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.

The Time Machine

I used to facilitate a lots of groups back when I was a psych nurse. Just in cases you didn’t know this, there are two types of psych nurses: those that love to lead groups, and those that don’t. There’s no middle ground.

That’s the truth. You can ask around if you like.

I loved doing groups. Probably not a big surprise there. I did groups on mental illness, medications, Cognitive Behavioral Therapy, cardiac health, whatever. I did groups on stuff no one had ever heard of before, like, the Ghost Dance of the 1890’s.

Maggie, did not like groups. She hated them. I worked with Maggie at the MVAMC. She wasn’t one of the best nurses I ever worked with. In fact, she was probably one of the worst.

Maggie would come to work early and check out her patient assignment, and then she started charting. Before her shift started, and before she even assessed any of her patients. She wrote the same two sentences on all of her patients:

Met with pt. Says he’s okay.  XOXO, Maggie.

Something like unto that. Everyone knew she did that, even her patients knew she did it. She spent most of her shift sitting behind the nursing station drinking coffee and taking cigarette breaks. Marj, my horrible boss, knew Maggie’s charting routine. And this is what she did about it.

Nothing.

Marj was an horrible boss in more ways than one.

* * * *

Want to hear a funny Maggie story? She had come in early and had done all of her charting before her shift started, as usual, and one of her patients had a seizure around the end of our shift. We called a code and ran down to his room to take care of him. And Maggie said this, “Goddammit! I just finished charting on this guy! I’m not writing another note on him!”

And everyone in the room stopped what they were doing, and turned to look at her. Even the guy having a seizure…

Another Maggie story. One of her patients had a condom cath, and she was supposed to remove it. A condom cath is pretty much what it sounds like. It’s an urinary catheter in the form of a condom. You unroll it you apply it, and it sticks to a penis like glue if it’s applied correctly. There’s actually an adhesive on the inside of a condom cath.

I probably put that catheter on that guy, so it was properly applied. Maggie had never removed one, so she asked me to come along. She told the guy what she was going to do, grabbed the tip of the catheter, braced one foot on the frame of his bed and started pulling, like she was trying to land a blue marlin or something.

I just about died to death. And you should’ve seen the look in that guy’s eyes. I made Maggie stop, and took it off myself. That guy thanked me every time he saw me.

And, one last Maggie story. Patient assignments were done by the charge nurse. I decided to have a little fun with Maggie one day, and assigned her to lead groups. Maggie just about had a fucking seizure.

“Are you kidding me!” she confronted me when I walked onto the unit that day. “I’m going to walk in there and look like an idiot for the first time!”

“Oh, it won’t be the first time.” was my response.

* * * *

One of our patients at the MVAMC was a guy we called Forrest Gump’s Smarter Brother. He kind of looked like Forrest, and although he was smarter than Forrest, it wasn’t by much. I can’t remember his real name, but he wanted us to let him use our time machine so he could go back in time to undo some horrendous mistake he had made years earlier.

I can’t remember what he’d done, but wasn’t something of all that much consequence, as least as far as the staff was concerned. I think most of the people involved in the care of FG’sSB all thought the same thing: Hell, I’ve done worse stuff than that! That wouldn’t even be in my Top Ten!

It probably wouldn’t have been in my Top Twenty-five. Or Top Fifty.

The Time Machine is the classic novel written by H.G. Wells in 1895. It’s been adopted into several movies and TV shows. My personal favorite is Time After Time, 1979, starring Malcolm McDowell and Mary Steenburgen. It’s a romantic thriller where H.G. Wells travels to the future chasing Jack the Ripper.

I thought it was a great movie.

At any rate, a lots of staff members at the MVAMC talked to FG’sSB, and they all told him the same thing. We don’t have a time machine, but he refused to believe it. He was probably a little delusional, that guy.

Psychosis and delusions generally go hand in hand, like anxiety and depression. But I don’t remember him being that psychotic. He just wanted to use our time machine, and he was convinced we had one, probably somewhere in the basement. Where else would you store a time machine?

Delusions are incredibly difficult to treat. A delusion is a fixed false belief, and once a delusion is born, it never really dies. You know, like that one guy who wants to be a prophet someday.

According to some psychologists, all religious beliefs are delusions. And, the popular response to that would probably be something like unto, Um, not mine. Those other guys, maybe. But my God, is real!

