New Orleans was beautiful, exotic, and the murder rate was soaring. I got a job in psych emergency at University Hospital, a long-suffering slab of concrete not too far from the Superdome. This was six years after Katrina and four years after University took over emergency care from its flooded sister hospital, Charity, a towering art deco gem. University, from then on, would be the de facto place for the poor to get care. If the paper reported a shooting and mentioned victims being taken to “a local hospital,” University was that hospital.
Charity never reopened, to the chagrin of community organizers and the delight of ruin pornographers. At its operational peak, Charity reserved up to 150 beds for people suffering mental and behavioral health crises. But after Katrina — an anxiety- and depression-inducing disaster — the only place for them was either the Orleans Parish Prison orUniversity’s overcrowded ER.
University was founded in 1859 under the name Hôtel-Dieu, or House of God, or literally God Hotel. It was originally run by the cornette-sporting Daughters of Charity, who served and treated the poor, and purchased by Louisiana State University in the 90s. By 2011, it seemed like University was in worse shape than the people it served. I worked there four days a week. Each department in the hospital had some sort of civic-minded nickname: RTA, Pelican, Jackson Square, etc. Jackson Square was psych admissions, which seemed appropriate given that the real Jackson Square is a veritable sideshow of eccentrics. The room held two stretchers, eight chairs, a desk, and a series of lockers for confiscated belongings. Always the lively atmosphere. Cops who brought in their charges would linger and shoot the shit with us, shaking their heads and laughing in that wryly tragic way peculiar of New Orleanians.
Sometimes there were fights: patient v. patient, patient v. authority, patient v. self. Sometimes Styrofoam bowls of grits were used as projectiles. Listless staff would loiter and laugh. One time a guy in the throes of a meth trip flipped over a nurse’s desk. Alcoholic doctors were paged. Four-point restraints and sedatives would be prescribed. The most unstable and most agitated patients were dosed with a cocktail of Ativan, Haldol, and Benadryl, otherwise known as a B-52. All of this could happen within five minutes of a new admission. In spite of such sudden violence, everyone in Jackson Square responded to every situation with rote good cheer, even the calmer patients. Once a patient asked if we were hiring — he was so tickled, he could see himself doing this every day. The charge nurse, sipping from a 64 oz. mug, told him to sit his ass down.
After it was determined that a patient was a threat to oneself or others, they would be transported to an extension of the ER in a double-wide trailer. “The trailers” was a metonym for fucked up shit. Every single member of every department knew about the trailers. If a code white (violent patient) came over the p.a. elsewhere in the hospital, people would just glance at each other knowingly — they didn’t have to know where it was happening.
Even though it was a short walk from Jackson Square, hospital police were required to shackle the patient, perp walk them to a waiting cruiser, and drive for all of thirty seconds to two reclaimed FEMA trailers, mashed together and put to implausible use. A rickety ashen deck hugged the siding. Critters and reptiles lived there. Even on nice days, the grey siding of the trailers could flip your mood.
The psychically damned are not to be fucked with. At times, it would require the force of four large men to subdue one petite patient. At times, the patients would raise their fists, claw, grapple, bite, spit, and scream. A man named Thaddeus punched a nurse right in the nose, then begged god for mercy. Just another manic Monday, was the joke.
Noncompliance and deep spirituality were intertwined symptoms. An eighteen year-old paranoid schizophrenic told me that he was a reincarnation of one of the thieves crucified at Calvary, the one bound for paradise. He said his dead brother was Jesus and his living brother was the doomed thief. He also said he worked for the FBI. I walked down the aisle, got a tray of food, and when I passed his room again, he said that I bore a certain resemblance to the lucky charms leprechaun, then asked what was for lunch. I said, “it’s magically delicious,” as I handed him his meal. He cracked up so hard, and for so long, they locked him in the isolation room.
