Before I became embedded in the world of pediatric oncology, I toyed with the idea of mental health nursing but because of my own mental illness the idea of treating patients with wonky neurotransmitters felt too close to home. I started nursing school at New York University, still unsure of what kind of patient I’d want to treat. We were assigned a different clinical rotation every eight weeks. My labor and delivery rotation taught me how little I enjoyed obstetrics. My geriatric rotation taught me that I’d rather be in a Turkish prison than work with the elderly. My pediatric rotation was perfect and would lead me to my future career. And then, there was my psychiatric rotation.
I was assigned a psychiatry rotation at the mecca of mental illness: Bellevue Hospital. The hospital was originally named because it had a “belle vue” – a beautiful view of the East River – and that little piece of trivia made my experience there all the more ironic. There is no beautiful view from the locked unit at Bellevue. You can see a sliver of the East River, but only through the space between the bars on the windows. So if you try hard you can grab a three-inch “belle vue.”
On the first day of the rotation I showed up in my white uniform. White is the single worst color a nurse should wear, given what ends up splattered and spat all over it. It is as archaic as it sounds. Originally meant to resemble nuns clothing, , nurse’s uniforms were long, white, shapeless gowns. White represented sterility, of course. Ironically, nurses rarely wore gloves or masks when the profession began -- the white gown was all they needed to protect them from patient’s germs. Thankfully, no nursing caps were required in the late ‘90s. I couldn’t bear that indignity.
Nuns and nurses. How far apart are we, really? There have been many times I’ve felt more like a pastor than a clinician. At the end of the day, we both tend to human suffering. Nuns have god as their muse. Nurses have compassion as theirs. Sometimes we pray as hard as nuns. We pray for a decent shift and to be able to eat lunch. We pray that we can take away some pain and make things better, even for just one hour. Like nuns, sometimes our prayers are answered with a resounding NO.
The lobby in Bellevue is an enormous vault-like room with security officers everywhere. It’s old and cold and smells like strong antiseptic masking urine. Like someone peed in a Listerine bottle. My fellow nursing students were noticeably uncomfortable. So was I.
We showed our badges to security and were buzzed into the hallway. It was painted the most depressing shade of yellow I’d ever seen, as if all the brightness of the color sucked from its hue. Scratches and dents marked the paint. I assumed they came from the kickers and screamers.
We were led to the conference room where the doctors and nurses presented the patients in short blurbs: “suicidal ideations overnight,” “paranoia intensifying,” “cheeking her meds this morning,” were reported with no affect. Matter-of-factly, they say that Joe in Room 112 was up all night yelling at the invisible army sergeant sharing his room. This is a different world, I thought. This is raw insanity I can’t relate to. Fascinating from afar. From the warm, lighted conference room that smelled like bad coffee and deodorant. This was alien.
My patient was a clean, middle-aged man named Rob. His front tooth was chipped, he had a scraggly, salt-and-pepper beard and looked like he desperately needed a sandwich. He was charismatic and smiled often. I enjoyed him from the moment he said, “We’re gonna have a great time together, you and me!” I thought so, too.
Rob had been brought to Bellevue by the police the night before, when they found him bathing in the Washington Square Park fountain. He was combative and when he threatened to drown himself (how that would possibly go down, no one knew, given the depth of a fountain), they 1013’d him. A 1013 is when the police, a family member, or a physician can admit someone to a psych facility, for up to 72 hours, against your will. Rob was well known to both the police and the hospital staff. He was on hour twelve of admission when I met him. He smelled fresh – likely from the Bellevue shower and not the park fountain. I was relieved. I looked at his chart and saw that it was his eleventh admission that year. I don’t remember his official diagnosis, but it was something with “depressive’ and “psychotic” in it.
I knew depressive. It made sense to me. I knew it like I knew my name. Psychosis just seemed…well, psychotic. It was foreign to me and conjured images of homeless, muttering people who smell. But Rob was different. He was happy and alive and funny. And he was a handsome man under the scraggle. His eyes were bright. He looked like a man with the potential to do great things. He was smart and eloquent and would’ve likely been a man that did great things if he was wired differently.
When I asked Rob why he decided to bathe in the park fountain, he quickly answered:
“Because I knew it would bring me joy.”
How simple. How adolescent. How liberating, I thought.
“Look,” he said, with his bright eyes oozing mischief, “I don’t often feel joyful. When I do, I gotta suck all the marrow outta that joy. I can’t be sure when it will happen again. That moment needs to be lived right away. Like you can’t even wait a few minutes if it comes, ya know? Because it may never come back….. It may not.…. What’s your name again?”
“Pamela,” I said softly, with a voice full of pity. I’m sure my face betrayed my condescension.
“Well, listen here, little Miss Pamela. Did you know, did you ever consider that you might never have another moment of joy again? When the spirit moves you, you grab it.”
We talked for nearly three hours and I found myself sort of falling in early love with him. He had that power.
I sat next to him in group. Group consisted of eight or nine patients sitting in school chairs in a circle and talking about their challenges on the ward. The therapist was a young woman whose main task was bringing the patients’ rambled narratives back to some sort of reality. She wasn’t very successful. I found myself getting antsy and uncomfortable in the plastic chairs. Rob was clearly the most eloquent, most intelligent and most dominant member of the group; that wasn’t saying much, since half the patients were fighting sleep-- dull-eyed and heavy-lidded. Still, I found myself feeling proud of “My Patient.” He seemed like a guy I would be friends with. Maybe even flirt with. I couldn’t see any sign of psychosis.
