, but I hope I do.

* * * *

I ended my semi-legendary psych nursing career at Aurora Behavioral Health, and I would work with several doctors there that I would come to view as not just colleagues, but good friends.

Bill Sbiliris was the primary doc on the Canyon Unit, my home at Aurora. We didn’t get along all that great at first. We probably had a similar opinion about each other: That arrogant sonuvabitch thinks he knows everything!

And then we discovered between the two of us we really did know everything, and we were both Minnesota Vikings fans, which was rare in Arizona. After that, we made a great team. Too bad our football team didn’t achieve similar greatness…

Doctor Bill also wasn’t afraid to lock and load medications. He was pretty easy to work with in that regard, and that made it easy for the nurses to drop the Canyon Hammer if we ever needed to.

Doctor Bill wasn’t so great at spending a lots of time with his patients. They called him Dr Drive-by. Be that as it may, Doctor Bill was a good guy to work with, and we stabilized a lots of crazy people together.

Doctor Bill also took very good care of the nurses. He usually stopped at Starbucks on his way to work and brought in a wide variety of caffeinated beverages for the nurses. He bought lunch for the nurses more consistently than any other doc I worked with, and he also threw great parties.

* * * *

Michael Fermo was another Aurora doc. He was also a very good doc, and another wizard of psychopharmacological management, and he spent a reasonable amount of time meeting with his patients.

Doctor Mike used to transfer a lots of patients to my unit. Fiona, the Queen of the World, was one of his patients. The nurses on his unit used to say their patients needed to spend some quality time in the Canyon. Doctor Mike used to say this: “I think they need some quality Mark time.”

That was a pretty high compliment.

For his especially difficult patients on my unit, we would do a Good Cop, Bad Cop routine. Doctor Mike always played the Bad Cop, and would rip his patient a new asshole, and then I’d put a band-aid on it and make it all better. And then we would laugh our asses off. We were incredibly successful, and there was mostly peace on the Canyon.

“How’s my boy doing today? Do I need to get all medieval on his ass again?” he’d ask.

“Nope. He’s got his damn mind right now.” I’d reply.

“Good. I love it when a plan comes together.”

And when it came to throwing epic parties, none of the docs I worked with could hold a candle to Doctor Mike. The only thing he didn’t have at his parties was strippers, even though I lobbied hard for them the next time.

* * * *

But my favorite Aurora doc was Reyes Topete. He was the staff addictionologist, and he was a freaking dream to work with. Whatever I needed for my detox patients, El Topete delivered.

“Give him Ativan 2 mg now, and set up a taper, 2 mg QID. I’ll see him when I come in and take care of the rest.” Or “Give her Subutex 8 mg now, and set up a four day taper. You need anything else?”

If I wanted a Subutex taper extended, no problem. If I wanted one stopped, it was done. If I thought we should add something, like phenobarbital, sure, why not. It was the same if I thought we should remove something from a patient’s med profile.

“You’re my eyes and ears on the unit.” he told me one day. “And if you tell me one of my patients needs something, or doesn’t need something, I trust you.”

As far as compliments from doctors go, it doesn’t get any better than that.

I told him about my drug use history, and he had trouble believing parts of it. Mostly the quitting part.

“And you just stopped? Cold turkey? Man, don’t tell my patients that! I have kids in college!!”

El Topete is from Guadalajara, Jalisco, Mexico–the Big City about forty miles away from where we’re currently living. He was thrilled when I told him we were going on vacation here the year before we retired.

“Really? I’m grew up in Guadalajara. You’re gonna love it! You have to go here, and there…” He was so excited he started speaking a combination of English and Spanish and probably a couple of languages no one has ever heard before, outside of a Star Wars® movie.

And when I told him we were retiring down here, he was jealous. At my retirement party, he cried. To this day, that touches me more than I can say.

* * * *

I’ve said before that I don’t miss working for a living, and that’s true. I’ve also said that I miss some of the people I used to work with. That is also true. I’ll probably travel back up to the States again from time to time, but I have no intention of staying there, and I sure as hell don’t plan on rejoining the workforce.

I’ll try to see as many of my friends as I can cram into any of our Stateside visits. But we do have a guest room here…

How to Save a Life

As a nurse, I was given the opportunity to save at least a couple of lives during my career. I never had to talk someone off of a ledge or anything cool like that, but I did talk to a lots of depressed people and helped them try to find a reason to keep living.

That’s really the key to surviving a serious bout of depression. Not killing yourself. Suicide greatly decreases your chances of ever getting better. And it really, really messes up your family. Suicide is never a good idea. Talk to someone. Get some help. Do something!

Please.

When I was a nurse, I was certified in CPR. I think it’s probably a requirement for most nurses nowadays. I went through periodic recertification every year or two. And you need that refresher training, unless you do a lots of CPR. It was a skill I had to utilize only a few times in my career.

I think the only time that I may have saved someone with CPR was at the MVAMC. It was in the dead of night, of course. An old manic guy had collapsed in his room, and one of the other nurses discovered him laying on the floor, unresponsive. She called out for help, and all nurses on the floor went running.

If you don’t perform a lots of CPR, it’s kind of a tricksy thing. There’s a series of steps you’re supposed to follow, but in an emergency you tend not to remember them, and you can’t call a time out to check the manual. Adrenaline takes over your brain, and you just react.

This guy wasn’t breathing and I couldn’t feel a pulse, so I started chest compressions. And, I probably broke half of his ribs. That’s actually normal, especially with an elderly patient.

If you’ve never had a broken rib, or a lots of broken ribs, it kind of hurts like hell. And that’s probably what revived the old manic guy I was working on more than anything else. He took a deep breath, opened his eyes, and then punched me in the mouth, splitting my lower lip open.

Oscar Wilde was correct, again. No good deed goes unpunished.

I’ve unsuccessfully performed CPR a couple of times. Unlike TV, where everyone needing CPR survives and lives happily ever after, there’s about a 10% success rate in reality, and not everyone that survives lives happily ever after.

That’s why healthcare professionals have Advanced Directives and Living Wills, and 80% of us are DNR/DNI. If I collapse in front of you, just step over my body and keep on walking. I will fucking sue you if you even think about touching me.

