I’m What’s Known As A “Difficult Patient”

A baffled nurse from “Africa” (the, frickin’ … continent) said to me once, “Why can’t you be grateful? You have a bed, you have food, you have medical care.” And I said to him, “Because this isn’t where I live, and they won’t let me go home. They’re holding me, and I don’t need to be here.” Which, that’s true. But what he said to me has always stuck as a North star toward gratitude. These are low-paid, hard-working people, dedicated to helping the mentally ill.

One of my lines to them was, “No, you’re not underpaid. You’re getting paid one hundred percent too much.”

Bob was one of my enemies. The last time I saw him he was stalking through the psych dept lobby at the outpatient clinic, probably after losing his job for refusing my psychiatrist’s two attempts to get me back on case management. I had my one chance to echo back to him his infamous line: “That’s your choice.” But I didn’t. After all, I’d known the second request would be denied. I was honest with my doc, to a point. I needed case management. But I knew what had happened. Bob hated me. They all hated me. I’m what’s known as a “difficult patient”. I either wanted to destroy their insides piece by psychological piece, or fuck them, or both.

I let my psychiatrist put the request through because I knew that Bob would refuse again, and it’s totally not his right to do that. With anyone. He ended up shuffling me over to the “severely mentally ill” case management team. One of them called me up and said, “You don’t seem at all like you’re severely mentally ill.” I said, “I’m not.” She said, “We would only come by once a month to check to see if you needed to be hospitalized.” I was like, “Yeah, no thanks.” So that was that. But I’m still technically with SMI to this day, I think.

Bob was (or maybe is) the head of the ACT team. There’s been a lot of positive press of late about ACT teams around the country. It doesn’t bear up from the inside, though. In the traditional set-up of therapist and doctor, you have one person who gov’t insurance requires to be at least an MSW, and one person who is required to be both an MD and have a PhD. The ACT team is a way around that, sort of. Two nurses (who are both fully-qualified RNs), a therapist, a “peer support counselor”, the doctor, and the one who heads up the team. I could never get over the fact that I couldn’t place my trust in their therapy process. My college girlfriend had gotten her PhD in psych. She went to Columbia in NYC for her Master’s, and Illinois School of Professional Psychology for her PhD. And I’d been in therapy all my life. Private practice. I knew the experience of being able to communicate with someone who didn’t focus on the details of what you were saying, but on the gist. Someone who understood patterns, theories, best practices, etc.

One of my therapists was Dalton. The first time we met he drove me out to the park, and we sat on a park bench where he went through some xerox’d quizzes with me. They were quizzes from the back of Cosmopolitan magazine. “Picture a woman descending a spiral staircase. Who are you thinking of?” — “I guess I’m thinking of D—.” — “That’s the one that you’ll never get over.” It was clear Dalton didn’t even know what therapists did in session.

Like Dalton, Bob didn’t have the qualifications. He was another way that the outpatient mental health clinic could pay people who had less than the required MSW. He was making decisions about whether or not I would be stuck in the hospital, transferred to adult foster care (!), threatened with AFC, etc. And he only had a Bachelor’s Degree, in something he would never specify, but which wasn’t psychology. As mentioned, he only knew one bit of psychology: “That’s your choice.” But if I would end up in the hospital, it was ultimately his own choice that would put me in the adult foster care system for the three months that seemingly every ACT team patient had to endure once or twice. (My parents, at different times, had to pay my rent at my real apartment while adult foster care sucked away all my social security.) And the adult foster care experience is so gruesome that I always have to deal with nausea — even now — in thinking about it.

That food’s a challenge, man. Even though they keep you hungry. Can’t think about that.

The backbiting, childishness, stupidity, evil … residents and managers. Can’t think about that either.

Counting the minutes for three months. That happened to me twice. What more could I do to Bob than I did? Luckily I never found out. I never straight up hit that fuck.

Maybe they get paid too little, come to think of it. But trust is hard when you’re crazy. I know that.


About Ian

"The less we know of someone, the greater their merits." (Oscar Wilde)
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