semicolon: 7. Inpatient

Physical Layout

Horrible map. Give me a break. I didn’t draw it in a nice studio.

A virtual tour of the unit:  A long hallway with patient rooms on both sides.  17 laps down and back equals one mile.  You would occasionally see someone doing it, or even a handful of folks on a walk together.  There were plenty of phones with short cords scattered in the hall and other areas.  One was near the end, by my room, and it became my favorite.  The cords were short so as not to provide a ligature danger.  They were so short you really only had one position you could be in, and that was sitting on the chair close to the phone.  Forget standing up, even if you were short.

My end of the hallway had a locked storage area.  The doors to the rooms had blinds in them between panes of (I assume) unbreakable glass.  You could open and close the blinds from outside the door.  Since they checked on everyone every fifteen minutes, at night they would flip them open and closed as quickly as possible.  So every fifteen minutes there would be a “snap!” and light would flood the room.  And then another snap of the blinds closing.

At the end of the hallway with the (locked) door into the unit, there were actually two locked doors to get out.  The first directly faced another Mental Health unit, and to the right outside the locked door was a lounge type area and elevators.  Pretty sure that was where visitors waited when the staff was getting someone to brief and search them for contraband, and open the door.  There was a bulletin board with the pictures and ranks of the doctors for the unit.  As I was leaving later that week I discovered we were on the third floor.

Ok, back to the unit.  At the door end of the hall was the admission and discharge room, which had a bathroom and lockers until you left.  Personal goods were stored in the lockers, and you could only access them if you had a really good reason.  And you would be escorted, and they would get the things out of the locker for you, and inspect it before handing it over.  

Opposite the admission room was the dining area.  Four round tables and the heaviest chairs you can imagine.  They must have been filled with sand or something.  They were plastic and you would grab one like you were going to slide it, and being plastic it’ll give little resistance, right?  Nope.  As I was checking out my case manager tried to move one and was fooled by the weight — and she’s done this countless times.  

The food ranged from ok to not great.  Institutional food, of course.  The chicken tenders were good, almost spicy.  There was a breadstick with cheese on it that was nice.  But the milk tasted funny, the juice was bland, and sometimes the meal options were.. confusing?  I ordered “Caesar Chicken” for lunch, somehow thinking it might be a salad.  But if not, something more substantial than what I got.  Which was one piece of chicken, lonely on the plate, which tasted a bit like caesar chicken.  I tried to find an image from a search for “single piece of chicken on a plate” and got nothing like what I needed.  After all, who would take a picture that sad?  Beyond the quality and clarity of orders, what you got was more in the “spirit” of the menu.  You wanted a cookie?  Might end up with asparagus instead.  Wanted a peach cup?  Sure, we’ll give you a breadstick.  Sometimes they were right, but sometimes they were absolutely nothing you ordered.  I guess you can do that to people in a locked ward, since they’re not going to come down and complain to you.

Like this, except gray chicken. And no silverware, just sporks. Also didn’t have a watermark of the place I stole the image from.

Beyond the dining area was the group room.  The wall between group and dining was a large unbreakable glass wall with a locked door in it.  It had plenty of storage cabinets (locked of course) containing craft and other occupational therapy (OT) items.  When attending anything in that room you were required to wear a mask.  We often did art there as a daytime OT group, or in the evening for “creative hour.”  They did have quite the collection of craft products!  When someone came to visit, they would unlock the group room and lock you in there.  And watch from the outside to make sure nothing untoward happens.  The view was similar to my rooms, but overlooked either staff or non-locked patient outdoor area.  Big fence, but some nice lawn furniture.  And (city) clean, fresh, natural air!  Sadly only seen.

