Welcome to the funhouse
“Door opening. Please stand back,” the robot woman’s voice says on the elevator. You’ve arrived. Welcome to the funhouse.
Don’t be more than two minutes late. You’ll be docked a quarter hour. If you’re first in line at the time clock by the seventh floor elevator to start your overnight shift in the psych ward, grab a chair. If you’re not, just stand and wait for five or ten minutes before punching in. Others will come, nurses and techs. Set your backpack down and look for your overnight assignment. It’ll be stuck to the clock, written on a Post-It or typed on a printout, to either the unit you signed up for, or floated somewhere else they need you in the hospital. You may be on the floor or on a one-to-one. You don’t know. It’s showtime.
Helen comes off the elevator first, an older white nurse, and sits down. You’re being floated to emergency, but there is no time to walk that block and punch in on time, so you’ll wait to punch in here. Helen checks her assignment at the clock and flops back down.
“I’m going to ER,” you say. “How about you?”
“Jesus fucking Christ, floated to 29 again,” she says, and sits back down outside the elevator.
Miranda, an African nurse, steps smiling off the elevator. “How are we tonight?”
“29 again, even though I insisted to not be transferred there.”
“How can that be?” Miranda asks.
“I hate that unit. It’s a shit-show. They’re so fucked up, they don’t know what they’re doing. Night after night, they’re not staffed, they don’t know what they need. I’m too old for this shit.”
You try to empathize: “That really sucks.” You don’t want to say that you are floated every single shift, because you have no claim to a location, because you are a casual employee now. That would not be helpful to Helen.
She says, “I gotta look for something else, this place is so fucked. I fucking hate unit 29.”
Miranda says, “They should not do that. I hope it’s okay.”
“Well it won’t be okay.”
“Hee-hee,” Miranda laughs. “Let me pray for you, my dear.” And she means it. Miranda crosses herself as you once did as a little boy in Catholic Church.
It’s 10:58 pm now, so you all rise and punch in, and wish each other a good, peaceful night. No one really has claim to a nice night. A nice assignment can turn into hell in minutes with manic, agitated patients, with a new admission who refuses to change into scrubs. You may be assigned to a pitch-black room with a patient with multiple health concerns, requiring vitals, fasting for labs, glucose checks, a patient in arm and leg restraints or Kevlar because she has been stripped of any sharps or ligature potentiality. You’re there to stop a patient from hurting others or himself, from strangling or cutting herself or popping a foreign object into her mouth. It can happen. Usually you can stop it.
Down in the emergency suite, a locked psych unit for mental and / or chemical patients, there are only four patients, but three are one-to-ones. You’re assigned to a Lewy Body Dementia lady, asleep in her room in a chair, who won’t go to bed and is almost drooping forward out of it. Then a nurse manager comes and reassigns you to a more dangerous man with dementia. He’s your age, a fall risk and assault risk, not strictly a psych patient. He’s in end-of-life cares, very physically wiry. He’s been kicked out of his care center. James is wearing scrubs, but his pull-up is loaded with pee and poop, and he’s muttering constantly. The smell reaches every corner of his room. You can almost taste it. He brushes off his lap with an ace of clubs playing card. He tears it into quarters, scrapes his dirty sole with it, then licks it. James did 20 years for murder, he says. That could be true. It doesn’t mean much, but he does have love and hate tattooed on his knuckles like the killer in the movie, Night of the Hunter. You’re successful in getting James redirected with a series of gestures and encouragement into the unit bathroom with the hopes of stripping him down, washing and changing him. You’ve put on a surgical mask and nitrile gloves. James cannot be coaxed into pulling down his scrub bottoms. Finally you touch them, lay off, touch them again, and very gently tug on the waistband, hoping James will allow you to help him strip down. He grabs your wrist fiercely with his strong hands, and says, “Keep your hands off me what do you think you’re doing?” Either due to menace or lack of awareness, he steps within inches of your nose. He says earlier he was just about to grab a snack when somebody got in his way, and blah blah blah. He’s not trying to front or menace you. He’s just completely apraxic, but you don’t know why he can’t do anything on purpose except protect his body.
It goes like that almost all night, despite an intra muscular sedative injection, which doesn’t faze him one bit. After ten minutes, he wants to walk the little locked unit shaped like a horseshoe and try all the doors, including the door of a very aggressive and impulsive young man we have just gotten down to bed, and we don’t want him to wake up, leap out, and beat the shit out of James. Armed security guards are a push button and 100 feet away, so it would be pretty difficult to kill someone that fast, but some serious injuries have been dealt in the years you’ve worked here. Finally around 5:00 a.m., with three staff, you give James a bed bath, and change his clothes and all bedding. It’s not thorough. He’s still filthy from head to foot. James finally falls asleep.
At 7:00, you are relieved by a day shift staffer. She says she’s heard it all, the whole report, and she’s not thrilled. The fluorescent lighting of James’ room is just oppressive.
You make the trek back to the time clock where you punched in. There you wait, afraid to touch anything because you’re not clean anymore, and there is nothing to wash up and no scrubs to change into. You pop Altoid after Altoid to knock down the smell inside your surgical mask.
Helen and Miranda meet you back at chairs next to the time clock.
“How was your night?” you ask whomever will respond.
Miranda smiles a comical crying face and says, “Disgusting!” because she was in a locked psych suite with a naked teenage boy who might at any moment be sweet and compliant, or run to a corner and poop, then throw it at you. “I prayed so much all night!” she laughs. “God, please deliver me from this. Make it pass, Lord!”
Helen stares at her phone, checks the clock to see if it’s time to punch out.
“How about you?” you ask.
“Me? Oh, I was fine,” she says. “For once a decent night.”
No insight for Helen, apparently, to contrast her start-of-shift with her end-of-shift, her previous grievances, and current bliss at the impending click and cachunk when she passes her badge over the clock and a green box appears, “Accepted punch.”
You take the stairs all seven flights down because while it’s bad for your knees, you need no one to say a word. You just need to decompress, feel the hard concrete steps, the weight of your backpack, and your eyes waving left to right.
On ground floor you hear the elevator empty your two coworkers into the lobby, and the robotic voice warn after they leave, “Door closing. Please stand back.” But you part out the side door alone in the rain. It’s a new day.