When I talk about taking inventory I don’t mean like in the 12 steps. I am talking about sizing up and placing each patient in a category. Yeah, this is me being judgemental as hell. It is a skill I wish I haven’t had to learn. It is a task I wish I didn’t learn about the hard way.

My very first time in a psych unit was at the county level in a community hospital. Given the setting it was not surprising that the majority of the patients were psychotic. Many were uninsured older people who had been in the system for years. I didn’t know back then what I was looking at, I know it now. Many had severe side effects from meds, anything from odd facial gestures to weird gait anomalies. I was seeing severe mental illness for the first time in my sheltered life. They didn’t teach this in my intro to psych class that had 1100 students. They preferred to stick with fun stuff like Skinner and his box, and Pavlov with his slobbering canines. No this was a far cry from that. This wasn’t some glossy presentation from the overhead system, this was reality. The cold hard reality of what years of mental illness does to a person. I was terrified. No notice was paid to my fear. I was just another patient, in a never-ending parade of them.

I tried to keep to myself and not make eye contact, but I couldn’t help but be in awe of my new surroundings. The old lady conversing with Bambi while rubbing her stomach over and over again in pattern. The young clean-cut looking guy that was talking 900 miles per hour about just how brilliant he was. When he wasn’t talking he was pacing, no not pacing, speed walking around the corridors.

There were a handful of patients about my age, all girls. I finally broke down and said hello. They all decided I was acceptable, and taught me my first lessons about how to survive on the locked ward.They had all been in the system and knew it well. Sally and Fran explained to me that they had personality disorders. I had never much paid attention in psych class to the various types of disorders, but these two were given the label Borderline Personality Disorder. Sally cut herself frequently, and happily showed me her scars, like a badge of courage. Fran pulled her hair out, and tended to burn herself. She also proudly said she binged and purged. I had no idea what she was talking about, so I just nodded. They were both very vocal about how much the staff sucked, and that they didn’t give a shit. As we sat there at lunch Sally raked a plastic knife across her wrist and delighted in the fact that the staff did nothing.

I knew these two probably were not the best ones to get a mental health education from, but I was too afraid to even attempt to talk to most of the other patients. By my second day, Sally and Fran decided I needed to be educated on the ins and outs of all things suicide. Holy shit was that an eye opener. Each had multiple suicide attempts, and each seemed very educated in the matter. I listened intently as they went thru all the various ways one could kill oneself, even arguing over which was more lethal. I was like I had opened Pandora’s box. It was fascinating sitting there listening to these two bicker over hanging versus overdosing. Fran described how to overdose properly. Sally was adamant that strangling oneself was a far better option, and much less messy. Less likely to go wrong. Somewhere in the back of my mind it was like a bolt slid into place. It just made sense all of a sudden. I carefully listened as she described knots. It was my first lesson in suicide. This was before the internet. Nowadays everything you might need to know is online. Back then, it was much harder to know what you are doing. I regret now ever meeting Sally and Fran, they gave me tools I didn’t have. Those lessons almost cost me my life a number of times.

I have gotten off track. I was originally blogging about inventory. Needless to say, in my years of hospitalizations I have learned to identify what I am looking at. For the most part I am usually right. Some are easy, manic bipolar patients tend to stick out like a sore thumb on an otherwise quiet unit. Especially in the first couple days before the meds hit the mania, or if they are refusing medication. Others, like I said above, stand out because of physical symptoms from their long battle with mental illness. As we go through our lives we learn to read the people around us, it makes us human. We learn to understand body language at a young age. It is no different in a psych unit. It is all the more important when you are not sure how the people around you are going to react. In the early days, I was a bit of an open book. Other patients preyed on that, so I learned quickly to be a little more difficult to read. I learned to keep my distance. Read the situation and the players first before I climbed into the pool.

In the years I have been in treatment hospitals have changed. I think they are a safer place then they used to be. Policies have changed, patient to staff ratios have drastically changed. It is safer for the patients, and safer for the staff. It is still critical to be wary and not get hurt. Inside I am constantly monitoring where people are in relation to me, how the vibe in the room is and what the others are doing. It is real easy for the shit to hit the fan really quickly. I remember being with my family during visiting hours one time. I was reading what was going on around us, and actually asked them to leave, so they wouldn’t have to see what was about to transpire. Like I wrote in my blog post about the yellow gown, the staff are well-trained (hopefully) to subdue and restrain a patient if necessary. On that particular Sunday, I knew what was coming and hustled them out the door just moments before violence erupted between a patient and his wife. I thank god they never had to see that, nobody should ever have to see that.

Whether on an inpatient unit, or outside living life, it is important to be aware of our surroundings. Many a life is lost, or forever changed by people not being in the moment. If there is one thing a psych unit teaches you, it is to be aware every minute, to take nothing for granted and to watch your back.