Arts & Letters
In a practiced routine, Marlene took off her slippers and handed me her robe. With one hand she held a faded hospital gown closed at the back and stepped onto the scale. Then I saw it. The inside of her right forearm was one massive, mottled wound. Gray craters tinged with pink reached from elbow to wrist and made the flesh appear molten, like a surreal lunar landscape.
I stepped beside her and started adjusting the lower guide, the one that measures kilograms by tens. As it clunked over the grooves my mind searched frantically for an explanation of what I had just seen. The guide settled uncomfortably at 40 kilos as the afterimage of her wound seared into my consciousness. It suddenly dawned on me: those craters were caused by cigarette burns, by weeks of repeated self-abuse.
"We'll be through in a moment," I said as the balance wobbled. I began adjusting the upper guide and she closed her eyes.
This was Marlene's seventh admission in less than a year. She had come in the previous evening, only three weeks after her last stay on the Psych Unit. We knew her as a reclusive young woman who rarely talked. Marlene had an eating disorder and had been suicidal in the past, but neither I nor the two nurses on the graveyard staff knew exactly why she was back so soon. During the night we examined the little that was in her chart. The reports from the admission team, social service, and psychologist would be completed and entered in the next twenty-four hours. All we knew was what swing shift had said in report: Marlene was hearing voices at home and hadn't been sleeping or eating well.
As the male night aide, my principle duty was to monitor the patients on the locked wing of the unit, but at the end of shift I also did routine tasks involving all the patients. It was 7:00 A.M. and I was tired, ready for my scheduled two days off. Marlene's weight was my last duty before charting and going home.
I edged the guide a kilo at a time into Marlene's danger zone, and was glad her eyes were closed. She had the kind of eating disorder where an extra couple of pounds can tip the balance to suicide. We used to weigh her facing away from the scale. But some time ago the doctor had decided that she should know as much as she wanted to know.
"Finished," I said, quickly sliding the guides to zero and writing her weight on a piece of paper. We walked back to her room in silence. Marlene was a slender woman in her late twenties. with classic Nordic features. Straight blond hair framed pool-blue eyes and cascaded onto her shoulders, falling to the middle of her back and torso. She never wore makeup. Marlene was so quiet that she was almost invisible. Given the chance, she would lie on her bed around the clock, with the curtains drawn and the lights out. The day staff routinely locked her out of her room. When I went to fetch her for her weight she had been sitting motionless in a rocking chair, staring at the closed drapes in the half-light.
"Breakfast will be in forty-five minutes," I said. "Is there anything I can do for you?" She shook her head and lay down on the bed, turning towards the wall.
"Please close the door when you leave," she whispered. I had almost shut the door when the faint voice said, "How much do I weigh?"
I hesitated and was about to go about my business, but Marlene repeated more loudly: "How much do I weigh?" I returned to the room and felt in my pockets for the paper, though I knew the answer. Our eyes met for the first time. "It's in kilograms," I said as she sat up. She waited.
"Thanks," she said, licking her lips. "What's that in pounds?"
I took out my pen and did the calculation. "Let's see. Multiply by 2.2. That would make...109.6 pounds."
"I've lost a few pounds," she confided, looking away.
Marlene's willingness to talk surprised me. "Oh?..." I said. "How much would you like to weigh?"
"My doctor says I should be about 115 pounds."
She was thin, but not emaciated. A perfect model, I thought. "Why do you think you're losing weight?"
This was against protocol. Long ago, I had been taught that why questions are pointless and counterproductive. "The patient doesn't know why he or she does or doesn't do anything," the instructor had warned. "You're wasting precious time with such questions." Oh, well. Marlene looked like she needed somebody to waste precious time with. I sat down on the bed.
She knit her brow. "It's because I'm afraid," she said loudly. "I'm afraid the food's poisoned."
I took her hand. "That must be an awful feeling, Marlene... You must be hungry."
She burst into tears. "Is the food poisoned here?" she asked, searching my eyes.
"No," I said. "I eat it all the time."
"I'm so scared. Those buttons…" She motioned to the call panel on the wall. "These lights…" She looked at the overhead fluorescents and then at the globe light over the sink.
"You're safe here," I reassured. "Very safe. You push the red button to call the nurse, and the white one to use the intercom. The little bulbs light up when you push the buttons next to them."
"I was afraid during the night," she continued, looking away again. "I thought somebody opened my door and peeked in. I think it was the devil. But I didn't open my eyes... I was too scared."
"Well, that was probably me opening the door, Marlene, or one of the night shift nurses. You're on regular checks here. Just to make sure everything's O.K. You know, it's just like it's always been."
She had passed the night without incident, though I now recalled that Marlene had ventured into the hall about 4:00 A.M. "I'm just seeing who's there," she had said when I asked if everything was O.K. I gave her the names of the staff and then she had gone back to bed.
"This is the first day I'm not showing up at work," she confided through her tears. "I'm afraid I'll get fired. I haven't missed a day of work before."
"Lots of people take time off from work for one reason or another. I've taken time off. Everybody gets sick now and then... It's O.K."
"It's the first job I've ever had. I got well enough to get a job... I haven't had it very long, but I love it so much."
"Oh? What kind of work do you do?"
