September 2011
The smell of fall was like warm rain in the woods. I strode through fluttering gold leaves and waved to inmates dressed in prison-issue khaki uniforms, enjoying a perfect autumn morning. They were on yard detail, hacking at ivy clinging to the razor wire which circled the prison. Uniformed officers stood over them, hands at their holsters.
No matter what their crimes, in the few weeks I had worked in the unit, I had begun to see their humanity and felt a kind of sympathy for them. The barbaric ice baths, insulin shock, and lobotomies my predecessors had once performed on these very grounds still caused me to shudder. I lifted my face to the sun and breathed deeply, enjoying the last warm days before the Minnesota winter swept in once again.
In the late 1800s, patients had worked on the land, growing vegetables, which were preserved in a system of neighboring caves. The food from their labor fed the old state hospital population through the long winters. The grounds now housed the modern Rochester Forensic Center, where I was the newest psychiatrist.
Corrections Officer Bud Anderson fell into step with me halfway to the entrance. At the time, Bud Anderson was forty-three years old, over six feet tall, and as large and gray-headed as a buzzard with a crew cut. “Morning, Doc. What a day, huh?”
I had heard through the prison grapevine he was having marital problems. Word was he had a core made of iron and a life mortgaged to the hilt. He also had a limb length discrepancy resulting from an injury during his service and wore an orthotic shoe with a lift. Even so, his gait was brisk and measured.
“So, how ya doin’ Grace?” Anderson asked with a familiarity that set me on edge. He smiled, showing a space the size of a small stream through his front teeth.
I hadn’t had time that morning for anything but a slash of lip-gloss and a coat of brown mascara over my nearly invisible lashes. A long lock of coppery hair slipped out from behind my ear. I felt as exposed under his scrutiny as if he’d unzipped my skirt and laid bare all the fears and insecurities I had had since Matt died. “It’s a beauty, officer,” I said, my eyes drawn to the inmates.
He swaggered through the lot and turned to ask me if I’d care to go out for lunch. I stared ahead, pretending not to notice the narrowing of his eyes and told him I was busy. The look he gave me was brief but I got a glimpse of something dark. To my relief, we reached security before any more could be said. I clipped the heavy key ring the officer at the station issued me to my belt and fled to my office.
The jangling of the keys and the sound of my heels clicking along the cold tiled floor only added to the din in the halls. The smell of disinfectant hovered in the air. I unlocked my door and closed it to the chaos of the psychiatric unit and leaned against the door. I closed my eyes, and for the second time that day, thought of Matt.
Before my husband’s death, I couldn’t have imagined my patients would be a volatile mix of inmates incarcerated for everything from narcotics to murder. Many were living out sentences here and some were deemed incompetent to stand trial, while others had been transferred from prisons around the country for medical or psychiatric care.
Shortly after he died, I gathered the strength that remained and moved to Rochester. The new job in the forensic center was initially bearable only because I had evenings and weekends free for the children. During my days in private practice, Matt had often been both mother and father to the children. But now I needed this 7:30 a.m. to four o’clock job and the mothering hours it provided.
Beep beep beep … Beep beep beep … “Paging Dr. Grace Rendeau. Dr. Rendeau please report to the dayroom in Psych West, stat.” The sound of the nurse’s page echoed through the building.
Jarred into action by the page and the beeper vibrating at my hip, I raced to the dayroom and then stopped stock-still to see two officers restraining my new patient. Emanuel Venegas struggled, his muscles bulging underneath his olive shirt. Blood splattered the walls like a Rorschach. Larry Reynolds, another inmate who had been escorted to the prison by US Air Marshals the previous day, held an icepack to his face and cursed Emanuel. The ebb and flow of aggression in the unit was still new and disturbing to me. Uniformed officers swarmed the dayroom, reminding me of a scene from A Clockwork Orange, and my heart beat like a caged bird. As tough as I tried to appear, the continual rage that spilled over on the unit still had the power to upset me.
