If you’ve never seen how quickly a syringe full of Ativan plunged into the meat of an ass cheek can work and you want to, just apply to work on the units.
“Lord knows we could use a floater,” the Director of Nursing says. She uses this phrase: “Lord knows.”
“Where do you need me?” you ask, not quite yet knowing what it means to ‘float.’
“Everywhere,” she says. “We get you part-time evenings when you’re not working the phones.” She lifts and checks a ream of sheets on a clipboard at her desk. “Adult, adolescent, children’s. And we might need you for an overnight every so often.”
You think of the elderly third-shift nurses you see sometimes as they trudge into the employee parking lot at sunrise. Serenely, slowly, they each carry a lunchbox toward their cars like an offering.
“Sure,” you tell the director. “I can do this.”
Your first day on the units, then, includes the sight of a raging adolescent male encircled by a mass of beefed-up nurses, followed by a wrestling takedown and then a dog pile onto the kid’s back while he howls. He’s in par terre on the bottom, the side of his face spread like sweaty cold cuts on the rough carpeting that barely pads the concrete floor underneath, both arms pinned by the two Army Reserve LPNs, Matt and Matthew, and then there’s the walrus, Wilson, holding the legs, and here’s Joyce as she runs from the nurses’ station with the syringe, and you watch as she grabs the elastic of the kid’s sweatpants and pulls it down just enough to expose the top of a globe of muscle that’s tense from pulling and leveraging for space.
“We are done here!” she yells, and no one knows what she means by this, but the capped tip of the syringe is in her mouth, and then the needle’s in the open, limbs everywhere wriggling and struggling below it, the injection sent in through the skin and the muscle that the boy’s yelling about now—
“Don’t you fucking touch me!” he screams.
—and then everything really is done, and it’s all over for him in a matter of minutes. The lorazepam rips through him, starting in the muscle and then spreading out in a circulatory wave before it crosses over the blood-brain barrier and drops the agitation levels down like a sedative.
“Can you stand?” Joyce asks.
“Fuck you,” he says, but the bile and bite from him are gone now.
“Will you stand?” Joyce asks.
After a moment: “Yes.”
From outside the Quiet Room (one of two on the Adolescents’ unit), with the door locked from the outside, watch as the kid collapses onto the blue safety mat, his body logy, his head drooping because it needs to be. Watch as he breathes slowly and calmly and defeatedly.
Listen in while Matt and Matthew remark later how damn strong the boy was, how they were surprised by just how much fight he had in him, and how they’ll need to remind themselves to go check on the kid later. But he’s still in there, seething on the blue foam mat, calmer now because the benzodiazepine is making him feel less anxious and cagey within the cinder block walls.
There are three steps in learning how to juggle. This is the first:
While you’re crammed into the receptionist’s desk at the local psych hospital each weekend—where the suicide hotline plugged on the commercials for the facility runs straight to your headset, no training necessary—you’ve got everything you need to pick up a quaint skill. You’ve got time to study for school or to read. Or to relearn DOS on the ancient IBM perched in the corner, or to pop and hold a wheelie in the battered wheelchair that’s parked between the front desk and the counselors’ office. The point is this: you’ve got time to learn how to juggle.
You will need three soft ball-type props. Small sandbag-like objects that fit into your palm are ideal, but you’re looking for spheres with a little bit of weight to them. If you have them, baseballs are better than racquet balls.
But you also need the props to be big enough to take up the volume of your open hand. Softballs are better than, say, marbles or those tiny bouncy balls you get from a grocery store vending machine for a quarter apiece. You need the size and the weight to be right, and only then can you try items of a different size. Chainsaws, squids, birthday cakes: you’ve seen videos of each them being thrown into the air and caught in succession. You’ll never juggle any of those, but for twenty seconds just a few months from now, you’ll find yourself juggling three basketballs in front of the adolescent patients while they’re relaxing in the gymnasium. You will get applause and that’s about it.
Step One: toss the ball in your hands, right to left and back again, up and over each time in the swoop of an arc.
Practice this step over and over and over again, making parabolas that fly in a measured calculus. Right up until you can feel the ball move between your supinated hands without looking at it. Repeat this until you can look away from what you’re doing.
