Hell has many offerings (chapter 9/45)
"You bothered by smells?"
"Just sayin this is ... just in the brick of the place, it seems. It's not like the prisons- piss is just one element of it, and it's not like Northville either- there is no... side to go to."
I was already aware, I had been in this building about 8 times now that year- but it was good for morale to allow him the liberty of getting out of his system what he may need to in preparation for this. It wasn’t a prison... not really. I mean, the people were in cages, most of them- and they were not allowed to leave- and the guards had the go for lethal force. The food was awful, there were more five point restraints... and star boards... which I have never seen in a run of the mill state or private.
"We have 45 minutes, you want to get a coffee?" He looked at me... he just looked at me. "Have you been hearing me? You eat or drink now, it is going to come back up and then we are there like that and you are a target, and if you didn’t throw up- drink coffee now and eventually you are going to have to take a leak and that is not an option here." If I am honest, I was a bit irritated with his tone. I did not understand his perspective. I looked over at him driving while I messed with the radio. I took the opportunity to sort of read the room...well the van. He was dressed smart, so there was that- he knew the tricks in how he was presenting himself for this. His shoes were really really clean, but that didn’t mean they were new- a lot of guys were already in the habit of knowing to keep their boots polished and his were lock laced, so he has been here. He had on a dress shirt- it was like a church shirt, navy and his sleeves were buttoned not capped and I wondered if he had ink because of that. Also like he knew what I was thinking he caught me off a bit by asking why I was wearing a necklace. It was tucked into two shirts, one with a collar. "What? How can you even see that I am wearing a necklace?." He looked at me with eyebrows lifted, "I saw you tuck it in when we were picking up... saw you go through the folders, too. What were you doing?" This direct questioning and what I assumed was his response to knowing I was checking him over made me chuckle a bit. "I was separating them by name, and the chain is fine- it is only stainless still so if your worried I will lose it in a yard brawl..." but he cut me off with a sharp, "Don't think this is a get in line by alphabetical and raise your hand if you need something situation, honey".
My amusement was no longer shallow. The feeling that the way he said honey and the way he cut me off lit the furnace. During this time in my life I was a very quick tempered person, all the time- all the time I suppressed this inner dialogue of rage that burned in my core, I worked very hard to keep the pilot light as dim as possible, and I had been by various extreme life lessons trained when to just clench my jaw and bear down. Nearly 75% of the time, I could mask this lava in my veins... but I lived my life in a cloud of hubris, and I had to kill that person before it killed me.
I spoke with everyone I worked with in a superlative manner and for several reasons. One- it showed you I respected that we chose the same work to be involved in, two- I commanded that back with my work ethic and abilities, and three- in a group situation, if something goes bad... the people you respect will remember that, even if you're a woman.
My survey of him was complete. "If you interrupt a southerner when they are working to make you feel at ease, or take the edge off- you tip the balances son and I hope that you are able to contain whatever your seemingly anxious level of intrepid output for this field trip is right now and speak to me accordingly and not like I am a spit-tail here for a ride along" I made sure we made eye contact and I smiled and did the universal head nod. He just looked on for a few minutes and I decided my little game was over, so I started going through the paperwork.
About fifteen minutes down the road is the turn off and I started re-sorting the folders, six I had the tabs facing east and four to the left, emptied my pockets into the cup holder and reengaged. "You know the ol'boy this place is named after received the Presidential Medal of Freedom? Sorta crazy to think of that when you're in there, huh?" His face did a sharp dart my way, "have you been here before?" I smiled, he looked a bit miffed I think, I am not sure of the expression on his face, after this trip we spent quite a bit of time working together for a few years but that was a face I only saw that day. "What is a split-tail by the way? because I was not being disrespectful." Everything in order as we turn into the drive to pull up to the gates now, "Yeah I have, and if you're from the deep south, it means female but not in a way that you should or can use it if you're not from the region and or over 70." Protocol at the gates. While Vic managed the credentials and paperwork with the guard I scanned the parking lot ahead of us for any familiar vehicles, one in particular. The gate opens and we drive into the lot, park, and commence the interior and exterior inspection before locking it up and heading toward the building. "You know I am from Mexico, right?" I laughed a bit, "way more east and a different set of mountains, ready?".
