Four North

By Marjorie Jones

Wednesday mornings from 10:00 to 11:00 am is always the most challenging hour of my week. It begins in front of a locked double door on the fourth floor of Downtown Hospital. Outside the door is a silver intercom unit with a gray button. The security camera to the right is enclosed in a thick glass bubble. I push the intercom button and wait for a response. "Can I help you?" inquires a pleasant, but no-nonsense voice. "Hi, it's Marjorie. I'm here for the group meeting," I speak into the intercom, but tilt my face toward the camera.

The door makes a slight, almost inaudible "click" and I open it. Then, across the small carpeted room to the next door. It, too, makes a slight click and soon I'm in a long, empty and silent corridor. The hallway contains a dozen doorways, mostly bedrooms with two beds each. Most of the patients here suffer from mental illness -- clinical depression, bi-polar disorder and schizophrenia the most common. They also have a history of alcoholism or other drug abuse. The staff refers to this section as "Four North"; its formal name is the Dual Diagnosis Crisis Intervention Unit. The normal "price of admission" to this unit is attempted suicide.

I enter the Group Room as the nurse on duty broadcasts, "Group time, everybody, group time," her voice echoing down the corridor. There's an assortment of well-worn chairs in the room forming a large circle around the perimeter. Some are plastic, some vinyl, and a couple are upholstered. The wall to the right is adorned with colorful paintings created during a previous day's art class. Some of the paintings are joyous, some angry. All are vividly colorful.

After six months of leading this meeting, I still feel inept and timid. As I wait for the group to arrive, the same thoughts and doubts enter my mind and cause my body to close in tight. I have no qualifications to be here, no insight into their problems, no special abilities that entitle me to take up their time. When I try to place myself in their situation, I know I wouldn't want to deal with some unknown woman without any counseling credentials. I'd want to stay in my bed with the covers over my head, hiding myself from the pain. If I talked to anyone, I'd want it to be someone with insight into why I did what I did, not just a person without a clue, a warm body.

We do have a bit in common, these compatriots of mine and I. Although personally agonizingly sane, mental illness has touched my life. My mother was definitely crazy; undiagnosed bi-polar disorder treated with Valium and Librium by the conspiratorial family doctor. My beloved sister fights the same demons. Addiction I know well, having had a long friendship with the fruit of the vine. But I've never fought the battles these folks have. I've never found myself living on the street, thrown out by my family. Never slept behind a dumpster, with only the voices in my head to keep me company. Never wanted to become a member of the wrist carvers' club. Never found life so terrible that death seemed an attractive alternative. Right before the meeting, I always feel both impotent and guilty of arrogance. How dare I think I have anything to offer these folks?

But then they begin filtering in and the question changes to, "How am I going to get them to talk?" They always come in alone, never in pairs or groups. Some wear hospital pajamas, others are dressed in nicely coordinated street clothes. Most are attired in mis-matched sweats culled from the box of donated clothes. I try to catch their eyes to see who may be interested in talking, or even in listening. There are tired eyes, angry eyes, eyes clouded over from medication, but also some interested eyes, inquisitive eyes, even occasional laughing eyes. As I begin the meeting, I try to make contact with each pair of eyes and smile each time I'm successful. I ask their name, introduce myself. This is done to draw them out. My only real directive is to encourage talk. Encourage talk that is positive, and focuses on good memories, good friends, and good choices.

I'd love to find a magic formula to make every meeting a successful encounter. But, each time is different. Patients are rarely there for longer than two weeks, and due to changes in medication are likely to be different people even if they do. Another variable is the dynamics among the patients. There might be anger simmering below the surface, or a genuine friendship forming.

Some meetings have been total failures. One or more folks will try to monopolize the time for their own purpose, either reciting a litany of their life's misfortunes, or explaining to the group why their brand of religion is the only legitimate choice. Then, there are other meetings where nobody is interested in talking. A few will offer a couple of sentences, giving me hope that something positive will begin. But then everyone will either fall asleep, stare into their laps, or shift uncomfortably in their seats, looking at their watches. It is these times that I feel the most anxious, wondering if I should just give up. But I never have. Instead, I continue talking, asking questions, trying to draw out the talk that is so important to recovery and self knowledge.

