Their clothes were shapeless garments that fit their shapeless bodies: not uniforms, only styleless wads of clothing donated by middle-class patrons who found salve for their consciences in charity bins for flotsam their guilt would not allow them to fling into trashcans. Some, who were habitually incontinent, might wear rubber (now vinyl) underpants, although it had been established with chronics that floors and clothing were more easily washed than could dermatitis and pustulant sores be cured; and so many, by chance or by choice, wore no underwear at all.
Marlowe, a microcassette recorder in one hand, a Powerhouse candybar in the other, alternately dictating and chewing, stood against one wall as the chronics shuffled past him on their way to be fed. Their faces were as shapeless as their bodies: some smiling, some grimacing, some frozen from the effects of too many shock treatments, too many drugs. A few seemed to recognize Marlowe, and waved or winked or muttered. Some, Marlowe thought, had been in Graceland longer than Marlowe, and that was forever. A grey-mustached grandmother in a shapeless polyester sack dribbled excrement as she shuffled past. The corridor stank of urine and feces and unwashed living dead, and no antiseptic nor disinfectant would ever cleanse it. Marlowe finished his candybar breakfast, waiting for them to pass before resuming dictation.
“If God exists,” a patient had once told Marlowe, “then what sort of sadist is he to curse the elderly with the indignity of loss of sphincter control?”
“An angry god,” Marlowe had replied with bitterness. “And vengeful.”
By midmorning Saturday Marlowe decided he had completed Friday’s tasks and it was time to recognize Saturday. He had contemplated napping on his couch, but there were two voluntary admissions waiting on West Unit, and the adolescent runaway on East had pulled her stitches out.
Marlowe dragged a toilet kit from his filing cabinet and paid a visit to the staff restroom, where he washed his face in cold water, brushed his teeth, gargled mouthwash, brushed his hair and beard. Returning to his office, he pulled off his red Hawaiian shirt, sprayed on deodorant, and changed into a blue Hawaiian shirt, also from his filing cabinet. Sleeping quarters were provided for on-call physicians in a cinder-block horror known as married residents’ housing, but this was detached from the hospital unit, and after a night when it took Marlowe twelve minutes to respond to a cardiac arrest from there, he decided to take calls from his office.
East and West Units cared for women patients, North and South Units for the men. Whatever symmetry had been intended by this plan had been completely obscured by the addition of the Adolescent Unit, the Med Unit, the Alcoholic Rehab Unit (again segregated by sexes and separated by a five-minute walk), and Central Administration — not to mention the semi-automonous Taggart Center for Special Children (once known as the State Home for the Mentally Retarded), the Crawford Training School (the state had seen fit to include a center for juvenile offenders within Camp Underhill’s disused facilities), and the R Everett Amberson Clinic (a former hotel refurbished as a drying-out spot for the less shabby class of alcoholics and pill addicts). It took new psychiatric residents a few months to find their way around, and a car was necessary to reach the outlying centers — a complication in that many of the foreign residents had licenses to practice medicine but not to drive.
Marlowe, who was not moved by tears and found them a bit bothersome, considered East and West Units more than a little bothersome. Granted that tears were nonverbal communication, women patients tended to use them as dramatic expression or as means to terminate an interview. A generalization, but an accurate one, for Marlowe had timed things. Even allowing for the additional time entailed by a pelvic exam on new admissions, as opposed to a quick grope and cough to check for inguinal hernia, it took half again as long on the average to complete any task on the women’s wards as on the men’s. Marlowe compared notes with several of the women psychiatrists and found their experience to be the same. Marlowe saw the basis of an article for the journals in this business of tears, but he left it unwritten as he hated the journals. The crucial point was that, given too many tasks and too little time to accomplish them, East and West Units demanded a disproportionate share of that nonexistent time.
Marlowe spent most of the day between East Unit and West Unit. It was a pleasant day, and families liked to carry their senile grandmothers and Valium-addicted aunts to the hospital on weekends. Everyone was off work, the children could come along, and it was a nice outing for Grannie or Noonie or Auntie or maybe Mom or Sis, who had begun to wander into traffic or seduce the paperboy after two bottles of vodka. Major holidays were worst of all, for then families liked to rid themselves of unwanted and incontinent organic old ladies, so they could enjoy Christmas or Easter without the pressure of an invalid. Graceland was cheaper than a rest home, and afterward, if conscience troubled, they could always take a drive and reclaim her. Best of all, on weekends they could drop a patient off and be miles away before the lone on-call physician had a chance to interview her. The worse the weather, the better Marlowe liked it: involuntary commitments might come in at any time, but it was unlikely that the family would decide to haul off Grandma when it looked like it might pour down all day.
By midnight Marlowe limped back to his office and collapsed on his couch. He had had fourteen admissions since morning, with more on the way. Most of the usual problems he had been able to deal with over the phone — too much medication, too little medication, extra-pyramidal reactions to the medications. Marlowe titrated and adjusted, switched from phenothiazines to Haldol or Navane or vice versa, dispensed Artane and Cogendn as required. Metal chains and straitjackets had required no such artistry, but the old-timers told Marlowe of how they used to scream and howl on nights of the full moon in the days before major tranquilizers, and Marlowe kept it quiet the nights he was on call.
Marlowe’s eyes stung. A Philippino resident had admitted a patient Thursday night and not noticed that he was a severe alcoholic; nor had the resident who inherited him in the morning and who transferred him to an open ward. When the patient went into DT’s with paranoid delusions, it took security two full cans of Mace to convince him to drop the table leg he was swinging like a club at anything, real or delusional, that came within reach. Marlowe had had to examine the patient once subdued, and Mace was still running like sweat off the man’s blistering skin.
The familiar coffee burn in his stomach reminded Marlowe that he hadn’t eaten anything except a candybar and a large tomato one of the nurses had carried in from her garden. Fast Fare had closed, even had Marlowe felt up to a short drive. Redeyed (“Remember—don’t rub your eyes,” security had warned him.), Marlowe pawed through his filing cabinet and uncovered a can of ravioli. He managed to open it without cutting himself, found a plastic spoon and fed himself cold ravioli from the can. He considered heating it on his hotplate, but lacked the time or ambition. He almost fell asleep while chewing, but his beeper reminded him who and where he was.
At 3 in the morning Willy Winslow on South Unit smashed the salt shaker he had stolen earlier and sawed at his wrists with the jagged glass. He was quite pleased when he flailed his bleeding wrists against the nurses’ station window, but neither the ward attendants nor Marlowe shared his amusement.
Winslow was a regular at Graceland, one of an undefined group of patients who enjoyed staying in state institutions, constantly admitted and readmitted, either voluntarily or involuntarily, and constantly discharged again. Winslow was well known to all the staff at Graceland; if he could not con a resident into a voluntary admission, he would gash his wrists and gain an involuntary commitment thereby During this, his seventeenth admission to Graceland, a concerned resident from one of the better private medical schools had devoted three months toward helping Winslow re-enter the community. Bolstered by an extensive outreach program, Winslow was to be discharged next week.