I wasn’t FG’sSB’s nurse, but I had heard about him in report. One day, one of the docs had just spent about half an hour trying to convince FG’sSB we didn’t have a time machine, and I started laughing.

The doctor was one of our residents, and he walked over to me. He said something like unto he didn’t think this was funny, and added if I thought I could do a better job, I was more than welcome to take my best shot.

So, I did.

“Yo, FG’sSB. Let’s talk. You’re right. We do have a time machine.”

“What!?!” the resident doc shouted.

“I knew it!!!” FG’sSB exclaimed.

“But let me explain how time travel works. Have you ever heard of the Law of Equilibrium and Balance?”

“N-No…”

“It’s the primary principal of time travel. In essence, you can’t go back in time to undo a mistake. The only thing you can do is replace the mistake you made with a different mistake. Do you understand what I’m saying?”

“Yeah, I think so…”

“That’s why the Federal government won’t let anyone use the time machine anymore. They tried it a couple of times. The Feds have made a lots of mistakes over the years, right?” I said, and FG’sSB nodded his head in agreement.

“Look. I’m not supposed to tell anyone about this, but I used to be a data analyst for the CIA, and I had access to all kinds of super top secret files. The Feds have a base somewhere in Greenland, and that’s where they did their tests with the time machine. The first time they tried to change something in the past, the Nazis ended up winning World War II.”

“No way!”

“Way! The Nazis ended up developing the atomic bomb before we did, and they nuked America off the face of the planet.”

“Wow!”

“So the Feds learned something from their experiments. You can’t actually fix anything by going back in time. You can only make things worse. They ended up having to go back and repeating their first mistake again to fix the shit they tried to fix! There has to be balance, get it?”

“Oh. I didn’t know that. So, if I went back in time…”

“You’ll only make everything worse. Do you still want to use our time machine?”

“Um, probably not. I don’t want to make things worse…”

Home run.

The best part of that, the resident doc came up to me and said this: “That, was the most incredible thing I’ve ever seen.”

* * * *

I have no idea if there’s an actual Law of Equilibrium and Balance. And while time travel is theoretically possible, I’m not sure it’s actually possible. But it sounded convincing enough to FG’sSB that he abandoned his quest to travel back in time, and he was discharged shortly afterwards.

And I probably wouldn’t have tried that intervention on everyone, but I knew it would work with FG’sSB. You can’t talk someone out of a delusional belief, but maybe you can use their delusion against them, so to speak.

There was a guy named Steve that was a frequent flyer at the MVAMC, and every time he came in he accused the nursing staff of trying to kill him, and there would be an investigation. So I said this to him, “How many times have you been here? The nurses here are highly trained professionals. If we really wanted to kill you, you would’ve been dead years ago.”

He never accused another nurse of trying to kill him to death.

* * * *

I’ve met more than one person that wished they could go back in time and undo some of the things they had done. I’m sure I’ve wished I could do that myself.

One of my desperately seeking time travel patients was Kathleen. She was at Aurora, and the first time I met her she was laying in bed, crying. I checked on her several times, and that’s what she did all morning.

At noon, I went into her room and said, “Hey, Kathleen. If you want something new to cry about, your lunch is here.” She got up to eat, and eventually stopped crying. And then we talked. Kathleen didn’t want to go back in time to change one thing in her life. She wanted to change all of it.

“Let’s say you could do that. Do you really think you wouldn’t make any mistakes if you could live your life over? As near as I can tell, everyone makes mistakes. I know I have. But those are the things that taught me my most important lessons. I might have had to repeat some of those lessons a few hundred times before the lights came on, but I wouldn’t be who and what I am now if not for those lessons learned.”

And then I told her about FG’sSB. And I told her some of the stories about my crazy life.

“And he believed your story about the time machine?”

“I’m evidently quite a convincing liar.”

“You must be. I can’t tell if you’re telling the truth or not.”

See? I told you.

“And you look pretty well put together now.”

“Years of putting together the pieces of my life. And now it’s your turn. Time to get your head out of your ass and get moving. Go take a shower. You’ll feel better.”

* * * *

My lovely supermodel wife and I went for a walk down the Malacon in Ajijic yesterday. We’re planning to go for a walk down the Malacon in Chapala tomorrow. It’s supposed to prettier than the one in Ajijic, and the Malacon in Jocotopec is supposed to be the prettiest of them all.