However, I've also been rewarded with an occasional amazingly successful hour. Those same folks who entered the door one-by-one connect emotionally with each other and then transform into a real support group. A sort of magic does seem at work. The meeting takes on a life of its own and my own role is reduced to observer. The realization that I was instrumental in the transformation brings me a true sense of satisfaction.

Although these magical successes are few and far between, the true duds are becoming rare as I gain experience and learn new skills. My "teachers" have been these compatriots of mine. They have taught me through their actions, words, and silences. I'd like to introduce you to some of them. These are only a handful of the dozens I've met, but each one touched me in some way. There's Robin, who told me that it was only through treatment for her self-destructive behavior that she learned compassion for others. James, young and sassy, who told a wonderful story of blowing one thousand dollars in two days. Evelyn, expressing heavy guilt for the death of her husband as a result of her drinking binge. Brian, who believes that his God has told him to stop eating because he's needed in heaven. And finally, Henry, the self-made millionaire who thought himself unworthy of his family's love and affection.

Robin

The first time I saw Robin, she immediately caught my attention as she perched, rather than sat, on the vinyl chair in the corner. Her shoulder length, bright red hair and deep red sweatshirt seemed to fit her name. The perching added nicely to the picture. Her face is extremely pale, with only a hint of freckles across her cheeks. For the first twenty minutes of the meeting, she didn't speak at all, but continually bounced lightly on her chair and jerked her head toward each speaker, listening intently. When she did speak, it wasn't to share a memory, but to keep others in line. "Tony, she said not to talk about your using. Didn't you hear?" "Venita, Debbie was asking for feedback, you're interrupting." She was direct, but pleasant, and no one took offense at her directives. It was a rather boisterous meeting and I welcomed her assistance at keeping order.

The hour was almost over when she announced, "This isn't on topic, but it's important to me. Before I went for treatment, I didn't care about anybody. As far as I was concerned, most people weren't worth my time. I wouldn't help anybody unless I thought there was something in it for me. But then, when I went for treatment, the therapist helped me learn more about myself. After that, I started caring about other people more. It taught me compassion. I swear that I never even understood the word before." When the meeting was over, she jumped down from the chair and walked over to me to shake my hand. "Thanks for coming. I really enjoyed the meeting."

The following week, Robin no longer perched in her chair, but sat in a straight backed chair and kept her feet on the floor. She explained that she is in constant pain from a back injury and the degree of pain determines her posture. She further explained, "My drug is PCP and has been for 15 years. PCP was originally used as an anesthetic until patients started jumping out of windows. It really messed up some doctors to see their patients jumping off the operating table and running for the windows. That's what happened to me, but it wasn't planned. I was at a party and there was a window with a balcony and one without. I thought I was walking out onto the balcony, but instead dropped three floors. My back has been in pain ever since and I take three methadone tablets a day. The treatment centers don't want me because of the methadone. The doctors here are trying other pain meds to see if something else will work. That way I can get into treatment."

The last time I saw Robin, she basically slept throughout the entire meeting. It didn't seem possible, but she was even more pale than before. She explained that the new pain meds were knocking her out. I so hope that she will find relief from her pain. I know I'll never forget her simple discovery that in gaining understanding of yourself, you gain compassion for others.

James

I didn't expect to hear anything from James. He'd come into the room, found himself a comfortable over-stuffed chair and promptly fell asleep. He slept quietly for the first 45 minutes of the meeting, no snoring, no falling out of the chair -- just curled up like a little boy in big chair taking a nap while the big folks talked. This didn't bother me; I'm used to some sleeping during the meeting. Many are on heavy meds or just exhausted from their ordeals. Besides, there were over ten others in the meeting and many were enthusiastic about sharing a good sober memory. We were having a wonderful time. The roomful of strangers had become easy with each other like old friends. 

As I started to move the group onto another topic, James woke up abruptly. "I have a good memory I want to share!" he announced, as he rubbed his eyes and put his feet on the floor. His whole body leaned forward, his hands clapped together with excitement and his eyes flashed with laughter as he started his tale.

