Circe (7 page)

The group members trickled into the therapy room slowly. They sat down in the farthest corners, away from each other, that they could find. When Katie finally closed the door, there were no more than six patients present.

"Is this all?" I asked.

"This isn't the acute ward," Katie answered. "Most of the patients here have been here for years and there is no reason for them to care."

"Can't we give them some incentive to come? Six out of 43 patients are coming to group? That isn't even funny," I said.

"We try things all the time. The patients can't get grounds privileges unless they come. They won't leave unless they come. They don't care. They only have to come twice a week and we have it twice a day. A lot will put in the mandatory two, but many won't even do that."

 Katie stood up suddenly and closed the door to the group room. She slowly approached the group.

"Alright," she said. "Who remembers how we are supposed to sit in group?"

Mr. Fat raised his hand eagerly. "We’re all supposed to sit in a circle."

The other patients tried to ignore the suggestion. "Get up and move into a circle facing forward," Katie said in an almost military tone.

The patients obeyed her order with a series of noncommittal shuffles and half-assed attempts at moving chairs. In the end they weren't quite in a circle, but at least they weren't facing the corners.

"Okay," Katie began. "I'd like you all to meet Dr. Black. He's going to be watching the group for a few days and eventually he's going to take over, so let’s all show him how much we can get done. Who wants to start today?"

Mr. Fat's name was too appropriate. He was a caricature out of some Flannery O'Connor short story. I almost snickered when I realized who he was. Mr. Fat was morbidly obese on a level that is rarely seen in day-to-day life. His legs were so fat that cellulite puckers dripped off of his ankles, and even the bony parts of his skull bulged with excess weight. He smiled lazily at me across the room and pushed his glasses back onto his nose. Surprisingly, he was one of the most well-spoken patients in the chronic ward. His pathology wasn’t so easily seen as everyone else's.

"Well," Mr. Fat began slowly, with a drawl you could almost see dragging across the floor. "I've been good since I've been here. I've been following the rules and I think I should be able to go home now." Every syllable he uttered was slow and laden with the heaviness of his presence.

"Hmmmm," Katie responded thoughtfully. "What brought you here?" she asked.

"They said I was too fat."

"Is that the only reason you’re here?"

"I eat too much." He whined like a little girl when he talked.

"What does your treatment plan say?"

"It says I'm fat."

"I think it says more than that. You haven't noticed any other behaviors that you think need to be changed?"

"No."

"They wouldn't have put you in here for just being fat."

"They did."

"Let's ask the group. Maybe they can help. What does everyone else think? Is being fat the only reason that Mr. Fat is here?"

An emaciated man in a red leather jacket virtually leapt out of his chair and very rapidly said, "He's one crazy motherfucker."

"What does that mean, Mr. Nicca?" Katie asked.

"He's crazy fucked, man. Y’all seen him. He be nasty. He gets his food and eats until he barfs and then he keeps on eating. Nasty piece of shit."

"Fuck you," Mr. Fat said. His speech became less slow in his anger.

"So you’re saying that he eats his food, vomits on it, and continues eating?" I asked.

"And that ain't all that nasty fucker does. He be nasty."

"Let's focus on this one thing. Do you think it is healthy to eat your own vomit?" Katie asked Mr. Fat.

"They don't let me eat. They hate me. I'm hungry all the time."

"Do you think it is normal to eat your own vomit?"

"I don't know," Mr. Fat whimpered.

"Before you were here, at the institution, did you see other people eating their own vomit?"

"No."

"So do you think it's normal?"

"Probably not."

"Do you think this is something you might need to change before you leave?"

"Maybe."

"So, there is more than your being fat keeping you here?"

"Yes."

"How are you going to change this behavior?"

"I won't do it anymore."

"You can ask for seconds."

"I'll ask for seconds."

"What else is keeping you here?" Katie asked.

"I just wanna go home."

"Where would you go?"

"To my mamma's house."

"Your mamma has already said she doesn't want you living with her. Isn't that right?"

"I don't know why."

