Coroner's Journal (14 page)

She's probably had suicidal thoughts. She even tried to act out on it. She must be in a great deal of emotional pain. She has the look of someone who carries a heavy burden. Her shoulders are hunched over even as she sits before me. Her face carries a seemingly perpetual frown. She is probably in direct violation of her own spiritual values. On some level she knows this. I'm glad to see the guilt. It means she has a chance. It can help her or it can kill her.

“I can't help myself at times. I know it's wrong, but I do it anyway. And I get so damned depressed, and the thoughts come . . . you know, about killing myself. Take a little too much crack or whatever. Walk in front of a truck.”

The feeling of despair emanates from her. She begins to sob. True to form for a government office, there are no tissues in the room. I offer her a paper towel to absorb the tears.

“I'll stay . . . and I'll try . . .” She buries her face in her hands and begins to rock back and forth—so much pain.

Her defenses crumble but she is likely to regroup. There will be attempts at manipulation, threats, hostility, and all the things she uses to keep people away. None of it will work with this staff. They care and they know how to deal with the bullshit. But right now she is real. She is vulnerable, but this is a safe haven. She appears to be one of those women who has been used and abused. I seem to be thinking a lot about my grandfather today. A professional cowboy from Oklahoma, he would have said she had been “rode hard and put up wet.” He'd consider that no way to treat a horse, let alone a human being, especially a woman.

Angela is out of control and swimming against the riptide. She is lost. But she is one of the fortunate ones. She has an anchor. Someone still cares about her. I agree with her involuntary admission. She is dangerous to herself and to others (her child), and she is at best ambivalent about treatment. But she still has a small spark of herself and her values left. I hope it will ignite. I hope we can give her a chance. I break protocol and give her a hug. She needs it. All three of us in that little dingy room are emotionally drained.

As Angela leaves the room, the nurse hands me another chart. It is with a tinge of emotional trepidation that I open it. A cursory review tells me this is going to be a very long day.

The volatility of dealing with mental health patients is exemplified by events that occurred during a previous coroner's administration. A patient attacked a police officer right there in the coroner's office. The officer was in mortal danger and was rescued only when another officer shot her attacker dead on the spot.

When you are involved with as many mental patients as I am, there are inherent dangers. Some institutionalized patients know who I am, and that I am the person responsible for their current address. Some are grateful—at least while they are taking their medication—for their improved quality of life.

Others, when their symptoms reemerge, either because they are not taking their medication or because they are using street drugs, can incorporate me into their paranoid delusions. Last year, for instance, I got a phone call from a mental health clinic. It seems that one of the patients, a known paranoid schizophrenic with a history of violent behavior, had called for help. The content of the phone conversation was that he was afraid to go to sleep because the coroner sneaks into his room every night and rapes him. His solution was to eliminate the coroner. No, there is absolutely no basis to his claims. But, yes, we did manage to get him the help he needed.

One day in the early 1990s as I was leaving Baton Rouge General Hospital, a patient I recognized appeared out of nowhere. He suffers from schizophrenia and cocaine dependency, a dangerous combination. It was late and I was walking toward my car in the doctors' parking lot. Problem was, I was focused on the car and did not have my guard up 100 percent. What I did have was a .32-caliber semiautomatic pistol in my right-hand pocket. I heard a grumbling voice to my left.

“I'm gonna kill you, you motherfucker!”

When I turned I recognized him immediately. He had that wild cocaine look in his eyes. His fists were clenched. He's a big guy, and it had taken several mental health technicians to restrain him the last time he was committed to the acute psychiatric unit. He also was HIV positive. In other words, he scared the hell out of me. The last thing I wanted to do was get into a fist fight with him, but I didn't want to gun him down in the parking lot, either.

My response was automatic. “Hi,” I asked him. “You doing okay, man?”

He looked surprised, unclenched his fists, and said, “Yeah, Doc, I'm okay.” Then he turned and walked away—much to my relief. You just never know.

