One Small Step For Man

One thing you really need on this job is an appreciation for little successes. A little progress is still progress, afterall, and if you want to do more than just survive working with folks with chronic mental illnesses, you have to learn to love whatever little progress you get.

Andy has been pacing a lap around our acute admissions unit for, no kidding, about a month. He's mostly silent, although some days he might stop to answer a question or two with, "I'm all set," before returning to his vigil. He's a young guy, only 21, and when he's well, he lives with a roommate in his own apartment. Trouble is, when he's not well, it takes him a long time to get better -- his last hospitalization lasted four months.

He came to us on a drug called Clozaril, which is a little unusual in a guy his age. Because of a potentially lethal side effect, Clozaril is often considered a treatment of last resort. People who take it have to have their white blood cell counts taken every week to make sure their immune systems remain intact. Since his last hospitalization was very long, and since he was discharged on the med of last resort, we're assuming that he's been tried on pretty much every other antipsychotic med already.

So we're not surprised that after a month his improvement has been only marginal. He's out of bed, which is a plus. He's dressed, he showers every now and again (clothes washing remains elusive). He sometimes can sit in group for a good while before he needs to go pace again. And this week, he's started to leave the unit to go down to the cafeteria with the other patients for his meals.

He's just the kind of guy who can fall between the cracks on an inpatient psychiatric unit. Nobody seems to mind all his pacing -- not even the other patients. If there's a little traffic jam, he'll just wait for his opening or go around without bothering anybody. He's not demanding anything, he takes his meds and he keeps out of the way. You might think that all of that is good, and believe me, it is. But the downside is that unit staff can stop trying to engage a guy like him, stop noticing him really, and assume that what you see now is all there is.

So if you weren't paying attention, here's what you would have missed: The other day, at a moment when the unit was pretty quiet, very-manic-but-starting-to-settle-down Gloria was walking down the hall toward Andy. They exchanged a few words with each other, then moved over to the wall and slowly sat themselves down. Gloria took the deck of cards out of the box she had been clutching and began to shuffle, then deal. I didn't watch for long, because I didn't want to ruin it for them by letting them catch me watching, but I think they stayed there for a couple of minutes, at least.

Don't take this the wrong way, but I felt that same mix of luck, joy and awe that I get when I'm in the woods and run across some critter doing something interesting -- lucky I ran across it, glad I noticed it before I scared it away, and amazed at what I'm seeing.

A small breakthrough, I know. But I'll take it.

Peace out,

Madeline