There was a certain look about Frank, a look like make me or prove it or you call that game? And standing near the reinforced window, the sun softening the ragged contours of his face, it was hard to know if he was really insane—a puzzle made of a fresh snow bank. Virgin white cut with shades of gray. Psych admissions were often a matter of three hots and a cot, the mental health deputies would say. How right they were, their minds were already made. Yet still I wanted to inspire change.
And so I said, How are you feeling, Frank?
He said, Okay.
And you’re adjusting to the hospital’s routine?
What about your delusions?
Yesterday you mentioned the mob.
They’re going to slit my throat, I would say.
Care to elaborate?
What’s the point?
I can help.
And maybe he was right— what little help I could provide was likely too late. For patients like him, the best bet was to minimize the pain. Which to me meant therapy and space. Then again what would the insurance company say? Treat him and street him, never mind the coping skills he won’t retain. Or snow him with meds then call it a day. But there was more to social work than getting paid.
What about the Abilify, Frank?
It makes it so I can’t shit.
I can ask the doctor to add a stool softener to your regiment.
The stools fine. It’s my guts what’re bad.
I pursed my lips.
And the voices, they won’t quit.
What’re they saying?
They’re screaming for a cigarette.
Well I guess it could be worse. They could be whispering obscene… Never mind. But tell me where you’ll go when you leave here, where you’ll live.
And you’ll be safe?
I said, Okay.
Because who were we to force upon him four walls, poly-blend sheets? Where he chose to live was his choice to make. And to drop him at a shelter would put more than one life in harm’s way. A history of violence is a hard thing to escape. Bombs exploded atop the brainstem. But that was a conversation for another session.
Do you have any questions for me? I said.
He scratched his chin.
If not, that’s okay.
What would happen if I tried to escape?
The police would bring you back.
I meant jump into rush-hour traffic.
And you lived?
Probably a months long commitment with the state.
He said, Oh.
He lowered his eyes, ran his finger down the window frame.
After escorting Frank back to the unit, I told Dr. Dobson of his constipation, suicidal ideation, and severely depressed affect. She told me to contact his family to let them know that the patient would be leaving before the end of the same day. I was to give them the phone number to the crisis line, for when Frank experienced his next break. When, not if; also just in case.
Frank stared into the middle space. From behind the nurse’s station, I asked him his pharmacy of preference, outlined the documents required for his MHMR admit assessment, and requested he sign a release for me to talk to his family about the diagnosis. To involve his loved ones would improve his chances of success and educate them on how to best support Frank through the recovery process. But when I slid the ROI across the desk, he crumpled the document, kicked a hole in the wall, then paced the unit, beating on his chest.
I’m a human being! he said.
What he meant was anyone’s guess, but when the tech attempted to calm him, he spat at her, called her a bitch. Then the charge nurse called Code Blue over the PA system, and onto the unit descended all available hospital staff—admins, cooks, and facilities men. They circled about him, with their hands held in front of their chests. The nurse stepped forward, whispered thinly veiled threats, and then down she went. Blood spurted from her mouth, covered Franks clenched fist.
I felt bad for her, but what did she expect? This wasn’t the Ritz. And what reason can be heard over the voices yelling homicidal threats—figments? God doesn’t love every one of His children best. There are winners and losers, usually the opposite of first guess. At least Frank knew to smile when they stuck him with max dosage emergency meds. Which is when I thought we might end up friends.
The nurse held a bloody napkin to her lip. Dr. Dobson sucked on the cap of her pen. I said, I think we should hold him, give the meds more time to take effect. Forty-eight hours isn’t enough to learn what’s happened to him, not to its full extent. And if I can convince Frank to attend a few groups, he may reveal more of what’s going on in his head—a win-win. Really he’s quite intelligent. Or he seems to understand the system. Which to me suggests a need not met. One more day, I pleaded. We owe that much to him.
Frank sat in front of the television, passing gas. The stench hung about him as a Linus Van Pelt-like mist. Sill I sat, feigned interest in the TV evangelist, preaching Original Sin. We were born to defy Him. But salvation could be had for the price of twenty-two inch rims, touch-screen navigation, and, to a lesser extent, limo tint. God wanted for his servants the finest Cadillac. And did we really want to betray His wish?
Frank said, Amen.
So you’re a believer? I said.
Well then maybe you’ll appreciate the topic of today’s life skills group—developing a positive social support system. If religion isn’t that, I don’t know what is. Care to join us?
How about a cup of coffee?
A cigarette then.
I opened the group with my story into recovery from mental illness. At sixteen I was diagnosed with major depressive and personality disorders after eating a handful of benzodiazepines, NSAIDS, and antidepressants. I bounced in and out of commitments for a decade, until I met the man who helped me see beyond the broken thoughts like dead bodies sunk in my head. Now my mission was to help others find their solution. And of the group I asked if there was anyone in their lives who might provide the same kind of perspective.
Which was when Frank shot to his feet, and said, I ain’t got no mental problem. The real problem is people like you telling me I’m sick…bad. Just because I don’t follow your rules doesn’t mean I’m broke or lost or stupid. I want to walk hand-in-hand with Our Lord and Savior. Unto Heaven. That’s it! Not like you give a shit. Oh and where’s that cigarette?
I said, What I hear you saying is that you find strength in your faith.
And that you don’t care for our treatment methods.
He curled his lip.
That’s excellent, I said. Thank you for sharing your experience. And you’re right in that religion can be a positive influence. Would anyone else like to share a helpful person, group, or association in their support system?
A sallow-looking man raised his hand.
Go ahead, I said.
Is there a particular woman?
That’s great! Our families are great supports, assuming they want what’s best. Which is not always the case. Consider yourself blessed.
The man smiled.
Frank muttered, Horseshit.
I said, Do you have something to contribute, Frank?
I see what you’re doing, calling my family garbage.
Tell me more about that.
About your voodoo mind tricks?
About what you perceive as an indictment.
Frank puffed his chest. Who’re you calling a dick?
The air in my lungs seemed to thicken, and the other patients held their breath. I thought to pray, but counted backward from ten instead. As if I could de-escalate him. God may have been the better option, but then again faith was a grift. Or we were doomed to live the same mistakes over and over again. No matter how many gold teeth glistened when the preacher grinned.
I watched the second hand on my wrist watch tick. My work phone rang the loudest ring of 4:50pm, amplifying the throb in my head. The taste of blood still lingered on my lips, the smell crusted in my nostrils, from where Frank’s forehead hit. He took me down quick, and the other patients couldn’t peel him off before he got a few good licks. But coming into the job, I knew of the risks. See: no good deed goes unpunished. Also compassion is a matter of dollars and cents. Like love and patience and respect. And so, Fuck it, I said, and went home to entertain the voices still chattering in my head.