(Chapter One - Madhouse Railings)
I have time for one last glance at the speeding clock which has possessed me for the past half hour, forcing me to drive as recklessly as possible, while still arriving in one piece, of course. My shift begins at four o'clock and I've just pulled into the driveway at 3:58, barely making it, and yes, I should have left earlier, I know, but that’s not what happened. Sometimes I’ll tell people that it’s really just a bad habit, a consistent chunk of laziness from my rebellious subconscious, maybe. I'm working as a counselor in a community based group home for twelve mentally ill individuals, five male and seven female, ranging in age from late teens to mid sixties. I get a glare, more than a glance, from Gail, who has been working with this "not-for-profit" company for six years. She is The Mom of The House, and usually arrives at least 15-30 minutes early and fully expects to leave early, a situation that has been adressed by our manager. Anyone who would like to, can, of course, come in up to 15 minutes early, but this does not change the rules on proper turnover to relieving staff members.
Some overlap is expected, even figured into chore planning. Gail doesn't appreciate when you don't show up for your shift a early, which I usually don't, and tonight it meant she had to start getting dinner ready with one of our residents. I would still, of course, end up doing most of this chore with Derrick when she left.
But with Derrick, whose chore it is to cook this week, it's no great challenge getting him started, that mainly consists of taking out the ingredients needed and explaining the process specifically to him. Once he's started you can leave him alone; he loves to cook but is somewhat intimidated by having to decipher the instructions. So you check on his progress every five or ten minutes and he does fine. You don't have to physically walk him through it, step by step, as you would with most. He is 19, but presently reads at only a fifth or sixth grade level, and therein lies his fear. Derrick could make most meals alone, if he had to, but needs constant reassurance to overcome his lack of confidence.
For the past few days, for example, Derrick has taken to asking "I'm a good person, right?", and telling everyone "I really like you, you're a good person!", with seemingly genuine enthusiasm. Derrick has trouble expressing himself, and he only does so now when in a rage; at which time he raves for long periods. His diagnosis is schizophrenia, which is almost always triggered be extreme mental stress, also true in Derricks' case. This disorder is generally regarded by professionals as lifelong. Schizophrenia is the "disorganization of normal thought and feeling", and not simply a split personality. This is now called multiple personality disorder, and although the two have been confused for years, they are now treated very differently. Multiple personalities are usually hospitalized for life, while schizophrenics, like most in this home, may be helped with medication and/or group home environments.
"I've been good for six days straight!", Derrick informs me after Gail has gone for the day. "I haven't gotten in any trouble for six whole days, isn't that great?". Derrick has begun to keep a running total because after punching another resident in the face at the dinner table one night, which resulted in the police visiting the home, he was repeating all the next day, "I'm having a good day, right?" and "I've been good all day today, right?", to avoid the topic of the previous days' problems. Finally, I asked him to try to put good weeks together, because every four or five days he's been abusive (physically and/or mentally) to others in the house. Resulting in new and unique problems to deal with for members of the staff present.
This time of day, while Derrick is cooking, the other residents are asleep in their rooms, out, or watching TV. Two or three have walked the five minutes into town for coffee, because the house only serves decaf. Regular coffee doesn't mix well with medication, but if one wants to walk into town for it they can. After dinner there are chores, and after that the clients can do as they please until curfew, which is 11pm on weekdays and 1am on weekends. Only one resident owns a car, and she won't have it for another two weeks or so, Donna just moved in and you have to wait a month or so before you can have a vehicle here.
"You hafta bring up lettuce so I can make lettuce for dinner you know", Nora yells from the living room to the kitchen where I'm talking to Derrick.
"You're gonna make some lettuce for dinner, eh Nora?" I ask her, and this gets a laugh out of Derrick, but silence from Nora. And then, as if on five second delay, "You know what I mean, I've gotta have salad, John."
Nora loves to tease, but like most of us, hates to be teased, and now I've successfully gauged her mood. It'll be kid gloves again today for Nora. Not that this will be any major change in my handling of Nora. As is known to happen, we didn't hit it off, at first. Nora interprets my sometime sarcastic sense of humor as hostility. And returns it ten-fold to me.
Nora had topped 240 lbs. last week for the first time, and visited the nutritionist; and had again told the woman that "The staff here doesn't help me watch my weight", and this time we found out. About the other times, too.
"Seven laps around the house," Gail told her later that day, "every day, and if it's raining out or something, you walk the inside of the house". "Slim fast diet, with salad for dinner and six glasses of water a day," the nutritionist said, "and come see me every week instead of every month for awhile". I relished every meal for the next few days after contemplating Noras' situation.
But she really seemed to be trying and weighed in at 233 this week. At 5'4, she still has a long way to go, but she seems to be making a real effort this time, and that's a ton of progress for Nora.
"Go ahead and eat before everyone else if you want, Nora", I tell her. I know she doesn't want to sit and watch us eating baked ziti while she has to have salad.