The next area down the hallway was what I thought of as the living room.  Moderately comfortable chairs, a rocking chair built like the dining area chairs, and a TV.  This is where we had the morning check-in with all of the patients and most of the staff.  The leader of the check-in was the “boss” of the day, and they were as varied as they could be.  One was strict and sharp, another was casual and funny, yet another was scared for her life because it was her first time leading a check-in.  The TV was on when there were no group sessions, meals, or (night) lights out.  The content on the TV was as moderate as you can get.  No content with possible triggers, which ruled out violence.  No shows with heavy vulgar language, which ruled out some movies.  No content with the rest of the triggers, like alcohol, suicidal ideation/depiction, no sexual content.  So what you’re left with is The Learning Channel and shows like ghost hunters and “Survive in the desert/snow/jungle” and so on.  So glad Trading Spaces isn’t still popular.  The TV quality was slowly degrading while I was there.  It went from watchable, to heavily purpled, and by the time I left the image was jagged/shaking.  It was a large screen TV (but not too large) housed in a metal box with holes for the sound to get out, and an unbreakable window of plastic to see through.  There was another one in the group room for presentations.

The separator between the dining area and the living room was half blocked by the wall the TV was on, and the other half was a counter bridging the two areas.  There was always (decaf) coffee there, and often crosswords or sudoku puzzles, both copies out of the newspaper, so some of them were hard to make out.  There was usually a newspaper, games, and sometimes snacks.

In the corner of the living room was the window for taking meds.  You would be called to the window or your assigned nurse would lead you there.  It was hard to hear through the speaking port, but raising your voice did the trick.  All day long people were getting regularly scheduled meds and PRN meds (the kinda you take when you need it, like for migraines, anxiety reducers and so on. Saved you a trip to the glossary. You’re welcome) and because it was in the living room / tv area watching a show included people being loud enough to be heard, or arguing with the pharmacist nurse.  If you’ve seen One Flew Over The Cuckoo’s Nest it was similar to that med window, but rarely was there a line.  

The heart of the unit was the nurses station, right off the living room, in the crook of the L, so to speak.  There was a big screen TV (not in a metal cage) that displayed the list of patients by first name, and their corresponding assigned nurse, MD, and case manager.  If you needed anything, this is where you started.  There was always someone there, and if they couldn’t help you they could find your nurse.  Because, you know, it was a small space.  Just look around and you can usually find them.

Not my hand

The nurse’s station was where you would find a menu every morning with your name in big letters.  You filled out the menu requests for tomorrow, and dropped it into a bin with the other patient’s orders.  You could also get headphones there, which were safety legal headphones that according to one of my nurses was “really bad” but the patients on the autism spectrum used them from time to time for calming.  I never tried them.  You could also find a crossword, but I’m guessing it’s weekly, as it was always the same one.  And for doing crosswords or sudoku or writing in a supplied journal, you could get pointless (literally) pencils or naked pens.  The pencils were useless, and write about as well as you can write with a lead made of soft plastic.  The pens however, if you can find one in the supply box, actually work well enough and are comfortable to write with. Essentially a soft flexible plastic tube over a pen cartridge.  I saved one to take home but when I got home I couldn’t find it.  Really bummed, it was my favorite souvenir!


There was a private shower across from the nurses station, and they timed it.  But at least you had enough privacy.  I didn’t use it, to be honest, but if I had stayed one more night I would have.  They also had a laundry machine/dryer that you could use.  Both laundry and shower you had to sign up for at a certain time but I never saw a long waiting list.

The is *exactly* what my room looked like. Ok, except for the desk and chair. I just had a heavy block of table.

My room was a single due to COVID, but would normally be a double.  Which would be an even worse nightmare.  A bathroom immediately to the right inside the door.  The bathroom didn’t have its own door, but instead there was a large yoga pad like piece of plastic attached at one side with a strip of nylon belt for a hinge, and on the opening side there was a strip of fabric with a magnet, so you could close it for just a little bit of privacy,  The “door” pad was covered with a picture of the ocean, beaches and tropical trees.  Pretty much the opposite of your context in the unit.  You could not bring in your own toiletries, but whatever you needed, they had a low price version.  The toothpaste was ok.  The sink (and all the sinks on the unit) was a ligature preventative sink  It had just the spout and if your hands were under it, it would pour cold water.  After a few seconds it warmed up enough to be called warm, but never hot.  When I got home I held my hands under the faucet a few times, thinking the water would just turn on.  The toilet was normal-ish, but any area that would have plumbing or pipes, or the tank, was walled off with metal.  There was a button to flush it.

