by Amanda Leduc
PLEASE PRESERVE MY TESTICLES FOR THE QUEEN.
The nurses get this note from the King of England just before the doctors discharge him to the street. He’s been in and out of the ward for the past two days. “Malingering,” the doctor says. To exaggerate mental or physical symptoms for attention, or other secondary gain.
He’s tall, this kid. Lean and angry. He wants to be admitted to the hospital. He lives at the YMCA. “I’m crazy!” he shouts at the doctors. “I’m the King of fucking England!” He won’t be told no—when they discharge him, he goes out to the ER waiting room, lies down on the floor, and starts screaming. The nurses bring him back.
“I’ll fucking kill you! I’ll fucking kill you all!”
He’s been admitted to the hospital before, and it doesn’t help. So the doctors assess him, and then he’s discharged. Again. He stops in front of my reception window before he leaves the ward.
“I’ll see you in hell. Goodbye, motherfuckers.”
No one’s ever called me a motherfucker before. Not even in passing.
“He’ll be back,” the nurses tell me. “Let’s just hope it’s not today.”
I had not wanted to work at the hospital. I had moved home—from Scotland back to Canada, from independence back to Mum and Dad—only because my visa had expired and there was nowhere else to go. No job. No money. Not even a driver’s license. I spent six months unemployed and scrambling for work, spending money that I didn’t have on interviews in Toronto, until finally, one day my mother called me from the hospital where she worked and said, “How would you like a job?”
I held the receiver to my ear and cried, there on the other end of the line. Then I said yes.
First I worked in the Outpatient Department as a data entry clerk in the blood laboratory. Patients handed me their lab requisitions, I entered their blood work into the computer, and then I gave the labels to the nurses. It was hectic in the morning, but by the end of the day there was nothing to do, so I drafted a YA novel in those open, un-busy moments at work. It was a novel about bisexual fairies, and it was ridiculous. But for a while I thought it just might make me rich. I figured I’d self-publish it under a different name. Amanda Hocking had just started to crest on fame then, and I was desperate.
Eventually I found myself wanting to make the YA novel better than it was, though, so I stopped. I did not want to be an author of books about bisexual fairies; I just wanted to move out of my parents’ house. I wanted to write essays. I wanted to start working on another novel, one that I actually cared about. I wanted my own life back. That was all.
Toward the end of that first year at the hospital, the woman whose position I’d been covering came back from sick leave, and I found myself unemployed again. Things stayed that way for two months. When another position at the hospital came up, in the emergency psychiatry ward, I applied. I’d grown to like the money. The duties: photocopying, filing, and registering patients. Faxer and coffee girl extraordinaire. The manager spent most of the interview asking about my time in Scotland. A few weeks later, she called to say I had the job.
“It will probably be quieter than the blood lab,” she said. “Bring a book, if you want. That might help. Nothing much happens here.”
Facebook Boy comes to the ward halfway through the summer. He’s eighteen, but looks about twelve. He comes in with two police officers. They found him teetering on the edge of a ravine, threatening to jump. After he’s been sitting in the waiting room for half an hour or so, he politely asks me if he can use the phone. He calls his mother.
“I need you to go on the computer. Can you go on Facebook and check and see if Amber and I are still together? We had a fight.” Pause. “Please, Mom? Please? It’s really important.”
Next—I’m assuming she hangs up—he calls a friend. “Look man, Amber and I had a fight. Can you go on Faceboo—oh. Okay. Well, maybe you can call me when you’re near a computer? I’m at the hospital. Just call here, to this phone.”
Then he calls his mom again. “Mom. Please. I’m so worried. I love her! Just check for me? Right now?”
Eventually, the police officers pull him away from the phone. “Next time he asks,” they tell me, “just say no.”
He gets angry and flings the officers’ hands away. “But I love her! You don’t understand. When you love someone, you need to know if they feel the same way about you! Just let me go on Facebook! Please!”
The officers tell him to sit down. Instead, he tosses a chair at the wall.
“Please let me go on Facebook! Please!”
The nurses put him in seclusion. No Facebook there, either. He spends most of the night banging on the walls and crying. “I need to go on FACEBOOK! YOU DON’T UNDERSTAND!”
