“Our treatments are designed to allow our patients to move toward a more independent future.”
– from the facility mission statement
From the back of the ambulance, the building looked dark and forbidding. Ground floor windows were all treated with tinted, reflective glass, and there was no sign anywhere near the sliding front doors to indicate whether this was a hospital, office complex, dental hygienist college, or abattoir of unusual design. The ambulance crew conferred by telephone with someone inside. “We need to wheel him out to the front door,” one said. “They’ll unlock once they see us there.”
Unlock, he thought. This place locks its doors.
Out of the ambulance, through the rain, up to the front door which unlocked with a click, and into a pristine and sterile lobby, where the ambulance crew talked with several nurses and handed over paperwork while he lay still secured to the gurney. He as embarrassed, lying there in his paper scrubs with straps holding him down. He had been told they were safety belts. But of course they weren’t, though they performed that function too – they were bindings, there to hold him on the gurney until such time as someone was ready to set him free.
After some conferencing, a nurse opened a set of double doors and the ambulance crew wheeled him in. The doors closed and the nurse locked them and just like that there he was.
It was quiet. There was no one there but staff and one woman pushing a walker down the hall, muttering. He was glad – he was going to have to live with people in this ward, and didn’t want them to see him rolled in on a gurney. Of course they had all come in that way, but it was 5:30 am and he wasn’t really thinking about that. But he felt acutely embarrassed and vulnerable, tied up and immobile and waiting at the pleasure of others to give him some limited freedom once again.
Jesus, he thought, all I did was fill out a form. It isn’t as though I tried to jump off the bridge or take the pills or anything like that. I went in because I was having thoughts, and I didn’t want the thoughts, and I needed help.
I hope this is help.
He was starting to have his doubts.
After what seemed like a long time but really wasn’t, he got unstrapped from the gurney and led into an interview room. There was paperwork. (There is always paperwork). The iPhone was taken away from him, dropped in a plastic bag, and sealed away. He had to put up a fuss to retain it long enough to text his wife with his location. Aside from his glasses, his wedding ring, one pair of underwear, and one pair of socks – all of which he had to sign liability waivers for (“the hospital bears no responsibility if these items are lost, stolen, or damaged”) he now had no possessions of his own. They even took away his green scrubs and replaced them with blue paper pants and a blue tee shirt – what he would come to think of as “ward chic”. They assigned him a bed, took a blood sample, gave him an injection, and he was officially finished with intake.
The ward had 16 beds – 13 occupied, including his. It consisted of a single long corridor with rooms off to either side (some of them with two beds, some with three) and a glass “emergency exit” door at the end. Through the exit door, if one stood just right, one could see a cherry tree in bloom. At the other end of the corridor was the nurse’s station/staff area where records, equipment, drugs, and the phone were kept. There was a vaguely seen room with a door like a walk-in freezer and a large window off the nursing station. It was labeled “Observation”. It was ominous.
Just off the corridor to one side of the nurse’s station was the day room. This was the social center of the ward. It had tables and chairs and a couch with stiff vinyl cushions. There was a television behind a thick Plexiglas window. There were crayons and felt pens and a few word puzzles. Books included the AAA Guide to Spain, a travel guide to scenic Tuscany, and Wine and Food: Pairings Made Easy. There was art – apparently made by former patients – on the walls and partly covering the window, obscuring the view of a parking lot and the blank wall of the building next door.
Almost everything of any importance to the daily functioning of the ward went on in the day room. Meals were served here. Group sessions on topics ranging from anger management to personal hygiene and art therapy happened here. Announcements about things happening on the ward and reminders about the rules were made here. Blood pressure tests and blood glucose tests were made here (yes, there was blood work being done in the same place that patients ate and congregated. Some of the patients didn’t like it, and when it was time for his blood draws he would frequently try to convince the nurses to do it somewhere else, but was often unsuccessful). Snacks were distributed here.
The ward had a converted feel to it, as though it had originally been used for some other purpose. Rooms were not uniform in size or shape. There was a locked stairwell leading to the second floor. There were areas where the walls were marked by signs that had since been removed. It wasn’t a bad place (as such places go he had imagined far worse – a veritable bedlam of cages and damp basements) but it showed some age and hard use.