I put on lipstick after lunch and quickly wiped it off, asking myself what the fuck I thought I was doing. Then I resumed my afternoon with Rob. I watched him draw a terrible picture of rain on a bridge during art therapy. We joked about how bad it was.
“It’s a good thing I’m not committed to an art hospital. I’m really good at depression, but I really suck at art,” he joked loudly. And I laughed genuinely. I brought him his mini paper cup full of pills. I looked each med up in my pharmacology book and diligently wrote down the indication, dose and side effects from each drug. It was three pages long.
Toward the end of the day I noticed that Rob was fading. I was, too, so I chalked it up to late-in-the-day exhaustion. He told me he was crashing and needed sleep and would see me tomorrow. I waved goodbye and went to read his chart. He walked heavy-footed toward his room. His small frame looked even smaller in his oversized sweatshirt. He didn’t go back to his room, though. He picked up the hallway payphone and started having an animated conversation with no one. He never put a quarter in the slot. He just picked up the receiver and started a monologue. Every so often he would nervously touch his mouth and cheek as if making sure they were still there. His voice got louder and angrier. I saw a nurse’s aide slowly walk towards Rob. She asked him how he was feeling and he whipped around and angrily said, “GET THE FUCK AWAY FROM ME YOU SWINE MAGGOT!” His pupils got big in fear. If I saw him on the street, I would’ve crossed to the other side. The nurse’s aide hung up the phone and took Rob away. He complied. He looked sadder than the yellow hallway.
An instructor gently told me that Rob’s behavior looked like the rapid cycling seen in some severely bipolar patients.
I stood there, staring at his metamorphosis. I couldn’t wrap my mind around how “my Rob” had become psychotic Rob. How fast the transition was. How possessed by a demon he appeared.
Now I realize that’s exactly what possessed him.
Psychosis is a demon that preys on sweet minds. People may have more tolerance and understanding of depression or anxiety, but psychotic people get passed over as undesirable others. Their minds are just as flawed. The difference is that their flawed brain is glaringly and disturbingly obvious. You can hide your depression. You can get up in the morning (though it may be a Herculean task and take hours) and you can go to work and be productive all day, smiling. You smile because your face knows how. It can recall the mechanics. It’s muscle memory. You can go out to dinner and have a conversation that makes sense. But it’s so difficult and the fatigue that follows is heavy. The image of your bed at the end of the day is what gets you through. Your body is so tired from your performance, it sleeps like the dead.
You can’t hide your paranoia, your pressured speech or your combative tirades. Psychosis is in-your-face mental illness. It’s angry and loud and ugly and painful to watch. As relatively sane people, we don’t like the noise of the psychotic. Maybe because it reminds us that the line between sane and insane can be blurry. Maybe because it makes us feel vulnerable, since, in some way, we intuit that nothing but dumb luck made us sane enough to get by. We comfort ourselves by thinking that the muttering, disheveled woman wrapped in garbage bags and crouching under an awning on Broadway is so “other” and far from who we are that it deludes us into feeling immune and safe.
The overtly psychotic make us anxious because they show us the underbelly of the human brain. They show us how messy and ugly people can become. With just a flick of the human genome, we are scraggly and wild-eyed. We are the undesirables.
I left Bellevue just as the sun was starting to set. As I walked the few blocks home, I realized the difference between Rob and me was a thin line of luck. I could’ve easily been a Rob. I could have a child, a sibling, a parent, a friend like Rob. Instead of inheriting the depressive gene, I could’ve inherited the schizophrenic gene that hovers over my family tree like a Dementor lying in wait.
The next day, when I returned to the unit, Rob was shuffling along with the other patients, indistinguishable from the crowd of overly-medicated, heavy-footed folk. I went to talk to him and was struck by how dull he had become. He had no interest in talking to me and kept repeating how he needed some goddamn fucking rest. He looked depleted and defeated. I told him to go rest, mostly because I had no idea how to interact with such a shell of a person. The yellow hallway made sense to me - this was a place where color dulls, where even sadness breaks apart. I tried to busy myself, helping the other nursing students and reading charts. In reading the charts I learned that nearly 100 percent of the patients had a history of sexual abuse. This was a locked unit of survivors. Those whose minds were broken by life and genetics. Stuck in a yellow hallway keeping them safe from themselves and their monsters.
One of the psychiatrists described Rob as “terminally ill”. I thought it strange to describe a seemingly healthy man that way. He had no physical ailments as far as I could read or tell. When pressed for more details, the psychiatrist listed all the treatments Rob had burned through to try to get into a remission from his illness. The list went on and on. Nothing worked. He continued to relapse again and again. The doctor turned to me and sadly smiled, saying:
“Sometimes disease is smarter than medicine”.
It sounded so defeated. It made me angry at the staff and medicine in general. How can they not figure something out to stop madness? I was naive then and didn’t understand the limitations of medicine. The brain is complex and we are still just scratching the surface of treating mental illness.
All that year, I looked for Rob in Washington Square Park, on West 4th Street, in Midtown. I never found him. I never saw Rob again. In my mind, he’s happily splashing around in a park fountain sucking that last bit of marrow out of his joy, mightily fighting his demons.