“Situational crisis,” says the ER physician. Eventually they send him home.
I trained for two weeks—the ins and outs of data entry, the intricacies of the fax machine—and then started working by myself. I pointed people in the direction of the nurses. I joked with the medical residents. Sometimes patients would walk into the ward on their own; more often than not they were sedated or strapped to stretchers, or they came in shuffling, flanked by police, their eyes focused on the floor. I photocopied things when I was asked and answered the phone when it rang. I played Scrabble on my computer. I wrote stories.
Answering the phone was the hardest part. Family members would call me and cry. They’d ask about their sons and daughters—how they were, when they’d be able to leave. Sometimes I’d get calls from parents whose children had yet to show up on the ward, terrified parents who didn’t know what to do.
“He says he wants to kill himself,” one mother whispered, after I’d been on the ward for less than a week. “What am I supposed to tell him? What am I supposed to say?”
After I’d been at the hospital for about two months, I had my first run-in with a parent. She’d brought her son into the emergency room because he’d been put on suicide watch. The ward was busy that day and her son sat with the nurses for seven hours before a doctor came in to assess him. Every twenty minutes the mother would come to my window and ask me what was going on.
“Why is it taking so long?” she said. “Don’t they realize he’s in crisis?”
I told her, “No, the assessments take a long time. The nurses are with him. He’s being taken care of. I promise.”
“But he needs to see a psychiatrist!” she snapped. “He’s on suicide watch! Don’t you know what you’re doing? I want to talk to someone who knows what’s going on!”
Eventually, the nurses heard the shouting and came out to speak with her. They called security and had her escorted from the floor. When she left, she was in tears. “But what am I supposed to do?” she wailed. “If you won’t help him, where are we supposed to go?”
Next time, the nurses told me, I was to call for security right away. “That’s emotional abuse,” they said, “and you don’t have to take it from anybody.” They were tough and brisk—so cliché, but true—and sometimes downright rude.
But rudeness in a hospital is survival, an entirely different kind of animal. I didn’t understand this when I first started working there; I understand it now. Even empathy has a timeline. Even compassion needs to be replenished.
I’m too soft for this kind of work. I worry too much about what everybody thinks when they knock on my window. If there’s no information to give them, somehow it’s my fault. I fumble for speech and come up empty. I do not know what to say here. Words mean nothing.
A few weeks after his first visit, Facebook Boy comes back. This time he wants to talk to his girlfriend on the phone. She called the police because he held a knife to his throat after they had a fight. The police bring him here in handcuffs. When they arrive, Facebook Boy is panicking because he’s not sure, again, if he and his girlfriend are still together. He really needs to know.
“When you love someone,” he tells the nurses, “really love them, you want to make sure that they feel the same way.”
But his girlfriend won’t pick up the phone, and so he punches a security guard. When they put him in seclusion, he pounds on the door for as long and as hard as he can. “Fuck you!” he tells the nurses. “Fucking LET ME OUT OF HERE!”
The officers are tired. They sit in reception and play Angry Birds. They can’t leave until he’s no longer a threat, and he’ll be a threat as long as he keeps pounding on the door.
“You wouldn’t believe,” one officer tells me, “how many calls we get each day because of Facebook.”
A few minutes later, the banging stops. “I’m sorry,” he tells the nurses. “I’m really sorry. I’m just so sad. Can you let me out? Can I go on the computer? Can I check Facebook? Please? I need to check Facebook. I don’t know what I’ll do if she leaves me.”
Facebook Boy’s mother tells us that he says this all the time. “I’m not worried,” she says. She is bored, nonchalant on the other side of the phone. “He wants to kill himself every day. I doubt he’ll act on it.”
Later, after the police have left and Facebook Boy has eaten his dinner, after he’s calmed down and stopped swearing, the residents go in to see him. He says he’s feeling better; he wants to go home. The residents organize his follow-up appointment. He’s allowed to use the phone. His girlfriend still loves him. He leaves happy.
The next day his family doctor calls our office, furious. Facebook Boy is there at his desk, his eyes downcast, contrite. He and his girlfriend have had another fight. “What,” says the doctor, “is your department supposed to do, exactly?”