Warren Hutchings, R.N., a balding, twelve-year veteran of the unit and the size of a minivan, stood in a wide-legged stance. “I gave ’em their meds and as soon as I turned my back, Emanuel punched him in the face. I heard the sound of cracking and turned to see blood spurting out of Reynolds’s nose. Then they were on the floor rolling, both of ’em throwing punches.”
What a way to start the day. “Emanuel, I’m going to have to put you in the hole. You know the rules. Please escort Mr. Venegas to solitary,” I instructed Officer Anderson.
Bud was as firmly in command of the situation as a colonel in charge of an offensive. He clamped cuffs on Emanuel’s wrists. “Please escort him to security?” He stifled a laugh. “You’re barking up the wrong tree if you think that’s gonna work around here. Around here, we say, ‘throw him in the hole.’ You’ve gotta learn to toughen up if you wanna survive in this place, Doc.”
I despised the smugness with which he expressed his opinions and pulled myself up to my full five feet, eight-inch height. “I’m as capable as anyone else of working here. I’m not going to dehumanize my patients on your advice, officer.” So much for having my back. Hutchings handed me a pair of sterile gloves. “Mr. Reynolds, are you okay? Let me take a look at your nose.”
Blood dripped from his nostrils and pooled on the floor. “I’m okay, Doc. Just get me outta here. I don’t wanna be anywhere near that lunatic.” He spit out a mouthful of blood, neatly missing my foot.
“I’m going to have to send you for x-rays. Mr. Hutchings, will you arrange for transport to the ER please?” I should’ve said, “Get him to the ER STAT,” but it was too late. “And get the hazard team to clean up.”
“Yeah, no problem,” Hutchings said, opening a wad of sterile bandages. “Hold these to your nose, man.”
I peeled off the gloves, washed my hands and went to the hole–a seclusion room devoid of everything but a sink, urinal, and a thin mattress on the floor. Emanuel rocked rhythmically in a corner of his cell, with his knees drawn to his chest and his arms clenched around his shins. Despair oozed from his pores. Thin morning light sifted in from the barred windows, illuminating thick, wormy veins protruding from his hands. He reached his arms toward the window, apparently hallucinating.
The smell of animal fear hovered in the air. “Emanuel, it’s Dr. Rendeau. Can you hear me?” I lay my hand on his shoulder and he began to weep. The staff’s mission was to staunch the flow of memories, prescribe antipsychotics and occasionally electroconvulsive shock therapy for the severely depressed. But for some patients, time was the only recourse. I asked if he would be willing to take his meds, and he looked at me without recognition.
Risperdol by mouth was what I had decided. If he refused, we’d have to give it to him by injection. He was obviously a danger to others on the unit, possibly even to himself. Hutchings agreed and said he might need some help giving it to him. I did not want a repeat of the earlier scene in the dayroom or to have the team called again unless it was absolutely necessary.
The patient pushed a long, shaggy strand of hair out of his eyes and nodded, almost imperceptibly. He looked like a man buried under an avalanche of pain but somehow still breathing. I waited until the medication subdued him to leave the room.
Before returning to my office, I looked once more through the peephole and watched in horror as Emanuel rose in a frenzy and tore the fabric of his mattress. I was shaking as I pressed a code into my beeper. Within moments, the team barged in, military-style, wearing black facemasks. They took him down, and I witnessed the degradation of a human being sunk to his lowest level.
Emanuel glowered at me. His despair drew him into a dark place far removed from the unit. I ordered him to be restrained and placed under constant observation in order to protect himself, and injected him with four mg of Risperdol–the beginning of a ritual that would repeat itself every four hours.
“Mr. Reynolds, please let me know immediately if there are any changes. I’ll see if I can get Josie Garrett to talk to him. Once he’s out of restraints, he might open up more to someone who speaks Spanish.”
Afterwards, I escaped to the relative calm of my office and sat at my desk, my head cradled in my hands. I had begun to realize working with psychotic inmates was not like my previous psychotherapy with the worried well. Most of my new patients had a very tenuous grasp on reality. If and when they were well enough to begin psychotherapy, it often began with angry protestations of innocence. Paranoid delusions about someone who was out to get them and anger at the raw deal they believed they had gotten followed.
