Minds apart

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By Roman Carlo R. Loveria

Author’s note: All of the patients’ names cited were changed to protect privacy.

The sun shines fitfully, signalling the coming of noon.  Around an old rubber tree shrouded in its own vines and branches, the deranged and worried gather on cracked concrete benches.  One man has no idea why he has to be restrained by five people from the barangay office.  Another, a woman, seems at home with the meaningless wails from the various wards.  And another one sits stone-still, bargaining with the cop next to him to loosen a pair of handcuffs on his wrists.
But alongside the mingled chatter for deathly silence of the mentally ill, mothers, siblings, and other visitors watch with baffled eyes as kin and friend are engulfed by a mysterious pair of doors.  Some ask for mercy from the white-clad hospital personnel, but this is the Psychiatric Emergency Room (ER) of the National Center for Mental Health (NCMH), where patients cannot be allowed to consummate their rage, and there can be no room for error.  Not a day passes when the emergency room does not welcome the ill but unwilling to seek remedy.
The wall clock said it was 9:50 in the morning when 42-year-old Vincent came through the stainless steel doors.  He had a staccato pace to his steps, typical of a man of his age.  “I just want to give my papers to the social worker,” he told a nurse’s aide who was standing by the door.  Clad in a pair of khaki trousers, a worn-out shirt with red and white stripes, and a pair of thinning rubber slippers, Vincent had all the trappings of a man from the province.  Although his hair was still black with a sheen of sweat, his bronze face already had oily wrinkles.  Only his narrow eyes retained their carefree calm from younger years.
Since the social worker was not yet around, Vincent stood by the waist-high L-shaped desk that occupied a quarter of the dimly lit room.  Somehow, the Freon-treated air of the ER put Vincent at ease from the rising temperature outside.  But protocol could not allow him to stay in that position for long.  A burly security guard, Alfred De Leon, and a nurse attendant walked through the metal doors, toward Vincent and said, “You have to lie down on the bed now.”  The two men were now standing near the new arrival.  At first, Vincent’s voice was begging, and then, his hands turned into fists that he raised below his chin as the attendant tried to pacify him by holding onto his elbow.
Suddenly, there came a fire into Vincent’s eyes as he started screaming in Filipino, “I don’t want to lie down!”  Over and over again he yelled, all the while sticking his elbows out and wiggling his body as the two men closed in on him.  But the security guard was quick to put one arm around the unwilling rebel’s neck and a hand to the back of Vincent’s head.  A third man was immediately called to help restrain the disturbed man.  Nurse Julius Cheong came to the guard and attendant’s aid, and with a few yards of cloth-straps, he was quick to tie Vincent’s wrists together.  Though having mustered all the inhuman strength that fear and anger could grant him, Vincent was clearly no match against the fully-cinched headlock.  Soon, Vincent’s legs gave way beneath him; warm piss ran down his pants, his face paled to a deathly white, and his eyes rolled to the back of his head.  The experienced guard immediately released the lock, so the patient was merely reduced to a weakened daze.  The guard shifted to holding Vincent’s shoulders, the attendant took the man by the ankles, while Cheong kept the hands pinned.  Together, they lifted Vincent and took him to the adjacent observation room and tied him to one of the four beds.  In a supine position, Vincent’s legs were tied to the lower posts of the bed while his right arm was tied to the right side of the bed, and his left arm was tied to the upper railing of the bed.  After this, Nurse Cheong, the security guard, and attendant Emerson Aurora left the patient to Junior Intern Sharon Bayong, who started checking Vincent’s blood pressure.  The sphygmomanometer told Bayong that Vincent’s heart was working at a taut 150 over 110, a far cry from the normal 110 over 80.
Right after what seemed to be a regular dose of action, Cheong set-up his laptop on the L-shaped reception desk.  A few moments later, the cold and tight air of the room was filled with the voice of a singer asking, “Why do birds suddenly appear?”
Just then, Dr. Reginald Afroilan, head of the ER, walked through the backdoor for his daily rounds; Cheong immediately informed him of what just happened then handed him the patient’s papers.  The petite Bayong quickly told Afroilan about the patient’s high blood pressure, but the stout and dark consultant nonchalantly replied, “He just got choked.”
An hour later, an attendant from another ward came through the backdoor looking for the newly admitted patient.  Looking at a sheet of paper in his hand, the attendant asked for Vincent in a raspy voice.  After being led to Vincent’s bedside, the attendant looked at his paper once more and said, “Your record says you were born on September 26.  Well, happy birthday!”  And Cheong’s laptop crooned on.
Directly to Vincent’s right, a woman with skin of burnished gold lay without restraints on her hands or legs.  She slept soundlessly, and did not even open an eye with all the noise that Vincent had stirred earlier.  Earlier that morning, the much calmer visitor came in.  Ana was endlessly talkative, had kinky black hair, and a rumoured gift for seeing into people’s futures, but was nonetheless diagnosed with schizophrenia.   She came early that Wednesday morning for her routine check-up.  Classified by the hospital as an outpatient, she regularly came in for consultation with her psychiatrist, but her condition does not merit the usual hospital admission.  Always fired-up for conversation, Ana has a hard time keeping her body and mouth still.
Wearing the simple blouse of a typical Filipina homemaker, she strutted about the ER with an air of familiarity.  Exchanging jokes with attendants and nurses through her signature routine of palm-reading, Ana pushes the envelope of ER policy.  A patient, by rule, should stay on one of the observation beds, but Ana is too restless for that.  And besides, she possesses an air of sanity that subtly coats her mental illness.
“Your girlfriend was raised in a wealthy family.  If you can’t satisfy her material wishes, she’ll look for another man,” Ana said to Cheong, who smiled and said, “Really?”  And, true to her illness, Ana could not decipher the subtle cue for her to clam up.  She continued to read faces and hands, then set her eyes on the sceptical Bayong.  Ana looked at the clerk with furrowed brows and said, “You are dominating your boyfriend,” but the medical student, who was understandably unimpressed, simply raised a brow and cocked a smile.
A few more minutes passed, before Emerson sternly told Ana to lie down in bed.  Her hands and legs were not bound to the bed, since there seemed to be no need to do so.  Bayong followed Ana to her bedside inside the observation room to take her blood pressure.  After the long hiss of the sphygmomanometer’s deflating cuff, Bayong brought her head closer to Ana’s, then asked in a low voice, “Is he cheating on me?”

