Despair

“I… I just can’t,” he sobs into his hands. “I can’t take care of myself… I can’t deal with things. I need to be in a home.”

“Any family? Anyone you could stay with?” I ask, already knowing the answer. Still, I hope that somewhere in his fractured memories, a loving family member might magically appear, someone who will take him in. I hope, and always I am disappointed.

“None,” he sighs raggedly, twisting a dirty sock in his hands. “There’s nobody but me.”

We sit on the side of a bare mattress in a seedy hotel room, surrounded by half-eaten food and piles of clothes, the room reeking of unwashed body and stale cigarettes. I wouldn’t be surprised if he hadn’t left this room since I’d seen him last.

“I need to be in a home,” he repeats, breaking into a fresh round of sobs. “Why won’t they put me in a home?”

I know why, but I offer no answer. How horrible must his demons be, that living in an institution would be his greatest hope? I vacillate between thanking God I will never know what he is going through, and wishing I did, and thus somehow understand him better and perhaps hate him less.

And God help me, hate him I do, sometimes. Every time the call comes in, “Non-life-threatening emergency, no priority symptoms. 50-year-old male, states he can’t take care of himself,” I know it will be him, and the weariness grips me and threatens to drain whatever small satisfaction I gain from doing what I do.

This wasn’t what I signed on for. This isn’t what I’m trained for. There is nothing wrong with his body; no illness to treat, no wounds to bind. It’s his mind that is broken, and there is nothing that I, or all the psychiatrists in the world, or anyone short of God himself can do to repair it.

And the futility of it makes me resent him terribly, makes me dread seeing his face. And the shame that he might see the resentment on mine burns me like a torch.

And so I say nothing, sitting silently beside him, and I bear witness to his despair.

“Why won’t they take me?” he sobs plaintively, clutching desperately at my arm. “Call Zeke,” he begs. “Zeke’s my friend. He’ll make them put me in. I can’t survive out here.“

How bleak must his life be, that he regards the parish coroner as his savior? People only interact with a coroner when a relative has died, or when someone thinks they’re crazy. Neither is a happy occasion.

The truth is that he’s not sick enough to be locked away. He doesn’t hallucinate, doesn’t hear voices urging him to do bad things. He doesn’t contemplate killing himself. He calls for the same reason he did last week, and last month, and a dozen times before that. He is simply a man for whom living independently and wrestling his demons are two tasks he will never, ever be able to manage simultaneously.

And he knows it.

He is too honest to game the system, too naive to understand that’s what it may take. Should I tell him what to say, how to act so that he’ll get at least a few days in a place of comfort, where people may at least pretend to care about his welfare? I certainly know the litany well enough. I could teach him the magic words.

But then, how will I justify it to myself, knowing that he’ll be taking up bed space needed by someone who is truly a danger to himself or others? In post-Katrina Louisiana, psych beds are all too precious a commodity. Mentally ill patients here move through a vicious cycle of hospitalization, medication, discharge, decompensation, hospitalization, medication, discharge…

… fragile people stuck in a meaningless revolving door of all too many psychotropic medications and all too little meaningful therapy, and altogether nonexistent followup care. They warehouse them and dope them with Haldol and Thorazine until their reimbursement capitates, and then suddenly declare that they’ve made significant progress and are ready to be released again into the world, with a prescription for medications everyone knows they can’t afford and outpatient appointments with a psychiatrist everyone knows they won’t be able to keep.

And if I did coach him on how to get committed, it would be a temporary solution at best. He’d likely spend at least 24 hours in the ER awaiting a psych bed… somewhere. And the ER nurses hate to see him coming, their weariness and distaste manifest in their expressions. It’s an expression I know well. I’ve worn it myself.

And so I don’t coach him on how to act, don’t tell him what to say. Resignation and dismay radiate from him like a roiling black cloud, threatening to envelop me if I get too close.

So instead I sit there, silently at his bedside, and I bear witness to his despair.

I find myself wondering what is the point of it all, asking myself if something, anything I do makes a difference. Patients like him certainly make me doubt.

Rookie Partner putters around the room, gathering medications, clothing, and personal effects. Wallet and a half-empty pack of Newports, keys and a small laminated card with the 23rd Psalm written upon it; they all go into a bag with the cleanest clothing and underwear we can find. A search is launched for his cigarette lighter, and RP’s impatience is etched upon his face as I make him scour the room for it.

The unspoken message is that finding the lighter itself isn’t so important as showing him that someone cares enough to look for it. RP may not get that yet, but he will. We’re still working on our nonverbal communication.

Finally the lighter is found, and it goes in the bag too, tucked carefully between the cigarette pack and its cellophane wrapper. RP waits by the door, patiently now, as our patient sits on the bed, still anxiously twisting that sock in his hands.

“Do you think they’ll admit me?” he asks tearfully, afraid to hope.

“I don’t know,” I dodge, and he sees the answer for what it is. He starts to cry again.

And silently I sit beside him, and I bear witness to his despair.

And then the radio crackles, and the pager vibrates, reminding me that we’ve lingered here too long.

“Come on Roger, it’s time to go,” I tell him gently, taking his hand and placing another on his shoulder. “Don’t worry, man. We’ll take care of you.”