Cast of Characters, Part 1: Patient F.S.

Image by Kent Matthews at Getty Images,

with my addition of the popular German emoticon for schizophrenia.
EDIT: It's been pointed out to me that this image is more bipolar than schizophrenic.
Oh well. It's hard to depict schizophrenia.

Schizophrenia is one of the most visible mental disorders in the media, particularly television and film. Who doesn't know about crazy people with voices in their heads? It's been ingrained into the public consciousness. Therefore one would expect a psychiatric ward to be lousy with schizophrenics, but sadly Ward 3A disappoints in this matter. We had only one schizophrenic out of all the 30+ patients who came in and out of the ward during my week-long stay. Just one.

 A schizophrenic patient's brain scan during a hallucination,

by Tim Beddow at Getty Images.

I call her Patient F.S., which stands for Fräulein Schizophren -- "Miss Schizophrenic" in German. Though I never personally asked her about her ethnic origins (I'm not sure I ever spoke to her, come to think of it), I gathered from her name and accent that she was indeed German. Except for the intimidation factor that comes naturally from All Things German, she wasn't what I expected from a schizophrenic, for she was the first I'd ever known. She was quiet, clean, and polite; she never made a fuss. Her comments in group sessions, when she attended, were reasonable and succinct.

Sigh. How boring.

Where was the unkempt madwoman who screamed about the voices in her head? If Patient F.S. hadn't told us all in her calm, reasonable way that she heard voices, I never would have guessed. Every patient is asked to bear themselves before nearly every group with the request, "Tell us your name and why you're here." Most cite the Big Three -- anxiety, depression, and anger. Sometimes something about suicide goes along with the depression and anxiety. But no, not Patient F.S., who looked at us all and said in her calm and matter-of-fact voice, "Hello, my name is [Patient F.S. name], and I'm here because the voices in my head were getting out of hand." Sounding so sensible and practical as she confessed that she heard disembodied voices made the others' confessions about the Big Three sound so unimpressive. It just isn't expected. My preconceived notions of schizophrenia need that unkempt, screaming madwomen.

Even the bipolar patients got nothin' on Fräulein Schizophren.

The only truly disturbing thing about Patient F.S. is what she said during a group discussion on going back to work after getting out of the hospital. She said that she wanted to go to school to be a dental assistant.

...


Fräulein Schizophren. The schizophrenic. A dental assistant.

Call me prejudiced, but I am. [sarcasm] Because I want the woman standing over me with sharp tools to hear voices that aren't really there. [/sarcasm] Going to the dentist is scary enough without adding a schizophrenic dental assistant into the mix. 

Original image by Ron Levine at Getty Images.

The irreverent word bubble is by me.

Sorta chills the blood, doesn't it?

Fun & Games

A mildly offensive photo from Getty Images by tempurasLightbulb.

But it made me smirk. So.

Despite there being "Activities" written twice on the schedule every day, there were never really any activities provided for the patients. The ward was just too understaffed. There was even one day that we didn't have group therapy sessions because there weren't enough therapists on duty. Therapist Hard Stare said when asked about the absence of groups that day, and I quote, "I'm not paid to do two people's jobs." They're really looking out for us, clearly.

Anyway, despite the cliche of things like art therapy in psych wards, Ward 3A had no such cliches to keep us patients entertained, save for two instances. Once, the "Clay Lady" came with her supplies to let everyone get muddy hands as a form of self-expression (I did not attend that one -- too tired). The other time was when Patient L had bugged Therapist Hard Stare sufficiently about her boredom on The Day of the Great Understaffing, Therapist Hard Stare rolled out the TV with the DVD player and popped in "Legally Blonde". I didn't attend that paltry offer of entertainment either. Something about Reese Witherspoon doesn't jive with my damaged psyche.

For the most part, we were all left to entertain ourselves during the long gaps between group therapy sessions and meals, which are the defining events of the day. (The meetings with one's doctor are so unpredictable in terms of scheduling that they cannot be relied upon for a sense of structure for the day.) A lot of patients just stay in their rooms, but the staff tends to bother you if you don't come out enough. "Socialize with the other patients!" they urge while I'm just trying to read a book in the pseudo-comfort of my hospital bed.

