Four Hours in “Purgatory” at the UNC Hospital Psychiatric Unit
Elizabeth Wheless describes her shadowing experience in UNC Hospital’s Psychiatric Unit. She focuses on how people going through the hardest times in their lives, dealing with things like autism and depression, are still able to hold onto their humanity and make the best of their situations.
CHAPEL HILL, N.C. — The last rays of sunshine fall behind the exterior of the University of North Carolina Hospital as night approaches. Downhill, tucked behind a group of bushes that outline the visitor’s parking lot, ambulances enter the docking area and EMTs in green jackets unload empty gurneys. Yellow and red brake lights illuminate the sunken, pale faces of patients in wheelchairs on their way through the main entrance.
Patients with physical ailments will soon fill those empty gurneys and will be released in a matter of hours. For those with psychiatric concerns, their night is to be spent in the Ground Neuroscience Hospital, nicknamed GNSH, where, in a room with no windows, the days melt together.
Social workers, nurse’s assistants, and the day’s psychiatrist convened in Control Room C, the psychiatric administrative room. Children’s drawings, clipped magazine pages, and a large whiteboard with inside jokes written in red decorated the beige walls. The staff hovered around computers, writing emails, telling jokes about their weekend, and observing the profiles of their next patients.
Before his shift ended at 6 p.m., the psychiatrist spoke about his life and his practice. He had gone to medical school, not for psychiatry, but for the reason many go into the medical field. “I wanted to help people,” he said. The knowledge that people needed him stood as his driving force to become a psychiatrist. Although he wanted to help people, he said he could not help all of them. He spoke of the systemic shortcomings of North Carolina’s mental health resources. “[GNSH] is the purgatory of the mental health system,” he said. “[The people who stay in GNSH] fall through the cracks of the system. There aren’t resources for them.”
Many patients within GNSH reported suicidal thoughts or depression. Homeless people often wandered into the hospital claiming they had depression just to sleep in a bed. Twenty-five acute trauma patients resided in its walls. Whether brought in voluntarily or involuntarily, each patient was given a bed, a purple set of scrubs, and no specific release time. Some had stayed only a few hours, but at the moment, four had stayed for over a month.
The elevator doors shut as the psychiatrist mentioned the wards upstairs. The third through fifth floors functioned as psychiatry wards for many of the hospital’s “lucky” patients. The third floor operated as the ward for psychotic adults, the fourth housed geriatric and crisis patients, and the fifth held the adolescent and eating disorder ward. The patients on these floors spent an average stay of two or three weeks. They had stable, longer-term hospitalizations. They received a bed to sleep in, psychological help, group interaction, and sunlight to see. They were given the opportunity to see psychiatrists and receive new or updated medications. The ability to shower and have personal belongings were also granted.
GNSH was for those patients “stuck in limbo” between discharge and a bed upstairs. The patients did not have a permanent place in the hospital. They were floating towards a chance for an improved life but held back by either financial problems or lack of beds. Thus, the naming of GNSH as “purgatory.” It is simply a resting place for lost souls. Those who don’t have a place. Those left behind.
The psychiatrist spoke of two types of patients the psychiatry ward saw regularly: elderly people, either demented or aggressive, and disabled and autistic children, some of whom were aggressive. Frequently, patients who were either dangers to themselves or others were placed within the walls of GNSH. Many residents had bipolar disorder, but due to the unpredictable nature of bipolar and its many facets, GNSH remained the safest place for them. “The media at large doesn’t understand bipolar,” the psychiatrist said. The elevator heaved open. The air cooled, sunlight disappeared, and “purgatory” emerged.
In the “L” shaped room, fluorescent light streamed through the glass windows on each side of the room into the public wing of GNSH (Figure 1). In front of Adam, a nurse’s assistant in burgundy, stood a ten-year-old girl. She pressed her hands and face against the glass and tapped them. Adam glanced up at her from his computer. His face broke into a grin and he waved at her. He turned his attention back to the Google presentation on his screen. Adam was a student at NC State by day but filled his nights at GNSH. He tapped away at the keyboard for a moment until she spoke again.
“Name?” she asked.
“You know my name,” Adam said without looking up.
Adam continued that way through his entire shift, nearly every day. Back and forth with the little girl. For hours on end. The nurses had grown fond of her and often entertained her with dolls, magazines, and stuffed animals. Her room differed from the blank beige walls and TVs covered with plastic boxes of the regular patient rooms; she had personal belongings around her. “I want to take her home with me,” another nurse’s assistant said with a smile. He turned to her window. “Hey! Do you want to come home with me?” he asked.
A 32-year-old man sat, back propped up with pillows, atop of his bed. Against the plain walls and the white bed, he stood out like a blob of color in his purple top, seafoam green pants and blue socks. He was admitted the night before at 7 p.m. for threatening suicide with a handful of Seroquel, an anti-psychotic drug. A schizophrenic with a history of hospitalization, he had been in this situation four times before this for suicidal tendencies. Despite his familiarity with the system, the experience still jarred him. After he had been involuntarily brought in, he fell asleep and did not wake up for 10 hours. He looked around the room for the windows that were not there and for the watch not on his wrist. “What day is it?” he asked.
He respected the medical profession and those who took care of him in GNSH, specifically the EMTs who had driven him to the hospital the night before. He spoke of his dream to become an EMT but due to his many hospitalizations, he could not complete the training. His life consisted of a series of suicide threats, ambulance rides, hospital trips and very little change. He lived cyclically.