"So where would you go?" Katie asked again.

"My mamma loves me."

"Why doesn't your mamma want you at home?"

"I don't know."

"Think about it."

"She was trying to starve me. She was always with them, trying to starve me. It wasn't my fault."

"We've been over this a hundred times. I'm not asking about what your mamma did, I'm asking what you did. Why can't you go home?"

"I stabbed her."

"You don't think that is something you should work out before you go home? Is it normal to stab people because they take your toast away?"

"I reckon not."

"So why are you here?"

"Cause I hurt people when I get too mad."

"Right."

"I can't listen to 'em anymore. I just gotta say to myself they ain't real. No one is trying to steal the food."

"Very good. Now next time you come to group I want you to be able to tell me why you’re here the first time I ask, okay?"

"Okay."

"You’re making good progress. You know that, right?"

"Right."

Katie looked at the rest of the group. She smiled comfortably. "Who wants to go next?" No one answered this time. The group sat quietly, trying to avoid eye contact. "How about you, Mr. Nicca? You had a lot of goals last time we met. Do you remember any of them?"

"Fuck! I ain't crazy. Shit, I don't need no goals. You not helpin' me and I told you what the problem was."

"Stay focused....."

"You know they still be under my bed!"

"Who?" I asked, more out of curiosity than anything else.

"Them demons. Always after my student loans. I don't have 'em!"

"Try to stay focused," Katie said. "What are you supposed to do when you hear demons under your bed?"

"None of y’all care. None of y’all. You just be puttin' me in this room with all these crazy motherfuckers! That bastard over there," he pointed to Mr. Guiles, who sat quietly with his tongue hanging out. "Pees on my bed. Why do he gotta be peeing on my bed? He can go pee on his own. And he smells and I gotta sleep in the same room as him and y’all don't care. You don't care and they want the money. I tell 'em I don't got it...."

"Mr. Nicca," Katie almost yelled. "Stay focused. What are you supposed to do...."

"Fuck you bitch!" Mr. Nicca stood up and pushed his chair over violently. He spit twice on the floor and ran out of the room.

Mr. Nicca's file described him as a schizophrenic, paranoid type who was nonresponsive to medication. He had been in and out of a number of hospitals over the past five years and no treatment had lasted for long. He had been at Circe for more than two months, so they had to shuffle him over to the chronic ward, but as soon as the doctors found a medication he was even minutely responsive to he would be discharged to yet another group home.

The rest of the group members did not say much. Many of them didn't or couldn't say anything. The group went by slowly, with Katie constantly prodding the patients with numerous questions and sometimes demonstrating the things they were supposed to be doing, such as brushing their hair or eating. The group wasn’t quite as much fun after Mr. Nicca left.

After group, I did my interviews. This, too, proved to be an exercise in futility. I interviewed Mr. Benoit first. He was a fifty-year-old white male who had been transferred to our side two days ago. I had all of his evaluations from his old treatment team on the acute ward, but I had to write another report for our ward.

I went to his room alone to do the interview and found him in bed. It was almost 3:30 and he was sleeping like my wife in the morning. I tried to wake him verbally, but he did not respond. Finally, I had to shake him awake. When he did wake up, he regarded me without concern.

"Do you know who I am, Mr. Benoit?" I asked.

"Sure."

"Who do you think I am?"

"You're that girl's husband."

"I'm your new doctor. My name is Doctor Black. We have to sit and talk for a while, would you like to get out of bed and get dressed so we can talk?"

"No. I need to stay in the bed."

"Are you sure? You would probably be more comfortable if you were dressed." I couldn't tell by looking at him if he had anything on underneath the covers.

"No. I gotta stay in the bed."

I shrugged my shoulders and sat down in the chair next to the bed. "Do you know where you are?"

Mr. Benoit looked around him at the room and the beds. "I'm at Sal's."

I began taking notes as he spoke. "You're at a hospital. Do you understand that? You are in a hospital."

"Yeah, I remember now."

"Do you know why you are here?"

