Notes from the Frontline

Working in the ward.

Is He One Of Yours?

Seeing your patients in a different context takes many forms.

“Is that one of yours?” my stepdaughter asks. She’s eight years old and mine for the afternoon. I see and hear him at the same time she does. But her matter-of-fact use of ‘that’ when ‘that’ is a man, upsets me, and I explain this to her.

We’ve taken the MAX train downtown to catch a movie in Portland, Oregon and the man is leaning against a low brick wall that encloses Pioneer Square. We will pass him unless we cross the street.

He wasn’t one of mine, but the question, ‘Is he one of yours?’ was, by then, something frequently asked of me. Now the responsibility of caring for another woman’s child, my husband’s daughter, weighs more heavily on my shoulders than the identity of the man who blocks our way on the sidewalk. I reach for her hand.

“What?” he shouts, a vehement challenge of an internal voice – his way of saying, “Quit messing with my head.” His arms flail and he’s noisy, this side of shabby, and obviously psychotic. He has thick black hair that stands up straight around his head and dark brows that meet in the middle of his nose bridge. Do I want to make eye contact?

He’s dressed in high-end Good Will, gray sharkskin sports jacket, clean jeans, white sneakers. He quiets as we near, nods politely, then moves aside to allow us to pass. He’s close enough for me notice crumbs of meals past in his beard.

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On the locked psychiatric ward where I work, I help stabilize men and women in crisis, usher them back into the community. These same men and women live in Portland. Sometimes they wander the city, looking for doorways in which to rest or food remnants or cigarette butts. They reek of life on the streets. The more fortunate of my patients have homes and families, careers, lives lived in a community where belonging is a given.

I routinely cross paths with them. Some are too ill to recognize me. Others don’t greet me – a moment’s acknowledgement and then something else on which to focus. Still others want to make contact, like seeing a teacher outside of school.

There are rules of engagement. I never greet a patient unless they greet me. I accept brief eye contact, no eye contact, a smile, a few garbled words, a turning away or a hand that reaches out to mine – whatever they want to offer.

A young man spends a weekend on the ward. He’s new to town, a graphic designer for a Portland weekly where I am a book reviewer. This is information I cannot share with him. He’s depressed, lonely, heartbroken at the end of a relationship who, for a fleeting moment believed that not living might be preferable to living. When he’s discharged, he confides that he feels ‘normal’ in comparison to some of the other patients. When he sees me on the street, he faces away and lights a cigarette.

Out in the world, interactions with former patients are beset with ethical challenges and boundaries.

Some of my patients are involved in the sex trade, to support their drug habits, pimps, kids. A visit to the ward is often prompted by an arrest or the need to detox down to a more affordable habit. “How ya doin?” they greet me if they see me on the street.

Or a couple of familiar heads appear like jacks-in-the-box from a dumpster. “Hey, you, I know you,” the woman says. She pulls her husband up from the trash. “Say hi,” she says. She has a broad smile and generous nature. She calls her husband ‘daddy.’ Daddy waves.

Over Thai food one evening, my husband notices a young woman at a nearby table. She looks at me with the briefest flicker of recognition, then nothing. I’ve learned not to take it personally. I continue eating my Pad Thai. My husband asks the inevitable question. I say nothing. She’s a schoolteacher and an alcoholic and several months later dies of seizures in the ICU during the her last detox.

I literally bump into a man whom I know from two stays on the ward.

“Hey, mom.” He yells out to his mother in another aisle of the one-stop-shopping market. We’re both trying on shoes. “My nurse is here. See? She’s buying Sketchers too.” He shows me his new runners, proud to have something in common with me, to share a moment of health. I greet him and his mother, whom I know from her son’s hospitalizations.

“He’s not taking his meds,” she says. I recognized the signs of escalation.

The following week he’s back on the ward, angry, brooding, pacing in his new Sketchers. Seventeen laps, one mile. Over and over. He doesn’t recognize me.

As my stepdaughter and I walk back to my car after the movie, I look for the man with the wild hair and sharkskin jacket. He’s in a doorway that we will pass. I nod to him. He nods back.

I know how it feels to belong. I’ve learned how it feels to be too visible. Half visible. Invisible.

 

Evelyn Sharenov is a writer and mental health nurse. Her essays have been published in anthologies and The New York Times.

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