The doors we came in were called 'the bay' at the time, or depending on who was with you 'exitus maximus'. Up a ramp, two steel doors, some guards they called 'orderlies' in the day, now called 'attendants'. Imagine needing a four year degree to be an 'attendant'. I knew I kinda won Vic when he joked toward my direction, so I figured the morning would go a bit smoother than it could have had he not relaxed a bit. As the doors swung open, we entered via protocol and there sitting on the other side of the check-station were two of my favorite faces. As we cleared the second set of doors and the bell rang, both stood up and took a few steps towards us. "Vic, Jon. Jon, Vic. Mia, you get the idea- Vic this is Mia." I could tell he was a bit confused- everyone shook hands, and I could tell all three were scanning one another. Jon was a real tall toe-head with glasses and blue eyes, he was the best male case manager I have ever worked with. He was funny, and had a bit of OCD but he was kind in a way that had to be natural and not learned, I respected him. "I see you got the memo" he said, when we shook hands and realized we both were donning boots, navy blue heavily ironed work pants, white undershirt and a short sleeve Dickies work shirt. At the same time we both very seriously said "never again" and left it at that, Mia was a small framed, pretty woman who always dressed to the nines. She was in slacks, a blouse, jacket and heels- she was young but her personality at work was hard core. She was my favorite female case manager to be in the field with- if you ever read Harry Potter there is a character in one of the books called Professor Umbridge; imagine that level of intensity and professionalism but exchange the evil with a full armor of steel at all times, and that was her.
We were escorted into one of what we called the 'copy n' cry' rooms. It was a desk, a copy and fax machine and the place you would often find a staff member or family of a... resident- taking a moment. I closed the door and immediately Vic asked why we had two other staff on site. Mia did not skip a beat, "You have 10 transports today and three row van, how did you think you would leave here with twelve in a transport for 11 bodies, did you look at your papers or are you just transport because..." I cut her off- Vic is new and he is a new transport and case management resource specialist, he is on this run today to learn. "I HAVE been here many times you know." We all looked at him. Jon looked through the small window in the door, nodded towards the hallway and asked, "how far"? Silence.
No one mentioned it yet, but the smell was already really strong where we were. Almost worse than usual this far near 'exitus maximus'.
A woman tapped the door and came in with four cups of coffee and some paperwork. Three of us accepted her offering and Vic just put his hand up a bit, politely refusing. "I'll take it Gale, golly you’re swell" Jon smiled and stuck his finger in the side of the cup to claim it. "I think you're an idiot" she plainly said. "Today most areas are 36'ed because of counts or transports, it is also first of the month and it seems some people are having issues with guardians and checks, so a lot is going on and the kitchen is not open for regular times, everyone is a bit shifted I guess you'd say. We have three of your people coming back from time out and one from the greens but he is not sick or anything, it was just a revisit from some stitches." Gale looked over our folders and signed each one. She had twelve wristbands with her, handed each of us ours and we started looping them on our belt loops. "Goes here Vic" tugging on his belt loop, "not on the wrist". I don't think he was embarrassed by it- but he had already ruined his from being sticky so Gale had to go make him a new one and excused herself.
"Okay cool", ever the optimist, "while she does that let's coordinate", I laid out the folders, six on one side, four on the other. "Okay Vic listen, no we don't go alphabetical we go by situational awareness. We know those six people, we do not know the other four. Of the 10 there are eight who really enjoy violence so right now we are making recipes for each van- you follow"? He nodded. "Mia, no females this time so if you guys are up to it I think Mr. White should get your front row attention- his chair can go back row next to Mike if he is acting decent. Two of our new folks are hot off the press so I feel they need to be in my front row, I have a bucky-bar we can put up and our seniors can be in the back to even out any conflict that may happen." Gale came back into our make-shift war room with a new bracelet for Vic and some sort of baked good for Jon. "Knock the door when you are ready, I will be in my office." "Hey Gale- this guy, his chart says 'Captain' what's this"?
