Orderly conduct

My short, strange career as a mental health worker

by Michael J. Woods

Day 1

"Dr. Strong to the admission unit, Dr. Strong to the admission unit."

The voice of the unit secretary comes over the hospital PA system as calmly as her nerves allow. "Dr. Strong" isn't a person -- it's a coded plea for all able-bodied men (and brave women), save for the kitchen help, to help restrain a particularly violent and/or psychotic patient here at "Goodwill Acres." (All names have been changed to protect privacy.)

Goodwill Acres is a private Boston-area psychiatric facility where I've taken a job as a mental health worker, or "milieu therapist." In this case, the patient who's about to get tag-teamed is John V., a 42-year-old who's being admitted with bipolar disorder. He hasn't been taking his meds at home and is delusional. Bug-eyed and snarling, Mr. V wants out because he's "due at the space station at the mall by 6 a.m." He refuses orally administered medication. After conferring with me, three other milieu therapists, and a handful of personnel who've answered the "Dr. Strong" call, his doctor recommends four-point locked leather restraints. We huddle to plan our advance -- who will grab which limb, which room we'll carry him to, who will secure the buckles that hold him to the bed.

This is my first day of work at Goodwill Acres. My training for this job has consisted of one college-level psych class (I received a D-plus), a string of mostly losing efforts in street fights and bar brawls, and six hours of orientation last week. None of this matters as the order is given to rush Mr. V. We attack. Years of mental illness and medication have taken their toll, and he is quickly subdued and shackled.

Mr. V's body may not be able to resist the onrushing "de-escalation team," but his mouth has plenty of bite. He screams "Niggers!" at two of my black colleagues, and promises he will see to it that the female nurses will "have their tits cut off." After the charge nurse shoots him in the butt with 10 milligrams of Prolixin and 5 milligrams of Haldol, though, the venom runs out, and within 10 minutes Mr. V is drooling on a pillow.

Day 2

My shift starts at 7 a.m. The morning crew takes over from the overnight crew, who have left us a tape-recorded rundown on the state of the 20 patients in this locked admission unit. The first thing we do every morning is listen to the tape: it notes any aberrant behavior and documents medications. The tape is a practical tool to prepare for potential problems, but it can also be darkly humorous. This morning, the charge nurse informs us that he was called to the four-bed suite housing one Marie M.

"Marie was found to be on the floor of her bedroom trying to remove her sanitary napkin with her feet, because she apparently didn't want to sully her hands," the nurse reports.

Day 6

Mr. V hasn't measurably improved. On the contrary: before the shift change, at 2:15 p.m., he pulled a Harry Houdini and slipped three of his four restraints, and now I hear him yelling.

"Can someone get me a big knife?" he asks.

Mr. V has one wrist still in restraints. He is standing next to his bed, which he has dragged over to his door, and he leans his head out, repeating his request. The linoleum floor around him is covered in his own urine, which makes his re-restraint more difficult. I kick off my penny loafers to gain traction, and the three on-duty mental health workers subdue Mr. V. The nurse pulls down his pants and aims a shot of Thorazine into his right buttock. Mr. V mutters one last, medication-garbled threat and drifts off. I hope his dreams are sane.

What I've learned so far: Euphemisms are big in this community. My favorite catchall term is inappropriate, which we use to describe transgressions big and small. One patient is reportedly trading oral sex for cigarettes. She was reprimanded by her assigned social worker, who noted the "inappropriate behavior" in her case notes.

Day 47

When not attending group meetings or occupational-therapy classes, the patients often can be found watching television and smoking cigarettes. "Tim Richards" lives on coffee and the Virginia Slims we hand out; like many patients, he enjoys the soothing hypnotism of TV. Richards, now in his 50s, with a long black beard overtaking his 130-pound body, was fully functional before a 1979 car accident. He now shows symptoms of Parkinson's disease, as well as aphasia, the loss of the ability to express and understand ideas.

