The Crazy Shift

Eight hours in an emergency psychiatric ward reveal the fragility of the human psyche--and the horror that can lurk within.

By Daniel Watson, published on September 01, 2000 - last reviewed on September 25, 2009

Report is over. Night shift forces smiles while saying good-byes and good-lucks. Day shift tries to respond in kind.

8:30a. m.

Pete and I huddle to decide who's going to start which cases.

"I'll do Chad. I know him from Northern Heights," I say. "You take the 16-year-old. That's a fair match." Juvenile cases are often quite involved, more so than usual, because of the minors' status and legal implications. Pete nods and we scuttle to the counter to set up shop for the day. I grab Chad's chart on the way; its thickness and heft are physical reminders of his lengthy psychiatric history. Although Chad has managed to compile 25 to 30 psych presentations to EPC in the last two years, I can't find any documentation of actual suicide attempts or violence. He does talk a lot about it, though. Chad is forever threatening to kill himself by electrocution or overdose or gunshot or hanging or jumping off a skyscraper. On good days he's really creative--a corkscrew into the heart, a chopstick through the ear. Sometimes he just says he feels like he needs to be in the hospital. When asked why, he replies, "Trust me on this one."

The behavior manifested the night before with the bed seems unusual for him, and it concerns me. I wonder if Chad has graduated from talking a big game to acting it out. I sincerely hope not. I have long felt that Chad is a powder keg ready to blow, filled to the brim with explosive rage, hurt and fear. Chad has consistently carried a diagnosis of schizoaffective disorder (a combination thought and mood disorder) and borderline personality disorder (defined partly by extreme behaviors, mood instability, interpersonal difficulty and manipulation). His childhood was far from ideal. After his drug-addict mother--herself schizoaffective--abandoned him at age 4, Chad was raised by an alcoholic grandfather who reportedly beat him. It is an all too familiar story, the passing of the mental illness torch down family lines.

8:37 a.m.

I find Chad S. in Seclusion Room One, sleeping noisily on a hospital cot, left ankle and right wrist strapped down with leather restraints. After several unsuccessful attempts to wake him verbally, I cautiously shake his leg. Chad slowly opens his eyes, looks at me and grins, muttering, "What's up, dude? Can you get these off me, dude?" lifting the restraints.

"Can you control yourself?." I answer. "I heard you destroyed a bed last night."

Chad yawns and at tempts to stretch. "Yeah, I had to, dude. But I'm cool now."

"You sure?" I ask, not fully convinced. Chad nods his head, and stretches again.

"Okay, I'll talk to the nurses." I go and check with Tom, one of the day nurses, who agrees it is probably safe to let Chad loose now. It is hospital policy to restrain a patient only if necessary, and only at the minimum level required. Once freed, Chad rubs his wrist, slips off the cot and plods my way. He has a tall, lanky frame with a budding pot belly. His face bears two wild eyes under stringy brown hair. He looks menacing.

Actually, I like Chad. I'm not here to be his friend, though. I'm here to get him help. He steps out of the bathroom and lumbers my way. I lead him to one of the interview rooms and we begin.

"Listen, man," he starts, "I was only protecting myself."

"What do you mean?"

"The dogs in the neighborhood are after me, plotting to kill me." He sits there looking at me, completely serious.

"Uh, why do you think that?" (I mean, how do you reply to that one?)

"I got eyes, man, I can see what they're up to." His eyes set into a steely stare.

"So, why were you in your neighbor's backyard with a knife?"

"Lettin' 'em know who I was. Lettin' 'em know they can't get away with it."

"Get away with what?"

Chad looks at me like I'm the stupidest person on earth. "Get away with murdering me, fool."

"Have you been smoking any marijuana lately, Chad? Doin' any drugs?"

"No, I haven't been smokin' any weed or doin' any drags and even if I was, it's my own damn business isn't it?" His voice is starting to rise and his eyes are dark. He's getting angry. I change the subject.

"Chad, how have things been going lately?" Chad lives alone in an apartment in a high crime-rate area, is psychiatrically disabled, on Social Security, and has far too much time on his hands.

"Oh, you know. I got it going and it goes around and around." Sometimes I have no idea what he's talking about. But at least he's grinning now.

"Have you been taking your medication regularly?" He kind of nods and shrugs, a halfhearted yes that tells me no.

"Have you been depressed lately?"

"No, I haven't been depressed. I've been feeling mad." His eyes flare for a moment. I don't like what I'm hearing and seeing.'

"What's this about tearing up the bed last night?" I inquire.

"What about it? They shouldn't have pissed me off. Everybody pisses me off. It's the law, brother." He slams his fist into his hand, half-grinning. There's something about that grin, and those eyes, that lurks deep within him, something that I don't want to get very close to. We finish and I lead him back to the containment area.

9-15 a.m.

In the command center I look up Chad's case manager's number and dial it. As usual, the CM isn't available, so I leave a message for her to call me as soon as possible. I begin the tedious process of writing up the report.

9:35a. m.