65-year-old thin white man with the longest white beard and white hair, and the lowest blood count and vitamin b-12 level, anyone on the floor has ever seen. he came to the hospital because he couldn't walk, and figures he probably needs his legs amputated. he is an incredibly fast and tangential talker. his main topics are his family - "good old fashioned german farm stock from up north who moved to the city after the war like everybody else!" he hardly even stops to take a breath... i heard about
his father's world war two experiences when he became malnourished and had to get blood and his great-aunt's anemia which resulted from a chronic metabolic problem that also caused some problems with her thought process and his brother's psychology degree in english lit and how his brother works over there in the building across the street and will be paying all the hospital bills so we don't have to worry the bills won't get paid. he won't be staying too long anyway,
just long enough to get some bags of blood and possibly have his legs amputated; he had a bike accident last december riding his bike, a schwinn varsity, you know the varsity used to be the most popular bicycle model in the nation back in the sixties, he found it in an alley for nothing, so he was riding across the monroe street bridge during that big ice storm late at night, and he fell and wrecked his bike and hurt his legs, and although he knew he should go to the emergency room, he didn't, and his legs have never been the same since then. the next day, he went to the emergency room and they took x-rays and said he had a broken ankle
but they never put a cast on it, and it's probably a good thing, because it would have just gotten wet, because he was living on the streets; right before that, he had been living in the library, conducting secret research into what you might want to call economic realities; but mostly he always lived on the streets, and he can tell you, things have changed out there; there's no more of what you might call man's humanity to man; it's dog-eat-dog out there nowadays, because of all the cocaine.
i keep trying to steer the flood of conversation back toward a psychiatric interview, and he shares that one time, when he was a grade-school kid, maybe ten years old, or maybe eleven, he was in the hospital for a little while, and they diagnosed him with tourette's syndrome, which was a new thing at the time, kind of a new popular thing with the doctors, back then, but they said there wasn't anything they could do about it; they didn't have the kinds of drugs and devices that they use nowadays, they didn't have the science for it, you know; so they sent him back home to mom and dad. he's had a few run-ins with psychiatrists over the years, you know, the rumor mill, they went with the stigma;
he's been crucified by them before, but he always takes it in stride; he doesn't let anything bother him too much; all that bothers him right now is he's been living in this hotel with the rent paid by the trust fund his parents set up for the whole estate, from the farm and all the livestock and the farm equipment and everything, to be divided evenly between all the three sons, but now he can't walk right, his legs feel all crinkled up all the time, they feel all crinkled up, even when he's just lying still watching the cable, and that's why he's pretty sure they'll both have to be amputated pretty soon.
is he crazy? no. he's just eccentric, with a 'medical knowledge deficit' and a vitamin deficiency.
One Home (William Stafford)
Mine was a midwest home - you can keep your world.
Plain black hats rode the thoughts that made our code.
We sang hymns in the house; the roof was near God.
The light bulb that hung in the pantry made a wan light,
but we could read by it the names of preserves -
outside, the buffalo grass, and the wind in the night.
A wildcat sprang at Grandpa on the Fourth of July
when he was cutting plum bushes for fuel,
before Indians pulled the West over the edge of the sky.
To anyone who looked at us we said, "My friend";
liking the cut of a thought, we could say "Hello."
(But plain black hats rode the thoughts that made our code.)
The sun was over our town; it was like a blade.
Kicking cottonwood leaves we ran toward storms.
Wherever we looked the land would hold us up.
57-year-old plump, sweet-faced lady who recently developed an overactive thyroid that was "treated" (inactivated/killed) with radiation, then never saw any more doctors or got any thyroid replacement medicine, resulting in a complete thyroid hormone deficiency. she simpers. sometimes she forgets and gives a long suspicious grimace, but then makes eye contact and deeply simpers instead. she whispers, "do you know John the Baptist? he was a Special Man."
her husband says, "honey, tell them about the--" and makes a gesture of two hooked fingers stabbing downwards at his leg. he mouths to us silently, "SNAKES!" she looks suspiciously over at us, then bats her eyelashes and whispers, "i don't know if i can tell you that. i don't know if it's safe to tell you that." he husband makes the fang-gesture again and mouths, "SHE SEES SNAKES!" and she simpers at us and whispers with extreme syrupy sweetness, "god loves me. i am one of his children. i'm like - you know - like john the baptist... i had a Revelation."
she agrees to take some thyroid medicine. it will probably make the snakes go away. she's pretty concerned it will make god go away. she isn't crazy. in the old days, children who were born without thyroids were called "cretins," from the french "chretiens" meaning "saints," for their emptyheaded innocence; they were considered to be beyond good and evil, and could do no wrong.
