I see the journey, the path I have taken like the wake of a great ship.

So there are many things I have had to adjust to over the past year, some more challenging than others. From just a getting around stand point the thing that frustrates me the most is light transitions, no matter how subtle they cause me problems. A light transitions, or at least how I mean it is when I move from a bright area to a dark area. The bubbles keep my eyes from adjusting very quickly, dilation is no longer normal for me. Even something so simple as leaving my house in the daytime to outside causes me brief episodes of dizziness and its when I am most prone to fall or stumble and then fall. During these transitions I do not see anything at all and then my eyes catch up and the ship rights itself. Some of the worst transitions are things like being in a car which cuts down the sunlight, then outside and a walk to an inside location that is a lot darker. This bright to brighter to darker causes me lots of issues. Even knowing that it will happen does not make it a lot easier. I am still adjusting.

I love and have always loved working with Schizophrenics. They have always been a terribly misunderstood population and throughout my life I come across people who are afraid of them and attribute terrible crimes to them, considering them all to be homicidally violent.  While there are certainly examples that some can be violent for the most part they are a tragic and passive group. When I first began working in the mental health industry local communities were dealing with the after effects of de-institutionalization. Suddenly older schizophrenics heavily medicated were out amongst the general population. Local agencies attempted to case manage them. One of the biggest challenges is that until the new generation of anti-psychotics came out in the 90’s the medications used to help them manage their symptoms were just devastating. There is a general misconception that Schizophrenics are detached from the world and nothing gets through. In fact its just the opposite. Everything gets through and medications essentially sedate all of these symptoms so that it certainly appears that nothing connects with them. Most of them exhibit the signs of tardive dyskinesia or better known as the thorazine shuffle that manifests with horrible tremors and a shuffling gate. The damage of these medications is irreversible.

Being intake coordinator of a general psychiatric ward we admitted a fair share of schizophrenics.  One of the first that I came across was my first week when a nurse asked me to go into the smoke room with Harold. Now I hated the smoke room, it was tiny and usually had three or four patients. Harold was on one on one precautions and had been brought to us by the police. All he really wanted to do was smoke. Everyone was fascinated with watching him smoke, he would light a cigarette and take one enormous inhalation and you watch it burn down as much as half in a single puff. He could smoke four or five cigarettes to most people’s one.  There was also a young girl who came in from time to  get stable on medications. She would tell you that she would soon discontinue the medications as soon as she felt safe to do so. She had to work and the medications kept her from holding a job. She lived a life with almost no friends in a small apartment with no television or radio. She said she knew when to come in because the faces on the wall turned ugly and cruel and messages more destructive. I cannot imagine how scary her world must have been. Another girl made amazing art, pottery, paintings that she sold by the road in her hometown where she lived with her mother.

Todd was my favorite patient of all time.  He was of indeterminate age and could have been anywhere from thirty five to forty. He had hair that did not quite reach his shoulders, blonde with a moustache anyone would have been proud of. I never saw him when he was not wearing a bluejean jacket and he usually reeked of cigarettes. He rarely spoke and when he did it was a short sentence in almost a whisper. He was very quiet very into himself and he heard voices even when stable almost constantly. He was managed by a local mental health agency and a case manager would go by his apartment every week to check on him. Most of the time she brought him in to treatment but sometimes he would come himself going through the emergency room. I would get a call that they needed an assessment on a catatonic patient. I would enter the room and he would look at me and I would greet him and say, “Let’s go to the unit.” He would follow me. I worried about him a lot, he had no one other than his case manager. There is always a sadness around Schizophrenics. Together me and his case manager would go through every inch of his file looking for clues on any family member. He was originally from Ohio but we never found anyone. I spent days following up on leads.

One day one of the nurses came to me and asked if I might run to the store and get Todd some cigarettes. He had money to pay for them so I went to talk to Todd. He gave me twenty bucks and showed me an empty package of some generic cigarette brand.  When I asked if he wanted a carton he nodded. One of the things that I did was always make a point o speak to Todd knowing that most of the time he would not acknowledge that I had spoken to him. I cannot imagine the world he lived in but I felt it important that he know that I knew him that I cared about him and it cost me nothing to do so.  Nurses always tried to educate him abut his medication and patients ignored him. He did not go to group.

I was happy to drive to the store and buy hum cigarettes.  When I came back I handed Todd his cigarettes and change which he did not count.  He nodded at me and I new he was saying thank you so I told him anytime he needed something to let me know.  As I walked away I suddenly turned remembering Harold.

“Todd,” I said, “you know, no matter how hard you try you can never be the kind of cigarette smoking. Harold is the king.” I knew he did bot know Harold from Adam.

At first he gave no indication that he knew I was talking to him and then there was the slightest movement of his head in my direction. Todd would never meet your eyes.

I said, “It’s true. Harold was a patient here one time and he would go into the smoke room light his cigarette and then inhale.” With that I would imitate the long inhalation of Harold smoking a cigarette.

“He could smoke a cigarette in two puffs. Harold is the King Todd but you might be able to be the Prince if you work at it.”

I had the biggest smile on my face and then suddenly Todd laughed. It was not a rolling on the floor kind of thing just the briefest of chuckles than he looked over at me and said, “That’s pretty good.”

“Have a great day Todd.” I said and I walked back to my office as if I were on clouds. Later the nurse who was standing there charting came by my office and said it was the coolest thing she had ever seen, I agreed it had been a remarkably cool thing.

When Todd was discharged he came by my office with his case manager. He stood there not speaking but I knew he was just saying goodbye so I told him to stay out of trouble and do the best he could with his medication and listen to his case manager. I let him know he was always welcome at our hospital and I would always do what I could for him,

I think there is probably nothing sadder than to have no one care for you which is why I get so sad. I hope if he is still alive Todd has someone. I hope someone is still buying him cigarettes. I know that the disease he has likely has destroyed any memory of the guy who bought him cigarettes and told him a story but I know I reached him.

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