I’m serious. I may punch you in the mouth.

I was a psych nurse, and there’s a little known fact about Psychiatry. The vast majority of our patients were sincerely depressed and suicidal while they were being assessed for admission. And the moment they learned they were going to be admitted, they were no longer suicidal.

In order to get admitted, you had to meet criteria. If you so much as whispered the S-word, you had to be admitted. And believe me, our patients knew the drill. Getting into the hospital was their primary objective. Their lives had gone to hell, and the hospital was their sanctuary and refuge.

There are many anxiety provoking aspects of psych nursing, but one of the worst is a patient that sincerely wants to kill themself after they’re admitted.

If someone truly wants to kill themself, they’ll eventually find a way. It’s true. I could suggest you talk to someone that committed suicide, but…

Our objective as nurses was to make sure they didn’t find a way to kill themselves while they were in the hospital. I had four patients take their lives while they were on my unit in my thirty years as a psych nurse, and it was a traumatic experience for everyone, staff and patients, every time.

I performed CPR on two of them, and I knew both times I wasn’t going to be bringing either one of them back. You don’t have to be a coroner to know when you’re looking at a dead person. They became organ donors, so they were able to help others in that regard. I do not recommend this method of organ donation, ever.

Life and death, they become part of the job when you work in healthcare. You win some, you lose some. You go on, or you quit because you can’t deal with it anymore.

But what if you’re not an healthcare professional? And you don’t have a lots of training? What if you’re just a guy riding your bike to work one morning? Then you might be my brother, Tom.

* * * *

My brother used to be a cook at the Perkins® restaurant in Sauk Rapids, MN. Like me, when I was I nursing school, he had a car that started about half of the time he wanted to drive it, and when it wouldn’t start, he rode his bike to work.

It must’ve been a morning that his car wouldn’t start, hence, the bike. And as he was pedaling his way to work, a panic-stricken woman ran toward him, screaming.

“Help! Help me! My son! I think he’s dead!” And she pointed toward a pickup truck in the yard, then ran to the house to call 911.

Her son was a teenage boy, and his head was stuck in the door of his truck, which was up against a tree in the yard. There’s a bit of a backstory to this. The boy was teaching his younger sister how to drive his truck. I’m not sure why they were driving in the yard, but it was Minnesota…

So, his sister was driving, and her brother was walking beside the passenger side of the truck, with the door open, giving her instructions on how to shift the manual transmission. I’m going to guess everything was going fine, until the truck got close to the tree. It was a really big tree.

It’s kind of difficult to imagine how something like this could actually happen, but the girl drove the truck really close to the tree–the passenger door of the truck was right up against the trunk of the tree–and wedged in between the door and the body of his truck was the head of the teenage boy, with the tree trunk as a giant doorstop holding the kid’s head hostage.

“His head was really fuckin’ stuck! His neck was caught between the door and the chassis and the tree. It was something so stupid even you couldn’t have done that!” Tom said, when he described the incident to me. “I tried to pull him out, but I couldn’t. So I ran around to the driver’s side. The girl that was driving was scared shitless. She was white as ghost. She had one foot on clutch, and the other on the brake, and her legs were shaking like crazy. Her brother was making all these weird choking noises, and his face was purple.

“I told the girl to shift into reverse, and she said, ‘I don’t know how!’ She was beyond freaked out, you know? She couldn’t fuckin’ move! The truck was in gear, if her foot would’ve slipped off the clutch, she would’ve chopped her brother’s head off, just like that.

“So I reached across her, and shifted it into reverse, then I lifted her leg just enough to engage the transmission to back the truck up. And when her brother fell to the ground, I reached in and shut the truck off, you know, so she wouldn’t run him over.

“I don’t know how long the kid had been stuck like that, but he didn’t look good. I mean, I thought he was dead. He wasn’t breathing, and his face was all purple and shit. I figured he needed CPR, you know, but I wasn’t gonna kiss him! So I just pushed on his chest, real hard, and then he started breathing again. And then he started looking better, and not all purple and shit anymore, and that was a big relief.

“I could hear sirens coming, so I figured an ambulance was on the way. So, I got on my bike and went to work. I didn’t want to be late.”

And that’s how my own bro became the Unknown Hero of Sauk Rapids. And he probably saved that kid’s life. I know his mother thought Tom had saved her son’s life. And his scared shitless sister did too.

I’m not sure if that kid ever tried teaching his sister how to drive again, but I doubt he ever tried teaching her by walking next to the truck with the door open again.

Tom wouldn’t stay the Unknown Hero. The next time he had to ride his bike to work, the entire family came running out of the house to thank him when they saw him pedaling down the road. They more or less adopted him as their official Wonderful Guy. A few years later when Tom almost got dead from a motor vehicle accident, they all came to visit him at the hospital.

* * * *

The accident my brother was in was because of something stupid Gary did while driving his car, and Tom was his passenger. Dan, Shorty and I would hear Tom’s version of the story, and Gary’s. Tom’s version won. And Gary was officially stupid, stupid, stupid.

Gary’s car was totaled in the accident, and his leg was smashed all to bits. He had to be put back together with metal rods and a lots of screws. He would spend close to a month in the hospital.

Tom had been hospitalized overnight for observation, and there didn’t appear to be anything wrong with him, so he was released the next day. I think it was a Sunday. I drove down to whatever little podunk town Tom and Gary had been in at the time of the accident to pick my brother up.

Tom and I were roommates at that time of our lives, and that would’ve been around January of 1980, I think. I had just started surgical technician school. We had an apartment across the street from the Vo-Tech.

A night or two later, my brother started complaining of severe abdominal pain, and his belly looked like a damn watermelon. I possibly helped save Tom’s life by recognizing his spleen had ruptured and got his ass to the St Cloud Hospital where he had emergency surgery.

Tom has never forgiven Gary for almost killing him to death.

But we all did stupid stuff back then, me and all of my friends from back in the day. Tom, Gary, Shorty and Dan. It’s probably more than a few miracles that any of us are still alive today.

