If you’ve never seen how quickly a syringe full of Ativan plunged into the
meat of an ass cheek can work and you want to, just apply to work on the
“Lord knows we could use a floater,” the Director of Nursing says. She uses
this phrase: “Lord knows.”
“Where do you need me?” you ask, not quite yet knowing what it means to
“Everywhere,” she says. “We get you part-time evenings when you’re not
working the phones.” She lifts and checks a ream of sheets on a clipboard
at her desk. “Adult, adolescent, children’s. And we might need you for an
overnight every so often.”
You think of the elderly third-shift nurses you see sometimes as they
trudge into the employee parking lot at sunrise. Serenely, slowly, they
each carry a lunchbox toward their cars like an offering.
“Sure,” you tell the director. “I can do this.”
Your first day on the units, then, includes the sight of a raging
adolescent male encircled by a mass of beefed-up nurses, followed by a
wrestling takedown and then a dog pile onto the kid’s back while he howls.
He’s in par terre on the bottom, the side of his face spread like sweaty
cold cuts on the rough carpeting that barely pads the concrete floor
underneath, both arms pinned by the two Army Reserve LPNs, Matt and
Matthew, and then there’s the walrus, Wilson, holding the legs, and here’s
Joyce as she runs from the nurses’ station with the syringe, and you watch
as she grabs the elastic of the kid’s sweatpants and pulls it down just
enough to expose the top of a globe of muscle that’s tense from pulling and
leveraging for space.
“We are done here!” she yells, and no one knows what she means by this, but
the capped tip of the syringe is in her mouth, and then the needle’s in the
open, limbs everywhere wriggling and struggling below it, the injection
sent in through the skin and the muscle that the boy’s yelling about
“Don’t you fucking touch me!” he screams.
—and then everything really is done, and it’s all over for him in a
matter of minutes. The lorazepam rips through him, starting in the muscle
and then spreading out in a circulatory wave before it crosses over the
blood-brain barrier and drops the agitation levels down like a sedative.
“Can you stand?” Joyce asks.
“Fuck you,” he says, but the bile and bite from him are gone now.
“Will you stand?” Joyce asks.
After a moment: “Yes.”
From outside the Quiet Room (one of two on the Adolescents’ unit), with the
door locked from the outside, watch as the kid collapses onto the blue
safety mat, his body logy, his head drooping because it needs to be. Watch
as he breathes slowly and calmly and defeatedly.
Listen in while Matt and Matthew remark later how damn strong the boy was,
how they were surprised by just how much fight he had in him, and how
they’ll need to remind themselves to go check on the kid later. But he’s
still in there, seething on the blue foam mat, calmer now because the
benzodiazepine is making him feel less anxious and cagey within the cinder
There are three steps in learning how to juggle. This is the first:
While you’re crammed into the receptionist’s desk at the local psych
hospital each weekend—where the suicide hotline plugged on the
commercials for the facility runs straight to your headset, no training
necessary—you’ve got everything you need to pick up a quaint skill.
You’ve got time to study for school or to read. Or to relearn DOS on the
ancient IBM perched in the corner, or to pop and hold a wheelie in the
battered wheelchair that’s parked between the front desk and the
counselors’ office. The point is this: you’ve got time to learn how to
You will need three soft ball-type props. Small sandbag-like objects that
fit into your palm are ideal, but you’re looking for spheres with a little
bit of weight to them. If you have them, baseballs are better than racquet
But you also need the props to be big enough to take up the volume of your
open hand. Softballs are better than, say, marbles or those tiny bouncy
balls you get from a grocery store vending machine for a quarter apiece.
You need the size and the weight to be right, and only then can you try
items of a different size. Chainsaws, squids, birthday cakes: you’ve seen
videos of each them being thrown into the air and caught in succession.
You’ll never juggle any of those, but for twenty seconds just a few months
from now, you’ll find yourself juggling three basketballs in front of the
adolescent patients while they’re relaxing in the gymnasium. You will get
applause and that’s about it.
Step One: toss the ball in your hands, right to left and back again, up and
over each time in the swoop of an arc.
Practice this step over and over and over again, making parabolas that fly
in a measured calculus. Right up until you can feel the ball move between
your supinated hands without looking at it. Repeat this until you can look
away from what you’re doing.