My sister also works at the hospital, in another psychiatry ward. She’s a nurse. She always says, “The ‘H’ on the door doesn’t stand for hotel!” But people come back all the time. They eat the hospital dinners. They sleep in the suites. One day a patient leaves bed bugs on the mattress—the suite is blocked off, the mattress burned. A few days later he comes back, and they do it all again.
The doctors call them frequent flyers. Some people come here to get help; others come because they don’t know what else to do. They don’t take their medications, or their medications aren’t enough, or they’re frustrated at the therapy they’ve been sentenced to. “It’s just a bunch of spoiled kids in a circle,” one patient tells the nurses. “Nothing’s going to get done in here.”
Still others come because they just don’t fit in with the rest of the world. One patient, a woman in her forties, comes here at least three times a week. She’s on a first name basis with every officer in the city. She has bipolar disorder, borderline personality disorder, learning disabilities. She loves her cats. She’s smart enough to know that the hospital can help, but her disabilities keep her young enough to think that the disease will go away.
“I didn’t ask for this,” she tells the charge nurse. Two days earlier, the social worker had sat her down in the foyer and planned her birthday party; she’d hugged everyone on the ward; she was that excited. “I don’t want this stupid disease.”
“No one wants it.” The charge nurse is unmoved. “But lots of other people have this disease, too. They make it work. So can you.”
On the good nights, when there’s no one on the ward, the nurses play solitaire. Or they read out loud from the communal copy of Fifty Shades of Grey and giggle. When I have nothing else to do, I get them coffee. Extra large Earl Grey, one milk. French vanilla cappuccino. Medium double-double. The girls at the coffee kiosk know me by name.
I spend long stretches of time here doing nothing. I let the Internet distract me. The Rumpus. The New Yorker. Maisonneuve. Friends at home are continually surprised by how much I’ve been reading.
“Where do you find the time?” they say.
I just shrug. “I’ll do anything to keep from writing.”
They always laugh.
But the truth is, sometimes I feel the emotions here so strongly that I don’t know what to do. No one pays attention to me; I’m just the fax girl, the data entry clerk, the coffee person. Parents sit on the other side of my window and weep because their children are falling apart. Spouses pace the halls and think about leaving. “I can’t do this anymore,” one husband said to me. “I love her, but I just can’t.”
Once, I watched a ninety-year old mother weep in our hallway chair because her daughter, who is in her sixties, had tried to hang herself in her kitchen. Had the daughter done something like this before? I’m not sure. The mother was German—her English was lilting and soft, impeccable. She sat in our hall and cried for hours—silently, without moving. Later that night, her daughter was transferred to another floor; the mother left after speaking with the nurses, tissues balled in the hollows of her fists.
The Barker comes to the ward a few days after Ronald Poppo has his nose chewed off in the States. The Barker sits in an interview room, again with the police, and barks nonstop for three hours. I lock the window at reception and wonder if a different man has come to us now, ill and raving like an animal, ready to gnaw at random flesh. Every now and then I check to make sure that the officers still have their noses. All I can think is, This is it, the zombie apocalypse has arrived.
The Barker is another frequent flyer, but I don’t know that until a few days later. He’s a few years older than Facebook Boy, but has the mental make-up of a child. He comes to the ward three or four times a month. His voice is higher than you’d expect from someone so tall.
Today he comes to us because he’s upset with his mother and wants to kill himself. He’s barking because he was having a panic attack in the waiting room, and one of the nurses tried to calm him down by asking him what animal noises he could make. He barks at the officers until they ignore him, and then he barks at the nurses. Eventually, he stops barking altogether, but only because he’s tired and wants to go home. The nurses bring him dinner; the ER doctor says he’s stable and ready to go. The police see him out. When the nurses bring me his discharge paperwork, they’re laughing.
“There,” they say. “Another story for your notebook.”
Three days later, he comes back. He’s in the middle of a divorce, he says. How can he live without his wife or his children? How can anyone expect him to go on?
The Barker isn’t married. He doesn’t have children, either. When the doctors remind him of this, gently, he nods and then continues on with the story. His wife is leaving him. His kids are going to grow up without a dad.
The nurses talk him down, eventually. He’s fed. He’s discharged.
The next day he takes half a bottle of Tylenol and ends up back in the ER.
