Withdrawal

There are a few times, with a few patients, that I am jarred. She was one of these times.

Small, skinny, with heavy bags under her eyes and thinning blonde hair, I could not tear my eyes from her sad, distant smile. I knew those eyes. I knew her posture, shoulders slumped inward, defeated already at such a young age. A heroin addict, going through withdrawal.

Someone I loved once, once and deeply, was an addict too. Tall, strong, with a wild grin and deep blue eyes, tanned skin and thick hair, he didn't look the part. He hid it well. But behind the facade, despair wrapped around his mind. I saw him then, when the smile was gone and his head was buried in his hands as his shoulders shook with the desire for a drug so devastating that he lost years of his life and his memory to it, running from a past that always seemed to loom large in front of him. When he lifted his head, the motion seemed to take all of his energy, and the bruises, dark, black, heavy, encircled his once fake-bright eyes.

As I watch her walk down the hallway, I see him in her steps, stumbling slightly from days without eating, days in which his stomach would not even hold water. I see how she weakly clutches a trembling blanket closer around her thin frame, and I remember how he could never seem to get warm. I see her bones, standing out against dehydrated skin, and remember counting his ribs as I counted his shaky breathing.

When she suddenly blacked out, stumbling to her knees, I remember catching his limp body with my own weight, stumbling back, bruising my back. When he came to, he cried, and so did I.

I would not date him while he was on drugs. That was the deal, and no matter how I felt, I was firm on it. So he stopped using. For a time, at least. When the shakes finally passed, when he could finally eat and smile real, tentative, smiles, the period that followed was bright and joyful. But his eyes never lost their bruises.

When I found that drug hidden in his bathroom a year later, I sobbed. He found me there, and could not deny it. The defeat was back in his eyes, in his shoulders, in his hands. I asked him why, and all he could do was shrug. I knew why. It was a stupid question. I knew he had not faced his demons, but instead tried to hide from them behind me. And for a year, it worked.

I left him then, for a while at least, and six months later, he reappeared in my life, brighter, somehow. Less bruised, less beaten. And for just under a year, we were together again. But what once was hopeful and lovely was marred by my terror that he would begin using again. I became paranoid, and he would watch me with sad eyes that still held a trace of their bruises. We fought, we cried, we made up and fought again, and finally we parted ways.

I never heard from him again. I don't know how he's doing, if he's still clean, or even if he's still alive. But as I see this girl, just a few years younger than myself, stumble down the hallway, I send a sorrowful prayer heavenward. I pray for her, and I pray for him.

And I pray for me.

Laughter

There are times with my job where it takes all of my patience to tell a patient that they are acting like a spoiled brat. Granted, I understand that they are afraid and are hiding behind a guise of impatience and rudeness to mask their terror and vulnerability, but sometimes some people take it so over the top that even the nicest people I work with are cursing about them behind their backs.

“Sara” is one such woman. She is rude, entitled, and snotty. If we did not drop everything to assist her right that instant, then we would have a Recipient Rights Compliant filed against us. If we told her 'no,' or tried to explain a rule, BAM, RRC. She drives us all up one wall and down another, and all I can do is hide it until I get home, until I can relax with my cup of tea and vent and yes, even laugh about it.

That's one thing I've learned, working here: Laughter really is the best medicine.

I sit at my kitchen table, talking wildly, complaining loudly, and my Chosen sits across from me with a little smile on his face as I begin to mimic her tone, her demands, and suddenly I see how pointless it is to get so worked up over one patient, and I too begin to smile, and suddenly we're both laughing, and after I'm out of air I just smile instead, and then he grins and knocks my shoulder, and I go to bed happy.

Too many people are too easily offended. I know outside of work that I am too. But Sara has taught me that I can't be hurt or confused or offended just because one patient out of hundreds treats me with dismissal and disrespect; I know I have helped a good many people fight their battles, and maybe even defeat a few monsters too. I do good work, and I am proud of my work.

I can't let one woman, no matter how frustrating she is, get the better of me like that. So instead I'll ignore the tone, ignore the rudeness and the threats, and treat her with the same efficiency and care that I do with every patient that I meet.

And, at the end of a particularly hard night, I'll go home, make myself a cup of tea and honey, and laugh about it.

