Discharge Narratives
BY LEAH MENSCH
*1
A person is meant to eat cotton candy and a hotdog at Six Flags Amusement Park in New Jersey, but John ordered a Caesar salad there, and it was the worst Caesar salad of his life. The croutons were soggy; they melted on his mouth like Tums, and because all of this unfolded over two decades prior, he can’t remember whether he made such a choice in the name of health or in the name of weird mid-adolescent post-voice-octave-drop, pre-chest hair angst. First mistake, he mumbles. Then he rolls a six and moves his pawn piece across the board into Bob and Linda’s Room. The game is Clue, where players are to uncover details of a murder—the perpetrator, the room of the house, the weapon in question—but Bob’s Burgers edition. In lieu of the game’s classic weapons—revolver, rope, lead pipe, knife—the weapons in question are burger phone, Gene’s Keyboard, spatula. How a psych ward in Manhattan came to own a game so specific is above the caliber of anyone, but the edition, the weapons at the very least, feels suitable, because if you want to kill someone—yourself, specifically—in the psych ward, you have to forgo the standard methods and get creative. Upon admission, the nurse sifts through your bag and orders you to tug the drawstring from your pants. All additional methods of strangulation and suffocation seemed to be covered, too. Spoons are the only approved utensil because if you plunge a plastic fork into your neck hard enough, you can puncture the aortic vein. Nurses make rounds every fifteen minutes, but, Futureproofing insists to John and the rest of us over evening board games, it only takes four minutes and thirty-five seconds to bleed out.
I think about these things—like how long one might take to bleed out—because I am depressed, frightened by the rapidity with which death’s appeal is closing in on me after so many years. Performance is an empty space through which everyone must step, and eventually you end up here, where all you have to show for yourself is one visitor, one set of clothing, a hospital bracelet, a medication list, and stories told on your own volition. Nobody knows the intimate details of my life, but everybody understands a version of my life: the feeling of not being able to sit up straight, of peeling a banana and not being able to swallow, not showering for weeks. Of counting dead rats on the streets of New York in sets of three.
*
Before the attending psychiatrist admits me to the impatient ward, they hold me in the psychiatric emergency room for forty-eight hours—evaluating my history, waiting for a bed to open upstairs.2 I hear a woman in the room to my left ask if the nurse can find her a sleeping pill. This isn’t my first rodeo, she says, tender laughter inflected in her voice. A woman in the room on my right is paranoid that she’s being watched, screaming and pounding on the wall that separates the two of us. She says she’s tired of being alive, and she wants out of this room, and I don’t blame her. We are being watched. The rooms are 5×10 shoeboxes, of which the doors never close and the lights never dim. In the corner of the ceiling, a camera is bolted to the drywall, and when I ask to be escorted to the bathroom, I see the station where a nurse is paid to stare at the surveillance screen, eyes peeled, hour after hour. We are suicide risks, but we are also histories to be mapped, however uselessly. The origin of crisis, if one even exists, seldom elicits a cure. I cannot find the beginning, and I cannot stop thinking about the end.
Located in industrial mid-town Manhattan, on the streets below the hospital, men in suits walk to work with purpose, runners jog in place at the crosswalks and drink bitter coffee, my classmates swipe their MetroCard and ride the train to campus. None of this matters until I am transferred to the ward, because in the Emergency Room, there is not a single window, save the one in between my room’s door and the nurse’s station. This is where I first notice John, though I won’t learn his name until two later, when we’re playing board games together. He arrives at the ER an hour after I do, but I am assigned the last bed, so they sit him in an armchair, a nurse standing over his body like a guard, equipped to catch him should he decide to run. He’s disheveled and catatonic, and he tells the nurse that he lives in the Upper West Side, that he hasn’t been to work in weeks. I can’t even remember what train I ride. I lose the thread of his voice when the woman starts pounding on the walls again, though I hear the psychiatrist recommend both the women and John for inpatient admission. Shortly after, he recommends me for admission.3
When I look at John through the little window, I catch glimpse of my own catatonic state, how close we are to the edge. The woman pounding on the wall is only a portrait of sound, but I know we are fewer than six degrees away from one another. I feel her inside of me, just as she feels me inside of her. I am so desperate for someone to recognize this and to, in the same breath, promise me that there is life to be lived beyond sleeping fourteen hours a day, mis-remembering the sound of my own voice, crawling across the floor. I would have gotten on my knees and begged. Maybe by coming to the hospital, I did. 4
*
