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7 East
I moved to Tucson, Arizona in September of 1974 for my second year of post-doctoral training. I was starting as a psychology intern working on 7 East, the wing of the University of Arizona's teaching hospital devoted to inpatient psychiatric patients. As my first placement in a formal medical setting, and my first time treating seriously disturbed patients, it was a challenging time.
Still, within a month or two I had come to understand the rules, regulations and routines of the ward, and had established working relationships with my supervisors, with the nurses who actually ran the unit, and with my patients. I felt that I could start to relax a bit and appreciate the experience.
However, one part of my responsibilities still provoked a lot of anxiety -- my once-a- week night shift on call to the emergency room.
Over the course of the year, those ER calls included dealing with a hulking, knife-wielding biker-gang member, talking a very panicked man into releasing the even-more-panicked nurse he was holding hostage, and calming a terrified teenager who was convinced that even the air was poisonous. But those weren't my most memorable ER cases.
The peak experience, the one that in some strange way came to epitomize the underlying craziness of my year on the inpatient unit, unfolded one night at the end of October. My pager buzzed, I hurried down to the ER, and was waved to a cubicle where a young, sturdily-built, and very wide-eyed woman, a university student I guessed, was pacing anxiously.
Before I could introduce myself, she opened the conversation by asking, “Is this a starship?”
I don't remember my exact reply, but, in keeping with my training, it was probably something like, “No, but it's a safe place where we can talk.”
We did talk, and for a long time. It quickly became clear that the agitated young woman— let's call her Molly-- was experiencing some kind of psychotic break. I couldn't tell if it was drug-induced, a good possibility given her age and the university setting, a first-time schizophrenic episode, also possible because of her age, or some other kind of psychotic decompensation. What was clear was that she was fearful, confused and disorganized, and needed to be admitted to the psych unit as soon as possible.
It took a long and intense conversation, but I was gradually able to calm her, reassure her that she was in a safe place where she would be taken care of, and gain her trust to the point that she warily agreed to come with me up to 7 East.
Following protocol, I called up to the nursing station to alert them that I'd be bringing a very anxious new patient to the unit. “Bring her on up,” the head nurse replied, “we'll be ready.”
What the nurse didn't mention was that there was something unusual going on that I wasn't aware of -- as people might say today, I'd missed the memo. The date was October 31. Halloween night. Apparently known to everyone else but not to me, 7 East had a tradition of celebrating Halloween in a big way.
So, when the elevator doors slid open, the scene that confronted Molly and me was not exactly the calm, safe place I'd promised. The normally drab and demure day-room was now heavily draped with orange and black crepe paper, with wispy ghosts, leering goblins and shaky skeletons swinging from the ceiling. Most of the patients were in costumes and masks, and a noisy party was in full swing.
To add to the craziness, another patient, a teenage girl who had been on the unit for several months, bounced up to us in a full-body rabbit costume and greeted us with a a shake of her floppy ears, a wide smile and a cheery shout, “Welcome to 7 East!”
It would be an understatement to tell you that all the pains I had taken to calm and reassure Molly, to gain her trust, to convince her that I was taking her to a safe and sheltering place, were instantly wiped out. It would have been better if we had stepped out of the elevator into a starship.
Luckily, two of the unit's very experienced psychiatric nurses nudged the welcoming bunny aside and took over, taking Molly by the elbows into a private room where, I knew, they would take her through the standard intake procedures and get her settled into the unit.
I retreated to the nursing station to document the ER visit and start her chart. After a while, the nurses came in to make their notes. They assured me that Molly was calmer, and in her room for the night.
Not quite. I can still see the final act in the night's drama perfectly clearly. The glassed-in nursing station looked out into the day room, a large, circular space furnished with couches, chairs and even a pool table. The patients' rooms lined the edge of the circle, each with a door opening into the common area.
I looked up from my notes just as the door to Molly's room flew open. I realized too late that there was another important detail that neither I nor the nurses had noted – Molly had arrived wearing heavy, Vibram-soled hiking boots. She now stood in the doorway of her room holding one of the boots like a quarterback about to throw a pass. Then, with a force and follow-through that seemed to express just how she felt about her welcome to 7 East, she flung the boot as hard as she could across the room.
To complete the scene, picture Albert, the inadvertent target of the pass. He was a fixture of the unit, the patient who had been there the longest. Albert was a mute, motionless, middle-aged man diagnosed with catatonia. Every morning he was wheeled from his room into the day room. He sat there, day after day, still and silent while all the activities—group therapy, occupational therapy, games--swirled around him. That night, in the midst of all the Halloween hubbub, he was sitting, Buddha-like, in his usual spot.
Until, as if fated, the heavy hiking boot arced gracefully across the room and smacked him, Vibram-sole first, square in the forehead. This proved to be more effective than any of the many therapies he had received, since he jumped out of his chair, scanned the room with a furious, accusing glare and shouted, “What the fuck is going on around here?”
My feelings exactly.
That's the end of the story, but I know that some of you will want to know what happened to Molly (and perhaps to Albert).
After his outburst, Albert sat back down in his usual place and, at least until I left the unit 7 months later, never said another word. Molly turned out to be suffering a severe schizophrenic episode, and over the course of the next few days became even more delusional. Happily, she responded well to anti-psychotic medication, and was eventually released to outpatient care. While she was recovering on our unit she formed good relationships with several of the doctors and nurses, but -- no surprise – she would never talk to me.