Niccolo’s name—not his real name, not anyone’s real name used as you’re writing this—is the first weapon the hospital fires against him when he’s admitted.
“It’s ‘Niccolo,’” he’s told them. “My family’s Italian.”
His fellow patients call him by what he wants, but only a couple of the staff members do. ‘Nick’ is what’s written instead into the top-right corner of the giant dry-erase board at the nurses’ station. A 4×4 grid of taped-off rectangles with a small tag at the bottom of each name: ‘acute’ or ’subacute.’ Wilson’s neat font size and typeface blend in with the rest of the board, and there it sits, scrawled out in bold, blue lettering—blue for acute, red for subacute—‘NICK.’
Yanked into the hospital in the middle of the night from the county’s Juvenile Detention Center, Niccolo is interviewed by a sleepy counselor, whichever one’s got the Mobile Assessment Team beeper next to their bed, who then in turn wakes up the on-call psychiatrist, who swears he will be there soon to sign off on the admission papers, but who doesn’t actually show up until right after his 8am coffee, which makes it now an hour into the morning shift’s detail, and this is how Niccolo first meets the men who will hold him down for a sedative and the woman who will inject him in the ass when no other chunk of unrestrained muscle can be found.
The summer of 1998 is a transition period for the hospital. The units are a mess, spread out into a fractal of patient rooms and spanned hallways. At the south end of the hospital is the adolescents’ unit, an open and airy corner that juts right up next to a battery of counselors’ offices and the exit to the parking lot and the Ropes Course, where the adult and adolescent patients can come outside for trust-building exercises (free falls, zip lines) and some fresh air. In the gut of the hospital, though, is Timber Line—not its real name, either—a specialized unit for adolescent male sex offenders. The boys there are watched by their own staff members and psych techs and nursing staff, although they share counselors and psychiatrists with the rest of the hospital. Timber Line is autonomous in every other sense, though, since they just rent out physical space and services. Their unit juts up against the two other units, the Adults’ and Children’s, and even though each unit is locked down and can only be opened by specific sets of staff members’ keys, there’ve still been stated worries from the children’s families about proximity.
“It’s like waving fresh meat in front of tigers,” you’ve heard one father say. On weekends, you’ve watched this man leave a cup of spit from his chewing tobacco next to the lobby doors so he can later collect it on the way out.
It’s not the Timber Line boys’ faults. Okay, it is, but look: there’s such guilt on their faces each time they file out their door past the children’s unit nurses’ desk. There’s the worry, the shame, the knowledge of what they’ve been told in so many therapy sessions—that because they were sexually abused by someone else, there’s a much greater likelihood that they would abuse others. This knowledge doesn’t seem to lift their heads or take the weight off their shoulders, but you can tell that the move from the Timber Line space to the Adolescents’ unit and vice versa makes them feel easier about the situation. Weeks afterward, they seem freer to talk in the hallways. To look around at the space in which they’re confined.
In the children’s unit, the patients ask questions about the move.
Who are the new kids? they ask. Or what happened to the boys? Why are there girls with the big kids now? And so on.
The renovations bother the smaller kids the most. The loud noises. The men from maintenance and their ladders and tools. On the afternoon when the entry door to the unit is replaced—Timber Line’s didn’t have a safety glass window to look out through—the charge nurse on the Children’s unit allows them to come up to the station to watch the hammering and drilling involved. One of the older maintenance guys slips over to where the group is watching him, lets each of the curious children get a chance to rev up his DayGlo-blue Makita.
The charge nurse, Other Joyce, will tell you later on her smoke break that one of the boys who held the drill was admitted because he stabbed his sister with a screwdriver—you will laugh at this because you have to laugh at this—but for right now, the children are just happy for the distraction.
The kids are each there for a reason, but not for the one you’d think. ‘Adam’ is here because of aggression toward his teachers at school, but you learn that these incidents started happening once his stepfather entered the picture. Or ‘Bethany’ was admitted because she tried to set the house on fire. (It was the first thing that seemed to get the attention she craved from her otherwise negligent foster parents.) She’ll go on to experiment by writing her name in feces on the wall of her room. One of your fellow psych techs will screech out in horror, and the noise will feel like home to many of the kids.