Before all of this, I was an adept liar. Able to obstruct parts of myself from public, private, personal view with a rapidity that frightened me. And then one day, with rapidity mirroring in reverence, I couldn’t anymore.5 I tell the psychiatrist I am admitting myself in short because I can’t even get my fucking shirt over my fucking head, and for months, I have been stumbling through my apartment doorway after class, eating cheese and crackers for dinner, yanking at my own hair. I am afraid that if I keep hiding, I will die in my tiny New York bedroom, and turn to dust.6
*
Futureproofing’s name is actually Max, but my roommate Kelly calls him Futureproofing because he insists he is in the hospital to better himself and become emotionally invincible—to (his words) futureproof. As if we weren’t all survivors of a façade identical in etymology. You go to the gym and eat celery to better yourself, Kelly says to me, in between bites of her veggie burger, drooping from its soggy bun, later that day. You go to the psych ward because you are fucking crazy. Futureproofing was born in Haight Ashbury and went to prep school and moved to New York to study computer science and asked the nurse for a paper cup full of hair gel every morning even though all of his family is in the Bay Area, and his father doesn’t show up to visit until day five. He is many years younger than I am, and the first time we meet, he tells me he brings girls to clubs in the West Village, how his friends used to call Pittsburgh—the city where I grew up—Shittsburgh. If I am not careful, I can draw him into caricature—though of course, the psych ward makes a caricature out of all of us, in our grippy socks, sending us to art group with model magic clay, tracking how any skills groups we attend a day. Two minimum. We walk through the hallway in gowns, wounds wide and festering, asking for a teabag, more deodorant, permission to floss our teeth, even if we are flossing surveyed in the nurse’s station. Everyone ferried through childhood in a major city thinks the Shittsburg joke is funny. It’s the third time I’ve heard the sentiment in a single month, but I laugh because I know Futureproofing, like nearly every other person I am hospitalized with, is living some iteration of being too depressed to get his fucking shirt over his fucking head. 7 To pretend I don’t feel a tenderness toward the group seems a wasted heartache, a refusal to turn and face one another, as if we have any other choice but to expose ourselves.
In the Bay, Futureproofing lived down the street from his grandmother, and often sat at her table in the morning, arranging words out of tile letters. He also uses his one phone call on her, and never talks about himself. I’m doing fine here, he says. He asks if she’s gotten her mail, if she’s made her doctor’s appointments, how she’s feeling on her new blood thinners. They don’t let us close our room doors, and Kelly and I are situated right across from the phone station, our beds pressed up against the walls, and we learn more than we wish to know. But right now, Futureproofing just wants to play Bananagrams after dinner instead of Clue. Every night for the first three days, he argues about gametime in the sunroom, a bag of tea steeping in hot water. Nobody ever wins in Clue, he says, implying that it is not so much a game of logic as a game of luck.
*8
If we had psych ward Clue, I tell Kelly, the weapons would be confiscated items: plastic fork, legitimate pillow, pajama pants drawstring, plastic wrapper on the pad the nurse gave you, dental floss. Someone runs away from the mirrored and monitored shaving room afront the nurse’s station with a strand of dental floss not even long enough to wrap around their neck. Kelly is beautiful and depressed and an undergrad with a deep affinity for information science graphs and poems. When I arrive, she is already three days into her admission, comfortable in the closure, reading To the Lighthouse at her desk. I hammer her with questions—a compulsion I always fight and an indulgence I rarely allow myself—though the walls of the hospital, white and windowed and barren, feel like a neutral zone. Her younger brother is institutionalized in Montana, sanctioned by the state, I learn, and the psychiatrist is unsure whether she has clinical depression or bipolar disorder or PTSD. Kelly doesn’t care about the diagnosis—she just wants to stop wanting to kill herself. She tells me she was born and raised in the rural west, and nobody from her family will agree to come out to New York and visit her. She tells me that psych ward Clue would flop for many reasons, though most importantly it would be too quick a game.
They’d call a code Black and lock everyone in their rooms until they retrieved the strand dental floss not even long enough to wrap around the circumference of a neck and restrain the patient.
The psychiatrists assure us they see a way out—they tell us that they’re writing our discharge narratives from our first meeting, but I don’t want to get my hopes up. Outside, the sky is very blue, and from inside the care room, a patient screams they’re too sad to keep living, the walls pulsing with their rage. Kelly and I have an arm in both—the yearning to care for ourselves, to be in the world and the yearning to not be. Most everyone in my ward is admitted voluntarily, signing our rights over to the hospital not out of legal requirement, but unabating despair.9 Playing board games, telling stories of our lives, we sit on a binary, steeped in our own discomfort: we are both tired of being alive and tired of wanting to die—bound to one another if only by a desperation to stay alive so overwhelming that we checked ourselves in.