There were a few built-in shelves on the left, and in the main space was the bed.  Along the windows was the air (conditioned or heated depending on the season) “shelf” where you could put stuff, or more commonly someone would sit on it while you sat on your bed for a check-in or MD interview, what have you.

I asked if the doors needed to stay open at any time, and was told I could always have it closed if I wanted, but the 15 minute checks would be flipping the shade.  So it’s not like you could lock yourself in there and close the shade, since it was controlled from the outside.  And there was no lock, of course.

There was no clock in the room, and no way to get one.  That was very frustrating, especially during “quiet hour” not being able to tell how much of the hour had passed.  There was a white noise machine in the room, probably someone had needed it in the past and they hadn’t removed it.  None of the other patients had one.  But it had a snooze timer on it.  You could set it to fifteen, thirty, or sixty minutes and it would turn itself off.  So all I had to do was set it to the amount of time I had before an event, and when it turned off I knew it was about time.  Took me a day and a half to think of that though.

The first night I did not have a CPAP machine.  The second night I had a hospital supplied one, and the third night I had my own.

Poor sketch of my room’s view

The view out the window was of trees immediately in front of the window, but only on the right side.  On the left I could see the bridge over the river for the university.  It’s the same bridge that a famous poet used when he jumped to his death.  My first year attending there was an article about a student who jumped off, killing himself.  And a friend from my youth jumped off it last year.  I had been watching his memorial group on social media, and he was in my thoughts very often.  But I thought it interesting that the only thing I could see well was a bridge I associated with death.

I was very happy to have views of trees.  Science and Nature are my religion, and it was nice to have something that was spiritual to me so close.  However, even though I was extremely familiar with the river and the roads around it, I couldn’t figure out exactly where our building was located until I looked it up later.

The time I spent in my room was either with MD’s discussing my case, or sitting on my bed reading or writing.  I was trying to maximize my time here, not just watch tv and mope.  Even at my lowest I knew this was an opportunity to learn about myself.  The room was comfortable enough, but it had an unfamiliar, peculiar antiseptic/scented smell that if I ever smell it again, I will instantly see that room in my mind.  That smell was one of the reasons I really wanted to go home, in the end.

Nurses

There were two types of nurses, for the most part.  The first were the care nurses, who could do all the medical things a nurse can do.  Talk about meds, check in with you in the morning to see how you’re doing, or even just answer simple questions about your case.  The other kind of “nurse” wasn’t able to answer questions, and would guide you to a care nurse.  They tended to be either scrappy looking or big and strong, and I thought of them as orderlies.  Like the ones in movies that they call when someone is acting out, and need to be subdued.  They are very clearly security.  

Some patients would get “nurse” minders, but they were really like bodyguards.  Not for them, but from them.  You could get a minder if you had a medical device that had ligature risks, like an IV you need to roll with.  Or if you have a history or risk of violence, or even if you’re just being ornery at times.  Some people would even get two minders, and they would follow so closely, like at an arm’s length.  If they went to the counter to read the newspaper, the minder would literally be right next to them, with the other minder covering any major exit points.  It was both scary and fascinating.  Any of the staff could be a minder, but there was always at least one orderly type very close.  It was such a subtle difference between different staff that it would be very easy not to even notice.  And one of my favorite “nurses” turned out to be an orderly type.  That was quite a surprise when I figured it out!

It’s understandable, though unnerving.  As the day wears on people get tired and cranky.  The environment doesn’t help, either.  It’s just that some of them have a bit of psychosis, too.  So when they get cranky they become dangers to themselves or other patients.  Happily, I never got a minder (that I knew of) as I was well behaved, even more respectful and polite than most of the patients..

