There is one way in and one way out of the psych ward. A yellow line is drawn on the worn tile floor, twenty feet inside the doors that slide open when the doctor swipes his identification card across a panel. I am somehow aware that once I cross this line, there will be no crossing back over it without permission. Beyond the line is the nurse’s station, a large room encased with thick glass windows for walls. Stepping up to the intake reminds me of late-night runs for cigarettes, the convenience store clerk safely taking orders behind a bulletproof enclosure.
I’m standing in the middle of an intersection with four hallways; to my right is a long, sterile hallway with a series of open doors; to my left is a hallway leading to a lounge area. And, in front of me, a shorter corridor that leads beyond the nurse’s station, away from my freedom.
Guiding me through the shorter route from the intersection, passed the nurse’s station, I notice yet another hallway extending to the right with another series of doors, identical to the first. It becomes clear that this facility is one large rectangle, built around the intersection at the entrance and the nurse’s station. The doctor makes a left and guides me into a private room. He tells me to remove my shoelaces and the string in the waistband of my sweatpants.
“This is for patient safety. We do not allow anything in the center that can be used to harm one’s self,” the doctor says as though he is reading from a script.
He asks me to take a seat. Pulling out a clipboard, he rattles off a list of questions long enough to make me believe it will be time for my discharge when he finishes.
Yes, I’ve considered suicide. No, I do not currently want to end my life. Yes, I’ve experienced much loss due to substance abuse — a job, yes; relationships, yes; money, yes; a home, yes. No, I have no history of violence, but don’t ask my family.
The list includes dozens of variations on the same questions.
“Okay,” the doctor says, sounding like our time is finally coming to an end. “You and I will meet twice a week, and we will test your medication levels at the beginning of each week.”
“How long you think I’ll be here?”
“We can’t say exactly. It depends on your medication levels.”
“A few days?”
“Some patients are here for only a few days. Most are here for longer.”
“Cool. You won’t need more than a few days for me.”
Holding my pants up by the waist, I follow behind the nurse who directs me to my room. There are two twin-sized beds. A man who appears to be in his mid-fifties sits at the end of the first bed. He holds his legs to his chest and stares blankly at the wall in front of him. I am forced to walk directly through the path of his gaze to reach my bed on the far side of the room. He does not flinch, eyes peering through me as though I am no obstacle to whatever vista is running through his mind.
“The door is to remain open at all times. An attendant will be positioned outside for the evenings, in case any issues arise,” the nurse tells me as she stands in the doorway.
“Issues?”
“Your roommate has been assigned a sitter for the evenings.”
When I ask why the person who will be sleeping less than five feet from me has been assigned someone to observe him all night, the nurse tells me that patient information is confidential.
Now it feels as though my shoelaces would be safer.
On the fourth day, I anxiously ask the doctor during our meeting, “So, are you releasing me today?”
“That’s not why we are meeting.”
“But you know I’m not a threat to myself or anyone else. There is no need for me to be in this place.”
“It’s not that simple, Jeremiah.”
Unfortunately, convincing this doctor isn’t as easy as the doctors from the neighborhood crisis centers I’m accustomed to. The neighborhood docs let you go the second you say you’re not going to kill yourself. This doctor is tougher. He explains to me that they must wait for confirmation that there are no adverse side effects from the medication. More importantly, the medicines must reach a therapeutic level to assess whether or not the treatment is benefitting me.
He then goes on to say, “And we encountered an issue. We were not fully aware of the severity of your alcohol abuse. Due to your history, we have to change your medication. If you were to relapse on the current medication, it is doubtful you would survive.”
Doctors admitted me to the center based on my recent expression of self-harm and put me on the most common medication for bi-polar: lithium carbonate. Switching the medication means my stay here will be much longer than anticipated. It will be another week before they test my blood again, and there is no guarantee the medication will be at therapeutic levels. Bureaucracy has extended my stay from days to weeks.