The next night, Kelly cries herself to sleep. What if I’ll never love looking at graphs again, she asks in earnest, which really means, what if I never achieve the stability again. We are forbidden from touching one another, but the nurse has just made rounds on the room, and she won’t be back for another fifteen minutes. I give Kelly a hug anyway, and I cry, too.
*10
Alan the music therapist asks us how our psych ward experience is so far. It’s about getting better, he says, but it can also be about joy. He gestures toward his guitar and smiles. Kelly shifts in her seat and John looks out the window. Alan, like the other therapists and doctors in the hospital, loves Dialectical Behavioral Therapy. You challenge your thoughts to change, he explains, handing us a worksheet. Alan won’t tell us where in he lives. He says employees aren’t allowed to disclose that, the way a teacher might skirt a personal question begged by elementary school students. I’ve estimated Alan is the same age as my little sister, but in the psych ward, all external hierarchy of age is defunct. The only thing clear is the line between crazy and sane, and although nobody really knows what, exactly, constitutes crazy, we all know we are crazy, and we all wear paper pants and grippy socks and we all get our blood pressure taken in the morning and we tell the nurse, every night, what we want to eat for breakfast. Alan wears dress pants and a tie. He clocks out, take the subway home. And anyway, I’ve already reckoned Alan lives somewhere in Brooklyn. Having said something about taking the G train to Manhattan for work, I know the G runs only in Brooklyn (unless you count two stops in Long Island City, and Alan says he’s never lived in Queens).
Kelly wants to ask Alan to play the Jeopardy! theme song on his guitar. Nobody can tell you no when you wanna be dead, she says. This isn’t true at all—a untruth we understood with searing clarity, a sentiment that had, in fact, sent us to the hospital in the first place. What Kelly has discovered, really, is a parable about asking for things, and disguising a demand with a please. It feels good to be seen, even if being seen means a nurse opening your door and checking a box next to your name every fifteen minutes and eating salad with a plastic spoon and playing clue in the sunroom while the sun set over the Empire State Building, glowing through the window. 11
*12
On the fifth day, Brian appears. Holding a Stephen King novel and a physics textbook, he is irritated that the nurses allowed him his microfiber cloth but confiscated his spray bottle of lens cleaner. What could I even do with that, he mutters, a thick Russian accent spilling through his lips. Poison my roommate? His roommate happens to be John, and John finds the sentiment of being poisoned funny. Alan, the music therapist, does not find the sentiment of being poisoned funny, but Brian keeps talking, giving Alan no space to interject. He’s an undergraduate on a prestigious fellowship at an equally prestigious university, and he’s worried he’s going to miss his math exam but really, he’s worried he’s going to open his apartment window and jump onto Madison Avenue. His sister-in-law drops him at the ER, and he makes no effort to hide his reluctance. I am being evaluated for a condition, he says, looking at each of us suspiciously. By the time you’re hospitalized, it isn’t a matter of if so much as what, but he doesn’t want to say this aloud, and nobody feels an urgency to correct what is already realized. I sense we have gotten by for so long in similar fashions—moving through the world saying, I am depressed, but not depressed like that, as if our functionality made us better. As if our functionality would last.
*13
I am surprised when I learn that John is nearing forty, and that he is a city architect. I know him only as a disheveled generous person from the ER, who likes the hospital’s gluten-free chicken tenders and won’t stop guessing “Bob and Linda’s Bedroom” even though we all know he has the card in his hand. We become acquainted with one another like this: our dietary preferences from the lunch menu, and which medications we took, mostly a result of the nurse’s lacking subtly. IT’S TIME FOR YOUR LEXAPRO she’d yell, yanking the glass day room door open.
We knew Brian was taking Abilify and the drug was making his hands shake, and he thought the potato chips were stale, and that Kelly was taking Zoloft and the pill was making her stomach ache and there had been an error when she was admitted that said she was vegan, and now the nurse wouldn’t allow her to order anything with eggs. Everyone knew, too, how the psychiatrist couldn’t find a mood stabilizer that didn’t give me hives down my neck and back.14 When we play games, the sun sets over mid-town and the Hudson River in our peripheral— orange and pink and bright. John says he can see the roof of his old apartment, where he lived in graduate school. Futureproofing says he forgets what the sun feels like—a week has passed since any of us have stepped outside—December in New York up and away. I scratch my scalp until blood colors the tips of my fingers red.
