was flattered to be named a charge nurse in the women’s Acute Ward at
Northampton State Mental Hospital. At 23, I’d never really been in
charge of anything before. This was the bustling, all-important day
studied Psych in my Midwestern nursing school: I’d spent three
months working at a private mental hospital, set amid lush, misty hills
near Louisville, KY. I’d learned to Listen Therapeutically. I’d crafted
Individual Patient Treatment Plans. I’d enjoyed it.
day, as a
reporter, I could even write about my experiences at Northampton State.
first day, the personnel department gave me an engraved plastic name
badge: Susan O’Neill, Day Charge Nurse. They sent me to my new ward for
seemed to be a staff shortage; the only person who could orient
me to my ward, and to the 26 patients in its beds, was Mrs. Flaherty,
the LPN who would be my assistant. She was a large, florid, middle-aged
woman, perpetually short of breath because, she said, she had a “heart
Flaherty told me that my “acute ward” served women suffering
active schizophrenia, mania, depression, alcoholic tremens—anything
that qualified as mental illness. It also served women who’d been in
the hospital for as long as anybody could remember, who were kept
docile by anti-psychotic medications in doses that would stun an
warned that there were always a few “special” patients, sent by
nurses on other wards who found them disruptive. Or who didn’t like
who, as I later discovered, didn’t like ME.
was responsible for everyone on the ward, and everything that
happened to them. And, of course, for the huffing, puffing, Mrs.
included: admitting and discharging patients,
keeping them clean, fed, medicated, uninjured, and dressed in
hospital-issued housedresses. We answered phones, ordered laundry, sat
with patients while they smoked (Mrs. Flaherty smoked, so this was her
bailiwick). We prepared patients for doctors’ visits, escorted them
from the locked ward to the lunchroom, the clinic and, when
appropriate, outdoors for strolls. We mopped the floor, changed the
linen, checked bedside drawers for contraband food (the 100-year-old
building was prone to mice). And I signed off 26 charts before the end
of the shift, when I gave report to the evening Charge Nurse.
going to be a challenge to fit in Therapeutic Listening and Individual
Patient Care Plans.
quickly settled into a routine, Mrs. Flahety and I. I’d sit with a
patient for about 15 seconds of Therapeutic Listening, then run to
answer the phone. I’d pass medications, check to make sure each patient
swallowed what I gave her, then lock up the cart and run to answer the
phone. I’d change linen with Mrs. Flaherty, then run to answer the
phone and leave her to finish the task.
ran to answer the phone because Mrs. Flaherty couldn’t run because of
her heart condition. Besides, she was smoking with patients or
transporting them or mopping the hall.
phone rang because of the
laundry. It was all about extra-large housedresses.
institutionalized for a long time became mellow and slow and
big. Most of my “acute” patients had been there forever. They wore
extra-large housedresses. There were Not Enough extra-large
housedresses. Not Enough dwindled to Practically None with every
laundry delivery. Perhaps they went to that place that swallows up
socks. Certainly, nobody was stealing them, because they were
astonishingly ugly—shapeless yards of once-cheery flowers and plaids,
faded to a mockery of a mockery.
I called the laundry to beg and cajole and, when that failed, called
other wards to bargain and swap. I had to be diplomatic. If I alienated
a nurse on another ward, she might send me one of her “special”
ongoing battle consumed my day.
did, however, get a half-hour for lunch.
first two weeks, I brought lunch and tried to eat it. But there was
always something—a patient falling, or terrified because she’d been
cornered by a mouse, or attacked by one of those “special” transfers.
There were questions. Voices commanding someone to eat the toilet
paper. I worked hard to rectify everything, to do it all.
truth, the interruption was usually something Mrs. Flaherty could’ve
handled. I staggered our lunches so she would be there when I ate.
the patients came to ME. Because I was the Charge Nurse.
Flaherty, for her half-hour, escorted the more able patients to the
cafeteria and ate there. “You should do that,” she said. “It’d get you
off the ward. The patients eat together; you sit with other staff, and
nobody bugs you. I’ll switch with you Monday.”
next Monday, I escorted my patients to the cafeteria while Mrs.
