A Day in the Life of a Psychiatrically Hospitalized Clinician (Part 1)
Editor's Note: This week Pulse presents the first installment of Liat Katz's brave and forthright story. The conclusion will appear next week.
I am a licensed clinical social worker. And, occasionally, a mental patient. Today, in this inpatient psychiatric unit, I am more a patient than a social worker.
It is Monday morning, and I am eating breakfast across from Owen, a muscular, flannel-clad, Paul Bunyan-looking patient. Little pieces of his scrambled eggs keep landing on his copper-colored beard. I sort of want to motion with my hand at where the eggs are on his face, but I'm too tired, and I don't really care. About anything.
Owen is an odiferous, rebel-flag-t-shirt-wearing, phlegm-spitting, hairy-eared mechanic who, to be honest, would not normally be part of my social sphere. In my professional life, he could be my client. But right now, unshowered and unkempt, I'm looking pretty rough around the edges myself.
At least Owen is wearing real clothes. Like several others here, I am on suicide watch, so I'm required to wear a hospital gown. I've been stripped of my clothes, my ID badge, my degree and my dignity. The staff have even confiscated my bra, explaining that it might be used to hurt myself or others. Don't they know that I need all the support I can get in life? I think. As if "death by bra" were a common occurrence from which I need protection. Other patients have made the best of our clothing situation, showing runway-worthy ingenuity: Some wear the gown as a robe, others use it as a dress, or use one gown as a gown and another as an undergarment or sash.
In yesterday's therapy group I heard Owen describe his experience with depression. Now it's as if we share a secret lover--for to know depression is to make love to the manipulative beast, to learn all of her intimate quirks. Depression draws you to her with such power, making you feel that you're a willing participant. As she leans in, she whispers in your ear that you are nothing, an incapable nobody, and she gives you shit-colored glasses to see through as a daily reminder. She says that she will stay with you and be your only confidant. She sits on your chest to make getting out of bed difficult. She hangs her full weight off of your shoulders, so that even showering or walking feels like an Olympic event.
Depression helps you forget anything positive about your life and insists that you sabotage any attempt at living without her. She whispers that the only way out is to die, then reminds you subtly, every day, that you can't even do that successfully.
Owen and I know that once depression got her claws into us, we were doomed--we had to submit to our locked doors and toiletries-behind-the-counter hospitalization, because we're in it deep with her. It's our penance for not pulling up our bootstraps strongly enough to resist her.
The stigma of our relationship with depression means that we can't reach out for help until it's too late. Besides, we think, we don't deserve any better than this. Owen couldn't get out of bed anymore to go to his mechanic's job, nor to maintain a relationship with his girlfriend, and I couldn't get out of bed anymore to work at my Adult Protective Services (APS) social-worker job, nor to parent my three- and five-year-old daughters, so what good are we?
Too exhausted to speak much, we sit in intimate, silent conversation about our shared lover, making the morning bearable. He wipes his beard with a napkin and musters a brief smile at me as I eat my bagel.
Later, when I'm done with my third nap of the day, I wander into the "day room." To make the time pass, I try to guess people's diagnoses. I think of all the resources and support systems I could set up for my fellow patients. Do they know about that new mental-health housing program? That guy could probably use his VA benefits to pay for his psych meds. Clearly that woman is not ready for discharge--and yet, there she goes. I keep it in my head; that's not my role here. Social worker, heal thyself (first).
A couple of fellow patients and I play the dangerous, ever-popular game, "What you could use in this place if you really wanted to kill yourself."
"You could stab yourself with a pencil," I offer, knowing I'll get no points for that one-—too boring.
"Bundle your sheets together and use them to hang from... from... from something," Owen remarks. As we all look around the room for something to hang from, I instantly regret playing this game. What if someone's not kidding? I think. How irresponsible of me to join in.
"You could just eat the food they bring us," I say, trying to lighten the mood. I look around. Mood definitely not lightened.
Moving on, I join another patient in assembling a small jigsaw puzzle of kittens in a basket. There are pieces missing, so we can't complete it.
In the hospital, even the simplest tasks become an exercise in humility. I decide that for my major activity of the day, I will shower. It's late, and I feel exhausted just thinking about it, but I request soap, shampoo and a towel from the twentysomething psych tech.
"You'll just have to WAIT," she snaps, as if admonishing a whiny child. I hadn't noticed that she was doing anything; she's just standing there. I'm twice her age, I think to myself. At home I don't have to ask permission to get shampoo; I must be really screwed up to need that.
She stalks to the supply closet and comes back. "Here!" she shouts, shoving a bottle at me.
"Can I have a towel too, please?" I ask in my humblest Oliver Twist manner. (I don't bother asking for soap; I'll use the shampoo.) Meanwhile, I'm thinking, Usually, lady, I'm on the other side of the desk from you, looking at my clients' charts when I'm here checking on them or consulting.