 

 

 

Cocaine dependency is a real bitch. The drug causes delusions, grandiosity, and paranoia, among other things. Officer Washington had escorted Arnold from his parent's pool house to my office under special invitation of an Order of Protective Custody. He was an unkempt thirty-three-year-old white cocaine addict who was determined to manipulate his way out of this little inconvenience. Since he was broke, he had resorted to stealing money from his parents and taking anything of value that he could find to hock at a pawnshop. Chief in his mind was the fact that he owed money on the street, and those folks tend to get their money or else.

At any rate, he was telling me that nothing was wrong with him and that his family was plotting against him and that was why he was in the hospital. He was most convincing, since he believed what he was saying. I could tell he felt confident that he was presenting himself and his case quite well. I committed him. But I did give him a word of advice. “The next time you try to convince me how normal you are, don't put your pants on backwards.” At which point he looked down to realize he had done just that. Then he threatened to sue me for kidnapping him.

He stabilized within a few days and was discharged. He later came by the office to apologize for his behavior and to let me know he had gotten into an outpatient treatment program. I never had to pick him up again.

The Hospital of St. Mary of Bethlehem, known also as Beth-lem Hospital, was originally established as a sort of general hospital in London in the mid-1200s. It ultimately had its name shortened to Bedlam, at least in the vernacular. A few centuries later, it became a hospital for “lunatics,” and since then the word “bedlam” has been associated with insanity and confusion.

I've been to Bedlam—the one in East Baton Rouge Parish. When I go to psychiatric hospitals for commitment evaluations, things usually go smoothly. Usually. Of course the vast majority of these patients are in an acute psychiatric unit. I should stress the “acute” part.

As soon as I was ushered through the locked doors of the acute unit one summer afternoon in 2001, I knew this was not going to be the usual. A rather large male orderly informed me immediately that “elopement precautions” were in effect. That means someone is trying to escape and you better be careful when you open any door to the outside world. I suddenly went on full alert.
Be careful here, Cataldie. If you are careless with door security, you may find yourself chasing a psychotic patient through the hallways.
I could feel the tension on the unit, and it was bordering on chaos.

The orderly has taken on more the role of a bouncer these days. I was careful as I navigated my way down to the locked nurses' station. It pays to be vigilant—one M.D. friend of mine ended up with a retinal detachment after a husky male patient cornered and pummeled him. I've been hit before. Sometimes you just do not see it coming.

I immediately sought sanctuary in the locked nurses' station, where I could review the chart on the person I was there to evaluate. The nurses' station is a safe haven, and it is brightly lit. All eyes—including mine—were on an unkempt female who was screaming through a hole in the glass barrier that encircles this station. Her red wig tilted to one side, the patient was yelling a string of obscenities at the nurse. It was as if we were under siege in a medieval fortress.

The patient, who seemed to be trying to squeeze her head through the small opening in the glass, had some white powder around her nostrils. Her anger was escalating. “You mother-fuckers! I'll get you! You can't do this to me!”

The head nurse, the only nurse on the floor with thirteen psychotic patients, mostly street people, seemed unruffled. She turned to me, acknowledged my existence, then went back to the chart before her. Without looking back up, she said in the matter-of-fact tone of an overworked psych nurse: “She's a schizophrenic . . . refuses to take medication . . . we know her well . . . she's a frequent flyer. One of her thuggy sons supposedly brought her some cocaine because she promised to tell him where her government check is . . . he
supposedly
held up his end of the bargain, she didn't . . . I think he tried to fool her with talc powder . . . she may be crazy but she ain't stupid . . . you know the drill . . . it's the usual crap.”

Nurse Overworked turned her attention to the screaming patient. “Listen, please go back to your room or it's seclusion for you. I don't have time for this now.” Her tone was firm yet respectful. An iron hand in a velvet glove—very nice work.

