Current Episode: Depressed, Severe

Christina looks mildly irritated from behind the glass of the nurses’ station, surveying the dayroom where all of us wait anxiously for breakfast, nursing tepid coffees in styrofoam cups.

          She calls the patient’s name again.

          “Sorry, coming,” the patient says, getting up from our conversation.

          “Yeah, go take your pills, crazy.” Another patient is at our table. This illicits an immediate, “Fuck you.”

          “Before I’ve had breakfast?” She moans and bats her eyelashes. I cackle with laughter. Christina ignores us, and Kevin shakes his head mildly, not averting his eyes from his computer screen. Kevin wears Cherokee scrubs and Christina wears Figs. The scrubs we wear are adorned only by a barcode, signifying them as property of Poudre Valley Behavioral Health Center. I imagine they’re sent out to be mass-laundered at a facility: rows of scrubs, emptied of patients, traveling in a damp single-file down a factory line.

          Breakfast arrives on a rolling rack pushed by a gentleman from the kitchen who mildly nods at us when we say thank you. The main event is something that was advertised on the menu last night as a “breakfast enchilada” – it’s egg, corn tortilla, ham, and cheese, and it is delicious, made even better after being doused in hot sauce packets. There’s a side of fruit, sausage links, and a hash brown. It’s a lot of food. I eat as much as I can stomach, knowing that I need at least 350 calories in my stomach for my medication to be properly absorbed. When Christina calls me up to the window she asks me if I have any thoughts of hurting myself or anybody else, I say no, and she hands me two small paper cups: one containing water, and one containing my two morning pills.

          There’s “us” and there’s “them” on the nursing intensive psychiatric unit. “Us,” the patients, and “them” are the therapists, care coordinators, doctors, nurse practitioners, techs, kitchen, and even janitorial staff – anyone tasked with determining every aspect of our waking lives. Last night Cody, one of the techs, went into my room and pulled my blanket down from my neck to my shoulders, whispering apologetically: “We have to see your neck.”

          My doctor outside the unit is a serious-faced man called Dr. Menge, pronounced “Meng-uh”. Dr. Menge is serious, but he is thorough, personable, and a good listener, and I’ve taken a liking to him after two years. The thing I like about him the most is that he likes to curse – when I say I’m feeling shitty, he’s quick to ask what kind of shitty I feel, just how debilitating the shittiness is. I think it’s because most of his patients are kids. When I told Dr. Menge I was feeling like I needed to go inpatient he sighed deeply, leaned back in his chair and stroked his chin over his surgical mask, and then said, after some thinking, “Well, I know how much you hate it in there. So when you say that you want to go inpatient I take that pretty fuckin’ seriously.” He echoed the sentiment, without the f-bomb, to someone outside.

          The wheels turned, I spent some time in the waiting room, and eventually, a nurse in full gown came to usher me to the inpatient side of Poudre Valley. That was two days ago. The first day I spent in full Covid isolation, waiting for my test to return. When it did, it was late at night, and when I woke up in the morning I woke to an open door, beckoning me to explore the wonderful world of the NIPU, in all its fluorescent-lit, linoleum-floored glory.

          I come from a Mexican-American household. My father works at Home Depot and serves mostly as a liaison for the Spanish-speaking blue collar population. My mother is a primary care doctor working diligently for the largest not-for-profit health care system in Colorado since its founding in 2010. I’d like to say I grew up in a bilingual household, but I grew up speaking English 99% of the time, and 1% of the time the slang my father spoke in south Texas in the 80’s, consisting of sayings that don’t quite translate to English (one taunt which I picked up roughly translates to “whitey, whitey, feet of a stinkbug”). My Spanish is a phantom limb – when I hear Spanish being spoken in public, my heart trills as phrases leap out and I open my mouth to jump in, but the words don’t take form. I remember the first time I Google translated “Bipolar disorder” (it’s “trastorno bipolar”).          

          When my mother and I have conversations in the kitchen about my “trastorno bipolar”, we have them in Spanish for some weird reason I have long forgotten: her Spanish flows from her mouth like music, and mine is jilting, awkward, tainted with a hideous gringa accent. “Hablé con mi doctor hoy,” I told her in the kitchen, several months ago when things were still fine.

          “¿Que dijo?” I squirm, not quite knowing how to say, “He asked, ‘How shitty is the shit?’ when I was feeling shitty.” I settled on: “No es importante. Pero, I wanted to let you know.”

          “Okay, mijita.” She likes to know what’s going on. She was the first person I called when Dr. Menge made the decision to admit me, and she insisted on speaking with him on the phone. He pragmatically relayed his concerns and the benefits of going inpatient and she was very calm about the whole thing, which I appreciated.

          I asked Dr. Menge if he would be my doctor on the unit, and he explained that since he’s an outpatient doctor, I’d be assigned to one of the inpatient doctors or nurse practitioners. I have had it out for nurse practitioners since one sent me to the ER with serotonin sickness when I was sixteen, so I was relieved to be assigned a medical doctor: Dr. Sayer. This morning Dr. Sayer is wearing chinos the color of Pepto Bismol and a floral button-up and he strolls onto the NIPU like it’s the happiest place on earth. “Julia, with me,” he says cheerfully, and leads me to the intake room where we can talk privately. I sit in the chair where I sat two days ago before being very professionally and somewhat apologetically strip-searched by two nurses, who were as nice about the whole thing as two people could be. “I heard about yesterday.”

          “Yeah,” I say. “Everyone handled that really well.” Yesterday an agitated male patient didn’t like the look I gave him and went on a profanity-laden tirade, which climatic finish was a threat to cut my “fucking cunt face”, a threat which ultimately got him sent back over to the acute unit.