"Staff says everyone has to eat at the same time, and it's not five o'clock yet anyway", she tells me. "I am staff, Nora", I remind her, "go ahead and eat now. The ziti needs another 10 minutes, at least".
By the time we sit down to eat, Nora's only halfway through with her salad. And what she was eating could have easily qualified as a salad bar in most restaurants.
"A little of that dressing on your cheek, Nora", I try to tell her gently. She's got it on her nose, chin and both cheeks, really, but I point this out with my hand after getting her attention, and she wipes most of it off. Not that having someone eat like a slob is anything new, everyone else is enjoying a very cheesy baked ziti and most of our chins are showing it. Dinner is a very quiet meal in this house when something everyone likes is being served; there are twelve people, plus myself, and everyone wants to get a share. And the radio had been shut off again, so the only noises are those of people munching. I guess there is a rule stating no music is to be played at mealtime, but I like a little music during dinner. I usually leave it on, but someone shut it off, and I was just too hungry to care tonight.
"Can I have a dinner roll?", Nora booms across the room to me after everyone has been silent for a while. She knew the answer already, of course, and had a big smile on her face when I raised my eyes to meet hers. I had the feeling that I was being watched while I tried to gain control of the melting cheese dripping from my chin, and I figured it was Nora, she did have a habit of staring at people for long periods, but there was little I could do at the time. Nora laughed and I could only return a goofy smile at her request, and she knew she had gotten me pretty good. And I bet it made her meal, because I know the salad surely didn't.
Nora is 21 yrs old, seems 13 part of the time, and 65 the rest. She reads at about the same level as Derrick, about fifth or sixth grade, and is as easily frustrated. The main difference is where Derrick explodes, Nora sulks, imploding. She was abused terribly by her mother, then was in a few foster homes. She had been gaining 5 or 10 lbs a week for about a month, and it seemed we couldn't do a thing about it. She wouldn't exercise at all, and ate sensibly in front of staff at dinner time. But when she went to her day program, she must have killed lunch, because the changes from day to day were plainly visible. Painfully obvious, even, obvious that it was painful for Nora. But until she could see her nutritionist, she wasn't accepting any help from the staff in-house. She was crawling deeper and deeper into depression, but as she was not accepting help, we had to help those who would, and call a specialist for Nora. And that seems to have worked, although Nora has lost 15-20 lbs before, only to balloon up again, just as quickly as she lost it. Now we had to figure out how to make it work this time, but this, of course, is mainly up to Nora.
"I feel the water again, John, I'm not making this up.", Doris told me, "There's a leak in the ceiling right above my head, I know it." And she was right, of course, I just had to wonder to myself how long she had put up with it. Doris suffered from delusions, she thought other residents, staff and/or doctors, had the ability to mess with her thinking process, and it made her very angry. Did she sit there getting dripped on throughout dinner? By the evidence of the puddle by her chair, I imagine that she did. Doris has been doing well lately, she still had her delusions, but she seemed to be enjoying these. Doris spends all of her free time smoking cigarettes and had the black lung hack to prove it. She watched one TV show, at 9am on Sunday morning, a religious program. Anyone entering the room while it's on will hear: "I just wanna watch one show every week, and we're gonna watch this show."; and she gets no argument. Usually, no one is up at that time anyway, medication is given out at 8am and then everyone goes back to bed. But make no mistake, if anyone had wanted to watch something else, they would have had quite a fight on their hands.
Doris is set in her ways, and in her mid-fifties, puts up with no crap from the younger crowd of the house, who gladly give her distance. Doris will even take advantage of staff, when she can, by getting extra money from her pouch in the office, money she will need for coffee and cigarettes later in the month. She recently told Gina, her primary counselor, that God had put a million dollars in her account and we were keeping it from her. She has been delusional for some time, as a result of her (schizo-affective) form of schizophrenia, but that claim was out of character for Doris.
"You're gonna have to slide down and finish your dinner, Doris", I tell her after investigating the problem above her, "it's starting to rain again and I won't be able to stop this leak." It was either rain or the washer above the dining room, but whatever it was, it was coming in from an overhead fluorescent light and I just wanted everyone to finish so I could turn it off and set up something to catch the water. But our leftover killer, John, had spotted the potential leftovers and asked if he could finish them off.
"Go ahead John, finish it up, everyone else is done", I tried to say as he asked,
"How long before the carbos hit me, John?"
"Probably by tonight", I tell him.
"How many you think I had?", he mumbles through a mouthful of ziti.
"I really couldn't tell you John, but you should probably work out a little bit tonight before bed."
John had weights set up in his room, and he did the best he could with what he had. Two tens and two fives, with a broken curtain rod shoved in between to do curls. He also used just the weights themselves, and in a few months you could see the difference. With about 125lbs on his 5'10 frame, he is still rail thin. But working on it. When Doris doesn't give him coffee, of course.