To My Daughter

I wrote this recently, and a friend and fellow psychiatric hospital worker asked me to post it here. She told me that the groups she has led using it have responded very well to it. I hope you all enjoy. It is called "To My Daughter."

My precious daughter:

I will never call you beautiful, that

ugly, caging word, but

I will call you strong,

confident, resilient, unafraid

to speak

your mind.

I will never call you cute,

but clever, and

laugh at your quick wit, your

darting smile.

I will never call you Darling—

instead, be Daring.

Take risks, climb

mountains, be unafraid

to lose.

You will never be my Princess, but

you will be my

Adventurer.

Face your battles, slay your

dragons, save

yourself.

Don’t be sweet—be

smart, learn the

whys and the hows, and

question

everything.

Don’t let me call you perfect—make

mistakes, throw

tantrums, be

human, be

you.

As I watch you breathe,

slow, soft, I

marvel.

I marvel at

your smooth skin, your delicate

lips pursed

in sleep, your

downy hair that I

feather

trembling fingers

through.

Oh, my precious, precious daughter,

I will never call you beautiful—

Even though

You are.

Instead, I will call you

Free.

Difference

About a week ago (http://wanderandworldwalk.blogspot.com/2014/10/to-hear.html), I wrote about a girl who confessed to me that her mother was rapidly growing abusive and she was terrified of he. I was unable to work with her since that day, as I was assigned to different groups, but on the day of her discharge I happened to be her staff again. She was smiling, happy, writing little notes to the staff that she wanted to thank. And then she pulled me aside.

“I'm not going to write you a note, Miss Miri, but you're amazing. You're the first adult to actually listen to me—they sent my mom to a mental hospital because of you, and I'm hoping she'll be able to get help. I thought no one would listen; you proved me wrong.”

And she gave me a big hug as she walked out the door.

I'm blinking back tears even now. I had hoped to know what kind of impact I might have made, to know if I actually made a difference, even a small one, and I am so incredibly blessed to have that knowledge. She was so scared that if CPS got involved, she would be pulled away from her family, and instead they were able to get her mother help and give her hope. She left my unit happy and smiling, eager to go home, to see her father and siblings again without having to worry about her mom hurting them.

It was a wonderful reminder that everyone deserves someone to listen to, everyone deserves a chance to be understood. Sure, her tearful confessions put me back in my paperwork and made me miss my break and caused me some serious stress, but knowing that she was heard because of me is amazing. I am so glad I listened, so glad I wrote down all of her sobbing, half-formed thoughts, and that her social worker took the time to talk to her. We made a difference, a real, solid difference, in that girl's life, and to me that is worth all the stress and exhaustion that one night caused me. She is a brilliant and wonderful girl; I wish her every happiness, as I do with all of the children I work with.

And next time I find a girl sobbing in her room, reopening her old wounds and hysterical, I will remember this girl, and I will listen.

And I will hope, as always, that I can make a difference.

Legends

I said goodbye to one of my most challenging girls today. I know it's likely that she'll be back (we see a lot of the same kids over and over again), but I really hope she lives a full and happy life. Her world has been rough and cruel to her; I am glad that I was at least able to make her smile.

I get weird looks from my fellow staff when they find out I tell stories. They don't understand what the point is of fairy tales once you reach a certain age. They forget that legends and fables have lessons within them, and those who are open to it will learn that lesson far better than any other way. This girl was one of those.

Every time I was her staff, she would ask eagerly for what kind of story I would tell, and spend the rest of the day wondering about it. She would rally the other girls around her, and send them all into silence when I dimmed the lights and sat. She'd drift off into the land of legends, and return with a faint, happy smile. For her, I wrote a list of books to read. I want her to continue that wonder even after going back to reality.

People who say that people who read or tell stories just do so to escape reality don't understand the point of that at all; we read or tell to make reality that much clearer. The grains of truth within each tale are the grains that will take root and grow; to understand that life, that reality, does not begin and end with your birth and death, but continues in one continuous, endless loop is both terrifying and freeing. Stories take the pressure off us to be the best; instead, they simply encourage us to hope.