Shorty almost killed me more than once, and he almost killed Dan to death and wrecked his motorcycle beyond all repair once. Dan almost got me dead at least once. I have no idea how many times I almost killed my best friends. You’d have to ask them. But we saved each other’s asses more times than any of us can count.

And that’s pretty much what life, and friendship, are all about.

And Deliver Us From Evil

I had my third session with Diamond Dave today. He performed his usual therapeutic assault on my body. And he also gave me a lots to think about.

Diamond Dave suggested I start sitting in a different chair at home. The fact that I haven’t gotten a lots better is somewhat confusing to both of us, so there has to be something still aggravating my back.

We have a couch, a love seat and kind of a captain’s chair in our living room. I rarely used the captain’s chair in Arizona, but it’s been a different story down here in Mexico. Lea and her kit-ten have taken up residence on the couch, and I started sitting in the captain’s chair. I figured it hadn’t gotten much use in the last nine years…

I had actually considered the chair as a possible suspect for my back problem prior to my appointment today. We’ll see how this plays out. Today, I’m semi-sprawled across the love seat, looking at the mountains on the other side of Lake Chapala. It’s quite lovely, actually. And once my back settles down after getting pummeled, I may even feel lovely myself.

The other thing David suggested is that I wear shoes whenever I’m not in bed. I think the chair is a much better suspect for the back pain I’ve been experiencing than my tendency to walk barefoot. But I’m willing to try anything if it means I can put this behind me.

That was interesting, but today’s major topic of discussion was energy.

* * * *

I may have mentioned this before, but I find Diamond Dave to be a rather interesting guy. And I’m pretty sure he’s a guy. David likes to wax philosophic about any number of subjects. And while I’m not sure exactly what sort of training one has to endure to become a Bowen Therapist, I think understanding energy flow has to be part of it.

I’m going to condense most of what David said into the next few sentences. After that, it’s all me. Humans are incredible energy generators. Think of feelings. In essence, a feeling is nothing more than emotional energy. The energy we generate can be positive. It can be negative. And it can be evil.

Now, as a guy, I am hardly an expert on emotions. If you doubt this, you can ask my wife. Guys have three basic emotions. Okay. Not okay. And pissed. We experience varying degrees of pissed, and these are expressed by the swear word in front of the word pissed. Guys can also be happy, but we use the word tits when we’re in that state of emotional bliss.

As a psych nurse, I knew something about emotions. Mostly that you need to tone yours down, okay? Most of my patients were emotionally out of control, that’s why they were in the hospital. And my job was to help them get a grip.

Unless they were evil. Then my job was to make them disappear as fast as possible and make sure no one ever spoke their name out loud again, ever. Or the evil people would be back.

I didn’t meet a lots of evil people as a psych nurse, but I met far more than I would’ve liked. Evil people are flat out scary, even when they’re trying to be nice. Actually, that might’ve been when they were at their scariest.

The two most evilest people I ever met were two people that had separately set themselves on fire. On purpose. They, and everyone else on the planet, would’ve been better off if they had been given another gasoline shower and a lit cigarette to finish the job. You might think that harsh, but I don’t really care what you think. Not about this.

There were very few people that effected me the way those two did. I would’ve killed them if I ever ran into them on the street. I’ve given this a lots of thought, and I’m pretty sure that’s a true statement. Seriously, I would’ve gone over the curb to run them over with my car while they stood on the sidewalk. And then I’d call the police and wait for them to arrive, but only if the burned people were dead. Otherwise, I would’ve kept running them over.

* * * *

As a Christian, I was raised to believe in evil, a very evil spirit named Satan. Once I decided to walk away from everything I had been taught about God, I also walked away from my belief in the devil. I was never able to stop believing in God, but I find it almost impossible to believe there’s an embodiment of ultimate evil anymore.

This is not to say I don’t believe in evil. I do. Evil exists, and it is very real. I fear its influence on the world in which we live appears to be growing stronger. I may not believe in Satan, but I’ve encountered some weird stuff getting lost seeking the Truth. Satan or not, there are some evil-ass things lurking out there in the darkness.

Satan is a Hebrew word that means opposer, or adversary. In the Book of Job, Satan appears in Heaven as kind of a prosecuting attorney if you will, that God allows to test Job’s faith. Satan is hardly the embodiment of ultimate evil. He appears to actually have been God’s ally.

According to Christian belief, Satan was thrown down from Heaven. Jesus said he witnessed this event. And because Jesus said this, it has to be true, right? Jesus was quite good at saying one thing while meaning something completely different at the same time. But if satan simply means opposer, well, this statement could mean that nothing that opposes God is tolerated in Heaven, and nothing more. And it still makes sense.

My dad didn’t live in Heaven, but he had a rule very similar to the above stated concept. My house, my rules. Anytime you decide you don’t like my rules, pack your bags and get the hell out.

I’m not sure when Satan transformed into the black-hearted sonuvabitch he is today. It was Satan that tricked Eve, right? No, it wasn’t. Satan is not mentioned as being in the Garden of Eden. There’s a serpent in the Garden, but the serpent isn’t named Satan.

There’s a common myth that Satan the devil used to be an angel of light named Lucifer that fell from grace and was banished from Heaven. And there’s the story that the fall of Lucifer came about because he refused the command of God to kneel before God’s masterpiece of creation, Adam.

In Milton’s Paradise Lost, Satan famously states, “Better to reign in Hell than serve in Heaven.” I’ve given this some serious thought about that scenario. I probably would’ve done the same thing as Lucifer. If any of those myths are true, Lucifer/Satan doesn’t appear to be evil, he appears to be some kind of genius. With morals, and integrity.

He probably has me beat.

The Greek word for Satan is diabolos, which means slanderer. Satan is described as the father of all lies. However, lying is not a sin, and God doesn’t seem to have had any problems with the fact that all of the people He initially chose to interact with would lie about something, or even a lots of things.

From my point of view, there’s nothing that opposes the Will of God quite as perfectly as human will, and pride. And if that is true, then Satan lives and breathes inside of all of us. If I do this, it will please God. But if I do this other thing, it’ll please me! To paraphrase Oscar Wilde, Lead me not into temptation, for I can find it all by myself. In my experience, if Satan does exist, he’s never had to break a sweat to get me to “sin.”