"Do you remember that time when Sal and them hitched that goat up to the house and went out to farm?"

"No. I don't know Sal. I'm Doctor Black."

"And then there was that dog when we were back in New York. What color was that dog? I can't remember. And then you shot it."

"Do you know what State you are in?"

"I'm in Louisiana."

"You're in Alabama." I said, taking more notes as quickly as I could.

"Do you know what day it is?"

"It's Christmas and we're taking Mary Easter Egg hunting...."

I couldn't really understand what he said after this, as his speech became garbled and frantic. I had to interrupt him after five minutes.

"Do you know who you are?"

"I'm John Benoit."

"Good. Do you know how old you are?"

"I'm 55."

"Good. Do you know who the president is?"

"Gandhi."

I held up my pencil. "Do you know what this is?"

"And then there was that time when...."

"Do you know what this is?" I asked again, attempting to interrupt him. I couldn't. He kept on talking in a never-ending stream of incomprehensible babble. His thoughts were barely linked together and he leapt from one story to another without any provocation. Finally, he stood up in midsentence and walked from his bed to the closet. He had nothing on except a filthy white t-shirt and he scratched his balls as he walked. When he got to the closet, he began putting on more t-shirts. He kept putting on shirts, doing nothing to cover his filthy genitals or shriveled ass.

"I think I have everything I need for today," I said as I left the room. Mr. Benoit didn't notice me leaving. He just kept on talking. I grabbed a mental health worker on the way out and told them to help Mr. Benoit get dressed. I made a note of their neglect in my report.

* * * *

I barely had time to finish my interviews by 4:30. I sat in Dr. Allen's office, hunched over her computer in the dark, like a gnome. She came in without a word or a smile and began putting paperwork in different files.

"Things went well today," I said.

"Ms. Gardner reports otherwise," she said dismissively.

"Ms. Gardner doesn't know what she's talking about."

Cassie turned and really looked at me. This was the first time I noticed that she might be attractive underneath her statuesque aloofness. Her eyes warmed a little and her lips parted, revealing chalk white teeth, like claws. "That's true," she responded.

She returned to her work and I returned to mine. For a while I felt satisfied that I had been right. "But," she said as she walked out the door, "truth doesn't always matter. You have to be a diplomat with the treatment team. Everyone on the team has to agree or nothing gets done." She slammed the door behind her.

"Then you should come to treatment team with me," I muttered under my breath.

Around 5:30 Andy and John showed up and waited for me to finish my paperwork. They were both patient with me, excited by their own experiences on the acute ward.

"I was impressed and frightened by the rapidness and efficiency of the entire unit," Andy said.

"I wonder if it's not too efficient," John responded.

"No lie, the turnover is incredible." Andy turned and looked at me. Almost forgetting that there had ever been any animosity between us. "We did three intakes each today. MMPIs, intake interviews, TATS, mental status exams on all of them. You should see the reports we are expected to write. And in the morning, for treatment team, the team puts the social worker's write-up on family resources and combines our report, with the psychiatrist's medical exam together and they make a decision on the fourth day. Can you believe that? Most people are referred someplace else in four days. It’s amazing, almost like a machine. The people that move on to the second floor are kept there for two weeks or four weeks max. Their medication is stabilized, referrals are made, and they are out the door. The days of
One Flew Over the Cuckoo's Nest
are gone."

"For better or worse," John said. "All praise to de-institutionalization and the ‘60s. I wonder if all of these people need to leave so quickly."

"I'm done," I said. "We can go."

"Dr. Allen must be a real slave driver," Andy said.

I smiled at Andy for the first time. "I guess so."

"We don't mind waiting for you, ya know?" she said. "Take your time if you have other stuff to do. We wouldn't want to get you in trouble with the witch."

"The witch?"

"Yeah, that's what they call her over on the other side."

I laughed. I couldn't help myself, and Andy and I laughed together. "You're not as tight-assed as you try to pretend to be," Andy said with an impish grin.

"Probably not, and you’re not half as annoying as you pretend."