Thursday, January 27, 2011

admin bob

if you're just joining us, or if like me you have a short attention span and maybe some brain damage that impairs your ability to form and retrieve memory totally reliably, i am at this point in the blog more or less alternately telling you what's happening now with all the fun stuff coming out of my kitchen and the building of the snohaus (pictures pending, i promise), and telling you piecemeal the story of my recent stay at the laughing academy.

so, even though i have some darling things going on in the kitchen and even though the snohaus is going awesome, it's back to brattleboro:

i don't know exactly what day he came in, because it was before i started taking notes. whole truth be told, this guy is probably WHY i decided i'd better start taking notes. as long as i'm telling the story i should probably remind you that none of us up there is a tourist. we are there because we are addicts, because we are sick. we are broken, every single one of us. some of us are there voluntarily. some of us are there "voluntarily", which is a fine distinction of law, some of us are involuntary, and some of us are out-and-out court remands.

me, i'm in there for "batshit crazy", which as far as i know isn't being included in the new DSM, but maybe it should be.

most of us, when we are there, though, are aware that we have a problem of some sort.

i believe that i have outlined the complex procedure of the community meeting for you elsewhere, but just in case you missed it, the general point is that when it's your turn, you say your first name, a goal for the day, a coping skill you might use, and a thing you're thankful for. in case you can't wrap your brain around that format, the agenda is conveniently written out for you on the whiteboard on the wall.

so this guy, bob, comes in and for his first community meeting, an afternoon meeting, he sits at the head of the circle at the table with the staff responsible for charting. and it gets to be his turn to talk and he leans back in the chair, crosses his legs casually the way you might if you were about to address a board meeting as the new chairman and you wish to appear friendly, and he starts his speech.

he starts off by giving his name. not just his first name, either.

"hi, i'm bob. bob crouch. that's crouch. not quite standing, not quite sitting. crouch. i came here with my lovely wife and six beautiful children of whom i'm very proud and we are very pleased to be here in your community to work with you people. my goal for tonight is to get to know you lovely people" (he pauses for a tiny moment here) "faculty, staff, and administrators, and see how this fine hospital runs. you have a very fine reputation and i look forward to working with all of you."

at this point someone interrupts his monologue to ask him what coping skill he might use, and what he's thankful for, two questions that puzzle him, but he fields them affably.

"a coping skill i might use is getting to know all you fine people, and i am thankful for my wife and six lovely children, all grown, who are scattered around the country from arizona to maine..."

he is interrupted again by someone who actually IS on staff who thanks him for his contribution and we move on to the next far less interesting person.

let's face it: bob is so far off script that he has caught the attention of even the most wildly schizophrenic patients and nobody in that room could have been more interesting than him unless they'd been tinted purple and had a potted plant growing out of their second head.

later that evening we're sitting in the common area and the nurses are all busy on something or other and i'm trying to get their attention in a subtle sort of way because i can see bob on his way. he goes right up to their little half-door, reaches over the counter, and lets himself in to the nurses' station. i don't manage to get any of their attention pointed in that direction until he has already gone into the back room and -i don't know- maybe helped himself to some files or something.

the nurses apologize to me for not realizing that i was trying to interrupt them with something important.


anyway, in the morning at community meeting, bob's right there at the head of the table, bright as a new penny and rarin' to go.

"good morning!" he says enthusiastically when it's his turn. "i may have met some of you yesterday. i'm bob crouch. that's crouch. not quite sitting, not quite standing. crouch. my wife and six beautiful children" (other patients will swear to me later that his count varies from five to nine, depending on when you hear him tell the story) "are very happy to be here in this community and i look forward to getting to know all you fine people, staff, faculty, and , uh, the rest-"

"do you have a goal for today, bob?" someone redirects him.

"yes. first thing this morning i'd like complete personnel files of all the medical and nursing staff brought to me for review so i can check everybody's credentials and later i'll want complete files for the rest of the staff and we'll see how this hospital runs. it has a very fine reputation." he says, still very pleased and open and friendly in just the way you would be if you had been brought in to review the entire operation for efficiency rather than for your detox.

"something you're thankful for, bob?" someone prompts, trying to get him back on script.