          “Are you okay?”

          “Yes. I’m fine.” It was fine – the moment the first fighting words had been uttered five staff members apparated seemingly out of nowhere to keep me safe, and try to calm him down.

          “How are you feeling in terms of the depression?” My prepared speech, that I outlined in crayon in my notebook yesterday, flows out of my mouth — I feel better thanks to the drug interventions, the group therapy sessions, and talking with my peers. Dr. Sayer approvingly nods.

          “Well that’s great, Julia. As far as the timeline for getting you out of here goes, I’m thinking Tuesday morning.” Shit. I’m starting to get sick of the food, and the flat mattresses, and the techs shining a flashlight in my room every fifteen minutes and pulling my blanket down. I am ready to go home.

          “What about tomorrow afternoon?” He considers this. “Yes, that could work. We’ll have to have you create a safety plan and schedule an appointment with your therapist, but that’s doable.” I beam at him and thank him.                     We thank a lot of people here on the NIPU. We thank the people from the kitchen, the nurses and techs when we ask for something, we thank them for meds, we thank the music and recreation therapists for coming and leading groups. When a nurse came clattering into my room at 5 a.m. with instruments for drawing blood and taking vitals, I thanked him.

          Dr. Sayer leads me out of the room, and I join the other patients in the dayroom. The friendly art people are here again – a tall bald man and a short blonde lady, the lady with the guitar and the man with a ukulele. They are singing. I think their names are Mike and Katie. Yesterday Mike led us in an exercise where we split a sheet of printer paper into thirds. “In the first section, draw your life as it presently is,” he instructed dreamily, “and in the last section, draw your life where you would like it to be. What are the barriers between you and your dream life? Draw them in the middle.”

          In felt marker, I wrote “TRASTORNO BIPOLAR'', and stylized it as a big brick wall between me, a rough caricature in blue scrubs, and my future: my future where I’m hand in hand with a pretty girl, the word “REMISSION” above our heads. “That’s very beautiful, Julia.” the art therapist said, in the tone of voice one might use for a preschooler. I bit my tongue and reminded myself that he was doing his best. I was very proud of it.

          I have seen awful things in places like this.

          “Sit with me, Julia.” a female patient who I’m friendly with motions for me to sit next to her. “You don’t think they’re going to extend my hold, do you?” she whispers. Mike and Katie are singing a song about watermelons. She’s here involuntarily on a seventy-two-hour hold. She told me yesterday at breakfast that after her boyfriend broke up with her she got drunk, cut herself a bunch with a kitchen knife, and called her friend who took her to the emergency room.

          “No, they won’t extend your hold. They won’t do that unless you’re like, trying to run out of here.” I pat her knee under the table so no one can see. “You’re fine. Just keep doing what you’re doing.” I want to tell her that last winter I was on an involuntary hold at a mental hospital in Colorado Springs, where I refused medications, told treatment to fuck off, and still got released when my seventy-two hours were up. I want to tell her that for-profit medicine doesn’t give a fuck about whether or not she’s well.

          Of the twelve patients on the unit, I am the only ethnic minority. I am also the only one here on a voluntary basis.

          My diagnosis is Bipolar I. I have had it since I was sixteen. This is my sixth inpatient stay overall, since I was seventeen.

          When I was seventeen I had my first inpatient stay at Children’s Hospital. It was scary, but parts of it were also fun – we all swapped phone numbers, even though it wasn’t allowed, and I texted a few of them once we were out. The walls were bright orange and green, there was soft furniture for us, and we would sit on the floor and just talk and hang out like normal teenagers. Most of us had a lot of things in common: most of us were bullied, had a hard time in school, and were cutters, with a few exceptions. Sleeves and pant legs were rolled up to compare scars. When I think of that stay I think of the bright green in the walls. For many of us, that was the last vestige of our childhoods. When I had my second inpatient stay at nineteen, following a pretty serious attempt on my own life, the walls were white.

          I can read my own chart, and the doctor’s notes through the patient portal. Dr. Menge’s diagnosis is as follows: “Current episode: depressed, severe.” That’s followed by the ICD code. I’ve been in and out of hospitals enough to have picked up some of their lingo: the ICD code stands for international classifications of diseases, and it’s what they use to bill your insurance. You’re living the American dream now, Julia, is what I thought to myself when I got my first bill in the mail for a private ambulance company my insurance had declined to cover.

          Imagine! My great-grandparents were migrant farmers who came to Los Estados Unidos seeking a better life, and their great-granddaughter was living it. I’ve been told that I have the same skin as my great-grandmother. I am the color of a chai tea latte. My name is Julietta, but everyone calls me Julia. I suffer from “trastorno bipolar”. My bracelet is crinkled from the shower. Mike and Katie wrap up their songs, and our “free time” before lunch commences.

          Christina and Kevin are at their computers charting. Patients wander into their rooms to lie down. Two patients are making phone calls. Two patients adjacent to me strike up a conversation about somebody’s boyfriend. I am tired of looking at white and beige. I close my eyes, and I transport myself back to the Children’s Hospital, then to Cedar Springs, then to Summitstone, then the others, each with different rules but the same basic idea, which is that you’re sick, and you can’t be trusted with your own safety, Julia, and you can’t leave. I wonder what my life would have been if I hadn’t told a school counselor what I was thinking when I was sixteen. I get up and go to my room, and lie down on the bed, and stare at the red eye of the camera in the corner. Dr. Menge let me keep my nose ring in, and I have to remember to thank him for that later. I don’t need to cry. I need to mourn the life that was lost to my illness, and the time I served in places like this one: the institutions that I ended up at, and eventually chose, because there isn’t a better alternative, and all I want in the world is relief from my current episode.