University of Illinois, Chicago, United States (Fall 2011)
Saying that we see emptiness in the eyes of a mentally ill person is a means for the rest of us to be ok, to stand apart. There is nothing there, so we feel better. But if we allow ourselves to soften and be present for a second, we can see that the blank is actually draped across the rest of her face. Her eyes very neatly hold the small bit of congruency that she still has. Not the blackness cut by sparkles in Ray Charles’s shades, it is more the wild loss of emotion that is left over from exhaustion and terror in a body whose face is covered with a hood. Like the laughter and cruelty we all saw in the photos from Abu Ghraib, in some people’s eyes, craziness steps behind reality, instead of bogarting the space ahead.
So sometimes, because making eye contact seems so obvious and yet so crucial, I get a little unsettled during the play and miss that something else is going on, or has been lost. There is a rhythm that vibrates in the body of a person who struggles fitfully with psychosis. And that rhythm is there even before the rocking starts—the rocking that must be somehow calming. I know because I was raised in a family of rockers. From the first day a baby comes home from the hospital, the rocker is for comforting. Everyone uses them to calm something, in themselves or in the babies. But even without one, the rhythm still takes over.
And then there is the angle of her head. It is adjusted just a little before she starts nodding and smiling over and over to nothing in particular. She has an answer. I just do not have the right question. It is not the one about how her night had gone. And I should have picked up on that. The questions that she needs are much more relevant. But I was thinking about the newest abscess on her breast and its pain, not about all of the other complications. She was much too tender and sweet for someone who had been awakened and poked and sliced and drained for close to sixteen hours. And childlike. She had stuck to this contract with paranoid schizophrenia, or the medication for it, and they were each honoring the other. But as the picture became a little clearer, I could tell that part of that agreement was getting to be slightly unsteady.
I hope to get quicker at tracking the multiple issues that almost all patients have but also at keeping those other struggles from interfering with the autonomy and nurturing that everyone deserves. Of course, though, being really linear, I will have to work harder at doing and thinking faster and keeping the sights adjusted. Ironically, because she reeled off the reason for each of her meds, even tapping her head kind of sarcastically and smiling when I asked about the anti-psychotic, I screwed up the eye drops. Dry eye syndrome. But evidently, right then, only an issue on one side. Oculus sinister.
So how did I handle possibly the most benign of her regimen? I put them in both eyes. And it was a “learning process because that check at the bedside is so important.” I will remember. I will not make this mistake again. But what about the others? If I can screw up eye drops, how will it go down with the things that are more critical? So what if I focused sharply on the 13 meds for psychosis and infection and hypothyroidism and the first Heparin injection I had given for real and the speed of the morphine push and the stool softeners and getting the anti-hypertensives into her within an acceptable amount of time? I fucked up the eye drops. And she did not correct me. Because she was informed but vague. Hell, I am informed but vague. It was not her job; it was mine.
And as it often follows, a report was completed, the charge nurse’s eyes were rolled, and the importance of it was shrugged off. These things often go undocumented. And, even though we were sorely outnumbered, my clinical instructor and I stuck with the protocol. The thing that bothers me most about how I handled it, though, is that I know I did not tell her because I was being instinctively ethical or noble; I did it because I did not want to worry about it—I did not want the guilt. How about that for Sontag’s metaphors? I fucked up the eye drops. The patient got her one med error that day that she is due statistically. From me. And more than anyone I have cared for, she needed me to not err. Because her eyes were not rusty or faulty. Or empty. Like a towing strap and the hook on the frame of a car, they were connected. And undoubtedly, she was better acquainted with that simple notion than I will ever be.
STEPHANIE EZELL is a student in the Graduate Entry Program in the College of Nursing at the University of Illinois, Chicago. This piece is one of the reflections on her first clinical rotation written for a culture and communications course taught by Geraldine Gorman; the process of writing became immensely valuable in short order. Before coming to nursing, she taught in alternative high schools and also worked with the developmentally disabled.