My head throbbed. Still trembling from the scene in the seclusion room, I dug an Aleve tablet out of my purse and sipped cold coffee from a lipstick-stained styrofoam cup. My calendar lay on my desk, Dane’s Little League game, highlighted in neon green. I closed my eyes and rubbed both temples. The children and the demands of my days with mentally ill inmates left little time for anything else. If I were lucky, I would find time to fit in a yoga class on the weekend.
The next morning, a band of sunlight sliced through my bedroom window. Jagged lights and a tingling in my right cheek signaled a migraine. I squeezed my eyes tight and gulped an Imitrex from my night table before stumbling to the bathroom.
There was a mandatory inspection at the forensic unit scheduled that day. I trawled through my drawers, with one hand on my forehead, and found a pair of pantyhose without a run. I then rummaged through the closet and found an ironed linen jacket and skirt. I prayed the AC at the prison was working.
The pain began to dissipate, and I mentally viewed the plan for the day. Make breakfast, drop the kids at school, inspection at work, come home, prepare dinner, help with homework, drive the kids to soccer and tee ball, and then baths and bed. I called Caleigh to hurry on my way downstairs. I didn’t want to be late.
The sound and smell of coffee perking was as encouraging as a pep squad. Five-year-old Dane sat sleepy-eyed at the table. “Can I have pancakes, Mom?” he lisped. His tongue poked through a checkerboard smile where his two front teeth had fallen out. He had freckled skin and copper-colored hair, similar to mine.
“Sweetie, we don’t have time for pancakes. What kind of cereal do you want?” I gave him two choices knowing if it were more, I would be late for work.
“Caleigh? Hurry, honey. I can’t be late today!” I called up the stairs again with a tight, fixed smile and then poured two bowls of cereal and a cup of coffee. My superficial temporal artery pulsed under my fingertips, and, still being an anatomy nerd, I was pleased I remembered its name.
The sound of thirteen-year-old Caleigh clomping down the stairs in wedge heels reverberated through the old house. She dropped her backpack onto the kitchen’s wide oak planks. “What’s the hurry, Mom?” Caleigh was fine-boned and delicate with soft, blond waves. Her eyes were ringed like a badger’s. I would have had her wash off the thick black liner if I weren’t in such a hurry.
Between Caleigh’s adolescent mood swings, the new job, and the constant rush, I ran like an old pair of shoes, wearing away at the edges. “Come on. You know I have an inspection at work today.” I poured my coffee into the travel mug. “We need to get out of here now.”
The children were quiet and crabby. Dane sat in the backseat with his stegosaurus backpack beside him. I looked at him in the rearview mirror and wished for the thousandth time Matt were here.
The school was twenty minutes away with no traffic. “Have a good day!” I called as Dane climbed out of the car and slung his backpack over his shoulder. “Carry it on both shoulders, sweetie!” He splashed in every puddle on the sidewalk on his way to the entrance. “Bye, Mom!” he turned and yelled, before merging into a throng of children weighed down with backpacks like brightly colored turtle shells. “See you at the game!”
I drove the few blocks to Kellogg Middle School, thinking about the inspection and what it might mean for my career. Hidden somewhere in the corridors of my busy life was a woman who wasn’t always rushing.
“Just leave me off. I can walk from here.” Caleigh smeared on lip-gloss and was out the door.
Sunlight glinted off the car in front of me, directly into my eyes. “Are you sure, honey?” I hated to admit how relieved I was not to have to wait in the line of cars circling around the entrance of the school. I dug in my purse for my sunglasses.
“Yup. See ya, Mom.” Caleigh hiked up her skirt and ran her hand through her hair.
The sharp, hammering pain in my temples finally settled behind my right eye and became a mere thud as I drove the short distance to work. I was worried about Caleigh. Ever since Matt died, she had been as angry as a hornet. Dane, who was three when his father died, barely seemed to remember Matt. This, in turn, infuriated Caleigh, who took every opportunity to tell me how differently “Daddy would do things.”