"I work with children in an elementary school."
This surprised me, for Marlene had seemed such a recluse on the unit."How lovely..." I smiled. "How old are the children?"
"They're kindergarten and first-graders. That's five-, six-, and seven-year-olds..." Then she blurted, "I'm afraid I'm hurting the kids!" and burst into tears again. "I don't want to hurt them," she sobbed.
"Of course you don't," I muttered, amazed. I glanced down at her arm, now covered by her robe.
"Marlene," I ventured hesitatingly, "do you like the kids?"
"I love the kids!" she gushed, looking up and giving me her full attention. We sat in silence and I marveled at the visceral power of this declaration. It was as if Marlene was not speaking for herself, but that all of womankind was speaking through her. Or perhaps she was speaking from some other world— a world of perfect joy, love, and purity. For a brief moment, a long-forgotten feeling from my childhood warmed me.
A tear coursed down Marlene's cheek. I needed to know more. "Marlene," I probed, "do you think the children like you?"
She immediately straightened. Marlene wiped away her tears, lifted her chin defiantly, and sat motionless, as if she was awaiting an awesome verdict from some invisible tribunal. I waited. After a long time she nodded gravely. Marlene was worthy of the children's love, but it seemed to be too serious an issue to celebrate.
With her looking away all the time I was having a hard time maintaining rapport. "Marlene," I commanded, "look at me!"
She turned and our eyes met again. I smiled. "That's wonderful," I said, "to have a job that you love so much."
"If I don't look at you," she broke in, "it's not because I don't want to." She was looking away again. "If I look at you for very long... your face melts."
Stunned, "Ohh...." was all I could manage. My hold on her hand loosened. Marlene must have sensed my implosion, and quickly resumed a previous thread. "It's not just the children," she offered. "Voices tell me people don't like me."
"Voices tell you people don't like you," I mouthed back, imagining my face melting. I glanced at my watch to reorient myself. In fifteen minutes I would be off work.
I was determined to end the conversation on a respectful note. Marlene was presenting a gradually more complex and strange puzzle. Perhaps it was a challenge, perhaps an invitation. I wasn't sure. Obviously, the pieces didn't fit in a normal way, but I had the sense that we were both being honest. Somehow, that was the essential thing.
"Let me try to understand, Marlene. Are you saying that the children like you, but the voices say that people don't?"
She nodded. Her world slowly was coming into focus. Children weren't "people" for her. They were better, more ideal. It was adults like myself that threatened her.
She was trapped, powerless. Because the ominous voices told her that adults hated her, she lived like an outsider in an adult world. The world of children was an oasis of refuge.
I suspected that Marlene deferred to the voices in all things– whether to burn her arm, to eat, to even live. She cowered before them. They had complete power to take away what she most dearly cherished. It was so easy. All they had to do was say, You're hurting the kids.
She was looking at the wall. "Marlene, I'll be off duty in a couple of minutes," I said. "Thank you for trusting me enough to share." I gave her hand a parting squeeze and stood up. "I know it's been difficult for you."
I walked pensively to the Nursing Station and opened her chart. "Patient up briefly at 4:00 A.M.," I wrote. "Otherwise quiet in bed. Extensive flesh wound on right inner forearm. No frank blood noted. Patient admits to auditory and visual hallucinations. Admits to fearfulness of surroundings. Thinks the food is poisoned. Weight 49.8 kg."
I closed the chart and went home.
When I returned to work after two days off, Marlene was gone. In swing shift report, the charge nurse skipped right over her room.
"What about Marlene?" I interrupted.
"She was discharged a couple of hours ago," she answered.
"Nope. Signed herself right out. She called her husband and he came and picked her up."
"She's suicidal," I said.
"I know that. But Dr. Friedman didn't want to commit her. He had her sign an Against Medical Advice waiver, and let her go."
"She'll be back," somebody added.
"Any minute now!" another piped in, to general snickering.
"Bart Holversen…" the report continued.
After report I went to the nurse's station and checked my night's tasks. At the door, one of the outgoing nurses wheeled around and came up to me. "Oh, I almost forgot. Before leaving, Marlene gave me something for you." She put her purse on the counter and started rummaging though it.
"What is it?" I asked.
"A drawing," she said, handing me a folded piece of paper.
I opened the 7-by-11 sheet and we looked at a childish pencil and crayon drawing. "Well, I gotta get going," the nurse said, closing her purse and heading out the door.
"Have a good one," I muttered and took the paper to quiet corner of the dayroom. I sat down and examined the drawing. In the lower left was what looked like a playground, with children and a swing. In the playground was a larger figure holding a ball. In the center of the drawing was a man and a woman, holding hands, and above them a blazing sun. From the woman's mouth was a bubble in which was written, "Go away." Huge tears dripped from one of her eyes and led to a table, behind which appeared figures dressed in black. Above them was a chimney, with smoke coming out of it.
I never saw Marlene again.
Copyright ©2005 by René Salm
René Salm, a writer who lives in Eugene, has been a spiritual quester, mental health worker, music composer, and piano teacher. His compilation Buddhist and Christian Parallels is at http://www.iid.org/publications/rfinal.pdf .
© Copyright 2000-2004 by West By Northwest.org
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