*15
We should organize a group fall, Dee says one night, while we are playing games. They mean we should all fall down at the same time so that they have to change the date on the wipe board in the nurse’s station, which reads LAST FALL: June 21, 2019. Technically, we are all classified as “Fall Risk” patients because they’re medicating us, and we have to read a pamphlet and sign off that we understand the danger we face. If only falling was the most pervasive concern, John groans. All week, we’ve been wearing a bright yellow bracelet, on the same wrist as our hospital bracelets which reads: FALL RISK. It’s only Dee’s first night here. They’re a professional powerlifter, hardly a legal adult, and snuck out to the ER in the middle of the night so their parents wouldn’t know, so not to wake their younger siblings. Katie, Dee’s roommate, agrees that we should fall. Fuck this, she says.
Katie tells me she isn’t supposed to be here. She is (her articulation) an addict who hardly has insurance, but the ward doesn’t support dual-diagnosis, and so the social worker is trying to find Katie a detox center with a sliding scale policy. She’s quiet and skeptical of psychiatric care, and she’s lived in Queens her whole life, worked at the same bar longer than I’ve been alive. Every evening when we play games, she tells me, before she walks back to her room to go to bed, that I will be alright. She can sense my fear of the brink, knows I have learned a lesson about my internal fragility, that the hospital has humbled me enough to understand that at any moment, something in my life could give. Katie is the only person saying I’ll be alright whom I really believe. She has lived this through—is still living this through. That’s the point. The still living.
I wonder if she is the woman I overheard tell the nurse, many days ago in the ER, that this wasn’t her first rodeo. It occurs to me she also could have been pounding on the walls, but I will never know for sure. I am no longer interested in deciphering which wound, which dictation of instability belongs to whom.
*16
Between the locked doors, a sign in the ward hallway proclaims that, if we walk back and forth thirty-three and a half times, we’ll have walked a mile. Brian holds a pad of paper in his hand and draws a tally every lap, and we walk, mostly in silence, until we hit thirty-three and a half, or until the dinner cart arrives, which is at 5:30, every night. Trying to teach us a lesson about routine and structure, the ward ensures the dinner comes at the same time each night, just as the sun is letting go over mid-town, burning our eyes through the windows, as to say: if you just eat three times a day, if you just play a board game or two, you might be OK. This doesn’t feel true at all, but we comply, hoping that if we pretend enough, one day, we really will be able to care for ourselves in such a way that we can get through the days. A half mile into the walk, Brian sighs and, unprompted, tells me he wants to be more like his father. He doesn’t give a shit.
Brian lifts his hands high above his head to emphasize the his father’s mannerisms. He’ll be like oh, you were in the mental hospital? So what? You’re young. Life goes on.
I don’t know if I’m supposed to laugh, but I do, and he grins. We don’t talk until the nurses call dinner, and he shrugs, says I hate this, and I really needed to come here, you know. I am quiet and he keeps talking. Despair is contagious in this city, he mumbles. I want to say everything is contagious when wounds are wide open like this.
*17
I tell Katie I hate New York. That maybe I should have labored harder for intimacy with the cityscape, but I can’t find any cityscape to know intimately, because until I come to the hospital, everything feels laden with a false sense of life. I had thought I wanted to hide, when what I really needed was to latch myself into an ecosystem—I needed people to ferry me through washing my dishes, changing my clothes. People to show me I could go on. I tell Katie I want to drop out of school and leave New York after I’m discharged. I ask her if this makes me a failure. She neglects the question. This is good, she says. You’re thinking about the future again.
*18
On the sixth night, Futureproofing makes an incorrect guess, with great confidence, and his character—Linda—is killed off. He groans. Nobody wins at this game, he laments, again. Dude, John says. Nobody wins at this game because we’re playing Clue in the psych ward. We’ve all already lost.
Kelly laughs so hard that she spits out of her orange juice. Oh my god, she gasps. I think I was happy for a second.
Later in the game, when I guess the murder correctly—and therefore win—John throws his hands in the air. Well, I guess that’s just life, he says. In a state of tired sarcasm, I compliment his use of DBT, tell him he could have stonewalled, but he chose, instead, to engage in radical acceptance. At this, he laughed so hard, he began to cry. Futureproofing put his head in hands lovingly. At John’s laughter, I remembered looking through my door ajar at the disheveled catatonic man in the ER armchair. Behind him now, through the elongated windows, the lights of mid-town, Murray Hill glowed, lit up his posture. I thought I had never seen someone look so beautiful.