There's always patients on the unit, though. By "unit" I mean the common area that surrounds the nurses' station, serving not only as common area but also as pacing track for the restless. Patient Ja, Patient G, and Patient F can usually be found doing laps around the nurses' station, ambling slowly along as if they might actually get somewhere if they just walk long enough.

There are awkward chairs to sit in, though, and a messy selection of games, which are typically missing vital pieces. (Eg. Yahtzee without the dice, etc.) There are also lots of puzzles which may or may not have all the pieces. Puzzles are nice and safe, but also infuriating for those of us with little patience.

Occasionally I would join games with Patients L, Ne, and S. There was Scrabble, of which Patient D was the champion, and Scrabble Slam, which I'd never played before but found quite entertaining. Look it up if you don't know it. Particularly for people who find regular Scrabble too slow-paced, Scrabble Slam is a good alternative. Games of regular Scrabble were usually abandoned fairly quickly, as the rules were for the most part made up as we went along, as it took some time to come to a consensus about how the game was actually played.

There was also Uno and standard card decks. A lot of the time I found myself practicing shuffling more than actually playing anything. Isn't that an image? Practicing shuffling over and over but never dealing. There was even a half-decent chess board with all necessary pieces, if a little mismatched. I played with my dad during visiting hours one day. ...I suck at chess.

The most ridiculous of any of these was Pictionary. There were no pieces, no cards, not even a box. Just the board. Despite these shortcomings, Patient L was thrilled by its presence. Apparently she and her parents used to play Pictionary all the time, so she had a strong emotional bond with the game, and could not be dissuaded from wanting to play it, despite the missing pieces. So we improvised.

We selected random pieces from the bottom of the games cabinet to be our board pieces. I believe there were two chess pieces, a Battleship torpedo, and a Checkers piece. I made dice out of construction paper and tape. (The tape had to be requested from the nurses, and I had to assure them that I wouldn't try to eat the tape. I really don't understand how that was a concern.) We tore up more construction paper to be our cards. Patient L knew the game so well that she was able to identify all the card categories and even produce some examples from each. We made about two dozen of these cards, selecting ideas at random. Dinosaur. France. Horse saddle. Christmas ornament. Once my brain started to give up on this random generation of things, I found a Better Homes & Gardens magazine and flipped through that for ideas. That was how I got "horse saddle" and "Christmas ornament."

Unfortunately, once we'd finished all the materials for the game, we were so tired that we'd lost interest in playing. But that's life. It was only to pass the time anyway.

Blank board from here, and Scrabble tiles from here.

Put together by me.

"LUNATIC" is actually a good play...

Groups, Part I

Yes, I just used Comic Sans. It's supposed to be ironic.

Chalkboard background from here.

Every day, roughly a half-hour after the morning Community Meeting, there would be Education Group, which is a group session that isn't therapy per se, but a therapist-led discussion of a specific topic.

The topics during my stay were as follows: Anger Management, Bad Habits, Affirmations, Teen Suicide, Substance Abuse, and Stress Management.

(Yes, that's only six topics and I was there for seven days, but one day, between Teen Suicide and Substance Abuse, the ward was so understaffed that we didn't have Education Group that day. No hospital is perfect.)

I can't say that I learned much in any particular Education Group. The day on Bad Habits was mildly interesting; I do remember the concepts of payoff versus trade-off, but Affirmations and Stress Management just made me want to bang my head on the table, which is never a good idea in a psych ward because that's something someone Really Crazy might actually do, and you don't want to seem Really Crazy, not if you want to get out any time soon.

Every patient is urged to go to every group session, of which there are usually four in a day. Out of 25-to-30 patients, less than 12 would show up to any given Education Group, on average. The other groups (community, process, and wrap-up) tend to get better attendance. Not sure why. My theory: Education Group is less about ME, ME, ME than the other groups, and god forbid everyone's desperate need for attention not be the driving force of a discussion. One day, when the subject was Teen Suicide, I chose not to go to Education Group. I was particularly tired that day because of my med changes, and I just wanted to sleep. Based on the generally low attendance, I figured it wouldn't be a big deal. WRONG.