I also find the concept of sin interesting. At this point in my life, I think the only real sin is thinking we’re separated from God. And as for the Ten Commandments, those are the building blocks of an happy life. If you do these things, your life will be much better. I have some experience with this. Personally, I’ve broken nine of the Ten Commandments, and my life was pretty much a mess.

One of the most amusing things to me about getting back into the church is the current Christian view about Satan, and how he is constantly seeking to distract and derail good Christians from their faith. Satan, it seems, has all kinds of spooky superpowers.

My darling daughter, Gwendolyn, told me this story about a Women’s Breakfast she went to at her church. There were electrical issues at the facility, and one of the organizers said, “Well, y’all, I guess Satan didn’t want us to have pancakes this morning…” Because, apparently, there’s nothing that will precipitate a crisis of faith like not being able to eat pancakes. Especially in Texas.

* * * *

There’s one other illustration of evil in the Bible. It concerns the Grigori, or the Seven Watchers. The Grigori were a group of angels that were supposed to keep an eye on God’s human children, and teach. But somewhere along the way, while the Grigori were, you know, watching, they noticed that the daughters of men were totally hot, and they started doing a lots more than watching.

The Grigori weren’t evil, they were good angels. Neither were the cute and adorable farmer’s daughters the Grigori had sex with. The Muffys of the ancient world couldn’t help it if they were irresistible to angels.

But their children were evil in a way that the world had never seen before, nor presumably, since.

And that’s not where Noah and the Ark come in, if you believe this story. God didn’t want to wipe out the human race, he wanted to wipe out the mutant children of the Grigori and the cute and adorable Muffys of ancient times. And behold, there was a great flood.

God apparently chose to feel some sort of remorse afterwards, and promised to never flood the earth like that again, and created the rainbow to remind Himself of His promise, just in cases, God forbid, He forgets.

We should probably all pray that rainbows never go extinct.

And one last word of warning. If you ever encounter an angel, whatever you do, do not have sex with it.

Saving Captain Covington

One of the perks of working for the Federal Government is the amount of time you get off. For starters, you get all of the holidays. When was the last time you got Columbus Day off?

And, you get five weeks of paid vacation a year.

In April of 1995, I did something I had never done since I had started working at the MVAMC. I took two consecutive weeks off, but I did it for a good reason. My father-in-law had called, and said he needed help cleaning out his house after his wife had died.

Wanda had died the previous October after traveling all the way from the bottom of Texas to Minnesota to see her baby girl before her fourth abdominal surgery in three years. Wanda had had an heart attack after arriving in Minnesota, and needed another coronary bypass surgery before she could safely travel back to the bottom of Texas. She would die on the table in the OR, leaving a tidal wave of shock and grief in her wake.

My lovely supermodel wife called her sister, and plans were made. The three of us would drive down to the bottom of Texas and clean out Dave’s house. We would rent a truck, load that sucker up, then drive back home. I would drive the truck. Leslie would drive our car. Lea would ride with me or Leslie. Done deal.

Early Saturday morning on April 8th, Lea and I drove from our house in Minneapolis to just outside of Ettrick, WI where Bill and Leslie lived on their hobby farm, Pfaff’s Happy Acres.

I loved their farm. Bill had planted a bunch of apple trees, and collected himself an herd of miniature goats. He named all his goats after Biblical prophets. Amos. Isaiah. I think he even named one Elijah. And he had a girl goat named Ruth, of course.

Leslie had a kind of a miniature horse named Andy. Miniature horses are supposed to be, you know, small. But in the Spring of 1995, Andy went through a growth spurt, and had turned into a mutant, semi-large horse.

I was much taller than Andy the first time I met him. Andy was a few inches taller than me the second time we met. And he had developed a bad attitude.

As I was packing Leslie’s luggage in the trunk of our car, Andy grabbed one of the goats by the scruff of the neck and started shaking it around like a ragdoll. I raced into the house to tell Bill.

Bill was working as a consultant back then, and he traveled a lots. Bill had just returned from a trip to Philadelphia, where he had contracted a particularly virulent, though short-lived stomach virus, and he still looked a little green around the gills.

Despite his weakened state, Bill and I ran out to the barn to do try to save one of the prophetic goats from the psychotic horse. We were able to get the goat away from Andy, but we were too late to save it. Then Bill moved Andy into a different pen before he decided to kill any more goats, but Andy wasn’t exactly cooperative with the move, and Bill was shaking with anger and exhaustion by the time he was finished.

“I have a really bad feeling about this…” I whispered to Lea, as the goat we tried to save took one last gasping breath, and died. We said our good-byes to Bill, and climbed into the car, and headed off to San Benito, TX.

* * * *

It’s a little over 1500 miles from Ettrick to San Benito, and none of us felt like spending twenty-two consecutive hours in the car. Dusk was approaching when we reached Oklahoma City. We found an hotel in Purcell, OK, and checked in. We would resume our journey in the morning.

Lea and I were ready to roll early Sunday morning, but Leslie was not. She was pale and clammy looking. She just needed a few more minutes to compose herself. Before we hit the road, we stopped at a nearby Burger King for breakfast. Leslie took one bite of her breakfast sandwich, and turned a stunning color of green. She ran to the Ladies Room, and she stayed there.

“Maybe you should go check on your sister, and make sure she’s still alive.” I suggested to my wife.

“She’s laying on the floor.” Lea announced when she returned, and sat down to finish her coffee.

“What does that mean? Should we call 911?”

“No. She’s just being dramatic. She’ll be okay.”

This was my first exposure to the odd dynamics of my wife’s family. There would be more.

There was an Urgent Care office next door to the Burger King. I thought about dragging Leslie across the parking lot to be evaluated. She’s a much larger woman than her sister, but when Leslie finally emerged from the Ladies Room, she declined all offers of medical treatment, and crawled into the backseat of the car.

“Drive!” she ordered. I drove.

The next 700 miles were perhaps the longest miles of all our lives. Leslie was utterly miserable. She moaned and groaned and prayed for death.

“If she doesn’t shut up, I’ll fucking kill her myself!” Lea told me during one of our stops for gas.