"Oh yeah, you will want to call him that or he will pretend he is in a fugue state, Dr. Moore challenged him on that a few times and he finally pissed his pants right there in his office- in the leather chair, too. He is no issues- his diagnosis is well documented and he came to us one other time. He lives in Ohio actually. He is having a good day, and there are no issues so long as you address him as he would like. If you don't have any females with you, he is fine with whoever." Jon laughed, "nope no females today" and winked at Mia whose eyes flipped back in her head like a slot machine.
"You doing seating"?
"Mr. Fletcher - put him next to Captain, for some reason he either really likes or fears him"
"You know why"?
"No. But... Mr. Fletcher is your wild card here, only here for 30 days and only leaving because of his guardian wanting to try specialized AFC, I don't think he is ready, she wants to spend less money. I know he bit someone last week and he has four yellow slips since being here."
"Sooooo Fletch is next to the Captain, thanks for that."
"That means David and Dale take our middle... a full house... this sound good"?
"Have you guys had people be violent in transport"?
Everyone got quiet. Jon produces a pack of peppermint gum and hands each of us a slice. "Vic", Jon took a second messing with his wrapper to make sure his words came out right. "Today you join an elite multi-faceted team of people who are some of the most powerful humans both in strength and somehow authority you will ever meet in your life... and so long as you work with this team, we are the people who have the pleasure of making sure they, and everyone around them are always safe. Violence is a part of all of this... Mia wants to hurt me right now." We all laughed a bit at the brevity.
Having a new person with our team was just as daunting as being in the facility and on the transport. Every choice we make impacts fourteen today, not just one and one person can make the choice for fourteen without a vote, or warning for that matter. You just maintain that nothing bothers you, and we will all pretend you did not wear a dress shirt to do a full transport, sound good"? He just looked around the room at us. "You got ink or something you don't want anyone to see?" Mia had to interject. Everyone ignored the question.
I handed Jon his folders and we had Gale escort us to our first wing.
Unlike prison, the sounds here are not consistent, same for the building, the staff, and the ... residents. It smells different depending on where you are in the facility, but the main undertone of everything else is defeat. I say that because it is like someone gave up on trying to make the original layers of stench better, because the cleaning products used smelled like puke and very strong play-dough, and because you have to realize at some point you must be able to override something in your person to just reside to ignoring the base smell. We always went in with peppermint gum because it allowed you to ease into the stench and also because in junior college, in a microbiology class back in the 90s my class all breathed on a Petri dish- just one breath, and swabbed our mouths then rubbed the swab on another and week by week we studied the dishes. We learned that a) if you are smelling it- you're absorbing it through your tongue b) human beings are disgusting c) no one should purposely pay to consume food from buffets and d) if you think about it too much you will be in a constant state of retching.
Wing one was the worst for the smells, it was where folks who had mobility issues stayed. Unlike the other wings, with some form of reward or benefit folks were able to, if capable, control bodily functions, bathe themselves, and tend to things that can get out of control very fast. Have you ever smelled a very old or oil drenched pillow? One pillow like that can collapse the air quality of an entire bedroom. There were more of these oil pillows than bars of soap. We always had our transports take theirs with them, they have to request that. On one trip we discovered the pillows were not washed or replaced, just reused. The most disgusting and disrespectful means of recycling happened here. We would toss the pillows in the dumpsters where we parked- we did this as a gesture of kindness that- after an incident where a patient wanted to keep the sack of stench in the vehicle for the hour drive became a bit of an inside game with our regulars. 'We called it the tossing of the thing' and it was a custom to pitch the stench sack as a way of flipping off the budget costs that gave it to them in the first place. There was only ever one exception to this routine in our vehicles and it ended up costing us over $300 in repetitive detailing to the van for the smell to be fully removed after being under the seat for the hour drive and then for nearly 5 hours because of a stop at the emergency room in route to the clinic. We had stickers on the inside of our two vehicles clearly stating no pillows were to be transported in vehicles for safety reasons and 'anyone unwilling to follow this policy would receive appropriate fees'. It was that bad.