Horror of horrors, missing a group session! Because I'd showed up to all other groups, except Anger Management, which was on my first day so I could get away with not going, and I don't have anger issues anyway so I just assumed that it wasn't mandatory for me-- Anyway.

Anyway, because I'd showed up to all other groups at the time, save one, I'd developed a reputation among the staff for being a good and involved patient (i.e. a patient who went to groups). This change in my behavior sent up red flags.

All I wanted to do was get some more sleep, really. That's all.

Which is what I told my roommate when she came to fetch me because I hadn't shown up. And what I told Perky Nurse when she came to check on me to make sure I was okay (again, aberrant behavior sends up red flags). I even said it to Therapist Chipmunk, who runs the Education Groups, because she came to my room herself after the group was over to see why I hadn't shown up. Being disrupted three times, I didn't get much of the sleep I was seeking. By that point, I was ready to snap, "What? Do you bother every patient who doesn't come to your stupid group? Because if you do, you've got plenty of other rooms to visit."


Of course, I didn't actually say that.
Because I'm a Reasonable, Cooperative, and Generally Well-Behaved patient.

It was just so damn hard, being that tired. But I smiled and apologized and assured I'd never miss a group again, etc. etc. -- all for her benefit, and the restoration of my good reputation.

Still, despite all that, it's still more common among the patients to skip groups than to go. In addition, every group always ends with fewer patients than when it started because one or two or three patients invariably end up walking out of the group. Usually without a word, they get up and go, chased off by whatever is happening in their minds.

Despite my reputation for coming to all groups, when it came to Education Groups, I ran the gamut of attendance options. There were three groups I went to, two groups I outright skipped (to varying reception), and one group that I walked out of about halfway through -- just the one group, and that was Substance Abuse. I don't have a Substance Abuse problem, so relating to those who do is difficult for me. Listening to the other patients was more than I could handle, particularly Patient Y, who is apparently addicted to every substance on this planet, professed as each substance was brought up in the conversation. I just can't stand attention-seeking behavior like that. Me, me, me. That's just how it is with these people.

Patient L tried to make the argument that cutting (that is, self-injury) is an addiction, but she walked out even before I did. I brought up behavioral addictions (like sex or shopping or gambling -- maybe even self-injury, if you should so argue it) because the idea of a sleep addiction was on my mind. That had come up during my very first Process Group, and it stuck with me. Still, the focus of the group was substance abuse, and that just doesn't fall under my list of issues. I didn't get any grief for skipping that one (mostly because it wasn't led by Therapist Chipmunk, for a change). The change in behavior went unnoticed.

I'm too tired to write any more. Goodnight.
Time to go tend to that sleep addiction of mine.

 From Getty Images, by Elke Meitzel.

Yep, this is pretty much how I roll.

Upstairs Issues (i.e. Religion)

 A Priest Talking to a Sick Child.

That kid's pillow looks way too good for a hospital pillow.

From Corbis, by L. Kate Deal.

While in the hospital, I was always fascinated by a particular paradox: overtly religious people who were suicidal. Patient Ne and Patient D were both examples of this. My first roommate, Patient D, was one of these lost lambs. She would even read the Bible in bed. There are plenty of healthy Christians out there who've probably never actually read the Bible, and yet here was a woman who had tried to end her life and was reading the Bible at bedtime. Though I suppose it's typical for patients to take solace in the Word of the Almighty God. I hope it gave her comfort.

The reconciliation of the religion/suicide thing is an issue, though. Hamlet had a line about that in Act I, scene ii. Or that the Everlasting had not fix'd / His canon 'gainst self-slaughter! O God! God! Hamlet's basically saying that he'd kill himself if it weren't against Christian doctrine. (And don't you English professors tell me that Hamlet wasn't suicidal. That line combined with the "To be or not to be" speech is solid proof.)

