Metro

I used to work as a nurse at a state mental hospital. It is in Norwalk, California and is called Metropolitan State Hospital. Most people just call it Metro. I worked there less than six months but it was interesting work and I learned a lot. But, as is so often the case, it took me years to figure out what I had learned. I came away with many memories but only later developed a cognitive framework in which to understand it all. (See what I did there? I threw out the term 'cognitive framework' so I could keep writing and maybe later I'll figure out what it means or if it even means much.)
DIGRESSION I went to school to become a licensed vocational nurse and passed the state boards to get my nursing license. Then I got a job but felt that I didn't understand what was going on. Everything I had learned in my nursing course was just jumbled in my brain and lacked a cognitive framework. A little more than a year after I left nursing school I spent some time doing private duty nursing. This involved working in the patient's home and caring for only one patient. I had many hours of mostly free time while I sat at the patient's bedside, giving care when needed but also thinking. When I was in school I learned thousands of facts and, now, I began seeing how they were all interrelated. I figured out the the interrelated system of the human body. The human body is like a work of art: a unity made up of parts that that lose meaning or life when separated from the whole. If the feet swell up the problem is probably not centered in the feet. Probably the heart has become less efficient and the force that draws excess fluid back into the circulatory system is most evident where gravity is least helpful: the feet. Or maybe the feet enlarge because the kidneys have become less efficient at removing excess salt and this salt has drawn fluid into the feet.
What did I learn at Metro? I developed a sense for identifying different psychiatric disorders. I didn't learn so much about text book definitions and lists of symptoms. I got a feel and categorized by intuition. I dealt with some extremely sick schizophrenics and saw people totally controlled by their disease. I had a patient named Daniel who spent most of his time walking around and around in the day room. He talked much of the time while he walked. He was addressing no one, he was just talking. He frequently talked about being able to trisect an angle. He also talked incessantly about having invented all psychiatric medications and that they had all been stolen from him by psychiatrists. Even though Daniel was bedeviled by his disease, he was in better shape than many of the schizophrenics we treated. Daniel could communicate with others and was mildly aware of the outer world. Many of our patients were not even aware of the outer world. They were completely caught up in the voices in their heads. We all have voices in our heads. Mine remind me of friends from junior high school, sing songs I don't always want to hear, tell me what people must be thinking about me, etc., etc. But I can usually ignore these voices and concentrate on the outer world. I have seen schizophrenia described as a disease that takes away the ability to distinguish between inner and outer. Most of us are able to identify inner and outer and separate them. This ability is much reduced in schizophrenics. And, sometimes, the inner becomes too loud for the outer to even be noticed. It is very sad to see because these people have lost almost all ability to have any control of their lives. I had a young girl patient who was totally focused on the voices and unaware of the outer world. She was medicated with Prolixin Decanoate, which is an injection that only needs to be given every couple of weeks because of it's long lasting sustained release property. By accident I once gave her twice the dose the doctor had ordered. And I watched her over the next few days to see if there would be any ill effects. I saw no difference. I began to think that since she had twice as much anti-psychotic in her that she might get a little relief from the voices within. I saw no change at all. Her disease was so profound that nothing seemed to make any difference.
We did not get any manic depressives. They tend to be too economically viable to end up in state hospitals very often. But we sometimes treated a variant. These were schizoaffectives who could be called a mixture of schizophrenic and manic depressive. They cycle between depression and mania and are also psychotic through it all.
I also got to see the operation of government up close. I was amazed at this and never got used to it. Some employees would come in in the morning, sign in on their time cards and could not be found again until it was time to sign out again. Many came in, stayed on the unit all day but did almost no work. Often if they were asked to do something would merely reply, "I don't do that," and return to their magazine or watching TV. This behavior amazed me. And it was treated as normal by management. I was told that, since they were state employees and union members, it was next to impossible to fire them. So almost any behavior was accepted. Nurses were the most responsible and most likely to work of all the employees. So the janitors were put under the authority of the nursing coordinator of each unit. The janitors were notoriously unlikely to do any work so the completion of their work became the responsibility of the nursing coordinator. On my unit it was Wanda. And Wanda struggled to get the janitors to do their job. But they only showed for signing in and out. I remember one time that Wanda confronted them as they were leaving after signing in. They threatened to rough her up and all the male nursing staff had to go and insure Wanda's safety. After that Wanda seemed to accept the fact that the janitorial work would never be done by the janitors. So janitorial became another responsibility of the nursing staff. We could usually get most of the work done by the patients by paying them with cigarettes. The levels of management above Wanda were never involved in patient care or the running of the units. The units were grouped into blocks of programs. And during the few months I was there these programs were constantly being broken up and reorganized. The acute psychiatric unit I worked on was part of three different programs during the time I was there. I finally figured out that this was just make-work to justify the administrative staff and keep as far as possible from the patients and lower level employees.
DIGRESSION When a psychiatric nurse says, "She did it," to another psychiatric nurse it is not a reference to sex. What is meant is, "She successfully committed suicide." It is usually answered with the questions, "How? . . . When? . . . Where?" and this usually followed up with sharing of memories of the patient.