Clothing

Try to imagine this but without shoes or a smile
Again, no smile

From almost the first moment you get to the Emergency Room, you are given the mahogany scrubs, with no pockets, belt or drawstring or elastic.  Until you come up with a method for keeping them up, you are always holding them with one hand.  Methods included rolling the top of the pants up, usually with a folded over bit of the top of the pants to “peg” them.  Or tucking the top into your underwear – the scrub top was long enough that nobody would see that.  Or even just not caring, and using a hand to keep them up.  The scrub tops were long-ish, since the scrubs you’re given are big enough to be baggy on you.  I actually liked the color, except for the sweatshirts.  If you were cold the staff could give you a sweatshirt, which was “safety green.”  They were warm, but clashed with the mahogany, being neon colored.  

I realize now that I should have smuggled a scrubs shirt out, as another souvenir.  They had plenty of them, I liked the color, and it was actually somewhat comfortable.  Also, I felt like for the amount we were paying we should be able to take home souvenirs.  Nobody has shared that number with me yet.  But it doesn’t seem like inpatient anything or ambulance rides are cheap.

See? Grippy! Kept them.

When you start inpatient you are given the scrubs, and the grippy socks.  They’re the kind of ankle sock that have rubber patterns on them so you won’t slide around on the linoleum floors.  Thus the term “grippy sock jail” due to the socks, and the spartan locked area you lived in.

For those patients who were admitted without much notice, they didn’t have much in the way of street clothes, so they just stuck to scrubs.  If you did have street clothes you wanted to wear, the staff would take you to the locked lockers and take things out for you with a good inspection to make sure they were safe.  As a result, I did not get my pajama pants with the drawstring.  But I did get shoes!

Schedule

The schedule looks something like this:

8:00-8:30 Breakfast
9:30 Ward meeting/checkin
10:00-11:00Group
11:15-12:15Group
12:30Lunch
1:15-2:15Group
3:00-4:00Afternoon quiet time / shift change
5:30Dinner
6:00-8:00art therapy or other activities
10:00Lights out

The group sessions were varied but interesting for the most part.  Usually well attended, but not mandatory.  The fact that the TV goes off during the group sessions surely shows that they are encouraging everyone to go.  The different types of sessions that I saw were Occupational Therapy – art with an explicit type of art or subject.  Creative Time, which was mostly just art.  They opened the cabinets and let people choose what they wanted to do.  It was really well stocked and included colored pencils, pens, oil crayons and chalk, even sticker by numbers books for an easy project.  Education was a typical “this is what mindfulness” is or distress tolerance and so on.  Dancy Therapy looked like they put music on and lead a dance session.  It looked exhausting to me and I skipped it.

MDs

There were a few different types of doctors.  The first were the residents, who would usually do the heavy lifting before the MD came in.  Asking about history, clarifying your story, talking about meds you’re on and so forth.  There were regular MDs that seemed competent, but some patients were complaining that their MD didn’t help at all, really.  And then there were the Professor MDs.  They usually had students of varying levels following them around.  And because they were professors, they were extremely good at communicating and breaking things down to simple concepts for patients.  Luckily, mine was the latter.  Sometimes they had a gaggle of students, other times they would fly solo.  More on that later.

Because it was a teaching hospital, you would occasionally see students hanging around.  You could tell the older students from the younger by the varying looks of fear on their faces.  I guess I can’t blame them.  They are locked in prison with people who are in mental crisis, and anything can happen.  Not often, but sometimes.

What I missed

First of all, everything.  When my doctors had offered inpatient treatment to me in the past, they talked about it being “time to take a break” or “a way of having some time to rest” – which made me think it would be a bit more gentle.  But it was grippy sock jail indeed.