Suicide is just Against The Rules, plain and simple, according to the Judeo-Christian perspective. I almost want to call hypocrite on these people. Though maybe it's more an issue of falling short of the mark.

Of course, I'm a born-and-raised atheist (yes, seriously), so I wouldn't defend my knowledge of Christian doctrine in court or anything. After all, when Patient R used the phrase "Only the guy upstairs knows" in a group therapy session, my first thought was "What? The billing department?"

I can be a little doctrinally challenged at times.

Other than people hoping that religion will heal their wounds, the most prevalent presence of religion in the ward was in the form of religious visitors. Priests, Imams, Rabbis -- holy personages of any religion are welcome. I saw both a pastor and an imam during my week at the hospital. (The imam was holding hands with Patient B as he did his slow laps around the nurses' station. He was one of a handful of lap-walkers.) AND -- get this, men of the cloth aren't limited just to standard visiting hours (11am-2pm and 6pm-8pm). They can visit patients on the ward at any time.

They call it the Pastor Pass.

Original found at SmartDraw.com

Keeping Calm and Carrying On

As a welcome-home / birthday gift, a friend gave me a journal with the Keep Calm and Carry On poster on the cover. I've always been fond of this poster, and I always love a new notebook (it's filled with such possibilities!), so all around this was an excellent gift. It's also pretty good advice. Just... keep calm and carry on.

I took notes all through my stay in Ward 3A, usually on little scraps of paper, completely at random, no sense of order. I just wrote as I observed. Once I returned home and received the Keep Calm journal, I transferred all my notes into the journal, categorizing them as things such as Patient Life, Groups, Staff, Religion, Meals, Cast of Characters, etc. This organization ought to make writing new posts for this blog all the easier.

Anyway, the journal's cover got me thinking. While "Keep Calm and Carry On" is a good sentiment for a psych ward, what other posters of that ilk might there be? Parody posters are popular for KCaCO, so I thought I'd do one of my own.

I made this one just for fun, using a combination of the KeepCalm-O-Matic and my favorite image editing program, Micrografx Picture Publisher (sadly no longer available). I'm very proud of the line art of the pills at the top. But, upon later thought, I figured that "be less crazy" is a bit negative for a motivational poster. So I tried again.

That's more positive, right? It looks more like the original poster, anyway. I think I'll put this on my bathroom mirror or something. Not exactly an affirmation or even a necessarily motivational sentiment, but still a good reminder to take one's meds.

Patient Phones

 Image courtesy of Corbis

The phone system in the particular ward in which I stayed was... pretty much atrocious. It wasn't so bad to make calls, but getting calls was practically a matter of luck.

There were three phones available to patients on the unit. There used to be four, but one hasn't been working for weeks and god forbid someone fix something. All the working phones were nestled in one corner of the unit, each spaced far enough away from its neighbors to give an illusion of privacy.

To make a call out, just pick up the receiver, dial 9, and then dial the number you're trying to call. I'm not sure why it's 9 that directs outgoing calls, but it's always "dial 9," isn't it? Always. Calls are supposed to be restricted to less than 10 minutes in duration, and that rule was abided by; I never saw someone make a long phone call, despite it being our only means of communication with the outside world. No one ever seemed to want to talk to anyone on the outside for too long. I'm not really sure why.

Receiving a call was the problem. The numbers of those phones (even the broken one) are given out to patients' families upon admittance, and when one of the numbers is called, the corresponding phone rings. As one would expect.

BUT

...there's no one assigned to picking up the phone. It's left to the patients. If you're near the phones and you hear one ring, it's your responsibility to pick it up. So of course you can imagine how much that happens, right? People sitting in that corner, sometimes not even doing anything, will just sit there as the phones ring and ring into oblivion. The first few days of my stay, that was how things were. My parents were at their wit's end, because calling any of the phones wasn't getting an answer, and the nurses who picked up the nurses' station number were just generally unhelpful. It's not their job to play operator. It's the patients' -- apparently.