His mom showed up to retrieve him a couple hours later, after he had been deemed okay to go by the coroner’s office. In southern Louisiana, the coroner’s is a coveted role. The coroner wields incredible power, can issue certificates that detain someone for weeks. Sometimes the coroner’s deputy wore tie-dye and a nose ring. It was like that. The mom was wearing a t-shirt that read “Lead me not into temptation – I can find the way myself!” She said to me, “Did you know my children are god’s children?”
After that, I tried not to joke around so much with the patients. I’d talk to them if they talked to me, offering reciprocal respect. I’d sit and write in the observation log. I’d walk from one side of the trailer to the other, asking them to try not to cross the wasp-striped strip of tape fixed to the floor — a ridiculous demarcation for someone already on the borderline of sanity. If not asleep or sedated, they’d pass the time strolling between the three walls of their room.
Room 16 had no door. In its place there was a pale blue curtain whose upper quarter was white fishnet. These were to be drawn back at all times. A small square Plexiglas window sat in the center of the far wall, offering a distant view of the old Falstaff brewery. Outside, metal blinds yawned away from the building at a forty-five-degree angle. In the center of the room, a single bed with a metal frame and head- and footboard made of the same material as the window frame. Some rooms were minimally equipped with sinks and faucets that poured strictly lukewarm water. The faulty plumbing sounded like crickets. Overhead, ceiling panels of imitation stucco, pearly fluorescent lights, and fire sprinklers. Every yard or so a mute loudspeaker jutted from the ceiling. These were never used, as disembodied voices can really freak out a paranoid schizophrenic. Convex mirrors bulged like eyes in disbelief, but they saw nothing, just a vacant gaze like that of a statue.
I could hear the shiftless shuffle of their blue paper shoes on the dimness of solemn linoleum. I thought of Wordsworth: Awed have I been by strolling Bedlamites…
Or they would hide under a sheet, shaking, giggling, and farting with the regularity of a mechanical doll. They’d be wrapped up tight, eclipsing the surreality of Magritte’s Lovers.
If further care was required, patients were transported to actual behavioral health centers. The hospital itself could not offer long-term counsel or treatment — it was more of a grim limbo between the madness of the street and medicated wellness. They’d be spirited out to places across the lake or on the West Bank, places that provided group therapy and cigarettes. Once a patient managed to escape during transport, then stole a pair of sneakers, went home, and presented them to his son. It was his son’s sixteenth birthday. The man was back in limbo within a week.
There was a general tendency towards repeat admissions. These were known as frequent flyers: people with substance problems, people with troubled homes and families, people without homes who feigned symptoms to get their three hots and a cot. The police knew these people like a grocer does his customers. Some willingly accepted help. Some felt they were shanghaied. These were people whom the system had failed and failed again, as though their lives were tests they could never hope to pass.
This was when potpourri and bath salts enjoyed a brief vogue as scoreable drugs. Observe the hallucinogenic underside of bougie luxury: what the rich luxuriate in, the poor and insane incinerate and snort. A habit-forming opulence. People without a history of mental illness were brought in freaking out on mojo. A man said that this was it, they were finally coming for him, they were going to eliminate him with a laser gun. I knew not to ask who They were. I privately referred to this man as Billy Pilgrim. Billy Pilgrim was given some juice and low-dose benzos. Billy Pilgrim came down after a few hours and was promptly discharged.
In the trailers, the more tranquil patients were encouraged to talk amongst each other. Recipes for the best scrambled eggs were traded. Certain charge nurses were lampooned with gifted mimicry. Plans for suicide were discussed at length. Frightened interns on their first rotation, usually white, from out of town, couldn’t figure out where to begin. They’d only ever read about illness. Now they were face-to-face with demon-haunted, head-banging, voice-serving schizophrenia. Where to begin?
If the doctor was out, they might consider the orderly. I had the scoop. I might’ve been literally scooping up shit because an elderly lady couldn’t help herself and the housekeeping department couldn’t help me. I might’ve been mopping up shit and telling interns not to approach someone from behind. Just don’t. Their lips would squirm. They might dispense a quick, nervous jet of air through the nostrils. They paced around like the people they were supposed to heal. Their step always quickened when it was time to leave, although I might’ve taken longer than necessary to unlock the door, as though to stall them, to say: Take a good look.