Mr. White was a regular, he was always happy to see myself or Jon though he was in the past extremely violent with members of several group homes. I never had an issue with Mr. White, but I never let him sit in the back of the van. A year before this trip, he was coming to the clinic from a specialized AFC (adult foster care) home for a regular therapy appointment and had a violent episode. He preferred being in the far rear of the van because he had a wheelchair (he had no legs) and his backstory lended him the respect of his wishes to always know where the wheelchair was. In the back, he could sit by it. The incident that landed him in the front bench on my rides was that he became very angry with a staff member who was driving the van and his temper boiled over. He unbuckled himself and crawled over 2 benches of people to get to the driver, biting him three times before he was restrained by the person in assist. He always had on a white v-neck undershirt (hence his nickname) and that day, once they got to the clinic and he was waiting for the ambulance to take him to the psych ward for a few days because of his outburst, he asked me if we could maybe trade shirts incase their happen to be a cute nurse on staff. The rumor was he bit off the driver’s ear that day, but the ear was intact- what he did do was gnaw several good times into the driver's forehead, peeling back his flesh from the bone on a two inch area. The rage point: driver explaining we would not have time to stop at Wendy's on the way home because he did not have the time.
Mia and Jon collected:
Mike, a middle aged man who after giving is little brother LSD when he was 15 and his brother 11 watched his only sibling run out and get hit by an oncoming vehicle and then suffer for years in and out of hospitalization for drug induced psychosis that never really went away until his suicide at age 30. Mike never got over it and developed a penchant for self harm less than suicidal and a strong desire for sexual deviancy. He had been in three of my group homes in the years I worked in that job, he broke one staff's back, did an estimated 10k in damages to another home, and was known for regularly trying to sexually assault female staff then file recipient rights against them for rape; so to hear them talk about it in front of people. I always got along with him, and I was able to talk one of my AFCs into allowing him to stay as long as I was his therapist.
Mr. Fletcher, an older man with a history of ongoing institutionalization; duel-diagnosed with schizophrenia from birth and brain trauma with an IQ under 90 from so many blows to the skull in fights almost always caused by the mental illness. That was the first time I met him, but he was on my caseload for awhile before being sent to a long term facility after too many reports of intimidating staff, he was sort of black balled from any form of semi-independent living. He was a 'biter' but oddly enough it was never something he was doing violently, he bit women he liked. In sessions with him or in groups, I would give him a hard rubber ball and he would bite it now and again when he felt happy. The group homes would not allow this activity, citing that the ball was a choking hazard... since the biting I guess was no hazard in that respect. His guardian was a lawyer, like most and not one time did I ever meet her, no staff had ever met her- she managed Mr. Fletcher like he was a rental home and she a slumlord. I honestly believe she hoped this attempt at semi-independent living would result in him finally saying the wrong thing to the wrong person at the wrong time and being done with him. She did not care that he was a wonderful artist, that he loved to sing, or that he was able to have very clear conversations about his mental illness that could have really helped many people. Eventually, she got her way.
Lonnie, 70 year old male, catatonic schizophrenia. There were times he would be speaking and a part of what was going on around him, and then about 65% of the time he was frozen in place, no movement- not even blinking. I never got to know him well, but I was once 'talked to' about my unwillingness to write a billable progress note for a 30 minute visit when he was in a catatonic state in his group home. I wonder how many people had.
Roux, 65 year old man with this self given nickname because he said he was the CEO of a gang affiliate out of Denim, USA and because he started it, he was the roux. He had a short stay with us, but talked the most on the way to the clinic of all his criminal enterprises. He was a severe alcoholic, his face was always very ruddy and I never heard him be mean to anyone. His family wanted nothing to do with him and he was 'managed' by a legal guardian who allowed him 7 hours a day unsupervised time from his group home, a bus pass, and $40 allowance a week. This encouraged him to steal... a lot.
Dale, who had about 10 inches of file that came with him, all of it saying he was malingering. I looked it over on the ride back and wondered how anything in his past landed him in the worst area of the facility meant for the violent and criminally insane. He had a calm and easy going demeanor and a decade of testing and moving around and services all pointing to him pretending something was wrong so as not to have to 'live in the real world or work'. Sometimes I wonder where he is now, and if he was perhaps a hard core gonzo journalist or if someone at the start of his care was just really pissed that day or at him and that one diagnosis followed him everywhere. He had money, too- all being sucked in by the system and in an account that had the same fiduciary the entirety of the time he was in the system when I met him.