Niccolo’s name—not his real name, not anyone’s real name used as
you’re writing this—is the first weapon the hospital fires against
him when he’s admitted.
“It’s ‘Niccolo,’” he’s told them. “My family’s Italian.”
His fellow patients call him by what he wants, but only a couple of the
staff members do. ‘Nick’ is what’s written instead into the top-right
corner of the giant dry-erase board at the nurses’ station. A 4x4 grid of
taped-off rectangles with a small tag at the bottom of each name: ‘acute’
or ’subacute.’ Wilson’s neat font size and typeface blend in with the rest
of the board, and there it sits, scrawled out in bold, blue
lettering—blue for acute, red for subacute—‘NICK.’
Yanked into the hospital in the middle of the night from the county’s
Juvenile Detention Center, Niccolo is interviewed by a sleepy counselor,
whichever one’s got the Mobile Assessment Team beeper next to their bed,
who then in turn wakes up the on-call psychiatrist, who swears he will be
there soon to sign off on the admission papers, but who doesn’t actually
show up until right after his 8am coffee, which makes it now an hour into
the morning shift’s detail, and this is how Niccolo first meets the men who
will hold him down for a sedative and the woman who will inject him in the
ass when no other chunk of unrestrained muscle can be found.
The summer of 1998 is a transition period for the hospital. The units are a
mess, spread out into a fractal of patient rooms and spanned hallways. At
the south end of the hospital is the adolescents’ unit, an open and airy
corner that juts right up next to a battery of counselors’ offices and the
exit to the parking lot and the Ropes Course, where the adult and
adolescent patients can come outside for trust-building exercises (free
falls, zip lines) and some fresh air. In the gut of the hospital, though,
is Timber Line—not its real name, either—a specialized unit for
adolescent male sex offenders. The boys there are watched by their own
staff members and psych techs and nursing staff, although they share
counselors and psychiatrists with the rest of the hospital. Timber Line is
autonomous in every other sense, though, since they just rent out physical
space and services. Their unit juts up against the two other units, the
Adults’ and Children’s, and even though each unit is locked down and can
only be opened by specific sets of staff members’ keys, there’ve still been
stated worries from the children’s families about proximity.
“It’s like waving fresh meat in front of tigers,” you’ve heard one father
say. On weekends, you’ve watched this man leave a cup of spit from his
chewing tobacco next to the lobby doors so he can later collect it on the
It’s not the Timber Line boys’ faults. Okay, it is, but look: there’s such
guilt on their faces each time they file out their door past the children’s
unit nurses’ desk. There’s the worry, the shame, the knowledge of what
they’ve been told in so many therapy sessions—that because they were
sexually abused by someone else, there’s a much greater likelihood that
they would abuse others. This knowledge doesn’t seem to lift their heads or
take the weight off their shoulders, but you can tell that the move from
the Timber Line space to the Adolescents’ unit and vice versa makes them
feel easier about the situation. Weeks afterward, they seem freer to talk
in the hallways. To look around at the space in which they’re confined.
In the children’s unit, the patients ask questions about the move.
Who are the new kids?
they ask. Or
what happened to the boys? Why are there girls with the big kids now?
And so on.
The renovations bother the smaller kids the most. The loud noises. The men
from maintenance and their ladders and tools. On the afternoon when the
entry door to the unit is replaced—Timber Line’s didn’t have a safety
glass window to look out through—the charge nurse on the Children’s
unit allows them to come up to the station to watch the hammering and
drilling involved. One of the older maintenance guys slips over to where
the group is watching him, lets each of the curious children get a chance
to rev up his DayGlo-blue Makita.
The charge nurse, Other Joyce, will tell you later on her smoke break that
one of the boys who held the drill was admitted because he stabbed his
sister with a screwdriver—you will laugh at this because you have to
laugh at this—but for right now, the children are just happy for the
The kids are each there for a reason, but not for the one you’d think.
‘Adam’ is here because of aggression toward his teachers at school, but you
learn that these incidents started happening once his stepfather entered
the picture. Or ‘Bethany’ was admitted because she tried to set the house
on fire. (It was the first thing that seemed to get the attention she
craved from her otherwise negligent foster parents.) She’ll go on to
experiment by writing her name in feces on the wall of her room. One of
your fellow psych techs will screech out in horror, and the noise will feel
like home to many of the kids.
