I won’t use the young woman’s name for reasons of libel that will become clear as you read the letter. The story to which she makes reference is titled “Lonelyache” and it appears in my collection I HAVE NO MOUTH AND I MUST SCREAM [Pyramid Books, 1974]. It is about a man who comes to unhappy terms with his own overpowering guilt about being a loveless individual. The “Discon” reference is to the World SF Convention held on Labor Day 1974 in Washington, D.C.
Dear Harlan:
We spoke briefly at Discon concerning reading sf to the mentally ill—your sf among others’. Something happened the other day that I thought might interest you.
I am presently working in the one medical-surgical building that——has. Since most of my patients are in here for only very short stays, there has not been much opportunity for me to continue the reading/therapy that I had been doing in another, quieter building. (Also, having IV bottles and bouncing EKG’s to baby-sit leaves little time for other pastimes, however therapeutic.) (And furthermore, I’m working midnight shift now—which cuts down somewhat on people interested in being read to.)
Anyway. In this madhouse of a building we have, among wards intended to hold up to twenty-five, one which cannot house more than seven: Ward 6A; otherwise known as Wounded Knee (from a time when we had five fractured patellas up here at once). A fracture ward, as it were, which also houses diabetics being newly-regulated, and staph infections, and new heart attacks who’re healing. Rather a quiet place as contrasted to most of this madhouse (pardon unintentional pun), and since I came back from Discon, my very own ward (on nights).
We have up here at present a patient who has put more employees of various sorts out on compensation for various injuries of various sorts than any other patient in the hospital.
The reason for this is hardly any fault of hers: the fault lies with the aforementioned employees, who worked constantly (maybe unwittingly, but that doesn’t excuse them) to drive her a good deal more insane than she ever was to begin with. The syndrome is easily described. A) Some facet of our enlightened state hospital system (the Earth should only swallow it) enrages/tortures an already hurting mind to the point where it can no longer control itself and the person attacks the first thing that comes to hand. Eventually, an employee steps in to halt the mayhem, and gets mayhemmed himself. B) The word goes around from staff to staff, from staff to patients, eventually is voiced right in front of the sick person involved: “That one is nuts, will kill you if you turn your back, goes bananas at the drop of a hat, etc. ad nauseam…” C) The person thinks, “I haven’t been too well lately, these are attendants and nurses and such, they say I’m crazy; who am I to prove them wrong? So I’ll be crazy, I’ll attack everything in sight…” and so it goes, and the ugly circle turns on itself. Follows thereupon much Thorazine, many camisoles, long hours in seclusion which do no one any good. Things get worse.
As it was on the night of this past July 4th. The lady who is now one of “MY PEOPLE” was in seclusion—as usual—on a third-floor ward. It was hot. No one would bring her a drink of water. Also, her room stank—as might have been expected: no one would take her out to the john, she had long since stopped asking, and had used the floor. The stench, and the heat, and her thirst all combined, and she rose up and determined to go OUT. Naturally, as she later explained to me, they would not let her out. So she reached out, heaved at the screening that she had been yanking on for the past five years, managed to detach it, and went OUT. Three floors down.
Naturally, she had fractures. The right humerus, the right tibia and fibula, a refracture of the left tibia and a new one of the left ankle. (Amazingly, that was all—no pelvic or spinal involvement.) She was sent up to my ward. It was very interesting up here for a while: she insisted that she was fine, that her legs hurt a little but she wanted to take a walk, that was what she had come out for, anyway…. What do you say to something like that? I cried a lot, and held her down. The next day I was transferred to another building, where they needed a nurse, so they said.
After much screaming and yelling at the chief of Nursing Services, I managed to get out of the nothing building where they sent me—a building in no need whatsoever of another nurse, where the only really worthwhile thing to do was to read to the patients—and came back to the Med-Surg building. It took me a month.
When I got back, I found matters somewhat improved. The day nurse on this ward is a good friend of mine, a very highly skilled lady who got something like a 99 in her psychiatric nursing course, and deserved more. She was not afraid of this patient, and had been doing constant therapy on her. It was working. The patient was calmer than she had been, was being weaned off the 4000 mg/day of Thorazine that her building had her on (500 mg/day is enough to quiet just about anyone, but a tolerance had built up), she was beginning to look around and see things, to form relationships with people (she was schizophrenic, and was actually reaching out …incredible). She still had relapses, incidents of going for people, of throwing things, but they were abortive. She was getting better.
Some time passed…she continued to improve. I got taken off my job for a while to go through the hospital’s orientation program, came back again for a little while, found her doing well, took a few days’ leave for Discon, came back, found her still getting better—and then everything fell in on me—on her—rather suddenly.
This requires a small digression. We have on this ward, on the evening shift, an idiot. It has the letters RN after its name, but don’t let it fool you: a nurse it ain’t. This person delights in tormenting the patients verbally, and not getting caught at it. God knows I’ve tried, but I must walk too heavy or something. On this particular night she told the patient that the day nurse (whom the patient loved dearly, and who was having her turn in orientation) was never, never coming back again. Are there words foul enough for such a person? Well…
I came on at 12, checked my ward, found things quiet: the patient in question resting in bed, awake. I went to her, checked her casts (arm and both legs), spoke to her: she didn’t answer. This was par for the course, so I wished her good night and went away.
About 1:30 I heard something go crack! and then heard glass shatter on the floor. By the time I was standing up, something went thud! and by the time I reached the door of the office, so had my patient. She was out of her bed, teetering on her casts, with a big sharp piece of glass in her uncasted left hand. The hand was bleeding a little, but that was not what concerned me. This lady was no amateur, no wristslasher; she would bend her head back to cut her throat. She was faster than I was: also somewhat larger. (Picture it if you will, Harlan: 160 lbs. of her, about six feet talclass="underline" 104 lbs. of me, 5’6”: and she has the glass. Who wins the wrestling match? You can’t use aikido holds on someone with three casted extremities. I can’t, anyway.) (Not when the fourth is flailing glass—and it’s my patient.)