She rolls her eyes and brings me a towel. It is only big enough to cover my left nostril.
The shower in my room has no curtain and no handle, just a bare, stripped knob. I try turning it right or left, but I can't get it to move. I figure maybe its operation is part of my mini-mental cognitive exam, so I'm determined to figure out how to use it. Surely I can master a shower handle. I summon my years of education and of putting together furniture and toddler toys, but, alas, I just cannot do it. I add this to my list of failures in life and, re-clothed, emerge defeated from the bathroom. I ask a nurse how to use it.
"Oh, honey," she says with a slight snicker, "that one's broken. Didn't someone tell you? Use the one in the hall."
I find the hall shower and maneuver the handle to produce a tiny stream of ice-cold water. This shower also has no curtain or lock on the door. The shower epitomizes all of my hospitalizations, really--each one a cold experience rendering me tremendously vulnerable, exposed and alone.
Was it worth all this to keep me from killing myself? Really?
I stand naked in an unlocked room in the main hallway with no curtain. Anyone could walk in at any time. Sinking to the floor and sobbing, the ice-cold water dripping onto my unliked, large, naked body, I immerse myself in a single stream of humiliation and punishment for being such a failure in life. What have I become?
The water splashes off my head as I think about what landed me here. This is perhaps my fifteenth hospitalization, the first being an eighteen-month stint in Chestnut Lodge as an adolescent, after suffering severe abuse at home. But I haven't been hospitalized in more than thirteen years. I feel completely caught off guard.
I thought I'd gotten my shit together. I have a family, I got through grad school with a 4.0 GPA (after finishing the ten-year, depressed-undergraduate plan), and I have a job. I'd thought that if I worked hard in therapy and in life, and took my medicine, I'd be immune to depression and hospitalization.
I was wrong.
I've been working in my county's Adult Protective Services (APS) department, investigating allegations of abuse, neglect and exploitation of vulnerable adults. Over several months' time, my ability to do my paperwork has been dwindling. I'd call people and not remember whom I'd called. One time I drove to the store in a neighborhood I've frequented for years, and I suddenly didn't know where I was, how I'd gotten there or how to get to where I was going. I pulled over and cried; I could not remember a time when the world was okay. I was fat and ugly and stupid and incompetent--always had been and always would be. My kids were asking why I was in bed so much.
Another day, I became disoriented and fell down a whole flight of stairs at home. Bruised and battered, I lay in a heap at the bottom for hours, sobbing. That night, I wrote goodbye notes to my children.
Reading the notes aloud gave me pause, and a chance to regroup: Even if I couldn't deal with life, I realized that I wanted to be there for my kids; those lovelies did not deserve to experience a disturbing, life-long reality that their mother had killed herself. I knew that I needed to be in a safe place to protect me from me, so I sucked it up and headed to the ER. After spending sixteen hours lying on a gurney by the nurse's station, I was brought here to the psych floor.
When the shower is over, I dry my left nostril with the washcloth/towel, get dressed and walk out into the hall. I feel like I don't belong here. Okay, I realize that I'm just as worthy of being here as anyone else, but I don't want to belong here.
I want to garner some respect--to loudly proclaim my credentials:
"I AM A SKILLED CLINICIAN. I AM ABLE TO NEGOTIATE COMPLEX CLINICAL PRESENTATIONS, CAREFULLY ESTABLISHING RAPPORT, AND I HAVE DEFTLY CONDUCTED INDIVIDUAL AND GROUP THERAPIES. I AM AWARE OF THE PSYCHOLOGICAL FORCES THAT UNDERLIE HUMAN BEHAVIOR AND EMOTIONS, AND HOW THESE FORCES RELATE TO EARLY EXPERIENCE. I AM CAPABLE OF GREAT INSIGHT, AND I HAVE HELPED OTHERS TO ACHIEVE INSIGHT AS WELL."
Instead, I just glance over at the staff at the nursing station.
A nurse, chewing gum and not looking up from her paperwork, declares, "Nine o'clock. Lights out, Katz. Go to bed."
About the author:
Liat Katz, a licensed clinical social worker, has published personal essays in Lilith and Washingtonian Magazine and has an upcoming fiction piece in Gargoyle Magazine. An alumna of New Directions, a three-year postgraduate writing program offered by the Washington Center for Psychoanalysis, she is also the current editor of their literary magazine. "I write to honor the clients I've had the pleasure to work with over many years. They have let me into their lives at their most vulnerable moments and, in turn, have let me into my own life. I write to make sense of the world I see through the lens of a clinician, a patient, a mom and a person just muddling through life." Liat lives in Rockville, MD, with her wife, two daughters, two cats and two bunnies.