You start to understand. The acting out, the late afternoon aggression, the
infighting. This is why the nursing staff and psych techs hate those hours
right after weekend or evening visitations with the families. The root
problems of their behavior, you learn, have come to eat dinner or lunch
with them in the hospital cafeteria.
You’ve heard rumors of the four-year old who’s been admitted. Back on the
loading docks, the nurses and psych techs wonder aloud at the admitting
“How is that child going to remember any of this?” Other Joyce says. “Let
alone how he’s going to go through the damn program?”
Watch as the lines around her mouth crack each time she purses them to blow
So when you finally meet ‘Carson’ on the children’s unit, you’ve already
read through the notes in his chart. You’ve clipped through assessments on
the learning disabilities, the outbursts, the abuse. When you’re working
the unit in the evenings, you and the other techs and the LPNs listen as he
screams obscenities into his shower or at the ‘mirror’ in his bathroom. You
ask if he’s okay constantly. You ask if he’s all right.
(It’s cruel to call the box up on the wall a ‘mirror.’ It’s all just highly
polished aluminum since glass on the units isn’t allowed. Using a step
stool that’s been cleared by the charge nurse so he can reach the sink, he
stands on it to bang his head against the shiny rectangle of metal anyway.)
Carson has dinner with his mother and the mother’s boyfriend, but he comes
back early after refusing to eat. As the rest of the unit winds
down—showers, pajamas, teeth brushed, a communal story book read to
the group in the long hallway of patient rooms—you slice him up an
apple with peanut butter and hand the styrofoam bowl to him, where he’s
perched at the edge of his doorway.
“I’m not going to sleep tonight,” he explains, wedging an apple piece into
his mouth. “And you can’t make me.”
“Okay,” you tell him. The plastic fork slides in the juice from the apple
and barely cuts a thing. “But if you want to be able to stay in your own
room tonight, you have to keep quiet. You can’t wake up the other
And then you realize your mistake: you’ve given him a way to get attention.
Negative or positive, you’ve come to learn, feels the same to children who
don’t receive much of it either way.
“I will,” he says. “I’ll do it.”
As the bubble of mercury panic starts to slide up your spine, you wonder if
there are any toys you might bring him from the day room, or a book to
“I hate stories,” he says.
You just need something to take his mind off the dimmed lights or the
noticeable quiet once everyone else is asleep, and then you remember.
“Let’s make a deal,” you say.
This one’s twice as difficult as the first. You can make the arch of the
prop between the right hand to the left and back again, over and over,
sure, but can you do this in succession with two balls? Because this is the
crux of a simple cascade in juggling.
Hold one ball in your right hand, one in your left. (This next part goes
quickly. Clear any and all breakable objects from the area.) Toss the right
ball toward your left hand. Once it’s headed up and over, toss the ball in
your left hand toward your right hand, keeping its arc under the arc of the
first ball. Toss, toss, catch, catch. Pause. Toss, toss, catch, catch.
Pause and repeat.
Once you can make both parabolas in the air, you’re ready for the third
step, which isn’t all that difficult to pull off, actually. Remember,
though, that you must be able to look away from what you’re doing to get
the action just right. You need to be able to feel where the balls are
going to fly into your hands instead of having to see it.
Toss, toss, catch, catch.
Where Carson’s been moved from acute to subacute care—you’ve been
told by the adults this feels like getting a prison sentence after being
thrown for just one night into the drunk tank—‘Darla’ has come in for
her trimonthly admit.
She’s a regular patient at the hospital, where the cycle of her Borderline
Personality Disorder includes thoughts of self-harm that just won’t go
away. You’ve been told she feels safe here, and if her psychiatrist is
willing to admit her on short notice (which he most always is), she’ll
check herself in if she can hitch a ride from a friend in the area.
So when the adults have completed their group therapy session for the
evening and the nurses on the unit have doled out the nightly meds, you
watch as the Director of Nursing clips onto the floor and right up to where
you are at the desk. She lifts the glasses from her face so she can see you
better and says, “Feel like picking up an admit?”