"I had one thousand dollars in my pocket and what I wanted to do was score, but my girlfriend calls me up and says she's coming over. Now I was pissed cuz I didn't want to see her, I wanted to score. But she insisted and then just came over anyway. She told me that she was gonna help me spend that one thousand dollars and we was gonna have fun. And there wasn't gonna be no dope at all."

He was no longer the only one sitting forward; he had most of us sitting on the edge of our chairs. We could tell that this was the start of a good story.

"Well, first we went to the park with all the rides. You know, down in San Jose. We drove down there and rode every roller coaster they had. I was scared out of my mind. We even rode that drop down thing that makes you drop real fast. She wasn't scared, so I had to act real cool, but you know, I was shakin' inside."

James was a natural storyteller with a great story and his audience was loving every word. He took us with him and his girlfriend on a two-day spree of fun and games. On Pier 39, they hit the moles with the mallet, posed for a picture in Old West outfits and experienced an earthquake. At Union Square, they danced to the music of some street musicians and she talked him into buying her a leather jacket. They ate Dungeness crab and warm sourdough bread while listening to New Orleans jazz. And he spent the entire one thousand dollars.

When he finished his story, he was grinning from ear to ear, laughing at the memory. "Yeah, that was a fun time we had, me and my lady. I'm gonna git out of here in a few days and first thing, I'm gonna go tell her how much she means to me."

Evelyn

Dressed in a light blue gingham shirtwaist dress and beige flats, Evelyn looked like a grade school teacher. Her short wavy black and gray hair framed a pleasant, but no-nonsense expression. Her wrinkled caramel skin looked silky soft, and her clear light brown eyes showed intelligence and warmth. Her posture was perfect, and she looked very comfortable in her proud carriage and ramrod spine. If I hadn't already been conducting this meeting for a few months, I might have thought her there by mistake. Surely she didn't belong in this ward. But I was already over those misconceptions.

As others around the room shared their thoughts, troubles and joys, she clucked and tsk-tsked, smiling and frowning as the story warranted, totally engaged in each person's tale. She offered warm and homey advice, delivered as though she were a concerned and loving aunt. I marveled as the recipients of her affection smiled with contentment.

After I responded to a personal question, I found Evelyn's intelligent brown eyes drilling hard into mine. "Did you say your husband died? My husband also died. He died three days ago, while I was in here. If it wasn't for me, he'd still be alive."
The room itself seemed to cry out as everyone stared at her and gasped. The only one who didn't start fidgeting was Evelyn. She continued to sit straight with her head held erect, her clear intelligent eyes still strong. But large tears fell silently from those eyes as she continued.

"I decided that I wanted to die and I knew that if I drank enough vodka, I'd die. So, I started drinking on Thursday and kept drinking on through Sunday. When I started vomiting blood, my husband wanted to call the ambulance, but I told him 'No, don't. I won't go.' Finally, on Monday, when I couldn't stop vomiting blood, he called the ambulance anyway. He begged me to let them take me to the hospital. I finally said ok."

She said all this without drama, but in a matter-of-fact voice as though she were diagramming a sentence. The pain she felt came through only in the large continuous tears that now covered her face and the anguish that showed in her intelligent eyes. It occurred to me that never in my life have I actually seen eyes with such sorrow.

"My husband never drank, not at all. But he's old, like me, and has diabetes and heart trouble. While he was worrying about me laying in the bed those four days, he forgot to take his medicine. He died the day after they brought me here. They let me out for one day to take care of some of the funeral business. But they sent a nurse with me and made me come right back that night. My brother's taking care of the rest of the details. The funeral is tomorrow."

Around the room, sad and shocked faces looked down in disbelief. No one had known before now. She'd kept it quiet. Oblivious to the effect her words were having on everyone in the room, she continued speaking without drama or dramatic pauses.

"I wanted to die. But instead, I killed my husband. We were married for over 35 years. Only my death will stop the pain and guilt I feel. The doctors are worried that I'm still suicidal. But I've already done enough damage with what I did last time. I have to live with this pain."

After listening to Evelyn's story, I realized there was nothing I could say. Any attempt at consolation would be a useless exercise. So, I just murmured, "Oh, Evelyn, I'm so sorry." Looking into her eyes and holding her hands, her grief became mine as well.