Everything about this place is a reminder: Don’t kill yourself. Large metal grates, spotted with small holes, cover the windows. We can view the outside world, but we cannot access it or even breathe its air. The windows are thick and laced with wire, so they can’t be broken and used to cut a wrist or a throat. Our utensils are made of such flimsy plastic that we can hardly cut the food, much less our veins. My only access to fresh air is a patio off the game room. Stepping into it reminds me of the cage that held my childhood parakeets. Even the smallest details are reminders of preventing death: the heads of the bolts used to construct the enclosure are smooth and irreversible. The metal grate surrounding every inch of this twelfth-story patio has holes small enough to prevent an orange seed from slipping through, never mind the size of my body — which wants to fly from this height, for nothing more than a moment to feel free.
Nearly all the patients here have arrived due to a shared interest in finality. Jason lives on a ranch; the burns from the rope he tied to a tree still bright around his neck. Ron didn’t cut deep enough. Mary cannot remember how she woke in a puddle of her blood and vomit. Ernesto can barely talk because of the bleach and cleaning supplies. And Jennifer tried overdosing on the medication prescribed to her when she last tried to end her life. These are the people who made it to a hospital in time.
At my next meeting with the doctor, he asks how I’m doing. I tell him, “Living doesn’t make sense. Everyone’s story seems to end in relapse at some point. What is the point if it always circles back to losing everything again?”
He responds, “How can you truly know if you don’t try?”
I tell him the evidence is overwhelming, and he does not have a satisfying answer.
This place is designed to keep me from dying, not to teach me how to live.
Later that night, once everyone is in bed for curfew, the health center is dark and still. Occasionally, someone hollers out in pain or fear or pure lunacy. Their noise bounces through the hallways like it is searching for a way out.
I am fully awake. The meds they give me for sleep only working some of the time. But the nurse allows me to sit and write in a lounge area outside my room that has light, as long as I stay within eyesight of his station. I choose a chair ten feet from the yellow line, the closest I can get without crossing over. My journal is about the size of my hand, and it’s challenging to write on the pages without a table. Folding my legs under me, I use the inner side of my left thigh and knee as an easel.
A pen the nurse gave me is hardly a pen at all. It is a thin rubber tube, about three inches long and maybe a millimeter in diameter — the size of a small cocktail straw. But a cocktail straw is sturdier. This thing bends at every point, except for the very tip — a small piece of metal that distributes the ink. Forced to grasp at its furthest extremity, the ends of my fingers brush against the paper and often eclipse the tip altogether, making it close to impossible to transfer ink to the page.
This wretched writing instrument is also meant to keep me from killing myself. Maybe I could try choking on it, but then it’s probably designed to dissolve at the slightest touch of saliva. And this is a hospital. One of the nurses, always within earshot, would end up saving me.
With the tips of my fingers straining to stabilize the tip to page, hardly producing legible letters, I write: If I drink, there is no doubt I will die; if I do not drink, I have no idea what will happen.
And without the patience needed to keep writing with this flaccid thing, I close the journal. My small but critical transition into possibly surviving is as simple as agnosticism: uncertainty.
All I know is that I do not know. Even the slightest and most pessimistic curiosity may now be the difference between living and dying. My flexibility is a dramatic change from my unswerving conviction only a couple of weeks ago. I knew then that death was a thing of celebration. Now I’m not so sure. I do not desire to live. But, maybe, I also do not wish to die?
It is not a clear choice to hold on, but a choice to not capitulate to death.
In this void of conviction, there is no faith. Understanding that I am no longer ready to end my life is not the result of having renewed hope that it will improve. The reason my grip remains on the cliff’s edge is by default: I am not ready to let go. Maybe my hand is merely stuck. Maybe it will loosen again. Maybe I will be prepared when I leave here. Maybe the fatigue of trying to remain alive is the same fatigue that makes it too tiresome to end it. And maybe that is all it takes: being too tired to make a final decision. For today, the pen will go in my pocket rather than my throat. I will not try to reverse the screws on the patio; I will leave the flying to the ones equipped to stay aloft rather than plummet from such great heights.