Graveyard shifts are a symphony of bodily music. A man’s grinding teeth sound like someone creeping across ancient wood. A woman’s snore terminates in an owlish hoot. Somebody might hum a hymn or mutter a psalm in their dreams, sleeping with the New Testament under their pillow. One guy, a john doe who told us his name was Bondservant Holyman, did this, every night for a week.
If the coffee & chicory ran out, we would stay up with cold drinks and bitch about the Saints. On breaks, we took turns napping in the linen closet on a bed of two chairs. If it was really slow, we got assignments to sit with patients in other departments. You would sit with a guy who was beaten into a coma, whose wife stayed by his side all night, playing a warped audiobook of health devotionals set to a new age drone:
“Resurrection power is flowing through my bloodstream.
My blood pressure is perfect and it glorifies the lord in every way.
Glory evicts these cysts.
I live and walk in divine supernatural health.
My arteries are commanded to be clean.
Every organ in my body is communicating with my brain as divinely designed by the lord.
My bones refuse the old curse.
My joints will refuse anything that tries to destroy their noble function.
I enforce life in my body.”
Or you would sit with a guy who tried to blow his brains out, missed, blew his nose out instead, and now insisted on watching classic movies, Clark Gable or Tyrone Power vehicles. This guy had a hole the size of a fist in his face and he’d try to laugh at Greer Garson in Adventure as she shot Gable a withering look – actually that’s the whole movie, a series of beautiful frowns and expertly knitted brows – while I was having something like a religious experience.
In the small hours of the night in a hospital in New Orleans, I imagine something like that happens on the regular. And when dawn broke, there were still two interminable hours to go.
Late in 2011, the state announced that University would face $15 million in budget cuts. Entire departments would be slashed or downgraded, including the detox unit and psych emergency. If there were ever something that New Orleanians didn’t need, it was certainly treatment for substance abuse and behavioral healthcare.
A pall of anxiety fell over the staff. We all walked around with bullseyes on our backs. One by one, beloved coworkers were axed. Idiotic flag-waving members of human resources called us into meetings where nothing was made clear but their own incompetence. One of them actually said “God Bless America” by way of farewell, after telling our group exactly how we were getting fucked.
By the end of February 2012, along with more than hundred others, I was out of a job. Between psych and general emergency, services were reduced by 20 percent. The mayor and the chief of police announced their concern over an influx in crimes committed by people with psychotic disorders. Governor Jindal blamed LSU. LSU blamed Jindal. Journalists warned of an impending public health crisis. And the population suffered. Families had their loved ones arrested, because the acute mental health services at OPP were better than the hospital’s.
Within eight months, I’d dealt with some more setbacks: hospitalization and surgery for a biking accident (guess where), a torrid summer fling that escalated to legit psychodrama, a lengthy power outage due to Hurricane Isaac, and a midnight pistol-whipping to the tune of $10 and a useless LG Slider. Four years ago, there was a lot of talk about the apocalypse. It was a frequent topic of conversation in the trailers. Jesus didn’t come, but some of these events felt biblically harsh. They also felt like they couldn’t have happened anywhere else. Be Nice or Be Damned.
Four years later, University was closed and absorbed into the newly built University Medical Center. Despite a colossal $1.1 billion reconstruction, the Center is still in trouble, as it faces a $15 million shortfall. Budget reductions and underfunding continue to plague the state Jindal left in shambles. The behavioral health department still has only twenty beds. 152 jobs are at stake. The complex itself, about as architecturally interesting as a server farm, makes one long for the simple honesty of a double-wide.
Then again, this is a city where a cop named Quincy Jones was busted for corruption, and “Mystikal Recidivism” isn’t a group show but a stark reality about the rapper’s legal issues. The intersection of art, crime, madness, and institutional fuckery is as much a part of life in New Orleans as the fact that it’s below sea level. Depending on where you stand, you can embrace one of two attitudes: no indeed and yes indeed. If you stand at all. If not, help is on the way.