In Case of Emergency

L was brought to the ward on a Monday by his family speaking of patterns in the frenetic voice of madness, sleepless for three days. In the intake, he reached for the antenna of the boom box next to him and bent it into a triangle. He grabbed the paper off of the table, ripped it in two, handed it to me, and pronounced, 'now you understand, and I can go'.

Mania. Totally nuts to actually see. Forget Mr. Jones, if anyone remembers it, with Richard Gere displaying his mania by handsomely playing Beethoven on a store piano. L feels unhinged, from another planet. At one point he grabs the lanyard around my neck and says, "I could take this and you would be upset", bizarrely obvious and direct, as if normal conventions of personal space and society don't exist. He's tortured by 'patterns' he sees in the everyday. Triangles, numbers. Pyramid schemes and the DaVinci code.

5 of Haldol and 2 of loraz and he sleeps. He wants sleep. When he came in, he said the only thing he wanted was sleep.

He needed the same cocktail twice over the next two days, a former lead blocker in high school prowling around the ward, not aggressive, but invasively curious; he ripped the IV pole off his bed and bent it on the wall trying to find out what was behind it after he found a 'hollow spot' over by the window. When I came in to see him the next morning, his room is bare of everything except a mattress, bottles of water, Kleenex and socks strewn across the floor as he sleeps.

"Can I ask you something?"
"Sure."
"I heard a hissing in my room, could that be, like, gas or something that you're filling my room up with?"
"Um, no. We don't do that. It was probably your heater."
"Because what are these for", he asks, pointing to the emergency shutoff valves for the O2 and vacuum tubes to the rooms. And just like that he pulls the cover off, the 'remove in case of emergency' cover, before I can fully articulate that it would be a bad idea.

He's just curious. He didn't want to cause trouble. But I see in that episode a bit of the difference between me and mania. I would never pull an emergency cover off; I'm conditioned and inhibited by years of having teachers tell me not to pull fire alarms. But he doesn't care, doesn't think, is just acting on his impulses. Same reason he grabbed me by the lanyard. When he's in that state, though, my own brain notices at a deep level that is unsettling in a way I've never experienced before with patients. I find myself instinctively positioning myself between him and the door of his room so I'll never be pinned in a corner, avoiding taking sharp objects into the room, watching him carefully.

One manic episode and anyone can be diagnosed with BPAD, or bipolar affective disorder. Features include those L is exhibiting, such as 'pressured' speech, loss of association, where it is unclear how he is switching topics. Lack of need for sleep, inflated self-image, easy distractability, hedonism, or increased activity can all be features, as well as duration of 1 week or severe enough to require hospitalization. L's distractability is incredible. He'll get up and leave a discussion to 'take a nap', go to the door, and change his mind to watch the news on across the hall, then see the janitor, and instead ask whether that janitor is new and go talk to them.

I'm on the ward for a month. L came in my first day. Some fun. More to come.