Mad Girl's Love Song (Sylvia Plath)
I shut my eyes and all the world drops dead;
I lift my lids and all is born again.
(I think I made you up inside my head.)
The stars go waltzing out in blue and red,
And arbitrary blackness gallops in:
I shut my eyes and all the world drops dead.
I dreamed that you bewitched me into bed
And sung me moon-struck, kissed me quite insane.
(I think I made you up inside my head.)
God topples from the sky, hell's fires fade:
Exit seraphim and Satan's men:
I shut my eyes and all the world drops dead.
I fancied you'd return the way you said,
But I grow old and I forget your name.
(I think I made you up inside my head.)
I should have loved a thunderbird instead;
At least when spring comes they roar back again.
I shut my eyes and all the world drops dead.
(I think I made you up inside my head.)
49-year-old red-faced burly-looking white guy who came in with chest pain and recurrent laryngospasm. this means his throat locks shut. he has a 'fibrillating' vocal cord (seen on bronchoscopy). a year ago, he was a firefighter who drove a ladder truck and "directed all the roof work," with nearly 30 years on the job. (he talks about his job in the present tense, but nobody else does.) in 2006, he got a hand injury that produced a chronic regional pain syndrome, and when they gave him an injection into his neck last year to numb the hyperactive nerves to his hand, it made his throat start locking up - twenty to thirty times a day, with no air for 60-120 seconds at a time.
now he also has atypical angina (seen on cardiac catheterization) - his coronary arteries go into spasms randomly, making the heart muscle starve for oxygen, producing chest pain - on and off all day long. the lack of oxygen to his brain is wrecking up his memory - he can't pay attention long enough to read a magazine article or fill his own pill boxes anymore. "hypoxic!" he says in triumph. "that's the word, hypoxic!" he's brain-damaged. these events do cause him some anxiety. it got worse when he was denied disability, since the hospital bills are piling up, and the medicines cost a lot, and his wife doesn't make much down at the grocery store. he babysits his grandkids during school vacations. antidepressants help a little. is he crazy? no. he's having problems with adjustment.
Outside History (Eavan Boland)
These are outsiders, always. These stars -
these iron inklings of an Irish January,
whose light happened
thousands of years before
our pain did; they are, they have always been
outside history.
They keep their distance. Under them remains
a place where you found
you were human, and
a landscape in which you know you are mortal.
And a time to choose between them.
I have chosen:
out of myth in history I move to be
part of that ordeal
who darkness is
only now reaching me from those fields,
those rivers, those roads clotted as
firmaments with the dead.
How slowly they die
as we kneel beside them, whisper in their ear.
And we are too late. We are always too late.
77-year-old skinny puerto rican fellow with a bushy gray moustache and grizzled old jowls, under emergency detention for bringing a concealed weapon into the hospital. when you ask him a question, he closes his eyes and appears to sleep for about 20 seconds, by my watch, before starting to answer - and sometimes he actually does fall asleep, so i wake him up, and we start over.
he states "... ... ...i must've been in a big hurry" and that's why he was carrying a loaded gun. he also says that the place where we are right now is "... ... ...my room, my place," the first time, and "... ... ...the hospital," the second; can't say what hospital. he says the date is "... ... ...september, 1977."
yesterday, he went to another hospital across town, where his wife was admitted several days ago. "... ... ...she's got lung cancer." he falls asleep. i wake him up and ask, do you worry about your wife's health a lot? and he says, "... ... ...i used to give my wife a pretty hard time." i didn't know what to say to that, so i shook him awake and asked, how did she take that, when you gave her a hard time? "... ... ...sometimes she'd yell... ... ...most of the time she didn't do nothing." i ask him if he has worries about his own health as well, and he says very matter-of-factly, "... ... ...nobody cares what happens to me."