As night started to fall, we pulled into Dave’s driveway. The first stage of our rescue mission was over. We had arrived safely, and more or less alive.

* * * *

Leslie looked a whole lots better on Monday morning. The Philadelphia flu had wreaked its’ havoc upon her, and then it was gone.

Lea and I slept in the guest room. Dave moved into his motorhome, so Leslie could sleep in the master suite. We usually went out to eat while we down in the bottom of Texas, except when Leslie or Lea felt like cooking. But I think those occasions were rare. The reason for our visit took an emotional toll on everyone.

Dave’s daughters surveyed the house like generals planning an invasion. They started sorting stuff into three piles: Leslie’s Stuff. Lea’s Stuff. Stuff No One Wants. The stuff no one wanted, like all of Wanda’s clothes, would be sold at a local consignment shop, or given away.

Leslie and Lea shed a lots of tears in the process. They understood the necessity of what they were doing, but it was tough duty.

Dave and I tried to stay out of their way as much as possible. He showed me his medals from the Army, two Purple Hearts and a Bronze Star, and casually told me how he got them. Dave had received a battlefield commission to captain during the Battle of the Chosin Reservoir in Korea after all the officers in his unit had been killed to death. He had only been almost killed, and as the highest ranking surviving NCO, he instantly became the commanding officer of what remained of his unit.

Dave had to have been the luckiest unlucky bastard I ever met. He was at Anzio in WW II, which was one of the worst places you could be at that time. And he was at the Chosin Reservoir, which was one of the worst places to be, ever. For all time. He was lucky because he wasn’t killed or captured, but he was wounded twice. And he was an emotional basketcase for the rest of his life.

He showed me his pistol, a .45 automatic, and offered to let me handle it because I had been in the Army, and I could appreciate it. But I had seen one too many handguns up close and personal, the last one during my vacation in Dallas with my buddy, Shorty.

I declined.

Leslie and Lea would occasionally question Dave about what to do with a particular item. He almost always opted to get rid of it. The sorting continued daily, the three piles of stuff grew progressively larger. No one else started exhibiting the symptoms of the Philadelphia flu, and I thought the rest of us were going to dodge a bullet.

Leslie felt like cooking on Wednesday. She made beef stroganoff, and she made a lots of it. We had a meal that couldn’t be beat, then retired to the living room to relax. After watching TV for awhile, we all headed for bed. And I started feeling not so good.

I can’t remember how many times I vomited, but by the time I finished, I knew one thing for sure. I would never eat beef stroganoff again.

Being sick is one thing, but being puking sick is the worst. Ever. I’ve rarely been puking sick in my life, even when I drank to excess, and I did that a lots. If I had been prone to vomiting, I might have been inspired to quit drinking sooner because I fucking hate puking.

I eventually crawled into bed, and started praying for death, much like Leslie had a few days earlier. I tried not to moan or whine too much because I knew what my wife had endured when she had been trying to survive her battles with Crohn’s disease.

But I was miserable. I eventually said this to my wife, “Honey, I hope you don’t think I’m a sissy or anything, but I’m sicker than a dog, and… I… want… my…mom!”

* * * *

By the next morning, I was pretty sure I was going to live, though I was feeling very shaky. And then Dave came into the house from his motorhome. We took one look at each other, and knew we had both fought the same battle.

Dave thought we all needed a break, so we got into his car and drove the short distance to the Mexican border to do some shopping and stuff.

Leslie and Lea walked around some of the streets of Reynosa while Dave and I parked ourselves in a little cantina and tried to drink a beer. It was perhaps the least amount of fun I’ve ever had with a beer in my hand.

We ate dinner at a Mexican restaurant in Reynosa, and I actually started feeling better. I was ready to back to the cantina, but everyone else wanted to go home. Lea said she wasn’t feeling too good. By the time we got back to Dave’s house, the Philadelphia flu was beginning its first assault on my wife’s already compromised body.

Lea’s health, or the lack thereof, had been the intense focus of our lives for the three previous years. She’d had four major abdominal surgeries, and had almost died at least three times. She had had about one third of her intestines removed, and had ended up with an ileostomy and an external pouch.

I wasn’t a medical nurse, but I knew enough about my wife and her medical issues to know she wouldn’t be able to survive the ravages of the Philadelphia flu without professional help. At the very least, she’d need IV fluids and electrolyte replacement therapy, or the consequences could be dire.

Lea ran into the house and down the hallway to the bathroom as soon as we got back to Dave’s house, and as the rest of us walked into the house, the phone rang. Bill was calling, from wherever he was in the world on business, and he needed to talk to Leslie. It was an emergency!

I had an emergency of my own to take care of. I tossed the phone to Leslie, got directions to the nearest hospital from Dave–fortunately, there was a little forty bed facility just a few miles from Dave’s–and helped Lea into the car, hoping she could get the medical attention she needed before she started having seizures. She said her muscles were starting to spasm, and I didn’t think a full blown grand mal seizure was far behind.

The local hospital had an emergency room. I got Lea checked in, and started explaining her complicated medical history to the admissions clerk while the staff started taking care of Lea. The ER staff all knew Dave and Wanda, and they assured me they wouldn’t let anything happen to Wanda’s baby girl.

But I knew this was going to be kind of an ordeal, no matter what anyone said. When I told the clerk at the desk my wife had an ileostomy, this was her response.

Illy-what? Can y’all spell that for me?

Like most ER’s, this one was busy. I gave the clerk a list of all the medications Lea was taking and the dosages of all of them. It was a very long list. I made her make a bunch of copies, and I would hand a copy to anyone that had anything to do with Lea’s care while we were in the ER. I stopped every staff person I saw, and told them I was a nurse, and what my wife needed. STAT!

The nurses in the ER were actually very helpful, and Lea had an IV running with a potassium piggyback running in no time. She didn’t have the same issue with vomiting that I had had, but her external pouch needed to be emptied constantly.

Lea’s nurse was a tall Texas blonde. Besides my wife, she was busy taking care of at least three other people, one of whom was a big hairy guy that had been brought in by a couple of Texas Department of Corrections Officers.