Tattoos covered his body from his neck to his legs. Music was his passion. He listened to Slipknot, Chris Young, and Machine Gun Kelly– all different styles of music. From learning to play the guitar at 18 to learning piano and trombone, music assumed a large part in his life, and he passed that on to his children.
As he spoke of his children, a small smile crept up on his face. Both the boy, 6, and the girl, 9, lived in Connecticut, far from their North Carolina-bound father. For the last several years, his license had been revoked, so seeing his children face-to-face was not an option. He had only been able to FaceTime with them or call them over the phone. However, good luck had come his way recently. “I got my license back,” he said, smiling. The ability to see his children again gleamed in his eyes.
His daughter was involved in musicals. He could not see her perform, as he lives so far away, but the pride he felt for her showed on his face. His son also loved music, but his taste contrasted that of his father’s. “His favorite song is the one… ‘Freaky Friday’,” he said with a laugh that brightened the barren walls (Figure 2).
Nurses began to heat up pastas and soups for themselves as patient’s dinners were passed out on large industrial rolling racks. Each patient ordered their dinner to their liking. Trays held milk, Jell-O and plates of salad and bread. Adam rolled the empty rack back in to the nurse’s station, sat down at his desk and opened the presentation. The resident nurse, clad in light blue scrubs, looked over patient records and police reports as he ate his homemade meal. Each staff member had their own uniform color that indicated their title: burgundy for nurse’s assistants, light blue for resident nurses, dark blue for radiologists, green for pharmacologists, seafoam green for burn, surgery, and Emergency Department residents. Purple was reserved only for psychiatric patients.
The nurses each told stories about their families and their beginnings in medicine. One nurse, born in Kenya, came to the United States for secondary education and found that medicine was the challenge she craved. Another started as a hospice nurse in Florida and came to GNSH four years ago. The resident nurse had been in GNSH for nearly six years and had the stories to go with it. He showed a scar running down his left arm from an 8-year-old and then a photograph of a large, swollen black eye a patient had given him. Tales of patients fighting each other flew through the nurse’s station until a small voice cried out, cutting through the noise like an arrow.
“Name?” she asked.
The little girl pushed a finger against the glass barring her from the nurse’s station. She noticed new people, and wanted to get their attention. Adam walked over to her and she asked to have the visitors brought in to her room.
The little girl sat on the floor of her room in a pair of blue pajamas with orange tigers. Scattered around her were ripped pages of magazines, crumpled sheets of paper, a pillow and purple blanket, and a cup of pink liquid. She held the title of one of the longest-staying patients in GNSH. She had lived in her private room for 25 days.
She was an aggressive, autistic girl with a history of violence.
Her parents had cared for her in their home for many years but as her illness worsened, they could not take care of her. Her parents rarely visited her, and the last time she was discharged, she was brought back three hours later for attacking her mother with a chair. Closed in by walls, she lived in her own room with a private bathroom. She could not be with the other patients in the public wing because she would attack them as they went to the bathroom. In her room, she looked at the door leading to the public wing. “Bad idea,” she said, then she looked at her bathroom. “Good idea,” she said.
Despite her lack of verbal communication skills, she was a bright girl. She named her dolls after the nurses and visitors. Adam, a redhead, had a red-headed doll named after him. The doll wore a white dress that clashed against the little girl’s matted and tangled black hair. When she stubbornly insisted her unkempt hair be put in a ponytail, Adam supplied her with the thick wrist-side ends of rubber gloves to act as hair ties. He kept watch over her as he opened the door to hand one to her.
She liked the sounds of snaps and would shout, “Snap!” to get those around her to start the sound. She grabbed the closest set of hands and held them to her ears to hear the snapping better. It seemed to calm her when she was frustrated or confused, which occurred roughly every 10 minutes. In those moments, she looked to the public wing. “Bad idea,” she said. Again, to her private bathroom. “Good idea,” she said.
She sang Christmas and nursery songs with hand movements and slurred speech. “The Itsy-Bitsy Spider”, “Jingle Bells”, and “We Wish You a Merry Christmas” were her favorites, but above all, she loved Taylor Swift’s “Shake it Off”. She swayed to the music and sang her own versions of the lyrics.
She acted like any other 10-year-old would.
Patients emerged from behind their green, flowered curtains and shuffled out of their rooms after dinner. One, wrapped in a black blanket, stumbled to the nurse’s station window. He stood, swaying, in front of the window. His voice was raspy and sounded like gravel. He whispered that his head hurt and asked for pain medication. Many were asking for pain medication or their usual dosage of medication. “You can get them at 8 p.m.,” the resident nurse said. One by one, the patients made their last phone calls to loved ones and retired to their rooms. With the shuffle of socks and the rattle of curtains being drawn, the night resumed as it always had.
The routine of the day was one of the only clocks in GNSH. The days in “purgatory” drudged on without an end in sight.
The windowless halls continued to contain patients waiting for a bed upstairs or a ticket outside. The tattooed man waited, alone, for his release day. The nurses chatted about their families, and the little girl was to stay another day in her private room, wearing tiger pajamas and continuing her conversation with Adam.
[Untitled photograph of the nurse’s station at the UNC Hospital Ground Neuroscience Hospital]. Retrieved November 4, 2018 from http://www.shelcollc.com/portfolio/healthcare/
[Untitled photograph of a standard room at GNSH]. Retrieved November 2, 2018 from http://www.shelcollc.com/portfolio/healthcare/