he "... ... ...can't remember" what the plan is, where his wife is now, who her doctor is, how long they've been married, or when it was they got married; how many kids they have, or where the kids live now ("... ... ...they don't care what happens to me"); where he used to work "... ... ...welding" or what kind of welding he used to do, what kind of car he drives or where his car is now. (he drove himself, his gun, and $374 cash to the other hospital, where he was intercepted "dishevelled and smelling of urine" by a security guard.) what do you like to do for fun? he shuts his eyes and gently shakes his head. do you like to hang out with friends? he gently shakes his head. he falls asleep.
i wake him up. i introduce myself again. he says he hasn't been feeling sad, blue, depressed, disappointed, or frustrated, but when i ask about feeling "guilty," he perks up and says, "... ... ...i get so angry." he watches the silent television for a few moments. "... ... ...i get so angry about things i have done in the past." two or three times, casually dropping it into the molasses-textured 'conversation,' i ask him, in different ways, what the gun was for, why he bought the gun, what he carries it around for, why he owns a gun, etc., and each time he says, "... ... ...for anything i want... ... ...for anything."
he says he bought the gun 8 months ago, not from a store, but from a private owner, not anyone he knew before, not from an ad in the paper, but "... ... ...i just bought it." he keeps it loaded all the time. have you been having any trouble with your memory? "... ... ...that's a good question," he says, and closes his eyes. he is demented, not crazy - it shows up, the shrunken brain, on CT. but i say to keep him detained. he's at high risk for murder-suicide.
889 (Emily Dickinson)
Crisis is a Hair
Toward which the forces creep
Past which forces retrograde
If it come in sleep
To suspend the Breath
Is the most we can
Ignorant is it Life or Death
Nicely balancing.
Let an instant push
Or an Atom press
Or a Circle hesitate
In Circumference
It - may jolt the Hand
That adjusts the Hair
That secures Eternity
From presenting - Here -
70-year-old rail-thin mediterranean-looking lady with big hair and a large pancreatic mass - good prognosis for complete cure if resected (no metastases). because of the mass, she is becoming more and more jaundiced, and this would cause permanent brain damage eventually. she refuses to have any surgery, because god has touched her, and she has been healed because she is a holy woman. she has died several other times in the past, and been brought back to life, and she has taken dead babies in her arms and brought them back to life, too. it was god that gave her her social work degree and her lawyer degree and her doctor degree. she raised ten children and they all call her mama, and they come to her to ask advice, she doesn't go to them, and they don't tell her what to do.
so far today she has called the governor, the city mayor, and channel 12 news, to tell them all that she is being held prisoner here by a man with the devil in his eyes who wants to cut her open and expose all her organs. he is satan. he is no friend of hers. she doesn't eat anything here, because she doesn't know what the devil may have told people to put in her food. they keep trying to make her sign the papers. she won't sign the papers. did the news crew arrive unannounced, with lights and cameras and microphones, asking to speak to the hospital's attorney as well as to the patient herself? they did. is she crazy? i'd say so.
A Sick Child (Randall Jarrell)
The postman comes when I am still in bed.
"Postman, what do you have for me today?"
I say to him. (But really I'm in bed.)
Then he says - what shall I have him say?
"This letter says that you are president
Of - this word here; it's a republic."
Tell them I can't answer right away.
"It's your duty." No, I'd rather just be sick.
Then he tells me there are letters saying everything
That I can think of that I want for them to say.
I say, "Well, thank you very much. Good-bye."
He is ashamed, and turns and walks away.
If I can think of it, it isn't what I want.
I want... I want a ship from some near star
To land in the yard, and beings to come out
And think to me: "So this is where you are!
Come." Except that they won't do,
I thought of them... And yet somewhere there must be
Something that's different from everything.
All that I've never thought of - think of me!
51-year-old obese asian guy with bipolar disorder, who was just here 2 weeks ago with an infected foot, recently in hot water for using his insulin needles to inject crushed-up pain meds directly into where it hurt, hospitalized now with chest pain, and i'm to see if he is a suicide risk.
yesterday afternoon the balcony collapsed while his 28-year-old daughter was standing on it. he tried to revive her by rubbing her arms and talking to her. she got up and was staggering around saying her chest hurt until the ambulance came. he thought she had probably broken a rib, and stayed home to babysit her 2 small children. half an hour later he got a call to come identify the remains. when he got to the hospital they told him she died of a broken neck. he passed out and started having seizures, and that's why he's under guard in the hospital now.
he says he's not upset - "i think i'm in denial" - and he hasn't been thinking about anybody's death but hers. i talk to his regular psychiatrist, who says he's at an extremely high risk, to judge from his many previous suicide attempts in response to 'acute emotional stressors'. the patient says he just hopes he can be discharged once the rest of the family arrives for the funeral. later that day he starts coughing and and he can't get any air and it turns out he has bilateral pulmonary embolisms - the dreaded "blood clot in your lung," both sides - which means, basically, he's not going anywhere soon. his bipolar disorder and his narcotics addiction are pretty well controlled. he's "only" bereaved.