I don’t know what this guy had done, but I’m guessing jail isn’t anywhere near as much fun as they make it look on TV. This guy presented with chest pain, but didn’t appear to be in any apparent distress as he strolled into the ER. He had a big smile on his face, and he waved at everyone, making sure they saw the handcuffs on his wrists.

Per hospital policy, the big hairy guy was restrained to a litter because he came in under police escort. He totally cooperated with that, but he had stopped smiling. Once he was restrained, the tall Texas blonde nurse explained what was going to happen in no uncertain terms.

A nasal cannula was placed in his nose holes, and he was started on O2. An IV was started, and labs were drawn, using the biggest needle the nurse could find. And she made sure she missed his vein with her first attempt. Then she informed the big hairy guy she needed an urine sample.

“I can pee in a cup. I do it all the time for my PO.”

“Nope, y’all can just lay back and relax. I’m going to cath you.” And she did, using a catheter about the diameter of a small garden hose.

The big hairy convict guy probably wasn’t in any pain in any part of his body when he walked into the ER, but after roughly thirty minutes of tender loving care from the ER staff, he was hurting in at least two places.

“Hey! Take me back to jail! I’m good! Get me the fuck outta here!!” And once his lab results came back normal, back to jail he went.

* * * *

Just between you and me, that was the most beautiful intervention I’d ever seen on a malingering patient, ever.

A malingering patient endorses a plethora of symptoms to lengthen their stay in the hospital. We saw this all the time in Psychiatry. Some of our patients wanted to stay in the hospital as long as they could, for a multitude of reasons.

Some of them were homeless, and if you’ve never tried living on the streets, it totally sucks. Some of them were trying to avoid going to jail, and I’m going to guess that probably sucks, too.

It might have been legal to restrain a guy and stab him in the arm with a really big needle a couple of times, then shove a garden hose down his dick in Texas, but it wasn’t in Minnesota. If we had been allowed to use those interventions, we could have easily cut our recidivism rate in half, if not more. We couldn’t even carry tasers, which I thought every psych nurse should be issued, no matter which state they worked in.

Seeing how Lea’s nurse was busy taking care of a guy that didn’t need any care, I decided to take care of my wife because she did, and I was a nurse, too. I grabbed a box of gloves and a basin, and I informed her nurse each time I emptied Lea’s pouch, or she vomited, and the volume of fluids she expelled each time. Her nurse was grateful for the help, and offered me a job.

One of the other ER nurses heard I worked in Psych. She came over to quiz me about her ten year old son, who had recently been diagnosed as Bipolar. I can’t remember her name, but she was probably a couple of years younger than I was. She was kind of attractive, and clearly overwhelmed by the situation with her son, and practically started crying on my shoulder.

That seemed like a weird diagnosis for a ten year old to me, and to her, for that matter. I suggested she get a second opinion from a real doctor next time, and spent close to half an hour listening to her. I wished her luck, then we both went back to work.

Bipolar Disorder is a terrible disease.

Lea’s condition had stabilized somewhat. Her nausea had passed. She was no longer vomiting. In fact, I thought she looked good enough to go home, and even Lea thought she was going to be okay.

But given the fact she’d had multiple surgeries and she had an ileostomy, and then there was her family history of heart disease…  The ER doctor didn’t feel comfortable discharging my lovely supermodel wife, no matter what we said. He wanted to keep her overnight for observation, just in cases.

And that’s where the ordeal started. Given Lea’s cardiac history, the ER doctor wanted her to be admitted to a monitored bed. The only problem was there weren’t any open monitored beds in the hospital.

Now, you might be thinking, it’s an hospital! Aren’t all of the beds monitored? A monitored bed is hooked up via EKG leads and highly sophisticated circuitry to an alarm system behind the nursing station. If something goes awry in a monitored bed, alarms go off and every nurse on the floor goes running to that room with crash carts and oxygen and a shitload of medications to save a life.

I used to work in Cardiac Care, and I understood the rationale behind the ER doctor’s decision. So we waited for a bed. And we waited. And we waited.

The first symptoms of the Philadelphia flu hit Lea about 6:00 PM. I had called Dave’s house a couple of times with updates. My last call was probably around 10:00 PM. Lea was doing better, but the doctor wanted to keep her overnight. Dave said he and Leslie were going to bed, but they’d leave the door unlocked so I could get in the house when I got home. They’d see me in the morning.

When midnight arrived, Lea was still waiting for a bed. She was getting a little upset with the wait. I was way past that.

I’m an incredibly patient man. You can ask around if you like. But this situation was beyond ridiculous. I asked to see the Administrator on Duty, every hospital has one, and I wanted some answers. I was informed she was busy, of course, but she’d be down to see me in a few minutes

When 1:00 AM rolled around, I demanded to see the AOD. Now.

She actually came running into the ER. She was a very sweet woman who apologized profusely in her darling Texas accent. She offered her condolences to us. Wanda had been a friend of hers, then explained the difficulties she was facing.

There were a limited number of monitored beds in her hospital, and they were all currently occupied. She had called in the maintenance team, and they were moving heaven and earth to hook up a monitoring system in one of the rooms to the nursing station so Lea could be admitted.

In the meantime, was there anything she could do for us?

Well, yeah, there was. It was incredibly noisy in the ER. It was filled with a lots of unhappy people. Was there any place to put my lovely supermodel wife that wasn’t as loud and busy while we waited for the monitored bed was being set up?

Yes! Lea could be moved into a room in the ER, and a real bed could be put inside the room. Lea would be more comfortable, and the room would be much quieter…

Lea said that would be fine. And the very sweet woman left to see that this was taken care of immediately. And it was. As to how long it would take for Lea’s monitored bed to be ready, well, that was a mystery.

When 2:00 AM rolled around, I was falling asleep standing up. I told Lea I was going to go back to Dave’s house. I hoped her bed would be ready soon, but she was at least in a quieter place, and maybe she could even get some sleep, but I had run out of gas. I had to go.

I think I finally got back to Dave’s around 3:00 AM. I would find out later that Lea would wait in that room for at least another three hours before she was admitted to her hastily assembled monitored bed.