This patient, Tomica, grunted another “Fuck you,” then mumbled her way down the hall. She was heading toward the dining area, oblivious to the fact that her wig was leaning perilously to one side, yet remarkably still on her head. She was definitely no stranger to the seclusion room, and the threat of being put there seemed to calm her rage somewhat. Boundaries do help, even primitive ones.

I searched through the chart rack for a flagged chart that would indicate that a person was here against their will. My mandate is to evaluate patients and determine if an involuntary admission was appropriate. If I think the person needs to be here under mental health law criteria, they stay. If not, they are released immediately.

I muttered to myself as I pulled the chart from the rack and stopped at the name.
Tomica Johnston. Of course. I should have known.

I glance at Nurse O. Finally, she smiles. This was not a nice smile. It was a misery-loves-company smile. I tried to recover. “I don't suppose you have two Tomica Johnstons here, do you?” Nurse O.'s smile widened.

I resigned myself to the fact with acknowledgment. “No? I didn't think so. Is there anyone who can help me talk to her?”

Nurse O. still had that wry smile on her face. She pointed to a young female tech who was evidently serving as hall monitor for the patients. I did not know this young lady, who appeared to be about twenty-five years old. She had probably been through the thirty-hour training course, then thrown into the pit.

As I was sizing her up for the task ahead, she suddenly bolted down the patient corridor at warp speed. “Nurse, nurse, come quick,” she shouted. “Gerald, you stop that, you too old for that.”

Nurse O. shot out to the hall at Mach 1. She definitely came alive when there was an emergency. I was running with her. This particular emergency: sixty-one-year-old Gerald was getting oral sex from a new admission, Alicia. They were doing the deed right there in the dining room. Alicia was on a psychotic manic swing and Gerald was somewhat demented.

The staff broke up the lovers' encounter. Gerald asked for a cigarette break and smiled. Alicia began shouting that she was going to have his baby.

Chaos is contagious, especially in a psychiatric unit. If psychotic patients perceive you have lost control or don't know what to do, they become fearful and begin acting out. They are like children in that they rely on you to furnish boundaries, and then they test those boundaries.

Nurse O. was a veteran and she knew boundaries were necessary here. We both did. Alicia was shuffled down the hall and placed in a chair right in front of the nurses' station. Nurse O. gave Alicia a stern look and commanded: “Stay right there in that chair.”

The young psych tech had taken to chastising both of them. “You should be ashamed of yourself. How people going to trust you around children?” Alicia started to sing, and would continue to do so for several hours, but she stayed in that chair.

Nurse O. returned to the nurses' station to see if there were any doctor's orders for medication to be given. There were none. She paged the on-call psychiatrist and waited. Her face was red and she was as flustered as a wet hen.

While Nurse O. fumed and waited for a return call, I elected to visit with Tomica in the hallway. It was a safety issue, hers and mine. I introduced myself and began to assess her understanding of her emergency commitment and the current situation.

She was semi-dressed in a hospital-issue gown. She had abandoned her hospital slippers in favor of her own tennis shoes—sans shoelaces. It is standard practice in acute units to take away shoelaces, which can be used for suicide by hanging. I noted that she had neglected her hygiene; there was a somewhat repugnant odor about the patient.

When she cocked her head sideways, I feared the worst for the red wig, but it stayed there, precariously perched on her head. “I know who you is. I seen you on TV with that dead baby. What you want with me? I ain't dead.” There was a short pause. “
Am
I?” Another pause. “Is you the Devil?”

Never enter a psychotic patient's delusions. When I was a medical student on the third floor of Charity Hospital of New Orleans back in 1972-73, I was assigned a patient in the acute unit. I let him get between me and the door—
stupid.
Then I began my canned medical-school interview. When I asked him about his current hallucinations, he told me the Devil was talking to him right then. Stupidly, I asked what the Devil was saying. Of course, the Devil was telling this giant to “have sex with you right now.”
Interview over! Now how the hell do I get out of here?