Damaged

When disaster strikes, sanity is a matter of degree.

"Smoking Tree" by FS999 / CC BY-NC-ND 2.0

The cool quiet of my car is blessed solitude before my workday. The drive to Portland begins in darkness and silence. I don't turn on the radio. I prefer the lull and hum of the roads and freeways. Although it's still warm, day and night move toward the balance of September's equinox. Every morning I'm greeted by a warning that police must check their guns and that patients through the looking glass are elopement risks. By the time I walk onto the ward, bright sunlight filters through the Lexan windows onto worn hospital carpet.
Which is to say that that September 11 starts pretty much like any other September 11.
Most of my patients are just coming to life. By the time they venture from their beds and are marginally awake and dressed, I know the rudimentary facts. In a series of coordinated suicide attacks, two jets have pierced the World Trade Center's twin towers in New York City, a third has crashed into the Pentagon, and a fourth is down in rural Pennsylvania.
I obey the human imperative to call family in New York, but the lines are down or busy or there's no one there to pick up. A flat electronic voice politely tells me all lines are busy and suggests I place my call again later. The ward manager wants to pray with me. I'm not a believer, but this morning I go along.
As in the usual scheme of things, a disheveled shuffling line of patients stops by the clinical desk to pick up their medications on their way to the community room for breakfast and a morning news program, followed by the first group session of the day. There's an eerie inevitability to what happens next. In a moment someone will turn on the large screen television.
In the course of eight hours, we--two nurses and three therapists--watch together as an endless loop of video crazily replays itself and the twin towers collapse and rise again and again in a bizarre demonstration of death and rebirth. We're mesmerized by the spectacle, the upturned faces of New Yorkers, mouths open to receive burnt offerings--the ashes of family and friends.
The most delusional of our patients incorporate the television images into their illness; they smell burned flesh and hear screams that we refuse to imagine. They watch without the filters we take for granted.
A young man sits up close to the television, close enough to distort any coherent image. "There, watch that body explode," he yells, somewhere between terrified and excited.
The young man's hair winds into a dozen or so thick blond dreadlocks. Dark stubble sprouts like new mown lawn on his drawn cheeks and his arms and legs are pocked with old or healing needle marks.
He's a literature and philosophy major at a small private college in Portland, the domain of the scions of educated well-to-do parents or talent large enough to earn a free pass. At first his heroin use masks the disorganization of his thoughts, the paranoid delusions and auditory hallucinations of his psychosis. Then it doesn't. He's on the ward in the middle of his first relapse, a month after he stops his medications because he feels fine, wants to lose the weight he's gained from his meds, has a new girlfriend. He wants to devour her, dawn to dusk. Normal desires, and the meds mess with all of it, disrupt everything, not just his delusions. They make him itch in places he can't scratch. A professor returns a twenty-page paper marked in red pencil. His parents bring him home from college when he's found standing on his dorm bed screaming that his feet are on fire.
Now he's up all night, can't study, and has a different interpretation of reality than I do. He's twenty, a junior, and is embarked on what will probably be a lifelong struggle with paranoid schizophrenia.
Another man, this one middle-aged, puts his arm around his college-aged peer. His face falls into friendly creases and jowls. He's protective, coming through a vegetative depression--the kind of smothering mood disorder that holds you to your bed. With the help of ECT--electroconvulsive therapy--and medication, he's fully awake. His hairline retreats, the remainder grays, ambivalent on how to grow old, but he's clear-eyed and animated. His relentless depression, now lifted, provides new insight. The two men share a room and are fast friends. They sit together at meals and in groups. The older man attempts to impart wisdom that has eluded him in his own life: you have to take your meds.
Both men--like most of the male patients--wear athletic shoes without shoelaces, ward policy. During groups, a row of shoe tongues loll to the side like panting dogs. This morning no one leaves the community room to wash or dress; pajamas and bad breath are the order of the day. Schizophrenia and major depression are untidy illnesses, and more so on September 11.
"How do we know the attacks are over?" a woman asks.
Her hospital stay was preceded by a double mastectomy, chemo, radiation, and an overdose of opiates that damaged the part of her reptilian brain devoted to survival. She's in her fifties, with disheveled gray hair. A bright purple blouse flutters to her waist like a deflated foil birthday balloon. Residual glue from electroconvulsive therapy electrodes sticks to her temples. Tufts of hair stuck to the glue; these lend a faintly comic air to her forlorn appearance. She huddles into a chair. We're supposed to help her feel safe.