* * * *

I woke up the next morning around 9:30 AM because Dave knocked on the door and told me Lea was on the phone. My head was foggy, and full of cobwebs.

“Come and get me!” Lea’s voice said. She sounded terrible.

“Are you being discharged?” I asked. I was a nurse. I kind of understood how hospitals worked.

“No! The fucking doctor here doesn’t think I have Crohn’s disease! He wants to run a bunch of stupid tests on me! I told him to go to hell!”

“How did he take that?” I decided to ask.

“He’s not very happy with me right now.”

“How’s everything else going? Are you getting your meds?”

I knew getting her meds right would be complicated. That’s why I handed out a list of them to everyone, hoping the floor nurses would get a copy and get them ordered.

“No! I haven’t gotten anything! Not even morphine!”

“I’ll be there in ten minutes.”

I was so pissed I was shaking. I almost asked Dave for his gun.

* * * *

Lea wasn’t in the best of shape when I had taken her to the ER, but she looked even worse when I arrived at the hospital the next day. She was drenched with sweat, and writhing on her bed. I was a nurse, and I was a very good nurse. I knew what what was happening to her the moment I laid eyes on her. My wife, was going through serious opiate withdrawal.

I went to the nursing station, then tracked down her nurse in the hallway, and I tried to be polite, at first.

“Excuse me. I know you’re incredibly busy, but my wife is in that room down there at the end of the hallway, and you need to come see her now, please.”

Lea’s nurse was a young-ish slob wearing light blue scrub bottoms and a multicolored top about the size of a pup tent. She kind of shuffled when she walked, and her hair looked like it hadn’t been combed since March.

“Yeah, I’ll be down there just as soon as I can. I’m doing something right now.”

“I’m sure you are, but have you seen my wife lately? She hasn’t gotten any of her meds yet, not even her pain meds, and she’s going through withdrawal.”

“I haven’t had time to go over her meds yet. Like I said, I’m doing something right now.” she replied, not even bothering to look at me when she talked. And that was the last straw for me.

“You listen to me, and you better hear every word I say.” I said softly, but loud enough for her to hear me clearly. “I’m a nurse, too. So when I tell you you need to come to my wife’s room now, I mean right fucking now. And if you don’t do as I ask, I’ll have your ass in front of the Board of Nursing before your shift ends. Now, move!”

I appeared to have gotten her attention. She stopped doing whatever it was she’d been doing and turned to look at me for the first time. I nodded in the direction of Lea’s room, barely controlling the urge to push her down the hallway.

“Oh my word!” she said when she entered Lea’s room and saw my wife.”She didn’t look like this the last time I was here! Let me go check her meds. I’ll be right back, I promise!”

“That’s bullshit.” Lea said, as her slob of a nurse shuffled out of her room. “I’ve been like this for at least an hour!”

“Well, let’s give her a minute to fix this. Then I’ll kill her.” I said. I was only partially joking. It’s probably a good thing I didn’t ask Dave for his gun. Unlike Hillary, I probably would’ve used it.

In a very short amount of time, Lea’s nurse returned with a syringe filled with Demerol. She injected the drug into a port in Lea’s IV tubing, and by the time she shuffled out the door, Lea looked a whole lots better. My wife exhaled a huge sigh of relief, and smiled.

“That’s better!” she said.

“Can you walk?” I asked. I was making an assessment. Lea was wearing a hospital gown and a pair of panties. The only clothes she had with her were a pair of denim cutoffs, which I pulled out of the closet and handed to her. She didn’t even have a pair of shoes. I had taken her purse and the rest of her clothes home with me when I left the ER.

“Yes. I’m fine now. Why? What are you thinking?”

“I’m thinking if I don’t get you out of here, you’re going to die.”

“Then get me out of here!” she said, and pulled on her shorts.

I disconnected Lea’s IV, and covered her IV site with gauze and tape. Then I started disconnecting the leads of the monitor. This was the tricky part. Lea was in a monitored bed, and the moment I started messing with her leads, all kinds of alarms would go off. A veritable army of nurses would descend upon us, and even her slob of a nurse would eventually shuffle back to her room to check on her.

But a funny thing happened when I disconnected the first lead.

Nothing.

No alarms went off. No one came running. And I got even more pissed off, if that were possible. When Lea was disconnected from all her equipment, we walked out of her room, down the hallway past her slob of a nurse, who was so busy doing something she didn’t notice us walk by her, and got on the elevator.

We walked out the front door of the hospital, my barefoot, hospital gown wearing lovely supermodel wife and I, across the parking lot, and I drove us back to Dave’s house. I think we laughed the entire way.

* * * *

Dave was waiting for us at the front door when we pulled into the driveway. He had a puzzled look on his face.

“Mark! The hospital is on the phone!” he said. His expression was also one of concern. “They said you took Lea out of the hospital without permission! They want you to bring her back, right away!” Lea was his daughter. And he had just lost his wife a few months earlier. I don’t know if he ever understood how many times his daughter had almost died in the last few years, but he clearly thought I had done something to endanger her life now.

“This is Mark.” I said into the receiver. Lea was explaining what had happened while she was in the hospital to her her father and her sister, and that way her family would know I wasn’t trying to kill her to death.

“Mr Rowen, this is the hospital administrator.” a male voice said into my ear. “I understand you and your wife have had a bit of a bumpy ride while you were here, but we would certainly like the opportunity to fix that. You’re a nurse, right? You have to know your wife is very sick!”

“Yes, I know.” I replied. “And I’d like to keep her that way if you don’t mind.”

“I…I don’t understand, Mr Rowen.”

“Yes. My wife was very sick, but your hospital did a great job and she’s doing much better now.”

“But your wife is still very sick.”

“And, she’s still alive, and I’d really like to keep her that way. However, if she had much more care at your facility, I don’t think she would be.”

“Now, Mr Rowen, that’s–”

“I agree. That’s more than quite enough.” I interrupted, and hung up the phone.

We had driven from the top of the country to the bottom of the country to help Dave do something he didn’t have the heart to do himself. And it was a task that nearly broke the hearts of my wife and her sister. They were clearing their father’s home of most of the items that reminded him of his dead wife, and collecting the items that reminded them the most of their mother.

