Notes from the Frontline

Working in the ward.

Collateral Damage

The list of victims is so much larger than we know.

The cool quiet of my car is blessed solitude before my workday. The drive to Portland begins in darkness and silence. I don’t turn on the radio. I prefer the lull and hum of the roads and freeways. Although it’s still warm, day and night move toward the balance of September’s equinox. By the time I walk onto the ward, bright sunlight filters through the lexan windows onto worn hospital carpet.

Which is to say that that September 11th starts pretty much like any other September 11th.

Most of my patients are just coming to life. By the time they venture from their beds and are marginally awake and dressed, I know the rudimentary facts. In a series of coordinated suicide attacks, two jets have pierced the World Trade Center’s twin towers in New York City, a third has crashed into the Pentagon and a fourth is down in rural Pennsylvania.

I obey the human imperative to call family in New York, but the lines are down or busy or there’s no one there to pick up. A flat electronic voice politely tells me all lines are busy and suggests I place my call again later. The ward manager wants to pray with me. I’m not a believer but this morning I go along.

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In the usual scheme of things, a disheveled shuffling line of patients stops by the clinical desk to pick up their medications on their way to the community room; then breakfast and a morning news program, followed by the first group session of the day. There’s an eerie inevitability to what happens next. In a moment someone will turn on the large screen television.

In the course of eight hours, we – two nurses and three therapists – watch together as an endless loop of video crazily replays itself and the twin towers collapse and rise again and again in a bizarre demonstration of death and rebirth. We’re mesmerized by the spectacle, the upturned faces of New Yorkers, mouths open to receive burnt offerings – the ashes of family and friends.

The most delusional of our patients incorporate the television images into their illness; they smell burned flesh and hear screams that we refuse to imagine. They watch without the filters we take for granted.

A young man sits up close to the television, close enough to distort any coherent image. “There, watch that body explode,” he yells, somewhere between terrified and excited.

The young man’s hair winds into a dozen or so thick blond Rasta plaits. Dark stubble sprouts like new mown lawn on his drawn cheeks and his arms and legs are dotted with old or healing needle marks.

He’s a literature and philosophy major at a small private college in Portland, the domain of the scions of educated well-to-do parents or talent large enough to earn a free pass. At first his heroin use masks the disorganization of his thoughts, the paranoid delusions and auditory hallucinations of his psychosis. Then it doesn’t. He’s on 3 East in the middle of his first relapse, a month after he stops his medications because he feels fine, wants to lose the weight he’s gained from his meds, has a new girlfriend. He wants to devour her dawn to dusk. Normal desires, and the meds mess with all of it, disrupt everything, not just his delusions. They make him itch in places he can’t scratch. A professor returns a twenty-page paper marked in red pencil. His parents bring him home from college when he’s found standing on his dorm bed screaming that his feet are on fire.

Now he’s up all night, can’t study, and has a different interpretation of reality than I do. He’s twenty, a junior, and is embarked on what will probably be a lifelong struggle with paranoid schizophrenia.

Another man, this one middle-aged, puts his arm around his college-aged peer. His face falls into friendly creases and jowls. He’s protective, coming through a vegetative depression – the kind of smothering mood disorder that holds you to your bed. With the help of ECT – electroconvulsive therapy – and medication, he’s fully awake. His hairline retreats, the remainder grays, ambivalent on how to grow old, but he’s clear eyed and animated. His relentless depression, now lifted, provides new insight. The two men share a room and are fast friends. They sit together at meals and in groups. The older man attempts to impart wisdom that has eluded him in his own life: you have to take your meds.

Both men – in fact most of the male patients – wear athletic shoes without shoelaces, ward policy. During groups, a row of shoe tongues loll to the side like panting dogs. This morning no one leaves the community room to wash or dress; pajamas and bad breath are the order of the day. Schizophrenia and major depression are untidy illnesses, and more so on September 11th.

“How do we know the attacks are over?” a woman asks.

Her hospital stay, preceded by a double mastectomy, chemo, radiation and an overdose of opiates, damage the part of her reptilian brain devoted to survival. She’s in her fifties, with disheveled gray hair. A bright purple blouse flutters to her waist like a deflated foil birthday balloon. Residual glue from electroconvulsive therapy electrodes sticks to her temples. Tufts of hair stuck to the glue; these lend a faintly comic air to her forlorn appearance. She huddles into a chair. We’re supposed to help her feel safe.

“What if they bomb us here?”

“How do we know this is real?”

“Yeah, what if they staged it like the moon landing?”

They look to us for answers. While it seems unlikely that terrorists have much interest in Portland, Oregon, none of us feel safe. We do, however, know it’s real and we have nothing to offer except words, soothing and hollow, words that don’t reflect our internal landscapes, our churning dread and apprehension.

The attacks resonate with my own terror of being trapped on an airliner going down; my fears go back to my childhood. In third grade we train to ‘take cover’ during air raid drills. It’s cold down there on the floor under our small desks, but not as cold as the Cold War. The desks are barely wide enough to contain our length, scalp to feet. We cover our heads with our arms and tuck our legs up under our bodies. I’m young, but not so young as to believe that this will help if an atom bomb falls on us. Depending on what we’re made of – brick, glass, flesh – and how far we are from ground zero – we’ll incinerate, liquefy or vaporize.

*This is the end of part one. Conclusion tomorrow.

 

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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