Tuesday, December 15, 2020

Christmas Arrives at Downey VA Hospital With a Gift for Warren



Warren was a big, tall man with a complexion that reminded me of custard pudding, forty-one years old, with half a lifetime spent on the back wards of Downey VA Hospital, a warehouse for the mentally ill. Like most all the patients here he was branded with the diagnosis of schizophrenia, chronic, undifferentiated. By the 1970s psychiatrists had given up on the idea of delineating the various subtypes of the illness; catatonic, hebrephrenic, paranoid, or schizoaffective,  all permutations were treated the same at Downey. Determining the underpinnings and concocting efficacious treatments for complex mental disorders like schizophrenia made nuclear physics look like a game show.The brain was a complex organ with very complex disorders.

Warren's most visible problem was that he was literally lost in space and required constant contact with a wall to do just about anything that required movement. Staff members regarded this as a behavioral manifestation of his psychosis and dealt with it  accordingly by initiating harsh measures like restrictions on privileges such as smoking and moving his bed to a dark, grim, windowless  area for special observation with threats of physical restraint if he persisted in his wall rubbing routine.

Watching Warren navigate the subterranean world of Downey's interconnected tunnel system was like following a bumper car at the state fair. He repeatedly bumped or bounced his right shoulder off the rough red brick walls leaving a trail of textile shards in his wake, similar to the sparks trailed by the bumper car contact wire on the electrified ceiling. His posture resembled the letter "J" upside down with the end of the letter in constant contact with the wall as he gallivanted along his way.

Just about any staff  reprimand, which was nearly constant,  to cease this shirt/coat shredding behavior was meant with a look from Warren that could smelt lead. Out of pure frustration, Warren developed a unique skill that involved tapping on the few panes of glass windows that had not replaced by plexiglass, skillfully he increased the force of the impact until the glass shattered, leaving his hand virtually without injury.

I talked to Warren about his need for wall rubbing and came away with an assessment much different from my esteemed colleagues. I thought the  incessant wall rubbing was not a direct manifestation of his psychosis or voluntary acting out. Warren had a proprioceptive disorder where he really could not tell the position of his body in space. He felt that without contact with the walls while moving he  would follow a circuitous path and never arrive at his destination or fall injuring himself.

That evening while pouring medications my eye was drawn to the heavy plasticized bottle the pharmacy provided for a solution we mixed with Thorazine concentrate liquid to make it palatable. The side and bottom portion of the bottle had a contour that was a near perfect match to Warren's right shoulder where it interfaced with the brick walls.

I took an empty bottle home that evening and went to work on a garment that could slide along those rough Downey walls and remain intact. Warren loved football, having played receiver  in high school, but while his team mates soared to the stars with their lives. he burned up as he plunged back through the atmosphere like the space shuttle Columbia.

After fashioning an appropriate skid plate from the pharmacy bottle, I drilled a series of tiny holes around the periphery of the plastic armor  and carefully sutured sewed the protective armor to the right sleeve of a Chicago Bears jacket  ala a craniotomy bone flap. A test drag across the outside wall of my apartment building proved successful. Warren was an avid Bears fan and I had a feeling he would really enjoy the jacket, especially if he could rub the brick walls without worry.

I carefully wrapped Warren's special Christmas gift complete with the  abrasion tested shoulder armor in a box that was emblazoned with the corporate jingle, "Tarreyton  100's for smokers who would rather fight than switch." He eagerly unwrapped the present half expecting a mother lode of cigarettes, but as he eyed the special jacket, his eyes gleamed. The look was priceless. He quickly donned the jacket with a renewed sense of purpose. When he spotted the shoulder guard, he couldn't wait to try it out with a quick mosey down along the hall walls. It doesn't take much to make some folks happy - one of the special rewards of working at a place like Downey VA Hospital.


  1. As someone who suffers from both bipolar effective disorder and severe anxiety, and having both positive and negative experiences in mental health units, it makes me so sad to here how other staff treated Warren for something totally beyond his control. The patients at Downey were clearly very lucky to have you for the time you worked there. Your compassion and willingness to see each patient as a human being rather than a set of complex behaviours was clearly way before it's time.

    1. With the folks a NAMI advocating for mental illness, treatments have improved. It's still sad to think that our corrections system is the largest provider of mental health treatment. Wishing you a festive holiday season.

  2. Terrific post OFRN and I can never get over your memory for details!
    We had a woman in the Psych. Unit I worked on once, in her 50s, marked ataxia. It looked more neurological to everyone despite a psychiatric opinion that had her land in our ward. The Neurology Registrar was called for an opinion and we received the response she was clearly mentally ill.

    Her condition worsened and we called for the Head of Neurology who scrutinized her history and discovered she had worked as a Theatre Scrub nurse in Papua New Guinea. She had Jacob-Kreuzfeld disease and died not long after diagnosis. She had obviously come into physical contact with an infected person in the course of her work.

    This unfortunate woman always stays in my mind as a perfect - and sad - reminder of the need for a clear, impassioned medical diagnosis and the importance of checking the patient's history. In this case the fact she had worked in Papua was the vital clue. I often wonder what was said to the Neurology Registrar who missed such a rare diagnosis. Sue

    1. I actually cared for a CJD patient before the work of Nobel Prize winning neurologist, Stanley Proisner, who discovered prions, a new infective agent. At the time Creutzfeld Jacob disease was thought to be viral. We were all scared to death of contracting such a terrible neurological wasting disease.

      Merry Christmas, Sue

  3. And very best wishes for the Christmas season to you and your family OFRN! Sue

  4. Very nice of you to actually be able to help the guy.

    1. It was fairly easy to help the guys at Downey. Even the smallest of kindly gestures were greatly appreciated

  5. I have been dreading going in tomorrow. Thoughts of my first Thanksgiving as a real bona fide licensed nurse, missing my family, and staring at dry and unappetizing dressing on the steam table at big city hospital, have left me sadly caring about my first world problems.
    Thanks as always for giving me a different perspective, OFRN. Although not currently employed in the care of the mentally ill per se, I am occasionally tasked with sitting with a suicidal patient when no one else more qualified ( i.e., cheaper to pay than an old warhorse OB nurse) is available.
    I truly treasure each and every one of your posts and appreciate the reminder that it is always a privilege to care for those who are bearing a heavier load than we are.
    Merry Christmas! Your blog posts have been such a comfort to me!

  6. Merry Christmas, Kathy. With a good number of decades in my rear view mirror, I find memories of being with and helping patients during the holidays a true bright spot, although at the time it certainly did not feel very cheery. I treasure your uplifting comments!