Saturday, August 25, 2012

Sharing is Caring - or an Invitation to a Fight

We’re on a full-to-the-brim 36-bed male unit for the severely Mentally Ill.  Three score of 22-57 year olds and the NA/AA (Narcotics Anonymous/Alcoholics Anonymous) meeting is in session.  Most of the ‘groups’ that take place here are staff-initiated.  This group is different.  One of our borderline, paranoid schizophrenic patients, JZ, initiated this meeting.  He’s totally delusional most of the time.  But he has his good days.  The stories he tells - we wonder, really??   Stories about 'the Haight', places we recognize.  We laugh a lot with him.

JZ asked to get NA started, even explained to us how to get the books and materials necessary for a real meeting.  He wanted to make sure ‘we can we have coffee & donuts, okay?’  We encouraged him to get other interested patients to sign up, and so he did.  It’s not anonymous, but that’s the way it is here.  Nothing is anonymous.  About a third of the guys on the unit put their name to paper.    

I’ve been to a few of these meetings now; I must say I’m learning more about these guys now than I did in years of ‘working’ with them.  They speak from their hearts, and sometimes I just want to cry.  Steven, who told of starting to drink when his “wife left me and took my kids, I was so damned lonely”.  Or Kelly, who spoke of when he was “two or three years old, my dad, he’d beat my mom all the time; I couldn’t do anything about it.  He’d come home and beat her and then one time he stabbed her over and over and over again and he went to prison.  He got out and came back and started beating her again.  I was just a kid, I couldn’t do anything”.   In my opinion, a lot of these guys are the remnants of a sick and apathetic society that didn't take care of them when they were so very, very small and innocent.

It’s 1030, military time, at the 24-hour locked state mental hospital where I work as a Registered Nurse.  My job is to pass medications, assess for physical illnesses, complete reams of paperwork, and at all times, assess for antecedent behavior that could erupt in violence.  It's dangerous here.  Danger strikes patients, staff and police officers alike.  People die here.  Not always from illness.  People are assaulted EVERY DAY here by severely mentally ill patients.  Patients, people that you don’t want living next door to you, or in the grocery store with your family.  Psychiatric treatment here is a difficult task.  Staffing cuts have left few professionals to provide barely minimal treatment to help some of the guys get out of here.  Some of them will never get out.

Saturday on the unit.  Weekends are the sweetest time, no appointments off unit, no escorts to clinics, no management folks visiting the units.  Everyone loves a weekend.  Most of the patients want to lay around and rest in their bedrooms; four patients to a room.  A few of them get up to watch TV or play chess or dominoes, listen to some music.  They come out for meals and ‘med-time’ - sometimes that’s the extent of their presence.  Many patients here are diagnosed with paranoid schizophrenia; they really do feel safer in their rooms, away from other people.  No surprise there.

At one of these meetings, JZ, our ‘facilitator’, is sitting quietly, intently listening to one of the participants read from the NA book.  He notices Jorge walk in and sit down across from him.  JZ opens up the NA/AA binder and gently passes over the Spanish speaking materials to Jorge, whose native language is Spanish.  WOW.  That was nice.  

We observe and attempt to interact with these guys - many of them forlorn, talking to themselves, yelling at noone, pacing nowhere, shadow-boxing with the air, or staring out the windows at the end of the hall.  Most of them are estranged from family, living off the kindness of strangers.  We ‘strangers’ slowly become their main contact with the outside world.  

We’re cursed and threatened, and sometimes, hit.  We’re also loved and respected once in a while.  The ‘kindnesses’ we show our patients is just part of our job.  The kindness seen as JZ handed those pamphlets to his peer, that’s what touches me.  A year ago, he couldn’t have done that.  He was so ill, violent, so full of voices and hatred, kindess was merely lurking somewhere deep in his heart.   The miracle drugs he takes every day, the caring and professional help given to him, have brought his own sleeping kindness to the surface.  Not all the time.  Some of the time.  That’s progress.

Outside the doors of the unit, out where I live, where you live, we encourage giving, sharing and caring.  Here we we see it in the NA/AA meetings.   Most often though, on the unit, it’s a no-no.  Patients aren’t allowed to share tangible items with others.  Too much of a setup for people.  The basic rule is, ‘if someone tries to share something with you, don’t do it’.  Don’t share food or ball-caps, or pants or shirts or headphones.  Sooner or later, as we’ve seen time after time, someone will be accused of stealing whatever it is, or ‘not paying for it’, or ‘didn’t give it back yesterday’, or ‘broke it’, or ‘gave it to someone else’. And the fighing begins.

Here, as in much of society, the weak and helpless are easily taken advantage of by the strong and mean.  Our borderline, anti-social guys easily intimidate the weaker ones.  Please, no sharing allowed.   Sometimes I want to look the other way at some of their sharing.  It seems so darn sincere, a fine act of kindness.  I also know that if I do, it will come back to bite me and everyone involved. 

All of life here is a work in progress.  The patients who are eventually released from this place are the ones who learn to be quiet and polite, store their belongings in their locker, keep to themselves, stay away from fights, take their meds and stop sharing.   All of us on the unit, patients who live here, and staff who come and go every shift, look for ways to keep out of harm’s way.  We keep in mind, most of the time, that help and kindness really are just around the corner.

The guys learn to be kind to themselves.  They learn some sort of kindness to others.  They learn how to get what they want without fighting.  And then we say good-bye to them.

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