Vic and I were met in Mr. White's discharge area with our two 'wild cards' that day. Adam H and Adam W. Initially Gale painted this picture of two violent men, and on paper- they were. Adam H had a wildly long rap-sheet with a pattern of events involving fire and malicious destruction of property, he was only 27 but looked like he was well over 40. He was given a diagnosis at age 10 of oppositional defiant disorder, which is basically the kid's menu branding of antisocial personality disorder, or sociopath. In mental health, you can always add on a diagnosis but it is almost impossible to 'plead one down' so to get better care. Diagnostic criteria and codes were also different and once a young person was handed that ODD card... that is just what they would ultimately be treated like, and never seen for who they were ever again. Adam W should not have been leaving where we were picking him up from. Not on this occasion, but he is the reason for only three 'new' transports in a vehicle and his crimes against children and animals should have landed him in a super 6, but he just continued to say that Abraham Lincoln was president, so he stayed in the government's income pool torturing and harassing people his whole life. I have nothing more to say about Adam W but that he is one of the examples of why I left working in mental health.
Then there was David. David was charming and you could tell he tried to maintain good hygiene and dress. He talked a bit at his intake about his childhood, and to be quite honest it was very similar to mine. One day he was huffing paint and something in his brain caused him to disassociate and kill his grandmother... in a very violent and terrible way. His high wore off near the end of the event, and he did call 911 himself- but after ten minutes of waiting for the ambulance and realizing he really did do the thing he was looking at, he 'put his grandmother out of her suffering from which he understood there was no way she would recover'. He really wanted to go to prison for his crime, but his mug shot was his face covered in very shiny silver paint from the can he was huffing (the metallic paints have higher chemical content and are said to have a 'better high' among those who use aerosol as a drug of choice) as if it had exploded or he painted himself that way- he remembers neither but had repeatedly asked for the mug shot to be replaced or retaken because the lending of the chemicals involved and his recollection of the events, which never changed or varied met the standard of his crime being 'not guilty by reason of insanity' even though he attempted to plead guilty- that mug shot got him a legal guardian who was a family member that 'fought for him', just did not respect his wishes. He landed in the facility on a technicality after a pretty substantial suicide attempt when the local mental health wards of the hospitals did not know how to 'manage' someone with his background, and the way in which he tried to end his suffering. They felt it best to send him to hell for a week rather than give him a few days of compassion. The details of his record were sealed so anywhere he went, staff say that shiny, wide eyed, bloody mug shot and a few sentences of legal jargon. David, and people like him are what helps people who work in forensic mental health to keep going.
Last was Captain, who I honestly thought was going to be a bit more or less than what he was. He was about 50 and had a strange yet striking appearance. He believed that he was a notable surgeon and King of a small country off the coast of North Korea. All of his assets and family were being kept from him because on travel to America one summer, he needed medical attention and received subpar treatment for anyone, let alone a surgeon and King. In an effort to help others, he wrote to the government officials about the low standards of health care in the country and requested a meeting to make changes. He maintained that when the meeting was established the group with him did a tour of one of the local hospitals that he, himself actually owned- when he demanded the institution be immediately closed for an overhaul of practices, big pharma intervened and he was deemed mentally ill and held against his will in his own facility. He was difficult to speak to, and used a lot of 'word salad' but there was nothing in his charting that showed he had been on any medications for years. He claimed he was banned from using the medical system in our country and that it was being used as a means of keeping him quiet to maintain political stability. I would not say he was a hostile person, but if anyone ever needed to be on Xanax, this was the guy. Vic asked him at intake if there was anything else he could do for him- the normal nicety you say to someone leaving your care and going into another’s... Captain took him up on it and asked him to dictate a letter, Jon gave the go ahead for this to happen as he was waiting for intake and for two years everyone talked about the forty page letter scribed over the course of hours in a holding area by a newby. I never read the whole letter, but what I did see made his desire to be called Captain pretty evident.
Fourteen people spent the day together - close to 10 hours in total from the time of meeting in a parking lot. Four got to go home.