I've only been a nurse for a few years now. I was hired as a new grad to work full-time nights on an inpatient psychiatric unit. I am the only nurse on my shift, and the long-standing mental health worker is reticent and sleepy and barely there, so to speak. That works for me. I don't like to be helped unless it's absolutely necessary. Sometimes it gets hectic - like when there are 3 or 4 admissions and it's a full moon. For the most part, however, my lovely little 14-bed unit is "the Q word". But when patients are actively psychotic or suicidal or simply unable to sleep, I welcome the opportunity to be an "authentic presence", and having the time to interact and engage on a one-to-one basis with someone who is acutely ... vulnerable is by all means my favorite part of being The Night Nurse. The one term that comes to mind when considering our patient population is recidivism. Perhaps being a relatively new nurse is what allows me to believe that regardless of the number of times a patient is admitted in a certain period of time, and despite the patterns of borderline behavior or denial or what-have-you that dictate frequent flyer mileage, each encounter is a new opportunity to, at the very least, help. There are some "regulars" who make me especially grateful to be where I am. This story concerns one of them.
H. was a ridiculously large man. I'm 6'2", 230 and change, and he made me feel diminutive. He was one of those guys that you think is fat, but when approached you realize that he is not, at all, and you take a step back or to the side and put your head down. He always came in rough - on a Police Emergency Certificate after tearing his basement or kitchen apart, a half day or so in 4-points in the ED, then down to us drooling the effects of chemical restraints all over his johnny coat. However, when he woke up, typically he was already the H. we recognized and enjoyed. He would still be psychotic, but all the loose associations and heightened religiosity were tempered by his high-pitched, mellifluous whisper of a voice. It was enough to make you laugh, unless you enjoyed breathing or walking and fun stuff like that. It was a beautiful voice actually, and this docile colossus of a recidivist with schizoaffective disorder always reminded me of Lennie Small from that Steinbeck novel. I still remember that voice, am remembering it now.
I went on vacation one autumn with my family to Amish country. My 4-year-old son is a perpetual ham. I can watch him talk to people all day. He's the unofficial mayor of wherever we go. When I returned to work, H. had been readmitted. He had walked for miles to the ED and checked himself in voluntarily. H. had been on the news. He was fishing in a row boat on the Housatonic River. He was a little drunk, very alone, and happy. A small boy started screaming for help. His uncle had capsized the catamaran they were riding, and had gone under. H. rowed, the oar handles must have looked like wooden Sharpies in his hands, and was upon the immersed mast in moments. Silence, save for the sound of water slapping the recumbent sail. The boy was gone. H. couldn't swim. He told the police that he had hurled himself out of the boat, but immediately started sinking and only just managed to grab the end of a blade before the oar started straining the oarlock as he pulled himself out from under. A woman in a bass boat came by a half hour or so later and spotted a man holding onto the side of an old rowboat with one hand, and half of a splintered oar with the other. She told a news reporter that she had originally responded from about a half mile away to the sound of what she thought had been a bear in a trap. The sound, she said, of that weeping giant would stay with her all her days. H. didn't speak for the first two days on the unit. Then, on my one night off that week, he hung himself with his bed sheet. That was a year and a half ago.
Two months ago, I admitted a young woman overnight. This was her first psychiatric admission, and she was scared. She was 21, doe-eyed, and addicted to benzodiazepines. She was also diagnosed with bipolar disorder; depressed, with suicidal ideation. Her name was S., and she was as small and quiet as a mouse. After a day or two, nurses and mental health workers were competing to see who could squeeze a word out of her. She didn't sleep well. Although she was pleasant and cooperative when I asked her questions or offered help or medication, I got the feeling that I was merely being tolerated. One night she came to the desk at around 0300 and asked if she could sleep in a chair in the lounge. She simply shook her head 'no' repeatedly when I asked her why. I let her sleep where she wanted, placed a blanket over her when she was settled, and let her know I was there if she needed me. The same thing happened the following night, except she was crying. This time when I asked her why, she hesitated then whispered that she was seeing a shadow in her room. S. had no history of psychosis, no hallucinations or paranoia; and, no delusions other than that she didn't deserve to be happy and had an innate inability to realize that she was not alone ("Don Draper Syndrome"). She smiled, either out of embarrassment or nervous fear, when she told me what the shadow resembled: "a levitating bear". The moment she said this I realized what room she was in and its history. The only surprising thing about it was that I hadn't thought about H. in a while, and that I didn't think of him every time I passed that room.
S. came out of her room one night and told me she had seen a ghost. I thought she would be anxious, request a p.r.n., and stay out in the lounge again. However, not only was she calm, almost serene, she was also somewhat voluble. "I heard a sound in the bathroom - a guttural, animal-like sound. I wasn't scared, though, so I went in. Sitting on the floor with his head in his hands was a very large man. Very large. I knew I wasn't dreaming, and I knew he was a ghost. Do you think I'm crazy? I also knew he was, uh, benevolent because when he picked up his head, I could see that he was crying, and that he looked like an over-sized Billy Budd. Do you know who that is? (I did - "God bless Captain Vere!"). He looked lost or confused so I told him to wait and I'd be right back. I just wanted to tell you. You think I'm crazy." No, I didn't. But this was probably more than she had spoken the entire two and a half weeks she had been on the unit, and as pleasant as it was to hear her voice, I was taken aback. S. said she was fine and asked permission to go back to her room. I told her I would check on her in a little while. She smiled and gave a curt wave. She was so tiny. When I checked on her in a few minutes, she was fast asleep.
S. was discharged before I could see her again. Other nurses told me that she said that she was hopeful when she thanked them. They were touched. It was also the first time a few of them had heard her speak. They also said that she had left me something, a letter. "What's your wife going to say?" Anyway, in the letter she said that she knew that everything was going to be all right. She said she had dreamt that night when she slept for "the first time in forever" and met "that huge-assed ghost". In the dream, he was swimming with a small boy in a moonlit river. They were laughing and playing and she didn't know why but it overwhelmed her and she awoke the next morning crying for joy. S. thanked me in the letter, and said she had written a poem about her ghost and her dream and about me and that I shouldn't be too critical because she had stopped writing "years ago". Funny girl, sweet kid, I thought. But when I read it, I was floored, absolutely. The lump in my throat returns every time I read it. I keep a copy in my wallet. I carry it with me.
S.'s poem and the memory of H. have become a part of the collection of things that give me hope - like my son letting the world in on his secret, or my wife's face when she doesn't know I'm looking at it. These people, these stories, these fleeting moments of respite and grace are what make life worth living. They are the things that carry me across the water.
The Long Night Closes
the golden hour
of our
waking
when daylight
is born
beside you
(The Giant
Albino
Three-Toed Sloth
called Sleep
devoured me
delivered me
to you) &
i dreamt
this:
you carry me
on your shoulder
across
a river,
which is you,
and set me down
upon the far shore,
which is you
as well
