Imagine

When I walked into work yesterday, I slid my identification card into the electronic time clock, signed myself up for my assignments for the day, nursed my coffee and nonchalantly eavesdropped on some of the pre-workday conversational chatter I'm not yet confident enough to join in on. See, when you arrive for work for a 7am shift at 6:40, you sign up for assignments inside the nurses' station and you are actually not permitted to enter the unit until 7:00am on the dot. So, you sit or stand and you chat or you listen.

Yesterday, I listened. And I heard that a patient, a 23-year-old young man who was discharged just a few days ago was dead.

"He just walked out into the middle of the street, right in front of a car."

They don't know for certain if it was a suicide, but, when you have an incident like this, befalling a recently-released former patient of a mental institution who had been expressing suicidal ideations and bizarre behavior, well, even I can put two and two together and get pretty close to four.

For the purposes of this blog, we'll call the recently departed "Ellis." I first met Ellis about three weeks ago. I was sitting in the activities room on the Acute Unit, writing a report, and he was shuffling towards me. I saw him from out of the corner of my eye. When you work in a psychiatric hospital, filled with prisoners and assaultive patients and convicted murderers, mixed in with the just plain manic, bipolar and disorganized, you tend to use the corner of your eye a lot more than the eye itself. I guess that's why a peripheral vision test is part of the pre-employment physical. It's kind of a big deal.

Anyway, Ellis was shuffling over to me. He had no shoes or socks on, and he was wearing a pair of black and red checked pajama bottoms and a black t-shirt that was full of holes. He had stubble, but it was kid stubble, the kind you could shave dry if you wanted to, maybe once a week and nobody'd notice. His hair was, well, fucked up. Light socket style-- Emmett Brown kind of a thing. It looked as if a bird, or several birds, had been nesting in there for a few months. His teeth were in disarray and, as he approached me, I put down my pen and looked at him.

"Can I talk to you, please?" he said to me in a small, meek voice.

"Sure," I said, "pull up a chair."

And he did. I really don't remember what we talked about, to be honest with you. He told me that he'd been a drifter for a while, I think, and that he'd gone off his meds, and that he was looking forward to "getting everything straightened out." I asked him the standard question we ask everyone, "Do you have any thoughts of harming yourself or anybody else?" He said "No." He appeared able to carry on a legitimate conversation. Five minutes after he walked away from me, he was taking off his clothes in the middle of the hallway. Maybe half-an-hour later, he had to be redirected for wandering in and out of other patients' rooms, ignoring directions, and for trying to escape onto the general ward through a secure door.

He shuffled down the hallway as if he were impervious to his surroundings, as some of our patients do, and believe themselves to be. He had to be watched closely, his behavior was unpredictable. But, after three days of good behavior, he was moved onto the general ward. There, he isolated himself, occasionally going to a group or two. Just a few days ago, I was monitoring the hall, and he shuffled towards me again.

"Can we talk?" he asked.

"Definitely, Ellis. Have a seat."

He talked, and I listened. Again, nothing remarkable. Not much I can really recall. Maybe that says more about me than it does about him. But it's kind of funny because I usually have such an uncanny ability to memorize dialogue and recall what patients say to me, but not Ellis. For some reason, his complaints or questions or statements just sort of blend into the milieu with dozens of other patients I've seen and talked to and interacted with.

But Ellis will be remembered by me as the first patient I ever heard play the piano at our hospital. One day while doing rounds, I walked towards the piano room, which is really never used for its intended purpose, and I heard a sound that made me stop for a moment. It was music. Music amidst the paranoid ramblings, the swearing on the payphone, the frustrated refusals of patients who won't take their meds because they "distort my face" or because the nurses are "poisoning the Crystal Light." There was music. I softened my step, so as not to disturb the beautiful, soft, pedaled strains of a song I recognized, but wasn't too big a fan of.

John Lennon's "Imagine."

As I walked past the piano room, pretending to be more interested in my rounds checklist, I glanced out of that trusty corner of my eye and saw Ellis, sporting his unmistakable, haphazard hairdo, seated at the piano, playing from sheet music-- I don't know where he got it. And, standing there singing, in a soft, sweet voice, was a one of my favorite patients-- "R," the religiously-preoccupied lady with a tidy sum in the bank, who won't use it until God speaks to her, and remains homeless to this day. "God," I thought as I passed the room, on my merry way, "what a pair."

And now Ellis is dead, "with God," as R would say, and I wonder if she knows that her accompanist is gone.