“There’s a fine history of writers working in mental institutions.” This is what a friend’s husband said to me the first time I talked about my job. “Imagine where Ken Kesey would be if he’d never worked at Menlo Park.”
Imagine that. Ken Kesey working the night shift at a laundromat instead, or maybe the midnight shift at some greasy San Francisco diner. Getting his drugs on the street instead of as the guinea pig. Would One Flew Over the Cuckoo’s Nest have ended up on the street then, too? Who knows? I like to think about Kesey, secure in the grip of LSD, wandering the halls and joking with the patients. Sometimes I fantasize about him sitting down to a long grey table, late at night, chicken-scratching into a notebook the way William Faulkner did, all those years ago when he worked the night shift at the factory.
You don’t really joke with the patients in Emergency Psych. Patients come here so the doctors can determine where else they need to go. They’re manic or sobbing or incandescent with fury. Sometimes they’re intoxicated. Sometimes they have their stomachs pumped in the ER before they’re brought over to the ward. They scream. They yell so loud that their voices disappear.
Still, I’m surprised at how much I laugh here. There’s another patient who visits us at least once or twice a month. He’s from Toronto, and we think he has a man-crush on one of the doctors. Every time he’s in he’ll ask me for a few sandwiches, a glass of juice.
“You don’t have any nice coffee back there, do you?” he’ll ask. As though we are Starbucks. “I’d really love some nice coffee.”
Once I got a call from the Patient Booking Department. “I just had a call from one of your patients,” the clerk said, sounding bewildered. “She’s in the ward right now, with you, but she said that the nurses have taken her purse, and she wants me to help her get it back. How did she get this number?”
When asked, the patient said she’d been calling her lawyer. Apparently she just punched a random bunch of numbers into the hospital phone. “She’ll get it back,” she muttered. “She must get it back. That’s her job. What else would I pay a lawyer for?”
One day a patient tries to escape from the ward. I’m carrying patient charts back to my office when she muscles past me into the hall.
“Lock the door!” the nurses shout. “Lock the door!”
But I don’t have to lock the door, because security tackles her before she gets there. They bring her down in front of my workstation—two men, tall and strong in their padded uniforms—and lean their weight against her buckled knees, her hunched and angry elbows. One man holds a hand against her head. They are gentle.
“Let’s go back into your suite,” one of the guards says. “The nurses can clean you up, and we can talk.”
“You’re hurting my arm,” she mumbles. “Get off my fucking arm!”
“If I let go,” he says, “will you try to run away?”
“This is prison,” the woman says. Her hair is broken, frizzed and grayish-yellow. The police brought her in earlier in the day because she called 911 when she was drunk. “I don’t want to be here! You have no right!”
“You’ll stay until the doctor can see you,” the nurse says, not flinching. She is young, closer to my age. We went to the same high school a few years apart. She’s normally so sweet and quiet; it feels strange to watch her now, hunched over the patient, her voice so flat and hard.
“We’re trying to help you,” the other security guard says. “I know it’s hard to imagine, but—”
“I don’t want your fucking help!” she screams. “I don’t want any of it!”
They wrestle her back to the room and lock her in. Eventually she calms down; the doctor goes in to see her and changes her meds. And then she goes home.
A few days later the police bring her back. This time she doesn’t run.
The nurses frightened me for a long time when I first started. They were all so brisk, so short. So frustrated as I shuffled my papers around. It took a long time for me to get their humour, to understand that you have to be tough here, that there is no room for pity. Sometimes there’s no room in the hospital either. You can be sorry for them all but that won’t do a thing.
One night a man with a great brown beard comes to my window.
“My name is Carter,” he says. “I’m hearing voices, and I want to know if I’m crazy, or if I should go to the police.”
Carter is polite, but like so many patients, does not want to wait in the ER. I direct him to the waiting room but a few minutes later he comes back.
“I don’t want to see someone if they can’t help,” he says. And then again, faster. His voice is rising, his hands cutting swiftly through the air. “Idon’twanttoseesomeoneiftheycan’thelp. Idon’twanttoseesomeoneiftheycan’thelp.”
What would you do right now, says a little voice in my head, if he pulled out a gun?