While in other hospitals, relatives are only too eager to keep watch over their patients, people who bring their charges to the NCMH are, more often than not, inclined only to help their patients “check in.”  Afterwards, relatives, or whoever brought patients in, would make a run for it.  And the hospital can only cower at the number of its “orphaned” wards.  So as a precautionary measure, right after any patient is restrained or gets settled into a bed, a relative is called in to keep watch.  A patient’s companion then serves as an insurance policy for the hospital: a deterrent for deserters.
Who would not want to leave their mentally ill at the NCMH?  A patient practically gets a home for the duration of his treatment, relatives would no longer have to worry about embarrassing themselves in front of their neighbours, and the mentally “sane” in the family could ultimately go back to their normal and happy lives.  But the sad thing is, as Emerson relates, “Sometimes, the parents actually make the decision to leave their children here.  Even worse are instances when relatives claim that their patient is a severe nuisance or hazard back home, just to get their patient admitted.”
When the NCMH first opened on December 17, 1928 in accordance with law, it did not have an emergency room for psychiatric patients.  Taking on the role of primary refuge for disturbed patients was the Outpatient Section (OPS) of the hospital.  But because of long lines and the inability of the OPS to accommodate patients outside regular working hours and during breaks, a wholly different service was required.
Somewhat an anachronistic appendage to Pavilion 2 (the technical designation of the OPS building), the ER stands out for its stainless steel doors that sit almost side by side with the Pavilion’s welcoming beige steel grills.
Upon entering the metal doors of the ER, one would immediately be treated to a good belching of cold air: something uncharacteristic of wards in the NCMH.  But nonetheless, as is common in most of the enclosed areas in the hospital, a signature ambiance pervades the space: a chiaroscuro courtesy of dim fluorescent lamps. Directly in front is a waist-high, L-shaped desk that creates another patch of square floor space, behind which the ER’s personnel keep their records.  And it also doubles as a sort of pulpit from which residents and consultants preach the guidelines of admission to a patient’s relatives.
To the left is an observation room where patients stay for a consultant’s assessment, and where their probable fates—to stay as a guest in any one of the hospital’s in-patient services or to remain an outpatient of the NCMH—is ultimately decided.  The observation room was supposed to handle five patients, but because of one broken bed that a patient decommissioned by pulling at his restraints, there are currently only four beds for the job.

