a well-known pancake eater

I wanted to clarify some things I said in yesterday’s post.  I may have been a bit too

breezy talking about sex addicts and too dismissive about other psych patients.  I

haven’t worked with sex addicts since 1994.  At that time, there was much debate

in the mental health community about whether or not it was a true addiction.

Advocates for that model argued that the endorphins released during an orgasm

qualified as the payoff because they resemble opiates.

I don’t know what prevailing thought on it is these days.  I do know that these folks

were in some real psychic pain.  Nearly all of them had been sexually abused as kids

or teenagers.  They diligently worked on their 12-step programs.  Many of the group

sessions were gut-wrenching.  One patient, at the end of the 28-day stay, said, “if I’d

known how rough it was going to be, I would’ve rather eaten a bucket of shit.”

One of the patients was admitted shortly before he and his partner were to leave on

the vacation of  a lifetime.  He lost a lot of money doing that, but felt that he simply

couldn’t continue with the elaborate deceptions he had set up.  Another patient

came in on Father’s Day, which dredged up a lot of guilt for him.  Yet another chose

to use the structure of the program to also give up smoking.  He had the whitiest

knuckles I’ve ever seen.

The patients I worked with on other units were generally not as motivated, but

they taught me just as much.  Many of them were the opposite of sex addicts: poor,

uneducated, left behind by mainstream culture.  They knew their life wasn’t likely

to get much better and they were angry.

But in that ocean of resentment there were islands of tenderness and humour.  One

of my favourite memories of psych work is of two old gentlemen, both with severe

Alzheimer’s, who were inseparable on the unit.  From a distance it looked they were

involved in deep, animated conversations.  But if you approached them, you rea-

lized that they were just babbling.

The funniest thing that ever happened to me on the job came when I was in the

room of a bipolar patient in his manic phase.  He had been medicated but he was

really fighting it.  He paced rapidly, repeatedly saying “Please don’t kill me!  Oh,

please don’t kill me!”  After an hour of this, I said “Ernie, don’t you think I would

have done it by now?”

He stopped abruptly, calmed down and said “You’ve got a point there.”

Working with patients in the lock-down unit was an education unto itself, posing

questions like how to put a pregnant woman into 5-point restraints.  This woman

was so floridly psychotic that she had to be kept isolated.  Sometimes she was so

violent that we had no option other than strapping her down.

Usually 4 points (wrist and ankle cuffs) were enough, but sometimes she thrashed

so much that we needed to use a waist restraint to protect the baby.  Problem was,

her waist was huge and we couldn’t put pressure on it, anyway.  So we had to strap

her legs and chest.  On her best days she was allowed to walk around in her locked

room. Once she peed near the door, pushed some of the urine under it and yelled

“Hey, my water broke!”

Another patient that spent a lot of time in restraints once called “Code Blue!” as we

were tying him down.  Often we could quiet him with an audio tape of his father

talking to him in soothing tones.  While one staff member with him in his room,

another staff right outside the door would play the tape: “Donald, it’s Dad.  I want

you to settle down.  I can’t come in right now, but I will soon.  Do what the staff

says.  I’ll see you soon.”

Donald’s eyes would grow wide and he would indeed settle down.

One of the most memorable patients I worked with was just in his 30’s but his mind

had already yielded to dementia.  We had to keep him separated from the rest of the

patients because of his bizarre behaviours like eating his own feces.  The day he left

the unit, strapped to a gurney, he said to me “You’re a well-known pancake eater.”

As the EMT’s wheeled him out the door, he added “although I can’t really prove it.”