On this Saturday, Richards has just watched The Flintstones and is sipping his coffee, black, during the noon newscast. Ted Kennedy comes on the screen, and Richards shows the first emotion I've noted during his stay. He yells angry slurs at the TV. Is it some Chappaquiddick/car crash flashback? I'll never know. He quickly calms down, then floats over to the coffeepot to get a refill.

Day 48

I wonder, is Richards conning us? This morning, two teenage female patients are in the day room with him. Both have a history of suicide attempts and are assigned to stay in sight of staff at all times. As I take my turn to supervise the girls, Richards rants at a particularly disagreeable infomercial.

The girls tell Richards to keep it down. Richards responds. Shaking but resolute, he hoists himself up from his spot next to the 19-inch RCA and shuffles over to the girls, disposable slippers skating on the tiled floor. Now facing the three of us, Richards lifts up his hospital-issued johnny, yanks down his briefs, and brandishes his penis at the girls. It is my duty to restore order.

"Mr. Richards, that was inappropriate. Why don't you spend some time in your room?" Off he goes, knowing he's done wrong. Aphasia, indeed.

Day 102

This hospital admits a wide range of patients with varying ailments; the one common bond is that they have insurance to cover the stay. One I can't figure out at first is "Poochie." Admitted yesterday, this kid is in a wheelchair. He's 18 and was dealing crack in Roxbury before a pickup hoops game deteriorated and left him with a bullet lodged near his spinal cord. Now he's a paraplegic, and he is here because he's depressed.

I push Poochie in the chair for a walk outside the unit, and I probe for some details into his lifestyle and psyche. Did he feel like this was cosmic payback for pushing drugs? What was he thinking, getting into the thug life?

Another bullet, this one in his throat, has left Poochie with a voice just above a whisper. "I think of money," he offers. He still advises his 16-year-old brother, who continues the sale of "gems," his pet name for crack.

Maybe Poochie senses my indignation, because he shows evidence of a conscience.

"I don't sell to no youngsters," he says, his $120 Nike Air-something sneakers dangling limply against the concrete as I push him back to the hospital, "under 16."

What I've learned so far: The boundaries of normalcy I have set are eroding. An example: My coworker Abdullah runs a community meeting every morning to allow the patients to offer suggestions, air grievances, and vent frustration. One patient is particularly morose. Two days before, her attempt to kill herself with a noose in the shower was thwarted by staff. Her antidepressant medications aren't effective, she claims. Abdullah's words of wisdom? "Just hang in there."

Horrific unintentional gaffe, the old me would have thought. Instead, I react with belly laughs when the unit secretary relays the story. A truly inappropriate reaction.

Day 144

I overhear a female paranoid schizophrenic on the patient pay phones today. She has responded to a classified newspaper ad asking for "New Faces for Modeling, TV Work."

"Hi, I'm calling to do some modeling . . . but I can't start now. . . . I'm in this Betty Ford-type place for two more weeks. . . . I'm 38-30-36. . . . I need to lose a little weight and I'll do some lingerie work. . . . Well, I've had my picture taken without my knowing it, and SUDDENLY MY FACE WAS ON POSTCARDS EVERYWHERE!" she screams, and smashes the receiver on the cradle. End of interview.

Day 199

This afternoon I escort a patient to lunch in the cafeteria. The charge nurse has instructed me to pay special attention to Mr. Davis, because he suffers from a disorder called Prader-Willi syndrome. In short, if unimpeded, Mr. Davis will fatally overstuff himself. Not in one sitting, but over time, he will literally eat himself to death.

The nutritionist prepares a special tray of healthful choices, like broiled chicken and steamed vegetables, that don't satisfy Mr. Davis. I am a human roadblock on his road to engorgement, preventing trips to the line for seconds and thirds, so he has to be content with sucking the residue out of a ketchup packet and pouting.

Day 245

The holidays are upon us. You know the state of depression many of us enter as we're faced with family reunions, obese credit card bills, and low sunlight? Sally Bates feels this way year-round, with brief respites. Her records indicate she's been shuttled in and out of psych hospitals since 1982; she is now 39. She is prone to instantaneous, unforced bouts of crying. Nothing seems to help. Even electroshock "therapy" (now there's a euphemism) hasn't dented her depression.