When she does, he'll put the grounds in the bottom of a coffee cup, fill it with warm tap water, and down it in one gulp. And for the next few hours it's the Beavis without Butthead show. He can hardly speak, he's so wired, but he can laugh. Like a hyena. Nonstop. Huh huh huh, huh, huh huhhuhhah. For hours. His giggling, especially after a "coffee" or two, is maddening even for those of us who only spend 40 hours or so in the house. And although he is painfully thin, he can eat far more than anyone else in the home. Anything in the fridge is fair game, and no combination of leftovers can turn his stomach. John eats every meal as if it were his last.
"Almost done, John?", I ask to try and hurry him a little, because he won't stop until all the leftovers have disappeared down his hatch.
"Mmph.", he responds.
"Should we take the rolls, John? You almostdone?"
"Yup, juss a little more, alright?"
"Alright, John, alright. People are waiting for you, though, OK?"
"Jussaminute, right?"
"OK, I'm gonna start everyone on their chores, whaddya got tonight, John?", I ask him.
"Upstairs bathroom; but I did it last night, so I know it's clean."
"C'mon, John..."
"I know, I know, juss givin' ya hard time, thass all."
"Payback, John. Remember, payback.", I tease him.
"You'd never...", he adds as he stuffs a little more in his mouth.
He's probably got a little room left in his throat, but that belly has got to be about full.
As he completes his massive dinner, the cleanup going on around him is just about complete. Before the TV can go on, all chores must be done, and John, for one, doesn't care. Those who like to watch TV right after dinner have long since finished whatever chore they had, some volunteered to do theirs before dinner. Some will, at times, even wait in front of the blank screen in anticipation. But John doesn't watch much TV anymore, mainly because his incessant laughter is a constant souce of tension between he and the other clients. As much as it might unnerve the staff, the clients are together all day, every day; in the house, on the bus to day program, at program, on the bus back, and at dinner. After dinner everyone scatters, usually meeting back at the office around eight o'clock for medication(s), but some arrive at 7:45 and others you have to hunt around the house for at 8:30. But Johns' laughter, even when he's in his room, with the door closed and the music blaring, even then it echoes throughout the house. Huh Huh Huh, Huh Huh Huh, huh, huh Huh Huh Huh. Lately, he's been taking the iced tea mix and hiding it. Then whenever he wants to get wired, he puts enough for two quarts in a 12 or 16 ounce cup and adds water; and it's The Beavis Without Butthead Show! Huh Huh Huh.
Johns' diagnosis is Organic Delusional Syndrome, which means, basically, that he did it to himself. In his case, it was heavy drug use, sniffing glue and whatever else he could get his hands on, along with unknown amounts of LSD. At 12, John was caught by his mother with a bag of pot, grass, and/or marijuana hidden in his room. And apparently following in his alcoholic fathers' footsteps, he did shots of hard liquor when his parents left him alone. At 14, he began with the glue, LSD and cocaine, all in amounts unknown. It is known, however, that in school to that point, he was considered to have "significantly above average intellectual potential". He appears today dissheveled, his clothes and person unwashed, with his eyes mostly vacant. John had made significant progress for about six months, but all ground gained now seems to have been lost. John is headed back to the hospital, and there is very little we can do about it at this point.
If we fail to help him in the long term, it will not be totally from a lack of effort. John really seems to enjoy being just the way he is, and detests anyone telling him what to do, a point of view I can appreciate to a point. No one likes to be told what to do, but John has become quite ornery when asked to do anything. We don't ask for much, usually. Take a shower, stop the constant laughter, clean up after you eat, etc. But since John dislikes most members of the staff, he finds it impossible to follow any of their directions. I have tried to tell him that if he took care of these things by himself, he wouldn't have these problems, but he already knows this, and just doesn't care. As long as he can bum coffee and cigarettes, he's happy to just sit in his room and giggle until he falls asleep, which he does early and often.
"John, wash off your plate before you go, alright?" I ask as he's leaving the kitchen, with his dishes on the counter, covered in sauce.
"Right, I was juss goin t'hava smoke, firss.", he mumbles as he retreats to the kitchen. John likes me and has never given me any problems. I do have clients who give me a hard time, and right now it's Nora. But the only problems she gives are the complaints to other staff members about my behavior towards her. Luckily for me, she has done this, at one time or another, to every staff member before me. Never quite this bad, she really doesn't like me lately. I keep her to her diet when I can, and she doesn't appreciate that at all. But I really have no choice, she would complain if I turned a blind eye to it as well. So it's really a lose-lose situation, except that maybe Nora can lose a little weight. If she were happy this way, that would be one thing. But she is miserable, and specifically campaigns for help, "it'll be different this time", then accuses us of being unfairly strict with her when we keep her to the nutritionists suggestions. I hear about it when I start my shift, about my predecessor, and they hear it about me when I leave. It really can't be helped with Nora, but it is extremely frustrating to those who are trying to help her.
When Nora says it's gonna be different this time, you want so much to believe her, that you must keep her to the diet when you can. We can't be with her all day, every day, so it's really up to Nora, anyway. And we suspect she has begun to cheat already, now we have to wait and see. The scale will tell the tale.
End of Chapter One
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