"oh, yes. i'm thankful for the opportunity to really get to know all you fine people."

it is disappointing to the rest of us when bob's turn is over. bob, on the other hand, listens to each of us in turn say our names, our goals (which include things like "to do a crossword puzzle" or "to work on getting space in a rehab program" or "to be able to stay awake in groups"), our coping skills, and the things we are thankful for. if it registers on him for a second that we are all mental patients, he gives no outward indication of it.

bob's like that pretty much nonstop. as far as i can tell he never talks to any of us, but he's always real thankful to be getting to know all us fine people so well. and every once in a while he's kind of lucid and sort of obliquely mentions that he might be here to work on "a problem" which we all know by now is a HUGE drinking problem and that his enabling strategy of choice over the years has apparently been to spew out enough authoritative and competent-sounding crap to make people leave him alone and let him just drink.

but he's so far gone now that it's just not working for him anymore. not even a little bit. mostly he still can't figure out where he is or what he's doing.

here's a fairly standard incident from the admin bob playbook:

he come striding down the long hall at about 2130 hours. night meds have been given, and things are winding down. a group of us are sitting by the cornier and he comes booming up:"good morning, everybody! what are you all doing?"
"uh, we're all getting ready to go to bed, bob. it's nine-thirty. at night."
"oh.." he says, i a little confused, but with an air of superior nature, "isn't that odd that you people are falling asleep just as i'm getting up for the day!"
"it's nine-thirty. at night." someone repeats.
"you should probably go to bed, too, bob." someone else says.
"oh. well, then. what time are you guys all going to the... thing... in the morning?" he asks, looking for information, but trying to appear to be in charge.
"we're all going to community meeting tomorrow morning at nine-thirty. tomorrow. in the morning. after we sleep." each of these points is added for emphasis because bob appears to need each individual piece of information fed to him again.
"and the... thing... is at what time?"
"nine thirty tomorrow morning, bob."
"remind me again. where is it?"
"in the day room." we gesture toward the day room, which is where every meeting is held.

bob goes to bed.

over successive days, we notice that if he opens the refrigerator or freezer, he walks away with it open, often as not without taking anything out. he is found in the kitchen with his pants down, apparently just before he confuses it for the men's room.

and there comes a day when admin bob is sitting on the sofa with his coat in his lap. those of us who have been around the block a few times know this is not a good thing. he explains that in the morning he had been given a very thorough medical examination and been pronounced healthy, so now he was going home.

twice a day up there a nurse takes your vitals. it's procedure. i don't care what anyone says. having your temperature, blood pressure, and o2 sat checked is not a comprehensive medical examination. and we all know that this is what bob is talking about.

and now he is demanding to go home, but it's clear that he's not competent. which means that without knowing what's going on, he has just set into motion the process: he has rolled the dice without even calling for them to be passed.

when you demand to go against advice, the law requires an independent evaluation. this is what we call "rolling the dice". if you came in voluntary but you want to leave before they think you should, you roll the dice. if you pass, you go home. if you lose, you are held involuntary for eight days and then you can be re-evaluated.

what happens is that a small panel of mental health screeners from the county come and they review the documents, they interview the patient, and they interview the doctors and appropriate staff. then they render their decision as to whether you represent a danger to yourself or others. it can be a time-consuming and resource intensive process and while people try to make things run smoothly elsewhere on the ward, the tension is there and the staff is just one or two notches busier.

you maybe wouldn't notice it if you were a stranger to the place.

but there's admin bob, on the sofa with his coat. we go to lunch. he's still there waiting, placid look on his face. we go out to group and we come back. he's still there. the veterans know exactly what this means.

and someone on staff has to tell him that he's not allowed to leave. i don't know who tells him, but there's this guy; i don't know if he's an RN or some other kind of staff, but he sits with bob a long time and they talk. it's tense at first; that's what body language tells you from across the room. it's a hard thing to be ruled incompetent, even if you understand what's happening.

but this guy, this nurse (i think), quiet, kind of uptight-looking, he just sits and talks with bob and after a while they're just two guys talking and bob is telling stories. he's smiling. and here's the miracle: he has been given some of his dignity back.


Margaret (Peggy or Peg too) said...

Bob confused me. but then again he may have been confused himself.

I hope this isn't insensitive but for some reason I love the term bat shit crazy. I like the sound of it. Some words just work that way for me. those 3 do it. Rat bastard is another 2 word phrase that I like the sound of.
Maybe because I am bat shit crazy.

Givinya De Elba said...

I love your writing, flask. I've put you on my blogroll so I stop missing your new posts. I too love the term, "bat-shit crazy." It sounds right, somehow.

flask said...

giviniya- thanks. you do me much honor.


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