Thursday, July 28, 2016

In The Maws of Mania

It may have been the most interesting moment in a long, and not very distinguished, nursing career.

That, of course, depends on how you define it: certainly when I was working on B6 / 5, I could legitimately call myself a nurse. But what about that month or so in which I helped my mother die? In that period, I drifted back and forth from being a son to being a nurse, and if I had had the experience a few decades earlier, I might still be a nurse, now.

There’s something special about it. Doctors make more money and earn more respect, but nurses are, I think, more loved and trusted. They’re there when doctors are not: in the middle of the night, in the middle of a crisis, and also—just as importantly—in those moments of triumph.

A friend in the ICU told me the following story. She had been shopping at the grocery store, and all was normal. Suddenly, however, a man rushed up to speak to her.

“Who are you,” he demanded. “How do I know you?”

She had no idea who he was, and was a little frightened by the intensity with which the man spoke.

“I know I know you,” said the man. “I heard your voice, talking to your child, and I told my wife: I know that woman! I know her voice! Who are you? What do you do? How do I know you?”

My friend—guardedly—told him her first name. Then she told him she was a nurse.

“What hospital?”

“UW,” she said, since everybody in Madison, Wisconsin, knows that UW is the university teaching hospital.

And also the tertiary medical center, which means that the worst, the most mysterious, the most intractable cases end up there.

“Where in UW hospital,” asked the man.

“The trauma center,” she said.

“I was there last year,” he told her. “I spent three months there, but I don’t remember a thing about it. I think I blocked it out, but all I can remember is the other ward that they transferred me to. So I don’t think I know you from there. But damn, I know I know you!”

His wife had now joined him, and my friend felt more safe. And just then, the two women stared at each other: my friend had no idea who the man was, but the woman certainly looked familiar.

“Good God, you’re not Joan, are you?” the wife asked.


“And you work the PM shift?”


“You took care of Bill for two months, do you remember that?”


Joan looked at the face, which she had last seen puffy, ashen, and filled with tubes. And then she remembered.


And then they were hugging, right there in the frozen food aisle, and she was telling him that she remembered: she had nursed him for two months, each day keeping up a running monologue with him.

“I used to tell you, ‘Hey, Bill, don’t give up on me now! You got a beautiful wife and gorgeous kids, and they need you, Bill. Bill? I know you’re in there….’”

Bill stabilized. The doctors made the decision: it was time to try to wean Bill off the respirator. It was successful, and it was becoming clearer: Bill was very likely going to make it. That’s when Joan, my friend, went on a two-week vacation.

She came back: Bill was gone. He had been transferred to another unit.

The point?

Bill had never spoken a word in his life to Joan. Much of the time, he probably couldn’t even see her. His brain was twisted with pain and drugs. His only connection to Joan had been her voice. And hearing it again, after a year’s time, had sent him on a frantic search to find her, to reconnect.

“I will never, ever, ever not speak to a patient again,” Joan told me. “It was one of the most powerful moments of my life. We just stood there holding each other, and looking into each other’s eye, and we didn’t want to say goodbye. So we traded numbers, and we never called, but that didn’t matter. Somehow, knowing that we had each other’s number was all the connection we needed…..”

Nurses have that.


Not so much….

I tell you this because I am checking Facebook, to find out how an old, old friend is doing. She’s a nurse, but also a patient, since she has bipolar 2-hypomania. And she is also, she tells me, rapid cycling, and I know, if not first-hand maybe first-and-a-half hand about rapid cycling. And I knew because of a very difficult patient on the psychiatry unit, B6 / 5.

She was a patient of Dr. James Jefferson, which almost guaranteed that she would be difficult. Because Jefferson had quite literally wrote the book on lithium: he was the heaviest gun on the faculty, and he did not take patients.


Jefferson was either consulting or giving keynote speeches or appear on Oprah or just being Jefferson. But Jefferson had long since done anything so mundane as see a patient. So the fact that he was seeing this patient meant two things: she was interesting clinically, and she had the social / financial clout to get the best.

Probably the last nurse to be of high social status was Florence Nightingale: we are not, generally, pulled from the top drawer. And so this patient was somewhat disliked, since it was hard, somehow, to read that her ski trip in Gstaad had had to be curtailed due to a manic episode. Or that she had called Bill Clinton, at a White House dinner, a polecat….

And she was a rapid-cycler. And so she had gone off her lithium, and gone manic, and then been hospitalized. Then, she had stabilized, which everybody but she appreciated.

Anybody who has taken the moving sidewalks at O’Hare airport has had a glimpse of what hypomanic feels like. Because there you are, sprinting past everybody else trudging along, and you are spending just as much energy and getting there twice as fast. Whee! Life is good!

Indeed it is—everybody would love to be hypomanic. But this woman went way past hypomanic into full-blown mania, which was not so fun.

“There are people with knives just behind me,” she whispered to me, after she returned from her 48-hour pass. “So we have to keep moving! Quick, and whatever you do, don’t look back….”

She had been completely normal when she left. She had stopped her lithium. Two days later, she was hallucinating and delusion.

Well, I gave her her lithium. I called the great Dr. Jefferson. And then, we started walking the halls. I began to orient her: pulling her back to reality. It was simple, really: if she was on a distant planet, I would point out the guard rails of the hospital. If she was flying a magic carpet, I would make her look at her feet. We walked, we walked, and then, forty-five minutes later, she began to clear.

In two hours, she was speaking calmly, brushing her teeth, thanking me for taking care of her, and getting ready for bed.

Perhaps you know—manics don’t sleep….

So now, via Facebook, my old friend tells me: she is rapid cycling. And she never has before. Oh, and the last major breakdown was ten years ago. And so I am messaging her, and tell her to call me, and now—having spent an hour and a half writing this—the communication has gone cold.

Or rather, it’s not. She’s just written to say that she has never rapid cycled from depression to mania as has in the last two days. So she’s at home, since she’s too anxious to work. Oh, and also can’t focus.

It’s odd, how nothing much seems to have changed. There’s still stigma, there’s still shame. I read it behind her words: an old friend of ours is in Madison from out of town, but she isn’t sure she can see him. She might, she worries, just break down and cry.

It would be the best thing, of course. But welcome to the worst facet of mental illness: at that moment when you most need human contact, when you really, really, should break down and cry in an old friend’s arms, what happens?

You withdraw.

Or so you think.

I know now. You didn’t withdraw: the disease has isolated you.