You start to understand. The acting out, the late afternoon aggression, the infighting. This is why the nursing staff and psych techs hate those hours right after weekend or evening visitations with the families. The root problems of their behavior, you learn, have come to eat dinner or lunch with them in the hospital cafeteria.
You’ve heard rumors of the four-year old who’s been admitted. Back on the loading docks, the nurses and psych techs wonder aloud at the admitting psychiatrist’s reasons.
“How is that child going to remember any of this?” Other Joyce says. “Let alone how he’s going to go through the damn program?”
Watch as the lines around her mouth crack each time she purses them to blow out smoke.
So when you finally meet ‘Carson’ on the children’s unit, you’ve already read through the notes in his chart. You’ve clipped through assessments on the learning disabilities, the outbursts, the abuse. When you’re working the unit in the evenings, you and the other techs and the LPNs listen as he screams obscenities into his shower or at the ‘mirror’ in his bathroom. You ask if he’s okay constantly. You ask if he’s all right.
(It’s cruel to call the box up on the wall a ‘mirror.’ It’s all just highly polished aluminum since glass on the units isn’t allowed. Using a step stool that’s been cleared by the charge nurse so he can reach the sink, he stands on it to bang his head against the shiny rectangle of metal anyway.)
Carson has dinner with his mother and the mother’s boyfriend, but he comes back early after refusing to eat. As the rest of the unit winds down—showers, pajamas, teeth brushed, a communal story book read to the group in the long hallway of patient rooms—you slice him up an apple with peanut butter and hand the styrofoam bowl to him, where he’s perched at the edge of his doorway.
“I’m not going to sleep tonight,” he explains, wedging an apple piece into his mouth. “And you can’t make me.”
“Okay,” you tell him. The plastic fork slides in the juice from the apple and barely cuts a thing. “But if you want to be able to stay in your own room tonight, you have to keep quiet. You can’t wake up the other kids—”
And then you realize your mistake: you’ve given him a way to get attention. Negative or positive, you’ve come to learn, feels the same to children who don’t receive much of it either way.
“I will,” he says. “I’ll do it.”
As the bubble of mercury panic starts to slide up your spine, you wonder if there are any toys you might bring him from the day room, or a book to read.
“I hate stories,” he says.
You just need something to take his mind off the dimmed lights or the noticeable quiet once everyone else is asleep, and then you remember.
“Let’s make a deal,” you say.
This one’s twice as difficult as the first. You can make the arch of the prop between the right hand to the left and back again, over and over, sure, but can you do this in succession with two balls? Because this is the crux of a simple cascade in juggling.
Hold one ball in your right hand, one in your left. (This next part goes quickly. Clear any and all breakable objects from the area.) Toss the right ball toward your left hand. Once it’s headed up and over, toss the ball in your left hand toward your right hand, keeping its arc under the arc of the first ball. Toss, toss, catch, catch. Pause. Toss, toss, catch, catch. Pause and repeat.
Once you can make both parabolas in the air, you’re ready for the third step, which isn’t all that difficult to pull off, actually. Remember, though, that you must be able to look away from what you’re doing to get the action just right. You need to be able to feel where the balls are going to fly into your hands instead of having to see it.
Toss, toss, catch, catch.
Where Carson’s been moved from acute to subacute care—you’ve been told by the adults this feels like getting a prison sentence after being thrown for just one night into the drunk tank—‘Darla’ has come in for her trimonthly admit.
She’s a regular patient at the hospital, where the cycle of her Borderline Personality Disorder includes thoughts of self-harm that just won’t go away. You’ve been told she feels safe here, and if her psychiatrist is willing to admit her on short notice (which he most always is), she’ll check herself in if she can hitch a ride from a friend in the area.
So when the adults have completed their group therapy session for the evening and the nurses on the unit have doled out the nightly meds, you watch as the Director of Nursing clips onto the floor and right up to where you are at the desk. She lifts the glasses from her face so she can see you better and says, “Feel like picking up an admit?”