We had all come down with the Philadelphia flu, and we had all survived. Even Lea. There had been one casualty, an innocent goat had been murdered by a homicidal horse, but that had been way back in Wisconsin, before we had actually set off for the bottom of Texas.

Thank you, God, I thought. And I also thought at least nothing else could go wrong on this trip, and that the worst was over.

But life is a funny thing sometimes. And while there might be times when things can’t get any better, things can always get worse.

Sometimes, they can get a lots worse.

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.

Glenda K

Glenda was one of our patients at the Banner Del E Webb Medical Center. Prior to being acquired by BannerHealth, Del Webb and its sister facility, Boswell Hospital, were managed by SunHealth. SunHealth was a very small fish in the large healthcare pond in the Phoenix area. When Banner offered to purchase their facilities, SunHealth quickly agreed.

The employees weren’t thrilled with the acquisition. SunHealth was a very good employer. The mostly elderly population that used and staunchly supported the SunHealth facilities were extremely upset. Del Webb and Boswell hospitals were their hospitals. They didn’t want a bunch of strangers roaming the hallways of their getaway retreat hospital spas.

That’s exactly how they thought of them.

Those little old ladies even had bake sales to raise money for a new MRI machine! Do you have any idea how many cookies that is? That’s, like, a trillion fucking cookies!! Maybe they should’ve put on some cute outfits and stood on the corners in Sun City and Sun City West…

Gero/Psych nursing is a sub-specialty area of Psych nursing. Elderly psych patients generally come pre-equipped with a whole slew of medical issues, and all of those issues have to be effectively managed, as well as the psychiatric disorders they are admitted for.

Glenda was an older gal, all of our patients had to be at least fifty-fifty years old. Most of our patients were closer to one hundred seventy-fifty years old. Glenda was married, and she was a hot mess. Her husband was a sweet, supportive, long suffering man.

Glenda had asthma, emphysema and COPD. As a result of her respiratory disorders and diseases, she suffered from chronic anxiety and depression. She was a very frequent flyer on the SAGE Unit, the Gero/Psych Unit at Del Webb. I would get to know her and her husband very well in a relatively short amount of time.

In all honesty, I was extremely uncomfortable in Gero/Psych. I was not a Real Nurse. I was a psych nurse. I had worked in a strictly psychiatric setting for twenty years. When we had patients that were that physically sick at the VA, we transferred them to a Med/Surg Unit. I had to learn how to start an IV, how to draw blood all over again–even do blood transfusions. 😓 In order to transfer one of our SAGE patients to a Med/Surg Unit, they essentially had to be dead.

If you don’t use those skills, you lose those skills. I had to be retrained in almost everything. It was good to be able to master all those skills again, but I had the same underlying fear that I’d had way back in nursing school. I was sure I was going to kill one of my patients, or in a worst case scenario, all of them.

When my senior manager offered me a clinical management position, I took it out of self-preservation.

Glenda was probably what you would consider a difficult patient. We certainly did. She was anxious and depressed at home, so she desperately wanted to be hospitalized. She was depressed and anxious once she was admitted to the SAGE Unit, and she’d demand to be discharged. That’s where I came in. The staff nurses would call me and ask me to come try to reason with Glenda.

As a clinical manager, I didn’t have anything to do with her patient care, but I had a lots to do with patient and family education and satisfaction. One of my managerial duties was to round on a random sample of the patients on the SAGE Unit to assess their rating of the service being provided to them. In the world of BannerHealth, everything revolved around Patient Satisfaction Surveys. And do you know what I discovered? Old people suck!

Man, they hated everything!! That’s when I started calling them Raisins, the sunbaked asshole/bitches that they were. It was almost impossible to get them to give us high satisfaction ratings on any service we provided on those goddamn surveys, and we needed at least an eighty percent satisfaction rating or there was hell to pay! 😭😭😭

I had worked in healthcare for twenty years by this time. I knew when we were doing a great job. I knew when we were doing a bad job. The SAGE staff was extremely talented, and they did an amazing job. They should’ve gotten elevens on a scale from one to ten.

My Filipino Posse, that’s what I called them–a lots of the RN’s were from the Philippines–Al, Julius, Liligene, Wei, Jing. Julie and Ethel. I loved them all. Well, most of them. Almost all of them were great nurses. Except two. And everyone knows who they were. And they weren’t Julie and Ethel. Those two were so darlingpreshadorbs!!

I worked with another rockstar nurse there, Rhonda Dolatshahi. Rhonda told me she wanted to be listed in one of my Reflections posts someday. Well, Rhonda, today’s your lucky day.

I told she’d have to be naked in the story I wrote. So I want to thank Rhonda for coming into my office, closing the door, and taking off all her clothes and saying, “You’re a nurse. What do you think this is?”

Yeah, that never happened. Unfortunately.

Where was I? Oh, yes. Glenda.

Glenda was unhappy about everything. The nurses were rude. They weren’t doing anything to help her. They never answered her call light when she turned it on. And so on, and so forth. Blah, blah, blah.

I did a lots of redirection and refocusing with Glenda. I doubt I did much of anything to actually change Glenda’s mind, but I did spend a lots of time with her, and that’s probably all she really wanted.

But there was that one thing about Glenda. And that one thing was her tooth.

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Glenda had one tooth. And it seriously looked like that picture. She had dentures, but she rarely wore them. So when I went to listen to her litany of complaints, her tooth jumped into my field of vision, and it was the only thing I could see. It was like her tooth was talking to me. It was like watching a train wreck. I wanted to look away, but I couldn’t.

I stared at her tooth as if it were the only thing that existed in the world. I knew I was staring at her tooth. And so did Glenda. She eventually started putting a finger to her mouth when she talked to me, obscuring her mutant tooth. I actually laughed the first time she did it. So did she, come to think of it.

Glenda’s respiratory problems eventually got the best of her. She died at home, thank God. You wouldn’t believe the amount of paperwork involved when someone dies on a psych unit. And there’s always a follow up investigation, even if the person dies from natural causes.

Vaya con Dios, Glenda. I have to believe you went to a better place, and you’re at peace now. And you have all your teeth once more.

Sorry about that whole staring thing.