"What if they bomb us here?"
"How do we know this is real?"
"Yeah, what if they staged it like the moon landing?"
They look to us for answers. While it seems unlikely that terrorists have much interest in Portland, none of us feel safe. We do, however, know it's real, and we have nothing to offer except words, soothing and hollow, words that don't reflect our internal landscapes, our churning dread and apprehension.
The attacks resonate with my own terror of being trapped on an airliner going down; my fears go back to my childhood. In third grade we train to "take cover" during air raid drills. It's cold down there on the floor under our small desks, but not as cold as the Cold War. The desks are barely wide enough to contain our length, scalp to feet. We cover our heads with our arms and tuck our legs up under our bodies. I'm young, but not so young as to believe that this will help if an atom bomb falls on us. Depending on what we're made of--brick, glass, flesh--and how far we are from ground zero--we'll incinerate, liquefy, or vaporize.
Sometime that afternoon, my father calls. I keep him in a nursing home in Portland, as if I own him and have that right. In the twilight of our relationship, he's hobbled by dementia and doesn't remember how to use the remote control or how to end a phone conversation. He's a captive audience. We weep about the city we know so well we can walk its streets in our dreams and never get lost. I call the nursing station and ask them to hang up my father's phone and turn off his television. Other than that morning, he's been doing well, the charge nurse informs me.
When I leave the ward that afternoon, a hunger overwhelms me. I want to hold tight to something innocent, a void so young and pure it's untouched by breath or fingertip; it has no history, no double helix. I visit my father.
The next morning everyone is haggard. The emergency room has filled and emptied and filled again during the night. We have no empty beds. Disturbed sleep and dark dreams prevail. The hospital ramps up staffing as aftershocks shift our roots from shared foundations--the common expectation of safety on our own soil. The first group on the first morning after 9/11 tallies nightmares--a ground-zero litany for the mentally ill:
"My house crumbled with me in it."
"I was burned alive."
"A baby floated through the air toward me. It had no arms or legs."
"I jumped out of a window but I woke up before I hit the ground."
In the big picture, I'm a bit player, an editor in the narrative version of their lives. I enter in the middle of the story, do a brief cut-and-paste, and move on. I'm a conduit: the scalpel, the IV bag, the splint, the voice that holds the fractured psyche together until the crisis passes and the patient can stand on his own. Together, the bit players are the tools in the toolbox.
There's always this question: What separates us from them? On some days it's a matter of degree. Anyone who experiences the loss of a child, a life-threatening illness, the turmoil of divorce, knows how fragile sanity seems at times, and rests well when the chill of danger passes. One morning you wake up and understand you've averted disaster.
I know it's unlikely I'll experience the horrors that bring men and women to the ward, because whatever doubles you over, whatever trigger, whatever errant chromosome, whatever neurotransmitter in whatever area of the brain has done this to them, has not done it to me. Whatever constitutes resilience has, in the service of survival, kept me going. Whether by luck or design, I remain upright.
The emotional and physical boundaries that are essential on September 10 mean less on September 11. On September 10, the physicians, nurses, and therapists on the ward have the power to say who's mad. It's easy--anyone who sleeps on this thirty-bed ship of fools is mad. What separates us on September 11 is just this: precious little. For a brief period of time, shared disaster obliterates the biological and cultural contexts of mental illness. What we have in common is greater than what distinguishes us from each other. Jets crash into the familiar landscape of my childhood and carefully established roles change, patients and staff coalesce, one superimposed on the other.
On September 10, sanity is a worldview, a consensus. Madness requires witnesses. On September 11 we are all witnesses, sane or mad.

At this writing, many September 11s have come and gone. Life moves on and away for those of us who are able to shun the political drama and the corrupt pageantry to become a private sorrow.
On another brilliantly clear, splendidly warm day in Portland, in another clinical setting, it's September 11 again. A young man enters my office. There are outward signs that he takes antipsychotic medication: tremors, fatigue, drool. His abdomen broadens just below his chest, putting his heart at risk, but vestiges of the handsome boy remain. Although he's making progress toward his goals, this morning he sweats profusely and he's hypervigilant. He startles when my phone rings. He requests a medication dispensed as needed to treat transient symptoms of anxiety or agitation.
"It's September 11," he says. On the television in the day room, another group of patients watch the towers fall.

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