I missed my musical instrument, especially since I was reading about the history of my specific model.  I missed shoes and warmth and hugs.  I got my shoes eventually, but still felt chilly a lot of the time, even with my issued sweatshirt or personal sweater. I missed fresh air, as none of the windows opened and they no longer let patients out into the backyard gardens.  I missed KFC, having seen a commercial on TV and had been having institutional chicken strips.  Hard not to compare.  I missed streaming services that don’t have commercials.  I missed our pets, as they really give me a lot of happiness and comfort.  But most of all I missed having something to keep my pants on.  And I missed time and days.  With no clocks it was easy to let go of the concept of time, and as most days were identical, you had to work hard to remember what day of the week it was.  As time was hard to judge, you come away with the feeling that you were there for weeks instead of days.

People

Obviously anonymous, but I’ll be mentioning some of them later, or just want to share the diversity of patient types.  These were not names we used with each other, just descriptives I can use to reference them.  I did refer to Mumbles by that term, and by the time I left many people were using it.  I might feel bad about it, but the people who adopted the term left the same day I did, so it’s unlikely still used.  Also, these patients were of many different ethnic and economic communities, which made me feel comfortable, as we live in a fairly diverse part of town.  The suburbs would not have felt like my tribe.

Mumbles was a young man, likely the youngest age that gets you into our ward, not the adolescent ward.  He did not make eye contact, and was always muttering what sounded almost like a rap, but it was more like thoughts being expressed.  LIke, every thought.  I initially thought he had two minders, as they were always outside his door when he was in his room, which was all the time except for meals.  Turns out the minders were for gangster, who lived across the hall from him.  I would occasionally hear Mumbles muttering at night, as he was just next door to me.  He was actually responsive, but not very willing.  At check-in we would all have a daily question to answer, and he heard enough to say “pass” every time.

Mama was the only person on the ward older than me.  She had a hoarse voice, I think she smoked in the real world.  She would make jokes comparing the ward to jail, and I really think she spent enough time in both to know as much as she did.  She was what I would consider an “experienced” patient, having been in inpatient before a couple times at least.  She arrived halfway through my stay and didn’t skip a beat.  Knew enough to be able to navigate the system.  She was also one of the people playing cards almost constantly when there were no groups or meals.

Old man – probably not that old, likely not as old as me.  But he was like a ward dad, and very nice.  He was tall, had a huge smile, and was always willing to share his experience to help someone out.  Was usually in the card game.  We talked for a bit about our experiences in the military.  He was army but that’s okay, he seemed nice enough.

Tank was in the unit on a legal hold, meaning he had to wait until it timed out and he was considered safe.  The people not on a legal hold could technically request to leave AMA as long as they were safe, but we all just waited until the MD cleared us.  He was a young man with a foot cast, and walked with a limp because of it.  Always seemed to be angry, and occasionally had a minder.  He never shared (“pass”) in check ins, never went to groups, and seemed to just be waiting on the hold expiration.  He would occasionally be surly, but I didn’t feel like he was dangerous.    Pretty much the only pastime he had was watching TV.  He had a favorite chair, and if someone (at one time me) sat there he would say he was sitting there.  In my case I just moved because I didn’t want to agitate him, but when Singer took the spot he just stopped, stared for a second, and then found another seat.  I think he knew she was not going to take his shit, and might even be able to take him in a fight, despite the fact that she was half as big as he was.  While watching TV he would get up every few minutes and go down the hall.  I wondered if he had something going on that made him have to go to the bathroom.  It turned out he was just going to one of the phones, and usually didn’t get through to whomever he was trying to reach.  At one point he was complaining about those ads on the TV and why were they the same ads over and over?  He was talking about commercials, had no idea what they were.  Funny, a bit.

Singer was a slight woman, very kind and spiritual and caring.  She also had a ton of tattoos, some that looked like prison tattoos.  She was funny and outgoing and very gracious, sharing her sudoku book or food at meal times.  She was wiry and tough, despite the fact that she was a full head shorter than me.  When she left she sought out every patient she had even the remotest pleasant interaction with, and was very sincere in wishing each one luck.  I call her singer because she would occasionally sing a song at check-in or during creative time.  Some of them were classics, some of them were her own creations.  It was always beautiful and inspiring.