I’ll bring my camera, and take a lots of pictures. I’ll post them on my Facebook page. This place is incredibly beautiful.

That should help me achieve better balance and equilibrium in my new life. I had no idea transitioning into retirement would be such a tricksy thing. If I had known that, I would’ve planned a little better, maybe. I might not have believed it.

There’s a couple of football games today to determine which teams will meet in the Super Bowl. I think Jim and Veronica are hosting a Super Bowl party. I’m going to make chili. It’s the only thing I cook anymore, but it’s the best damn chili you’ll ever have.

It takes a couple days to make the World’s Best Chili. If you want the recipe, let me know…

Let’s see if I’m any closer to being a prophet. Falcons over the Packers. Patriots beat the Steelers.

If I’m right about that, I’ll make a Super Bowl prediction.

Diagram of a Defense System

Back when I was a psych nurse at the MVAMC, I worked with a lots of Vietnam vets. They were struggling to find their way through the morass of PTSD symptoms they were suffering from, mostly unsuccessfully.

PTSD is a complicated disease. It’s symptoms are legion, and stealthy. They’re like unto an army of ninjas, and just like ninjas, they attack without warning.

In an attempt to help my brother veterans gain some insight into what they were fighting, I came up with this presentation to help them see what they were up against.

Imagine your life as a game of chess. I actually used chess pieces in the group. I arranged them on a table and moved them around as I explained my idea.

Your opponent attacks. You go on the defensive to protect your position, and the pieces you employ are defense mechanisms. These are tools we use every day of our lives. There’s nothing inherently wrong with this. Defense mechanisms help us survive. But, do you have any idea what kind of weapons you’re using. Or why?

What I’m talking about is something I call a defense system. Anytime you have more than one component, you have a system. Think of it like unto an home theater stereo system. Multiple components working together to produce an integrated effect.

That’s what your defense system does. By utilizing a series of connected mechanisms, you create a buffer zone to keep you safe from the world around you. There are hundreds, maybe thousands of defense mechanisms, but let’s start with the basics. There are three fundamental building blocks that every defense system is built upon.

Repression. Suppression. And Denial. After that, the sky is pretty much the limit, but let’s start here.

Repression. If you’re confronted with a traumatic memory, your brain will automatically repress it. This reaction is hardwired into your brain. You don’t even have to think about it, it just happens.

Suppression. When repression doesn’t work, this kicks in. This takes some conscious effort, but these two mechanisms work together, and they’re pretty damn effective. But life can be complicated, and sometimes you need a lots of tools to get a job done, right?

Denial. When repression and suppression don’t work, you have to start bringing in the big guns. With denial, you can make stuff disappear. Denial is a total negation.

It did not happen.

Defense mechanisms are powerful weapons. And they are mobile! They can be deployed wherever they’re needed, and there are ga-zillion of them. You can lock and load and secure the perimeter, and blow shit up with a thousand different kinds of armament.

Minimization. Take a big problem, and make it small.

Maximization. Take a small problem, and make it big.

Rationalization. Logically analyze anything to pieces until it dies of boredom.

Intellectualization. Logically analyze something to pieces until it commits suicide to get away from you.

Shuffle the deck and play them when and where you need them. You can do this shit all day! And there’s a lots more where those came from. Deflection. Projection. Sublimation. Humor. Drug and alcohol use. Do a Google search. There’s a list of defense mechanisms a mile long.

But any effective system needs a fuel supply to keep it up and functioning. And we have that, too.

Anger!

Anger is almost always a secondary response. The precursor might be fear, or shame, or guilt–and it might only be present for the blink of an eye. None of us like feeling that way, but anger. Yeah, were good with that.

Anger, is a powerful fuel. And I’ve seen you guys. Anger is where all y’all have been living. Anger can also be a defense mechanism. No one wants to be around an angry person. Anger is like an electric fence. Only an idiot pisses on that, right?  Anger is like one of those multi-tools. It can do a lots of stuffs.

There’s one major downside to anger. It’s exhausting! I can stay angry for a couple weeks about something my wife or daughters do, and then I have to let it go. It wears me out. You guys have been pissed off for what–twenty or thirty years? How’s that going?

And what happens when you run out of fuel? Everything shuts down! The walls come crashing down, and then what?