Flaherty ate on the ward. I followed everybody through the cafeteria
line without incident until we reached the big tub of jello that served
as desert. The patient in front of me, a chronic schizophrenic with a
zombie lurch betraying too many years of maximum-dose Stelazine,
scooped out a handful of jello, dumped it on her plate, wiped her
green-smeared fingers on her extra-large housedress, and moved along.
next day, I brought lunch, locked myself in the office, and told
Mrs. Flaherty to tell the patients I was gone. It felt cruel, but
ward doctor came once a week to review the patients. I called them
into the office one-by-one for this important event.
doctor was a young woman from the Philippines. She was actually a
pediatrician; she needed these hours of state-sanctioned work for her
insisted I stay with her during interviews. After
each patient left, I’d close the door. “Now—what did she say?” she
asked each time in heavily-accented English.
spoke very, very slowly.
did occasionally get new patients. One woman checked herself in
after a fight with her husband. “He kept yelling at me, ‘You’re crazy.
You’re crazy,’” she said. “So I sez, ‘Okay. You think I’m so crazy,
okay—I’m gonna go commit myself up to the nuthouse!’”
minutes of watching stoned women lurch around the room in extra-large
housedresses, she decided to check herself out. Unfortunately, there
was a minimum stay for self-committed patients. She spent it
alternately hiding in bed and chain-smoking with Mrs. Flaherty.
sometimes got new patients who were truly ill. The teenager who’d
flipped out during an acid trip; alcoholics in DTs; the odd bipolar or
schizophrenic who really was “acute.” They didn’t stay long, no thanks
to my hasty Therapeutic Listening and non-existent Individual Care
Plans; the medication flattened them, and they went home to family
willing to care for them.
affable new patient thought she was Pope John XXIII. She responded
well to anti-psychotics. The doctor discharged her after a month.
day she left, one of the old chronic patients knelt down at the door.
The home-bound Pope held out her hand as she passed, and the supplicant
kissed her ring.
was seven month pregnant when I quit my job.
was an icy December.
I was big-bellied, cumbersome, and the walk down the street, across
Smith’s campus and up the hill had become precarious. I found myself
fearful of those “special” patients I’d gained through laundry
negotiations. I was tired, tired, tired. I had lost my illusions about
Therapeutic Talks and Individual Care Plans.
had ample reason to quit. Still, I didn’t.
I met my nemesis.
was deposited on the ward an hour before my shift’s end. Pretty,
young, dark hair, brown eyes, no firm diagnosis. A drug high, mania,
delusions; whatever the case, she would not answer intake questions.
She would not unpack her bag. She planted herself on her assigned bed,
looking fit and slim in a dress that was far too good for the ward,
stiletto boots on her feet, nylon-clad legs crossed, and she cursed
us—the patients, Mrs. Flaherty, me.
asked her to do something essential, I don’t remember what. Something
that required her to move off the bed.
called me “a stubborn
fucking Irish bitch.”
it was the long day, or the hormones, or the fatigue. Or maybe I
had been around crazy people so long that I was crazy myself.
remember that I grabbed her wrist and pulled her up off the bed. I
remember her eyes widening—surprise, then a spark; and I recognized in
that instance that she was consciously considering hurting me badly.
she laughed. She shook her hand free and came with me, cursing
with every cooperative step.
checked her in, handed her a small housedress, signed my charts, gave
my report. I walked to the administration building. I wrote out my
two-week notice, handed it to the personnel director, and went home.
thought, someday when I’m a reporter, I’ll write about my experiences
at Northampton State Hospital.
SUSAN O'NEILL is
the author of Don’t
Mean Nothing: Short Stories of Viet Nam, and has edited Vestal Review (http://vestalreview.net),
an ezine/literary journal for “flash fiction,” since it began nearly
ago. Her stories and essays have appeared in such varied media
journals (e.g.: RN Magazine), lit
magazines (e.g.: Indiana
Review) and Spoken Word sites (http://BoundOff.com).
She eventually graduated with that BA and starved
for a couple years as a reporter, and is now one step away from living
bridge in Brooklyn, as a writer. Her more-or-less monthly essays can be
in a Blog linked to the bottom of her website (http://susanoneill.us).
still technically an RN, but would
probably kill somebody—unintentionally . . . although
you never know—if she went back to work in
[copyright 2008, Susan O'Neill]