Day 246

I tried to allay Sally's fears that the Mafia, of which I am supposedly a member, has no desire to harm her.

"Numbers are down in La Cosa Nostra, Sally," I offered. My anecdote about Raymond Patriarca, the pork chop he promised to finish during his bust, and Patriarca's penal stint didn't have the calming effect I was after. Sally fixes her most withering stare on me and demands, "Just get away from me." I do.

What I've learned so far: I can't decide whether my skills as a low-grade therapist/bouncer have improved. The constant strangeness is permeating my psyche, leaving me wondering if mental illness is communicable. Some of the people who have worked here for a while could certainly be mistaken for patients. It may soon be time to move on, because I don't want that to be me.

Day 320

"Nurse Greenberg," who has worked the admission unit at Goodwill for nearly 20 years, offered me an unsolicited diagnosis today: "Look at you. Energy of a slug, poor complexion, losing your hair." This wasn't even the lowlight of the day. Sally Bates was readmitted after suffering a dissociative episode at her group home, and she remembers me. "If I fall, will you bring me to my room and feel me up?" she blurts. I am too weary even to blush, and I snap, "Sally, if you can't hold it together, you're going to your room!"

Day 340

To this day, one of my all-time favorite patients is Richard J. Lombardi. The chronic schizophrenic smokes incessantly, as the bulk of the patients do, and he butters me up so I'll give him an extra ration of those Slims. Lombardi is as lovable as any coughing, drooling, 63-year-old schizoid has a right to be. And his outlandish non sequiturs are just short of profound.

When I introduced myself to Lombardi, as I do to every new admission, he answered, "I'm Richard J. Lombardi. The J stands for Jesus. I was born April 1933, aborted April 1934." Soon after, Lombardi dubbed me "Blue Angel," because I slipped him extra smokes and I had worn a blue shirt that caught his eye.

Today, Lombardi's doctor attempted to have a face-to-face in the corridor.

"Hi, Richard. Got a minute?" he asked gently.

"No," Lombardi spat, along with a few teaspoons of saliva.

"But I'm your doctor," the physician countered.

"God is my doctor!" Lombardi thundered, and limped away. The doctor regained his composure and moved toward his noncompliant patient. Lombardi whirled around and raised his hands.

"Watch it! I have two lethal weapons in my hands!" Lombardi warned. Holding nothing but his fingers in his hands, both clenched in kung fu grips, he punctuated that bark with a big blob of phlegmy drool that crept out of his mouth and fell to the carpet. Game, set, and match, Lombardi.

What I've learned so far: I'm disenchanted. I don't think Norman Vincent Peale could lift me out of this funk. Maybe it's because I don't see the successful cases, the ones whose brain chemistry is set straight enough to keep them out of Goodwill Acres. The people I see are the people losing the battle. The final straw is day 357, when another patient, Michael Thomas, pushes my buttons. He has refused to vacate the smoking area during a group therapy session. I move in to persuade him to head to his room, and he becomes irate. We grapple and he bites my forearm. I'm wearing a thick sweatshirt, but the bite breaks the skin, and at that moment I decide my career as a glorified orderly is finished. No more "healing" for me.

The director of nursing isn't surprised when I call to resign. She's used to high employee turnover. The pay is low; the atmosphere of intermittently contained lunacy and violence doesn't create what most people would consider a desirable working environment. You can't stay if you lose the ability to separate work and home, if you allow the patients' illnesses to seep into your own life. If you can't punch out with a clean conscience, then you have to build a hard exterior, and I couldn't do it anymore. Maybe I never really could.

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Postscript: Thomas refused to submit to an HIV test, so I am left wondering. He has been homeless for stretches, his social worker tells me, and I have no clue what his habits are. I am now enjoying time in an infinitely more upbeat work environment -- I am now a telemarketer.

Michael J. Woods is a writer living in Brighton. He can be reached at Mi28w@aol.com.