This isn’t your first time driving the hospital van. You’ve transported
adolescent patients to the city’s medical center for CT scans or to have
bandages and wounds checked out, and you’ve gone out on pizza runs for the
staff. But this is the first time you’ve ever made a patient run for an
“I’ve seen you up at the front desk,” Darla says, stepping into the
hospital van when you pull up to her apartment. She tosses her duffel bag
into the backseat, makes small talk on the drive back like she’s been
picked up in a taxi. “You working the units now?”
“Yup,” you oblige. “Couple of weeks now.”
You’ve met each other before on a couple of Darla’s self-admits, and she’s
told you each time she has trouble with her memory. About a mile out from
the hospital, when things go quiet, she drops the guarded staccato when you
ask her, “You doing okay?” But you already know this answer to this
“Now that I’m going back in, I am,” she says. Her southern accent is softer
now, rounded at the tips like her Mary Worth haircut. “Stupid Borderline
flares up every so often, you know?”
Before you started working as a psych tech, you remember Darla was
eventually admitted one night after her psychiatrist was out of town and
the on-call doc wanted her to be evaluated first thing Monday. She
threatened self-harm, he balked, and so Darla stripped naked and went for a
walk in her neighborhood until she was picked up by the police. They drove
her straight to the front desk, where she trundled by you in a hospital
gown and a threadbare blanket.
Tonight, though, when you wheel into the circle drive and drop her off at
the front door, you see that the on-call assessment counselor’s come in for
the night. Dressed in his shorts and flip-flops, he looks relieved he’s
just having to process Darla here, rather than having to go out to
interview her and get her transported from the county hospital’s emergency
“I’ll walk you back to the unit when you get done,” you tell her. This is
your best attempt at reassurance, and she nods impatiently, ready to get
out, get admitted, and feel safe again.
In the 45 minutes it takes to get her processed, you make notes in the
adult patients’ charts. This patient was communicative in group therapy
while this patient was not. This patient had a healthy appetite at dinner
while this patient drank only her soda. You document BIRP after BIRP after
BIRP: Behaviors, Interventions, Responses, and Plans. And then you’re done
for the night.
So when you walk back up to the intake office to check on Darla’s
admission, you bring something to pass the time with you. Three small,
sand-filled canvas balls. Just in case.
“That looks fun,” she says, hoisting the duffel over her shoulder. She’s
smiling now. The look of relief floods across her face, a blush of red
across an anxious white.
“I’ve made a deal with the kids on the children’s unit,” you explain,
practicing. Toss, toss, catch, catch. Toss, toss, catch, catch. “You
Now comes the hard part. For a simple three-ball cascade to work, once you
can make the double arcs happen between your hands, it’s time to toss a
third prop in there. Put two balls or bags in your right hand, and place a
third in your left.
Warm up by practicing the first two steps. Toss with the right, catch with
the left, and back and forth again. Then toss with the right, toss with the
left, catch with the left, catch with the right. Repeat with that third
ball in your hand each time. Feel the weight and space of it there.
Once you’re ready, toss the third ball into the mix. Ball #1 flies from
your right hand to your left. Ball #2 hops just afterward from your left to
your right. After you catch the first ball and then whip it over from your
left hand to your right again, throw ball #3 into the works, substituting
the props out of each hand as they come. Repeat and start over and repeat
and watch the balls or bags fall out of your hands onto the floor—constantly,
infuriatingly—until you can feel where each object will go when you
throw it. Keep the balls aloft in the air as best you can. Build muscle
memory from the weight of each object.
That’s almost all there is to it. It’s only when you can not stare directly
at the action, though, that you’ve got any sense of control here.
See, the trick is being able to look away when you think you should be
Two weeks later, on the day Niccolo leaves, you don’t get to say goodbye.
His insurance coverage has ended after 30 days of inpatient treatment, and
his psychiatrist has discharged him and set him up for outpatient therapy.
He’s told you and some of the other staff he knows he’s not ready to leave,
though, and you’ll see him again in a few months as he’s transferred over
from juvie. There’s at least less rage in him now. Fewer triggers that send
him careening into the red. He’ll take a swing at Wilson, the recovering RN
with the walrus mustache, during his return stay, and he’ll be shut down
into subacute care for three months afterward.