Nurses and attendants in the Psychiatric ER work in three eight-hour shifts: the first works from seven in the morning to 3 p.m., the second stays from three to eleven in the evening, and the third grapples with the darkness from eleven in the evening up to 7 a.m. the next day.
Asked what their own parents and relatives think about their action-packed occupation, nurses and attendants commonly shrug off the question since they opt not to talk about their jobs with the people they care about.  Nurse Glen Francis Garcia, who has been keeping his post for a measly one year and four months, has learned to keep mum about his work.  “I don’t tell my parents what happens here,” he admitted.  An older hand, Emerson Aurora, with eleven years under his belt related that, “A patient landed a punch on my face once, but I couldn’t fight back.  All I could do was to restrain him.  Now that’s something you wouldn’t like to tell your wife, would you?”
Nurses and personnel in other hospitals are sometimes accused of not giving proper attention to patients for different reasons, and one of them is laziness.  But in a psychiatric ER, there is little room for sleepyheads.  So to stay awake, jokes are to go around frequently, and music is allowed to infect the air.  Patients can come in meek as infants and, in a flash, unleash blind fury that knows no family or stranger.  So nurses and attendants have to keep their quick reflexes alive all the time, just enough to pin and restrain a raging man or woman.
And to make things a tad more complicated, restraining patients is not their only duty.  As Aurora said, “Before a berserk patient ever lays a finger on a doctor, or some other hospital staff, they’ll have to come through us attendants first.”

But patients’ relatives usually get the harder part of the whole shebang.  One patient, who arrived at 10:30 in the morning, came in sober but with handcuffs on him.  Simon, clad in a pair of denim shorts and a white shirt, allowed himself to be restrained in bed, but the attendants remained cautious as he was eerily silent and stared blankly into space.
Unresponsive even to his own name, Simon coldly complied with the hospital personnel.  Right after the clerk took his blood pressure and palpated his balloon-like stomach for organic pathologies, Simon’s mother approached her son.  She stood by his bed side with a crestfallen look on her wrinkled and sunburnt face, since this was the sixth time that she had accompanied her only child to NCMH.  But just as the mother laid a hand on her son’s forehead, Simon yelled, “Get out!”  This did not shock the mother, now close to tears, who trudged out of the observation room and then sat on one of the benches.
“He wasn’t always like that,” the mother said about Simon, who had already done time in the NCMH before.  But when Simon stopped taking his medication, he began talking again in the unintelligible tongue of the mentally ill.  “He would cuss and swear but he never did any harm to himself or our neighbors,” said the mother.  However, that morning, Simon lashed at his mother with a knife, and sliced a cut on her right palm.  Raising a bandaged right hand to her mouth, she said, “When he stopped going to church, it was then that we noticed that his illness came out again.”
Other patients got themselves a ticket into the NCMH for their own antics that got onto their relatives’ nerves.  For Vincent’s family, they decided to bring their breadwinner to the Psychiatric ward when he started collecting garbage.  It would not have been much of a problem that Vincent worked for a cleaner environment, but then, he had the habit of bringing collected refuse into the house.  Added to this, Vincent’s records say that he was an Associate Marine Engineer.
For the likes of Ana, it was just her loud mouth that got her into trouble.  She even admitted, “My husband denied anything to do with me!”  But this did not stop her from caring for her mother.  When the attendants got her to lie down on one of the beds, she quickly drew out her wallet and said, “Please give this to my mother.  She might not have anything to eat for lunch.”  And when she arrived that morning, Ana had with her a one-and-a-half foot wide bilao of rice cakes, for the attendants and her consulting physician.
Working with the mentally ill may be too taxing for many, especially for relatives.  But it seems that the fear associated with caring for these people is just a result of a misinformed public.  As one nurse said, “Working with them helped me to understand them better.”

Montage Vol. 11 • September 2008