Girl was  the Emma Roberts character (from the movie It’s Kind of a Funny Story) of the ward, albeit chubbier, with colored hair growing out, and visible self harm scars.  She was someone I would guess might be working on or having completed a GED.  Turns out she had her Masters in something mental health related.  She was very smart, very outgoing, and usually very pleasant.  She was going to rehab (with Old Man) after the inpatient stay, and her boyfriend had just finished rehab and was in a sober house.  I thought it was cool they were both cleaning up at roughly the same time.  She was usually in the card game.  She was almost half my age, but we got along well.  She was one of the first people to talk to me, and was always ready with a nice word for anyone who looked glum.  That’s a lot of nice words.

Spectrum was a young girl who was on the autism spectrum.  Not the smartest in the ward, but as nice as she could be.  She would be sitting in the living room area and just yell “HEY NURSE!” until a nurse came.  Usually for something simple and mundane, not really worth yelling for a nurse about.  But that was just her way.  She was working on her “GDE” and would often need help with assignments.  I’ve always maintained that getting a GED is both easier and harder than getting a high school diploma.  Some of her practice sheets were ridiculously simple, while others were really hard.  Who goes around knowing the year the state was founded?  I rely on internet searches for that kind of detail.  She had been “in the building” for over six months, moving from unit to unit, but also spending time in different kinds of places in the system.

Steve-O started the day after me.  He looked enough like the celebrity that I had to consider a while if that might really be him.  He wasn’t.  He lived in the town I grew up in and sells insurance.  He did not make a sales pitch while in the unit.  He was a nice guy, often did laps in the halls, and after leaving the unit was going to stay at his brothers in a far suburb because it would be a good peaceful place to recuperate.  No idea why he was in, but he was one of those folks who obviously wasn’t planning the stay.  He had little kids at home and knew that would be a stressful enough environment that he should just go back there.  Was usually in the card game.  He was probably the closest to being a peer of mine.

Little came into the ward during the day, and she looked terrified.  Turns out that was just her resting face, and she was another very experienced patient on the unit.  She had a nasogastric feeding tube, which she had on almost constantly.  When we had meals she would only have beverages and maybe a light snack.  I have no idea why she had it, but she talked like she had it since she was very young.  She was quiet, experienced, and had a 24×7 minder due to the tubes and charging cable on the device.  Very nice, looked  very young but had recently gotten an EMT certification.

New the last new patient before I left.  She was an older woman with an accent I couldn’t place.  Possibly german.  She paid attention to everything going on around her, like an inexperienced patient like me.  She seemed to know what she was doing, however.  She always wore a mask and hadn’t gotten to the point where she could sit down and socialize yet.

OT – a bright, cute blonde young woman who ran many of the group sessions and all of the OT sessions.  Very helpful, very sweet.  The epitome of a healthcare care worker.  Seemed to genuinely love helping people, seemed like the girl next door.  But she could also be very gently clear and direct if someone was acting up.  Probably the person we saw most regularly as there were one or more OT sessions per day.

Gangster – This was the young man that had two minders around the clock.  At night they would be in chairs outside his room, close to mine.  At least one of the minders was the biggest “assistant” in the unit at the time.  Gangster never talked about going home, and I’m not sure how long he had been there, but it seemed like he was probably there for a while, and didn’t sound like he was getting out soon.  Talked like a young man who thought he was toughest around, as well as overtly and awkwardly hitting on the prettier staff on the unit.  With the way he was doing it, I doubted it worked in the real world, much less for people who had read his file.  He didn’t act out the whole time I was there, but you always felt like he was about to.

There were other patients and many staff, but these listed were the ones I interacted with or watched the most.

Introduction | Glossary | About

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