And hope then will flourish into dreams, dreams into goals, goals into reality. The strongest, most successful, happiest people in the world may not always be the richest, but they will be the ones with heads stuffed with lore and hearts singing with hope and promise.

And for this girl, hope was all she wanted.

What Was

I walk slowly down the halls of my old Residential Unit. It is filled with adults now, and in the distance I can hear their conversation. Down what was once the Boys' Hall, I inhale the faint scent of women's perfume, and am mildly surprised to find I miss the stench of sweaty gym socks and body odor.

To my right is the nurse's desk, where once our supervisors sat and surveyed the unit, a radio on hand always in case of emergencies. Now, two staff sit and chat with the patients, handing out water, crackers, and juice.

Where I once taught my kids about life and hope, women watch television, their eyes glued to it, resentful when we shut it off for groups or discussion. I smiled faintly at the indelible swear words scratched into the wall by persistent children; even now, they have left their mark.

One of the doors that leads to the classrooms always sticks; I was there when a boy punched it, bending it slightly. I mention this to a coworker, and they look vaguely horrified; I simply smile sadly. I miss him. I miss all of them.

Our classrooms have been converted into counseling rooms and a small cafeteria; bare walls have replaced clumsy drawings and cheerful posters, tables and chairs lined where once desks scattered.

As a whole, the unit has not changed much. The murals are still on the walls, the view is still quite lovely, and the windows offer plentiful sunlight. But the soul of the place has changed. There is no longer a sense of wonder that children, even children as jaded as the ones I loved, bring to a place they call home. There is no piles of colored pictures, no picture books, no Disney movies. It is almost spartan, compared to what it was once.

True, this new unit is far smoother; we rarely, if ever, have to do physical managements, and I don't think we've ever used the seclusion rooms, but we also never sit and play Magic, or talk about parents and siblings. The women here are pleasant, kind even. The kids were unpredictable at times, uncertain, tremulous and wild.

I guess I miss the suspense.

I know I miss the wonder.

I hope they're happy.

I hope they're free.

Fatherly Love

One of my favorite girls was discharged today. She was always so bright and cheerful, open and honest. She smiled as she packed her bags, excited to go home, but nervous too. I helped her get everything together and felt a little sentimental as she left my unit, beaming.

She came back 30 minutes later in tears.

Unbeknownst to us, her father had come to pick her up. The problem was that her father did not have custody of her, and the minute he saw his daughter he began to swear and curse at her, calling her names and mocking his child. The nurse discharging her simply turned around and took her back.

I talked to her, and all she said was “I don't know why I expected anything different. He's always making fun of me, calling me fat or ugly or stupid.”

It was terrible to see her lose her smile. Even though technically it was bedtime, I set her up with a movie while we waited to see if her mother would be able to come and get her. Every time I did rounds, I poked my head in to make sure she was okay, and she would give me a wan smile.

When we finally got word that her mother would be able to pick her up, I was relieved to tell her—and checked to make sure that she was comfortable going home with her. She nodded, looking a little less distraught. She asked if she could lay down while waiting for her, and of course I agreed.

Not everyone who has children deserves them. This girl was bright, smart, popular and beautiful. She was ambitious and practical, and I watched everything she had learned here dissolve under the insults of her father. I hope her mother offers more support, but I have seen a great many kids come and go here; it's almost like a revolving door. There are some kids who act out right before they are set to be discharged just because they're scared to leave. If they tell us why, we try to help, but sometimes they are so used to silence they don't know anything else. In that case, all we have is a vague sense of something being wrong, and we can't report that to CPS. We can, however, pull their social workers aside, and hope that they are able to glean more information.

And for this girl, all I could do it hope that her mother will help her grow and thrive—and that she'll never have to talk to her father again.

Impact

Today was a good day until about 10:00 pm. That was when the sobbing and screaming began. At first, I didn't think much of it; as strange as it seems, this is commonplace in a hospital like mine. But as I was putting away paperwork, about to start my break, I could hear the nurses talking frantically about rearranging everyone. I told one of them I was going on break, and offered to postpone, and she gasped in relief and shipped me off to sit the the new “unofficial AL” girl.