Eyes Fastened With Pins (Charles Simic)
How much death works,
No one knows what a long
Day he puts in. The little
Wife always alone
Ironing death's laundry.
The beautiful daughters
Setting death's supper table.
The neighbors playing
Pinochle in the backyard
Or just sitting on the steps
Drinking beer. Death,
Meanwhile, in a strange
Part of town looking for
Someone with a bad cough,
But the address somehow wrong,
Even death can't figure it out
Among all the locked doors...
And the rain beginning to fall.
Long windy night ahead.
Death with not even a newspaper
To cover his head, not even
A dime to call the one pining away,
Undressing slowly, sleepily,
And stretching naked
On death's side of the bed.
44-year-old handsome snoring black man with "multiple medical problems." he has been "inpatient" - hospitalized - for 18 days - one wants to write "impatient for 18 days," but surely it's much longer than that. the nurses roll their eyes when his name is mentioned. he has been purely evil to every single "care provider." he was admitted with chest pain and shortness of breath a day after his most recent crack smoking, and so was obliged to receive the full court press "rule out MI" (heart attack). then he mentioned he saw some blood on the toilet paper recently, and that his right hand seemed weak. all this necessitated investigations by a lot of different people and machines, over days and days.
meanwhile, he became angrier and angrier that his chronic pain "all over" was not being treated. he "needed air" frequently, so he'd go outside and disappear for hours at a time, in his little hospital gown, in a hospital wheelchair (left leg amputated as a consequence of uncontrolled diabetes) - the dialysis team kept having to go out searching for him to give him dialysis three times a week (he has end-stage kidney failure as a consequence of uncontrolled high blood pressure).
when i went to visit him, he was incoherent because as usual he had demanded and gotten all his "prn" (as-needed) meds at once, together with his scheduled narcotics - nurses are extremely reluctant to ever dose a patient this way, but he bullies them into it, another reason they hate him - so he was dozing peacefully under dilaudid, oxycodone, IV benadryl, and valium, with the television blasting and the room heat up to 85.
he was able to slur "i aaaiiinnnn swiss-idol!" and try to push me away from the bedside, before nodding out again. the day before, he'd told the medical student he might as well empty the vending machine downstairs and take all its tylenol at once, and this was interpreted as a suicide theat, and that's why i'm here.
he's a young handsome muscular guy with dead kidneys and a missing leg, a non-healing wound on his remaining leg - according to the records, it's been an open wound since june, three months ago - and, according to the records, has been impotent since diabetes killed the nerves to his you-know-what. he got strep throat in his 20s that wasn't treated, and developed rheumatic fever, which ate up his heart valves, so he has two mechanical heart valves and has to be on hardcore blood thinners for the rest of his life. he takes the same three asthma meds he's taken since childhood. his life expectancy is maybe a year.
is he crazy? i wrote "UTA," unable to assess, "d/t sedation."
Life Is Fine (Langston Hughes)
I went down to the river,
I set down on the bank.
I tried to think but couldn't,
So I jumped in and sank.
I came up once and hollered!
I came up twice and cried!
If that water hadn't a-been so cold
I might've sunk and died.
But it was Cold in that water! It was cold!
I took the elevator
Sixteen floors above the ground.
I thought about my baby
And thought I would jump down.
I stood there and I hollered!
I stood there and I cried!
If it hadn't a-been so high
I might've jumped and died.
But it was High up there! It was high!
So since I'm still here livin',
I guess I will live on.
I could've died for love -
But for livin' I was born
Though you may hear me holler,
And you may see me cry -
I'll be dogged, sweet baby,
If you gonna see me die.
Life is fine! Fine as wine! Life is fine!