This isn’t your first time driving the hospital van. You’ve transported adolescent patients to the city’s medical center for CT scans or to have bandages and wounds checked out, and you’ve gone out on pizza runs for the staff. But this is the first time you’ve ever made a patient run for an intake.
“I’ve seen you up at the front desk,” Darla says, stepping into the hospital van when you pull up to her apartment. She tosses her duffel bag into the backseat, makes small talk on the drive back like she’s been picked up in a taxi. “You working the units now?”
“Yup,” you oblige. “Couple of weeks now.”
You’ve met each other before on a couple of Darla’s self-admits, and she’s told you each time she has trouble with her memory. About a mile out from the hospital, when things go quiet, she drops the guarded staccato when you ask her, “You doing okay?” But you already know this answer to this question.
“Now that I’m going back in, I am,” she says. Her southern accent is softer now, rounded at the tips like her Mary Worth haircut. “Stupid Borderline flares up every so often, you know?”
Before you started working as a psych tech, you remember Darla was eventually admitted one night after her psychiatrist was out of town and the on-call doc wanted her to be evaluated first thing Monday. She threatened self-harm, he balked, and so Darla stripped naked and went for a walk in her neighborhood until she was picked up by the police. They drove her straight to the front desk, where she trundled by you in a hospital gown and a threadbare blanket.
Tonight, though, when you wheel into the circle drive and drop her off at the front door, you see that the on-call assessment counselor’s come in for the night. Dressed in his shorts and flip-flops, he looks relieved he’s just having to process Darla here, rather than having to go out to interview her and get her transported from the county hospital’s emergency room.
“I’ll walk you back to the unit when you get done,” you tell her. This is your best attempt at reassurance, and she nods impatiently, ready to get out, get admitted, and feel safe again.
In the 45 minutes it takes to get her processed, you make notes in the adult patients’ charts. This patient was communicative in group therapy while this patient was not. This patient had a healthy appetite at dinner while this patient drank only her soda. You document BIRP after BIRP after BIRP: Behaviors, Interventions, Responses, and Plans. And then you’re done for the night.
So when you walk back up to the intake office to check on Darla’s admission, you bring something to pass the time with you. Three small, sand-filled canvas balls. Just in case.
“That looks fun,” she says, hoisting the duffel over her shoulder. She’s smiling now. The look of relief floods across her face, a blush of red across an anxious white.
“I’ve made a deal with the kids on the children’s unit,” you explain, practicing. Toss, toss, catch, catch. Toss, toss, catch, catch. “You hungry?”
Now comes the hard part. For a simple three-ball cascade to work, once you can make the double arcs happen between your hands, it’s time to toss a third prop in there. Put two balls or bags in your right hand, and place a third in your left.
Warm up by practicing the first two steps. Toss with the right, catch with the left, and back and forth again. Then toss with the right, toss with the left, catch with the left, catch with the right. Repeat with that third ball in your hand each time. Feel the weight and space of it there.
Once you’re ready, toss the third ball into the mix. Ball #1 flies from your right hand to your left. Ball #2 hops just afterward from your left to your right. After you catch the first ball and then whip it over from your left hand to your right again, throw ball #3 into the works, substituting the props out of each hand as they come. Repeat and start over and repeat and watch the balls or bags fall out of your hands onto the floor—constantly, infuriatingly—until you can feel where each object will go when you throw it. Keep the balls aloft in the air as best you can. Build muscle memory from the weight of each object.
That’s almost all there is to it. It’s only when you can not stare directly at the action, though, that you’ve got any sense of control here.
See, the trick is being able to look away when you think you should be paying attention.
Two weeks later, on the day Niccolo leaves, you don’t get to say goodbye. His insurance coverage has ended after 30 days of inpatient treatment, and his psychiatrist has discharged him and set him up for outpatient therapy. He’s told you and some of the other staff he knows he’s not ready to leave, though, and you’ll see him again in a few months as he’s transferred over from juvie. There’s at least less rage in him now. Fewer triggers that send him careening into the red. He’ll take a swing at Wilson, the recovering RN with the walrus mustache, during his return stay, and he’ll be shut down into subacute care for three months afterward.