Darla, meanwhile, has come back too early. She’s started cutting again,
something she hasn’t done in ages. When she left the Monday after you
picked her up, she seemed distraught but thought she could manage. Talked
about self-care, about getting her meds and her apartment organized. She
seemed hopeful, and now this. Tonight, you watch as she’s wheeled in on a
stretcher by EMTs, thrashing all the while, angry and gritting and red.
After the yelling dies down, you’ll visit her the next morning. She’ll tell
you that there wasn’t much to fuss over. She just needed to be here and
didn’t want to be here at the same time.
But tonight, right before bed, her stretcher passes through the children’s
unit on its way to the adults’. The yelling brings the kids out from their
rooms as they’re brushing their teeth. Mouths open, they stare at the
sight, Carson included. If home is chaos for the children, at least it
doesn’t have stretchers of screaming people rolling through the living
room. You’re not sure if this is what kicks Carson into overdrive, but
something does, and minutes after the EMTs leave the way they came, he
starts slamming the door to his room, over and over again.
“That is enough,” you tell him, grabbing the door from slamming at the last
second. “Everyone else is getting ready for bed, and you’re being loud in
He growls. Carson does this: this growling. He bares his teeth, acting like
something feral he’s seen elsewhere, and he growls. And when he realizes in
the middle of his sound effects that you’re still not going to let him slam
the door on its frame, he throws a fist into the air and charges you.
You wonder which cartoon he’s picked this up from as you grab his swinging
arm in the middle of its arc.
Joyce, who’s perched at the nurse’s station at the front of the hallway,
yells down, “Do we need to go to the Quiet Room?” And you ricochet her look
back toward Carson, who you know has heard the threat.
He panics, and so you yell back, “We’re good here, I think.” Even when
Carson throws his other arm at you, fingers balled into a fist, you hope
you are good. And that the poor kid won’t have to spend his bedtime routine
pacing on the blue canvas mat of a cinderblock-walled enclosure.
“Or at least we will be,” you say out loud. And this is when Carson starts
As part of your orientation for the units, the man who runs the ropes
course once walked you through patient restraint. Where to hold a wrist to
stop a patient from trying to cut themselves with a stolen pair of
scissors. How to transport a violent adult away from the unit and up to the
awaiting police. How to perform a basket hold on a child.
“Stop,” you say, but Carson rears back, yanks his four-year old fist away,
sends it back into the meat of your forearm. “Just stop.”
And so you cross his arms for him in the struggle, pulling him backwards
into your lap as you sink to the floor. In the rooms up and down the
hallway, the other patients are getting ready for bed, listening (if they
can hear it) to the sound of your back thumping and sliding down the
drywall. You move his arms and pin them against his body, right over left,
with the right hand slipped up under the crook of the left elbow like
you’ve been taught.
“We’re just going to take a small timeout,” you tell him, watching for his
legs to start kicking, but they don’t. He’s not here to fight, just to face
the backlash. So he sits with you, huffing and puffing and angry, but he’s
quiet. He’s held. He’s getting attention from another human being. He’s
And as his breathing slows, as the growls die down, you whisper to him,
"It’s bedtime. If you can calm down, I think I’m ready to hold up my part
of the deal we made. You remember?”
In the nighttime, under the fluorescent glow of the white lights of the
children’s unit, Carson looks up and seems to understand.
“I’m calm,” he says, still trying to wriggle away. “I’m calm.”
But you believe him.
“Can you stay put?” you ask, heading for your bag at the nurses’ station.
"I’ll be right back.”
And you fetch the canvas balls you’ve tucked away in the water bottle
pocket of your bag. Three squishy sandbags that you clutch in one hand as
you trek back down to the end of the children’s unit hallway, where
Carson’s peeking his head from around the door jamb.
Just shy of a month, his mother will pull him from the unit—"Against
Medical Advice,” his chart will say—and you’ll never see or hear from
him again. But for right now, as you remind Carson of the bargain you’ve
made him, as you let the juggling balls fly and fall in arcs and circles,
he’ll climb into his bed with a smile, and it’ll stay on his face there in
the dark after you turn off the lights and close the door behind as you
leave, and if you don’t look too closely.