Brian

The Wednesday meeting was not the first time I'd seen Brian. I remember seeing him at 40th and Telegraph, proclaiming his love for Jesus of Nazareth. He didn't appear to be homeless, as his clothes were neat and clean and his beard trimmed. But he definitely appeared to be living on the outskirts of society. He's a rather attractive man, tall, slender with blondish brown wavy hair and bright blue eyes. At the meeting, he sat in one of the larger chairs, but it still seemed much too small. He kept fidgeting in his seat and beating a rhythm on the sides. His long legs couldn't figure out whether to stick out in front or wrap around the back.

The group was discussing methods for dealing with cravings and how to avoid triggers. Brian had been listening politely and then raised his hand high in the air. I nodded and asked, "Brian, do you have something to say?"

"Yes. This is an interesting topic, but it's not necessary to me. I'm never going to drink again in this lifetime. This is a fact." Many others clapped and cheered. "But you see my life on this earth isn't going to be very long. God has told me that my job is done here and that I must come to heaven as he has work for me there." Many of the others in the room now looked down in their laps, or at the ceiling. "God has told me that I need to come to heaven and that I must stop eating so that I will die. My family is very upset with me. They think I'm just being difficult. They won't believe that God has actually told me that I need to do this."

I was tongue-tied. There was nothing I could figure to say to this. My hope was that the staff knew what they were doing. He continued talking, thus saving me from having to respond just yet.

"Of course, you know I'll be able to drink wine in heaven. Everybody can drink up there, and nobody gets sick or too drunk."
I found my voice long enough to say "Is that right, Brian, I'd never heard that."

"Oh, yes. It's quite true. There is wine at all the dinner tables and everyone can drink it."

My mother taught me the value of biting one's tongue at certain times. I decided that this was one of them.

Henry

Sitting in a wheelchair and dressed in blue and white checked hospital pajamas, Henry was wheeled in by an orderly. He looked to be in his late 50s, with brownish gray hair and steel blue eyes. His eyes met mine right away, but had an embarrassed look about them. There was no one else around yet, and I introduced myself. He responded, "Hello. It's nice to meet you. I'm Henry." There was a slight accent from an Eastern European country. We exchanged further pleasantries and talked about the weather. It was a very cold morning. As the room filled up with younger and more active men and women, Henry seemed to fade into the background. He remained there for over half the meeting.

About 45 minutes into the meeting, he was ready to speak. He moved his hand ever so gracefully from his lap to the side of his cheek as a signal that he wished to talk. He then had the floor for the next 5 minutes. "I am so ashamed of myself. I know that my family is ashamed. I've let down everybody. My wife, my children, my grandchildren. I'm not a bad man. I've supported my family for 35 years with my business. It's been a good business and we have over 8 stores now. I knew when I was a young man that drink is not for me. But, sometimes I'd drink for a few days. Always too much. I'd hide it from my wife. She thought I was on a business trip. But this time was too much. I was at our cabin and I drank four gallons of wine in three days. When they brought me here, they thought I was going to die. I've been here three days. This is the first day I can hold a cup."

At this, he was interrupted by one of the younger men. "Yea man, I remember, you couldn't even sit up straight yesterday. They had to prop you up. You've improved a lot."

"Yes. I've improved. But what if my wife and children won't let me come back to them? What if I've ruined everything I built in my life? I'm feeling like such a loser."

There were kind and gentle words spoken by many of the others in the group. "Of course they will. I bet they miss you a lot." "Three bad days isn't going to change 35 years." "You should call them." I did find out later that his wife and sisters came to get him the next day.

When the meeting had ended, he spoke to me privately. "You know, I've been here three days and have felt miserable the entire time. During this meeting, I've started to feel better. It helped me to get things out." Then, in a show of strength, he stood up out of the wheel chair and pushed it out the door and down the hall.

His remarkable transformation had me both genuinely pleased and also mildly bewildered. Could my just showing up actually be a factor in such changes? This incident filled me with such a feeling of warmth that it carried me through many of the really difficult meetings to follow.

It's been said that each person is a universe. This often comes to my mind on Wednesday mornings. Each one a universe, and currently in crisis. I don't know if my conducting this meeting will make any real difference to them, to their lives. It seems silly to think that a mere one-hour meeting could change a universe. However, it is having a very profound effect on the universe that is me.