*19
John and I are discharged on the same day. We sit next to one another at the nurse’s station, and they take our blood pressure, give us our medicine in a paper cup, ask us if we’re having any thoughts of hurting ourselves, hurting others, one last time. Katie is gone. Dee says the social worker found her a treatment center in New Jersey, that she left last night. The nurses give John his scarf and dress shoes back in clear plastic bags, and give me my backpack and the drawstring belonging to my pajama pants. I don’t know what to do with the string—how I could ever manage to thread the fabric back through my pants—so I tell her to throw it away. The nurse opens the ward’s doors, and walks John and I though, and the ward doors close behind us. He gives me a hug, says eat a Caesar salad for me. Then we part ways, headed for our respective train stations, and I wonder how I will ever tell any of these stories, when I cannot find the beginning, and this is the only end I know. Outside, it is cold, but it also light.20
1 Chart Comments:
7:48 PM
Name: Mensch, Leah DOB: 06/30/1999
CC: sent in by university counselor for eval/suicidality; No known prior hospitalizations Patient Acuity: Urgent
2 Patient (they or she) is a 22 y/o grad student from Pittsburgh, who lives in Brooklyn. History notable for bipolar disorder. Patient claims prolonged depressive episode of “nearly three years.”
3 Pt is appropriate for admission to HCC10 for voluntary psychiatric admission. Pt is insured under Aetna student and is in network.
4 States she is feeling hopeless about ever achieving remission from her symptoms. Continues to be cooperative with idea of inpatient hospitalization to help achieve some stability. States “part of me knew always knew I would end up here.”
5 Reports this has been going on for 3 years, and has developed ways of getting by and putting up a facade that is difficult to remove.
6 Diagnostic impression was most consistent with major depressive episode given anhedonia, depressed mood, difficulty concentrating, feelings of worthlessness/guilt, hopelessness and hypersomnia.
7 Patient’s chief complaint: “I can’t even do the little things”
8 Patient was met sitting in her room during change of shift. She appeared calm and cooperative on approach. Patient endorsed her mood as “okay” affect bright and reactive. In the evening, patient was withdrawn to her room, though she appeared to be social with her roommate.
9 Admitted 9.13, patient is capacitated and consenting for inpatient treatment, legals signed and completed, notice of status and rights delivered to patient.
10 Patient seen and evaluated this morning. No acute overnight emergencies. States mood is “still depressed.” Current protective factors include: stable relationship with family, fear of dying by suicide, academic engagement. Current risk factors include: anhedonia, anxiety, prominent mood symptoms, perceived burdensomeness, separation from family/friends.
11 Patient attended 2 groups this afternoon: Music Therapy and Goals Group. Engaged in listening to live music and also participated in DBT skills to promote self-care in treatment. Maintains supportive relationship with peers.
12 Pt was received in her room. She was pleasant and calm on approach, presenting with a bright affect. She was social with roommate but isolative to room. Will continue to monitor.
13 Patient received sitting in her room, polite on approach. Denies thought or intent towards self/other harm. Patient is cooperative with medication. Engages well in conversation. Busy during the day participating in groups, engaged in reading and social with peers.
14 Reports SSRIs have been most effective for her however developed hypomania/mania and so this was stopped. Reports partial response to Lamictal and lithium however highest dose was 150mg, and triggered rash
15 Patient has been continually educated and reminded about fall risks and prevention, as patient is on medication that can cause dizziness. Encouraged to utilize call bell and keep herself well hydrated. No falls reported thus far. Patient expresses fear of stability after hospitalization and community without peers.
16 22-year old woman presenting with depressed mood in the setting of interrupted psychiatric care and psychosocial stressors, now stabilizing in the milieu. Leading diagnosis is major depressive episode given anhedonia, depressed mood, difficulty concentrating, feelings of worthlessness/guilt and hopelessness. States mood is “getting better.”
17 Pt attended 2 groups this afternoon: Music Therapy and Musical Meditation. Engaged in singing familiar songs to promote safe emotional expression and socialization with peers. Pt continues to practice DBT skills on unit, thoughts and feelings acknowledged.
18 Today, patient continues to progress toward discharge, tolerating lamotrigine well with improved mood and affect. Maintains supportive relationship with peers.
19 Per rounding notes, Pt slept at least 7.5 hours. Pt states that she feels better on lamotrigine, and that she continues to feel that this hospitalization was necessary for her recovery. Patient endorses readiness for discharge, though expresses fear about future instability. Has been thinking about various options re: her studies. Plans to go home to Pittsburgh after discharge.
20 At the time of discharge, the patient: denies active, imminent suicidal ideation; exhibits good behavioral control. The patient’s presenting behaviors and psychiatric complaints have improved throughout the course of hospitalization. Patient remains at a chronic risk of self-harm and suicide for the reasons described in the discharge narrative.