Your defense is breached. You have to fall back. You bunker up. You run!

Yeah, you do all those things, but then you have to find a way to get your system back up and running, and that’s not easy to do when the enemy is looking over your shoulder watching you. That’s what brings you guys here. This is the place you come to when your defense system crashes, and you can’t do it on your own any more.

I mentioned drug and alcohol use earlier, but it’s such a pervasive problem I want to take a moment and talk about it. Eighty percent of the people that come here for treatment have a secondary diagnosis of drug or alcohol abuse.

Only eighty?

Well, it could be higher, but that’s the statistic the administration here likes to throw around. I know I’ve tried these methods myself, and while they might be effective in the short term, they are completely ineffective in the long term.

Alcohol is a depressant. If you’re not already depressed, you’ll end up that way if you abuse alcohol long enough. Also, mass consumption of alcohol tends to short circuit the wiring of your defense system.

Yeah. That’d be true for me. That’s why I quit drinking.

I had not quit drinking, so it’s more than a little ironic that I was telling someone else to take a look at their drinking habits when that’s what I needed to do myself.

Well, there you have it. I’m not telling you guys to quit drinking. I’m just throwing this out there to give you something to think about. But even if alcohol isn’t an issue, look at all this other stuff. We all have these invisible walls that protect us from stuff we don’t want bombarding us. But it probably works in reverse, too. We’re expending all this energy to keep stuff from getting to us. How easy is it to let our emotions out?

Is it easy for us to let someone know we love them? These walls we have constructed are well built, and they are strong! But in the end, we have essentially created a state of siege mentality–nothing gets in, nothing gets out, and we have stopped living, in exchange for simply…existing. And I know what you’re all thinking, What the fuck am I supposed to do?

I don’t have any answers for your questions. I don’t have any solutions to your problems. Hell, I don’t have any answers or solutions for mine. But we have to start somewhere if we’re ever going to get our lives back.

Awareness is the first step. Once you’re aware of a problem, you can start to do something about it. What you do, well, that’s up to you. You’re gonna have to figure this out for yourself.

I been watching you, Mark. I see you up at the nursing station. Sometimes you just sit there, and stare. You have PTSD, don’t you. You’re one of us, ain’t you.

That was a guy named George. He diagnosed me in that group. I have to admit, I was a little freaked out to hear that. But I couldn’t argue with what he said.

The Nam vets called it the Thousand Yard Stare. Someone could be standing right in front of you, and you’d never see them. You were seeing shit in your head ten thousand miles away.

But however freaked out I might have been, it was nothing compared to what the guys in my group were feeling. They came up and analyzed the chess pieces as if they were going back into combat.

When that guy tried flanking you here–it opened a breach when you redeployed there. Your back is to the river…  You have no drop back position, no place to regroup. You’re about to be overrun.

We all are!

The guys in my group practically ran out of the room.

* * * *

About ten years later, I presented this to concept to my AA group, Squad 46, the bestest squad in all the land. And when I finished, I was met with

Silence.

My group members finally came out from the tables they had been hiding under, and discussed my presentation. I’ve discussed bits and pieces of it with a lots of people over the years, but I’ve only presented it in its entirety twice. This makes three.

Sometimes I think it’s the most significant idea I’ve ever imagined, mostly based on the reactions of the people I presented it to, not because it’s actually been proven to be an effective therapy or educational tool.

Oh, and I do make the World’s Best Chili.

Most of the time I don’t think about my concept of an organized defense system at all. But I did this morning. Maybe someone will find it useful. And that’d be cool.

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.

The Jawbone of an Ass

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

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

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

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

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

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

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

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

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

It takes an awesome skill set to effectively manage that.

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

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

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

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

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

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

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

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

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

“You asked for it.” Melissa replied.

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

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

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

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

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

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

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

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

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

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

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

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

Like that was going to happen.

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

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

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

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

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

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

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

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

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

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

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

Get out and vote.

The Witch Queen of New Orleans

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

To Sleep, Perchance to Dream

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Didn’t do a thing.

Next night, get an order for an extra dose.

Didn’t do anything.

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

Didn’t do a thing.

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

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

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

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

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

Anyone want to guess how many days that might be?

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

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

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

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

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

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

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

“Can’t you call the doctor?”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“Never trust a man that says trust me.”

The Muppet Woman

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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