Darla, meanwhile, has come back too early. She’s started cutting again, something she hasn’t done in ages. When she left the Monday after you picked her up, she seemed distraught but thought she could manage. Talked about self-care, about getting her meds and her apartment organized. She seemed hopeful, and now this. Tonight, you watch as she’s wheeled in on a stretcher by EMTs, thrashing all the while, angry and gritting and red. After the yelling dies down, you’ll visit her the next morning. She’ll tell you that there wasn’t much to fuss over. She just needed to be here and didn’t want to be here at the same time.
But tonight, right before bed, her stretcher passes through the children’s unit on its way to the adults’. The yelling brings the kids out from their rooms as they’re brushing their teeth. Mouths open, they stare at the sight, Carson included. If home is chaos for the children, at least it doesn’t have stretchers of screaming people rolling through the living room. You’re not sure if this is what kicks Carson into overdrive, but something does, and minutes after the EMTs leave the way they came, he starts slamming the door to his room, over and over again.
“That is enough,” you tell him, grabbing the door from slamming at the last second. “Everyone else is getting ready for bed, and you’re being loud in here.”
He growls. Carson does this: this growling. He bares his teeth, acting like something feral he’s seen elsewhere, and he growls. And when he realizes in the middle of his sound effects that you’re still not going to let him slam the door on its frame, he throws a fist into the air and charges you.
You wonder which cartoon he’s picked this up from as you grab his swinging arm in the middle of its arc.
Joyce, who’s perched at the nurse’s station at the front of the hallway, yells down, “Do we need to go to the Quiet Room?” And you ricochet her look back toward Carson, who you know has heard the threat.
He panics, and so you yell back, “We’re good here, I think.” Even when Carson throws his other arm at you, fingers balled into a fist, you hope you are good. And that the poor kid won’t have to spend his bedtime routine pacing on the blue canvas mat of a cinderblock-walled enclosure.
“Or at least we will be,” you say out loud. And this is when Carson starts to pull.
As part of your orientation for the units, the man who runs the ropes course once walked you through patient restraint. Where to hold a wrist to stop a patient from trying to cut themselves with a stolen pair of scissors. How to transport a violent adult away from the unit and up to the awaiting police. How to perform a basket hold on a child.
“Stop,” you say, but Carson rears back, yanks his four-year old fist away, sends it back into the meat of your forearm. “Just stop.”
And so you cross his arms for him in the struggle, pulling him backwards into your lap as you sink to the floor. In the rooms up and down the hallway, the other patients are getting ready for bed, listening (if they can hear it) to the sound of your back thumping and sliding down the drywall. You move his arms and pin them against his body, right over left, with the right hand slipped up under the crook of the left elbow like you’ve been taught.
“We’re just going to take a small timeout,” you tell him, watching for his legs to start kicking, but they don’t. He’s not here to fight, just to face the backlash. So he sits with you, huffing and puffing and angry, but he’s quiet. He’s held. He’s getting attention from another human being. He’s connected.
And as his breathing slows, as the growls die down, you whisper to him, “It’s bedtime. If you can calm down, I think I’m ready to hold up my part of the deal we made. You remember?”
In the nighttime, under the fluorescent glow of the white lights of the children’s unit, Carson looks up and seems to understand.
“I’m calm,” he says, still trying to wriggle away. “I’m calm.”
But you believe him.
“Can you stay put?” you ask, heading for your bag at the nurses’ station. “I’ll be right back.”
And you fetch the canvas balls you’ve tucked away in the water bottle pocket of your bag. Three squishy sandbags that you clutch in one hand as you trek back down to the end of the children’s unit hallway, where Carson’s peeking his head from around the door jamb.
Just shy of a month, his mother will pull him from the unit—”Against Medical Advice,” his chart will say—and you’ll never see or hear from him again. But for right now, as you remind Carson of the bargain you’ve made him, as you let the juggling balls fly and fall in arcs and circles, he’ll climb into his bed with a smile, and it’ll stay on his face there in the dark after you turn off the lights and close the door behind as you leave, and if you don’t look too closely.