The Assaultive Unit

Disclaimer: All persons, places and things in this document are imaginary; any resemblance to actual persons, places or things is purely coincidental.


An evening with the boys.

I nearly always enjoy working on this team. For one thing, all of the patients are men, and I like men. For another, many of them are in here for years and years and over time they become old friends. The pace is slow and laid back - all of these guys are taking massive doses of various drugs - we watch a lot of TV and play cards. Staff stay alert to brewing conflicts. Safety first is the rule here, since all these guys are here for some agressive behavior other, and are mostly not averse to physical confrontation. Two or three have head injuries. I've always felt disturbed by this inasmuch as this is a hospital for the mentally ill - brain injuries are a different kettle of fish altogether, and we have no particular expertise in treating them. But here they are and staff make the best of it.

One brain injured patient is missing tonight - he's at the medical hospital. Had a massive heart attack. Is expected, I gather, to recover, although he's had significant heart damage. This is a remarkable patient. He has no short term memory. He can remember things that happened to him before his big accident, but can't remember 10 minutes ago. Since the big accidnet was at least 25 years ago, he is continually surprised at what year this is, how old he is, how long he's been here. Each and every time you tell him the current price of cigarettes, or cars, he's absoutely astonished. You can do this all day long with him...tell him something about the present and watch his amazement. He has chronic pain in his back. He, more than anything in the world, just wants to go home and go back to work. Used to work construction, used to belong to the union, remembers the phone number of the local, is desperately unahppy at being confined here with nothing to do, nowhere to go, no memory, no future, just pain interrupted by smoking every other hour. His is a really awful fate and it's really awful to watch sometimes...here's this guy who has to live each day without the benefit of short term memory, with chronic pain, with no hope of ever getting better....ever...he's been with us six or seven or so years now (he's astonished when you tell him).

Everyone who's worked with him has heard him say, "Can't you just kill me?"
"Well," we say, "no, actually they won't let us do that". "Can't you just give me the electric chair?" he says. And he means it. He doesn't understand the fix he's in; over and over and over he says, "I just want to go back home." Of course, he has no home...the home he's remembering was sold years ago, his parents are dead, his siblings are not interested in him. He has a court appointed guardian who brings him a candy bar twice a year. He always think some other guy is wearing his shirt and if we're not on top of it, he'll beat the shit out of him. He gets a cigarrette every other hour, and an extra one when he puts on his diaper at bedtime...he's incontinent now because whatever's going on in his back results in a lack of sensation to urinate...we can remind him during the day, but at night he needs a diaper. This is humiliating each and every bedtime, and staff has learned to bribe him into it with an extra smoke.

Anyhow, this guy had a massive heart attack....and come to find out....no one....not his social worker of many years, not his court appointed guardian...no one...has gotten him to sign a DNR form.

The poor guy gets a chance to exit, and we've got our foot in the door. We save him.

Now he's even more disabled...and still gets to come back here...although it'll all be new to him when he returns.

I confess, this gives me the urge to intervene somehow; if the system had a face, I'd slap it.