When he leaves, I think about him back out on the street with all those voices in his head, and I start crying. I cry for the rest of the night. I calm down and wash my face. Then I think of him, tall and lonely in his beard, no end to those voices in his head that no one else can hear, and I cry again.
I have some experience with depression. Not much. I was depressed for a few months during my third year of university, and then again just before I hit thirty, when I was living with my parents. Situational depression, brought on by stress and debt. Each time, that’s what it was.
I slept a lot. Nothing interested me. I went to school, and then later to work, only because I knew that the alternative to not going to school and not working was to lie in bed and let that crush me. I cried in the middle of campus, on the bus, and for long, uninterrupted periods in the shower. During my second bout, when my life was boxed up in my parents’ basement and I slept on the bed in the guest room, I’d wake up at night already sobbing. One night I stumbled to the kitchen and stared at the pills in my father’s medicine cabinet—he suffers terrible migraines, and that night I stood in the hollow moonlit glow of the kitchen and wondered what would happen if I took his Fioronal pills all at once. No more debt. No more anything.
But I did not take the pills, because even then, I knew that things would get better. I would get a job, and eventually I would move out, and sooner or later I’d be living on my own again and things would be okay. Eventually my verve would come back. Wasn’t that how it worked? Didn’t things always swing up, in one way or another?
The people who come to the ward—it’s different for them. This is sadness and anger and sickness twenty-four hours a day. This is a ten-year-old child, sobbing in her mother’s arms, and parents who’ve dealt with her mood since she was eight. This is the twenty-two-year-old man who’s tried to kill himself three times in the past two weeks. This is the kid with recurring psychosis who can’t hold a job and comes to the ward because the shelters don’t have room for him anymore.
“Thank you,” he says each time. To me, to the nurses, to the doctor. “Thank you for your help.”
This is the fifteen-year-old girl who comes to our ward late at night, gets discharged by the doctor, then hangs herself in her bedroom soon after she gets home. Sometimes even the doctors miss the signs.
Sometimes things do not swing up—sometimes it’s just that simple.
Ken Kesey, as it happened, liked his job at Menlo Park a great deal. He didn’t think that the people he spoke with were insane—he thought that they’d been pushed to the fringes of the world. If he were here in the ward with me today, I think he’d argue that we are all complicit; though we might cheer for the usurpers in movies and in books, in real life, we want what makes sense. We might root for McMurphy, but at the end of the day we want Nurse Ratched in charge.
One day at the end of my shift, a patient drinks three bottles of hand sanitizer, then smears shit all over his room. The security guards don disposable blue booties and walk into his room wearing masks. Chemical restraint, says the doctor’s order. They sedate him and transfer him back to the regular emergency area for monitoring.
He’ll come back. So many of them always do.
The King of England jumps off a bridge one day late in October. We hear about this the day after it happens—the hospital administrators come through and speak to the nurses, fill out all their paperwork. Everyone’s in shock.
“He was a pain in the ass,” one nurse says to me. She’s almost crying. “But I never thought he’d do something like that. He didn’t seem the type.”
He is just a name now, a jumble of letters on the page. That night, I copy flyers and make them into little booklets, then fan the booklets out in the foyer. It doesn’t take long, so I copy more. Fold and press. Fold and press. Depression, anxiety, mental health. More jumbled letters. How to Get Help.
The King of England was twenty-two when he asked to have his testicles preserved. Now he is dead.
Tomorrow someone else will come, and there will be another note. Facebook Boy. The Barker. Someone else whose face I don’t yet know. In a week’s time I’ll leave my shift and walk to the street in time to see our cat-loving patient run out in front of a car.
She’ll survive. When she comes back to the ward, the nurses will be gentle with her, like she’s the finest piece of porcelain they’ve ever seen.
Please note that names and certain identifying details have been changed to protect the privacy of individuals involved.
Amanda Leduc is a Canadian writer whose essays and stories have appeared or are forthcoming in Crossed Genres, Big Truths, The Rumpus, ELLE Canada, PRISM International, Prairie Fire, filling Station, Existere Journal, Conclave, and other publications across Canada, the US, and the UK. Her novel, The Miracles of Ordinary Men, was published in 2013 by Toronto’s ECW Press.