His room, which he shared with a glassy-eyed schizophrenic who said little, didn’t snore, and was in all ways about the best roommate that anyone could hope for – contained two beds, each with no sheet and a single blanket and a single pillow. There was a writing desk and chair, which he couldn’t for the life of him figure out a use for given that they were allowed no pens or pencils, and crayons & felt pens were limited to use in the day room. There were two individual lockers with padlocks for which the staff had the keys, which again he could not figure the use for given that practically everything he owned had been taken from him and locked away. There was a window that looked out onto the same parking lot and blank wall as the window in the day room. It got no direct sun. There was a bathroom with no door but a shower curtain, a toilet that sounded like a jet engine when flushed (he soon learned the basic ward etiquette – don’t flush after lights out unless it’s a #2), a small sink, and a small shower stall with no shower head and a water control button that you had to push approximately once every 30 seconds to keep the water on. There was toilet paper, some towels, and some soap available in the room. Additional amenities such as shampoo, conditioner, toothbrush, toothpaste, a comb, and antiperspirant had to be requested from one of the nurses.
This was where he would be living, until others decided to let him go free.
Since he finished his paperwork about the time that everyone got up for breakfast, he had no real opportunity for sleep. He ate a bland but filling breakfast (eggs, toast, bacon, and farina) but missed the coffee (which turned out to be decaf anyway). He did what most people would do under similar circumstances – kept his head down, kept quiet, observed the others on the ward, and tried to figure out what the group and individual dynamics were. He attended a group session, spoke a little to others, avoided snacking, and tried to put on his game face for the staff to show that he was feeling better and not the sort of person who would do terrible, terrible things that might get him put into a locked ward as a threat to self, threat to others, or profoundly disabled. When he was not doing something else he tried to nap to catch up on his sleep, but unsurprisingly found it difficult in a strange bed in a strange environment surrounded by strangers. He had his blood glucose tested four times, his blood pressure taken twice. and received his meds for both diabetes and blood pressure. The hospital did not carry the type of insulin that his doctor had prescribed, he was informed, to he was getting a substitute. They would be using a sliding scale to determine his dosage several times a day based on his blood glucose results. They were very concerned that his blood glucose level stay healthy.
For dinner they served him pasta and cake.
That was how the day passed.
His wife and two friends came for a visit. He was pathetically grateful to see them, fighting to hold back tears. The three of them could only visit two at a time. They had to be searched before being let into the ward. He felt simultaneously ashamed that they saw him like this (disheveled, wild-haired, in paper pants inside a locked ward) and profoundly moved that they would go to the trouble of coming to see him, an hour drive away each direction. There was not really all that much to talk about – conversations about being 5150ed and life in a locked psychiatric ward were by mutual consent off the table – but the companionship was wonderful, like a breath of clean air in the midst of poisonous haze. His wife promised to bring him some books to read (since Wine and Food, Pairings Made Easy held little allure and there were no plans to go to Tuscany), and at the end of visiting hours he watched his wife exit the locked door through which he could not pass.
At 10:00 pm the tv was turned off and it was time for everyone to go to bed. This is when he was informed about the monitor he was to wear. Because he had been diagnosed with sleep apnea, they intended to monitor his blood oxygen levels with the aid of a device that looked like a large sports watch attached by a wire to something that looked a lot like a clothes pin. The watch went on his wrist and the clothespin went over one finger. It monitored his heart rate, and shone a light through his finger to determine his blood oxygen level. They were very concerned about making sure that his blood oxygen level stayed high, so a staff member would check on him and get a blood oxygen reading from the device once every ten minutes throughout the night. If by chance he happened to have rolled over, tucked himself under his blanket, or had shifted his arm and the monitor so it could not be read, the staff would wake him up to get him to move so they could get their reading. He was admonished to simply keep the arm with the monitor outside the covers with the monitor facing up so he could avoid having the staff disturb his sleep.
He pondered how he could do that while asleep, but could find no simple answer. It turned out that for most of the night it wasn’t an issue though. The woman across the hall, who had glossolalia, would talk or sing or clap and keep him awake, or someone elsewhere in the ward would conduct a conversation with things unseen, or the bathroom light – which could not be turned off – would bother him, or his own fear and anxiety would pull him away from slumber, So the checks for his blood oxygen every ten minutes didn’t bother him much. The bed checks ever ten minutes didn’t bother him either though they were not run concurrently with the blood oxygen checks which meant that someone was literally coming into his room every five minutes throughout the night.
In it’s own way it’s clever, he thought. If you never get to sleep, you can’t suffer from sleep apnea.
The blood oxygen monitor also monitored heart rate. His was in the low 90’s. He spent a couple of hours trying to voluntarily lower it through meditation and directed breathing. while watching the monitor for positive or negative feedback. Eventually he got it down to the high 60’s.
It was the closest thing he had to a video game.
A little after 3:00 am he dropped off to sleep.
It had been 41 hours. No one had yet asked him why he was depressed.