“AL” means arms-legnth. It is for patients who are high, high risk for hurting themselves. She was unofficial because a doctor hadn't ordered it. I realized with a shock it was a girl who had been on my group that evening, and wondered what on earth she could have done in the hours since bedtime to demand such care.

I walked in the door, and a nurse was sitting cross-legged on the floor across from the girl, who I'll call Erica. Erica was trembling visibly, eyes red. The nurse looked quite relieved when I came in. Erica offered me a wan smile, and I returned to her a genuine one. I sat in the same position as the nurse, and asked her what was going on.

“I did a bad thing,” she said flatly.

“What happened?” I asked.

“I thought I had 15 minutes.”

“15 minutes to do what?”

“I tried to strangle myself. But Miss Cheryl walked in!! I thought I had a whole 15 minutes!”

I was shocked, but I didn't say so. Erica had been hiding under the desk when I first came in the room, but once I sat down she had joined me, and we had played cards and talked and laughed. I thought everything was as well as it could be. But I was wrong.

I didn't know what to say. What can you say to a girl only 14 years old and already determined to die, a girl who is pulled into herself, shivering from adrenaline and terror?

“Would you like to hear a story?”

A half smile, a small nod, and she buried her head in her arms and cried as I told a tale of love and patience. When it was over, she had a tiny, real smile on her face.

“How do you do that? I can't even believe I'm smiling,” she said, ducking her head, touching her face.

I just smiled, and we talked. Now that she was more settled, she was more willing to open up. She told me about how she'd been planning it all day, but how some of her plans went south. She'd wanted to be isolative all day, to make everyone annoyed by her.

“But then you were my staff, Miss Miri,” she said ruefully. “Lots of people, they come in here negative, and I can feed off of that, but you never do.”

I just laughed a little and gestured for her to continue.

She told me about her father, who had just died mere weeks before. Today was his birthday. She laughed, she cried, and I listened. We talked about God, about faith, about books and taking time to care for yourself, and she listened, and I rather hope she heard me too. I tried to give her hope. I don't know if I succeeded.

“Sometimes I just think you're all actors,” she told me, leaning back. “That this is all one big play I'm not a part of. I know it's not like that, but sometimes I wonder.”

I nodded in understanding. I told her a little of my own life, of watching my friends struggle with different mental disorders and some overcome, some, sadly, refuse to accept any help. And she listened.

And, after an hour of talking, of sharing, of tears and laughter, she sighed, stretched, and stood.

“I think I need to go to bed,” she said as shift change began and a new staff appeared at the door to watch over her.

“All right.”

“Thanks, Miss Miri,” she said quietly.

“I'll see you tomorrow, Erica. Feel better—and sleep well.”

And I left her, half-asleep on her bed, no longer trembling, a new staff at her door, and I wondered and hoped and prayed that that mere hour made a difference.

To Hear

It was her first time here, her third night, and she was scared to death. I found her hiding in the bathroom in her room, sobbing hysterically and scratching open the cuts on her legs. Calmly, far more calmly than I felt, I shepherded her into our dayroom and sat down across from her. She was hysterical, practically incoherent. All of a sudden, the story spilled out: her mother, a woman diagnosed with bipolar disorder, was rapidly deteriorating, yelling, screaming, and she was terrified that she would start becoming physically abusive soon. The details changed but that core stayed the same.

“I don't belong here—she does! She's crazy!” she sobbed over and over again. “I've told people but no one listens!”

As she talked, a nurse leaned against the doorway, listening. We exchanged glances and tried to comfort her, but she would not be settled until after the nurse left and another thirty minutes had passed. Finally, I was able to ask her to help me clean up the dayroom to distract her, and after a while, she finally went to bed.

As I went into the conference room, the nurse saw me and strolled over to touch base.

“She was very erratic, wasn't she?” the nurse said conspiratorially. “Her story kept changing.”

I nodded noncommittally and grabbed the report. Since I was the one she'd first opened up to, it was my job to write it down.

I left out the inconsistent manner of delivery, and wrote down what parts had remained consistent. I hoped her social worker would take her seriously.

Before I left for the night, I poked my head into the girl's room again. She was fast asleep, exhausted.

As I walked out to my car, I sent a prayer that we could help her.

And that I could show her that some adults, at least, will hear her.