As a patient picking up the phone, you have to respect the other patients' privacy. You say "Hello?" and maybe a "For whom are you calling?" and a "Who may I ask is calling?" but absolutely nothing else. There's no "Hello, you've reached psychiatric Ward 3A, how can I direct your call?" As if where they're calling could possibly be a mystery. Just "Hello?" and then you go fetch whomever the call is for. (That part is why no one likes picking up the phones.) It can be quite a task, finding the person. They could be somewhere in the common area around the nurses' station, or in the kitchen, or in the TV room, or in their own room. And it's forbidden to go in anyone else's room. You just have to stand in the doorway and call inside. I once had to fetch Patient B for a phone call, and he's basically comatose. I had to repeat myself three times to get him to understand that he had a phone call. By the time I got him to the phone, the caller had hung up. C'est la vie.

I used to imagine what it'd be like to have an automated system for a psych ward's patient phones.

"Hello, you've reached Ward 3A -- the loony bin! 
Please listen carefully and make a selection.
For incoherent ramblings, please press 1.
For an emotionally-charged argument, please press 2.
For paranoid delusions, please make your death threat after the beep..."

And so on.

They could have a number assignment for all the general symptoms. That could be reduced to nine numbers, right? Anxiety, Depression, Suicidal Thoughts/Attempts, Anger Management Issues, Substance Abuse, Psychosis, Forgot To Take Their Meds, Schizophrenia, and Bipolar Disorder. That's all the biggies, anyway. Everything else is just a subcategory.

Image courtesy of Corbis.

Hospital Socks

Yes, those are my feet and my socks. 

Picture taken with my iPhone and filtered with Instagram.

Hospital socks are the great unifier. Though some patients wear standard-issue hospital gowns and paper-based hospital pants, and some patients cling to normal life by wearing street clothes, but about 90% of all patients in this ward (which holds about 30 patients) -- they wear the standard-issue hospital socks with diamond-shaped grips. The socks put us on the same level, marking us as equals, because everyone is nothing more than a patient here. You could be a successful career-person or a homeless person on the street, but all of us are patients in a psych ward and all of us wear these ridiculous socks.

That other 10% wears real shoes (usually Crocs, actually), but the socks are everywhere. I think it's a matter of comfort. As we struggle with our demons, we want an iota of comfort: we want our feet to be warm and safe.

We're not allowed to go barefoot for some reason.

Accommodation

 A typical psych unit room, this one from Cedar Hills. 

Note the uncomfortably thin mattress, which is standard to the field.

Picture taken from the The Oregonian.

It's hard to imagine a hospital bedroom in a psychiatric unit is anything but what it is. There's not much in way of "character," and the character there is only reaffirms the truth of the matter. You are in a psych ward. You are crazy. You are likely a danger to yourself, if not also to others. If nothing else, you somehow disrupt the normal flow of society. The world cannot accommodate your Otherness, so adjustments must be made -- for your own safety, of course.

There is no mirror in the bathroom, for mirrors are easily broken and broken mirror shards make good weapons. The result of this is that everyone's hair looks terrible.

Someone, at some point, had written in Chinese on the wall next to my bed, likely in crayon. It had been painted over again, but in certain light the texture of the letters still show up, a stark matte against a clean, gleaming surface.

I also spent the first few days of my stay being jealous of my roommate, who had two of the substandard pillows instead of just one, and two substandard pillows comes closer to a real pillow than just one, at least in terms of depth measurement. One just has to ignore the weird plastic covering that crinkles with any movement.

The curtains aren't bad, though. They're blackout curtains, so when you completely close them and turn off all the lights, you can't even see your hand in front of your face. Not so good if you're terrified of your roommate standing over you while you sleep, but good if you're a sensitive-to-light sleeper.

If you stay too long in your room, the staff views it as a Bad Sign. They like to coax us out into the open of the unit common area, which is the radial space around the island that is the nurses' station. Ragged books, games and puzzles with pieces missing, uncomfortable chairs -- gee, I wonder why I don't like hanging out in the common area. I'd prefer to stay in my room, 308.