It was almost unimaginable: a staff of thirty-five nurses directing the nursing care for 8,000 patients. Our nurse visited the unit twice daily to dispense medication to those few patients for whom it had been ordered. Most patients were not receiving medication, both a sign of the times and a reflection of the sense of futility that pervaded the unit. . . .


     I knew from Art that a neurosurgeon visited the hospital twice a week to perform lobotomies. The lobotomy program had been omitted from my hospital tour and was rarely mentioned. However, some of the post lobotomy patients lived on Freud II. As Art explained it to me, the neurosurgeon was a very unpleasant person who loved his work too much. Art recalled that a patient who had attacked the neurosurgeon during a provocative evaluation interview was immediately scheduled for and given a lobotomy that very afternoon. What was left of her was now a very docile patient who vegetated on our unit at Freud II. She looked the same as the other patients. Had I not known she’d had a lobotomy, I would have thought of her just the way I thought of the other incurable schizophrenic patients. . . .


     I could do what I had so desperately wanted to do, treat some of the Freud II patients—even though, of course, they were considered hopeless cases. Esther and Art shared an office adjacent to the day room. We decided that my interview room would be the linen room next to their office.
     I had a table and two chairs moved into the linen room, which now served as my psychotherapy office. The table was placed between the two chairs. The patient’s chair was to be close to the door that exited into the day room. Behind my chair were piles of linen and stacks of old clothing. I wasn’t sure who was going to be more scared in the therapy sessions—me or the patients. But I wanted to be protected by the table as a barrier, and I wanted the patients to feel they could easily escape into the day room if they became uncomfortable during our therapy sessions.
     I hadn’t forgotten my tour of the hospital. I had felt bewildered and overwhelmed for days afterward as though in some bizarre dream. Yet despite the horrible things I had seen being done to human beings for their presumed betterment, my fear had been tempered by a kind of disbelief. I was an anesthetized viewer, almost a tourist or visitor numbly looking at phantoms doing curious, unimaginable things. All I had to do was float from one weird scene to another.
     Now as I settled into what I envisioned as my real work, I began to experience a new set of feelings. At first it was curiosity about my charge, my responsibility, my duties. Then it was tension and nervousness, ultimately blossoming into real fear with sweating palms, tightness in my chest, and light headedness. These were symptoms of my fear of interacting with my own seriously ill patients in a direct and hopefully therapeutic way. Of course they were all so ill, their behavior so crazy, that I didn’t have a clue as to how to relate to them.
     And I was scared. I hadn’t been prepared for this.


     In paranoid schizophrenia, even without treatment the patient’s thinking and speech became more coherent; but the hallucinations and delusions continued. The patient seemed to seek a rational justification for his new psychotic reality. For example, “Of course I hear voices. The CIA has selected me for an experiment with brain loudspeaker implants.” Paranoid schizophrenic patients might appear so coherent that, if they didn’t tell you about their delusions and hallucinations, you might be fooled into thinking that they were normal people.
     In catatonic schizophrenia the patient became mute and preoccupied. He became stiff, with little if any concern about eating or drinking. He paid no attention to toileting and might become incontinent of both urine and feces. Caregivers would have to feed, clothe and clean the patient who apparently didn’t care anymore. It wasn’t that they were depressed and immobilized. It was that they were living in another world, and oblivious to their bodily internal signals . . . .


     The attendants were puzzled about what we were doing. They dutifully pushed together a circle of about thirty of the scratched and beaten-up dark-brown wooden chairs. With their assistance, a number of patients were invited, cajoled, and herded into the area and commanded to sit in the chairs in the circle.
     I tried to start the meeting. “I am Dr. Widroe. I am going to be here on the unit for the next three months, and I want to get to know all of you. Can you tell me your names?” Silence. No one told me anything. I repeated myself two or three times, my voice growing louder and more shrill each time. More silence.
     The community meeting never happened. It never happened because no one there was capable of being a part of a community. Gathering the patients for any event outside of mealtime or bedtime was like trying to organize a swarm of mosquitoes or flies. A few patients sat down on the wooden chairs as directed. Some who had sat down then promptly popped up and wandered off. Others came close to the chairs, eyed them suspiciously and continued to stand. A few more sat down minutes later. Of those who sat down, many had their eyes pointed toward the now blank TV screen. Were they still seeing pictures that I couldn’t see? After ten minutes of no response, I quit. Even when I gave up and announced that the meeting was over, no one seemed to notice.


     Except for the noises of the TV in the day room, voices and sounds that had nothing whatever to do with real life here, Freud II was always a quiet place. When the thunderous sound of piano music began, it was as shocking as if a boom box suddenly were turned on at high volume in a university library. I ran out of my office to see who was responsible.
     It was Bernie, a patient I barely knew, sitting at the piano, playing barrel house boogie. I couldn’t believe my ears. And I couldn’t believe what I was seeing, either. Bernie was rocking to the rhythm, a broad smile on his face. While he played, he looked twenty years younger than his fifty-five years. I walked over to compliment him and to encourage him to play more. It didn’t matter that the piano was way out of tune. His music had injected a new dimension of life into a mostly silent world whose only other sounds till then had fallen from the overhead TV.
     “That’s great, Bernie.” He didn’t respond. He didn’t even seem to notice that I was there. I looked around, expecting to see others who were admiring Bernie’s music. But no one else appeared even dimly aware of what was going on. It was amazing to me that no one paid any attention. After he had played for about ten minutes to a happy and appreciative one-person audience, Bernie abruptly stopped playing and walked away. It was like someone had switched off a light. Just as suddenly as when he stopped playing, his appearance changed. He now looked at least fifty-five, gaunt and ill kempt. In a moment he melted into the group of silent TV watchers.
     Later I asked Esther and Art if Bernie played the piano very often. Neither could recall that he nor anyone else had ever played before. The upright piano, a donation from someone’s estate, had been an unused piece of day room furniture—it’s only sound an occasional plink from someone who walked past, impulsively drawn to touch the keys.
     Everyone had a story, even if you didn’t clearly know what it was….


     Zeke, a middle-aged man, had been catatonic for seven years, kind of an incontinent mannequin. Staff washed and dressed him. They guided him to the dining area where he slowly ate with his hands.
     Each day when I was touring the unit on doctor’s bedside rounds, Zeke stood at his bedside in an unchanging posture with one arm elevated like a disheveled and exhausted Statue of Liberty. [Then, just questions and silence.]
     Dr. W. “I hope you are OK, Zeke. Do you mind if I move your arm?”
     Zeke: (More silence)
     I would then move Zeke’s arm—as I had done on many other days. I marveled at his waxy stiffness and my ability to briefly mold his position and then change it again. . . . Over several months there were only slight variations in this one–sided conversation. Then one day I noticed that there were beads of sweat on Zeke’s forehead. If he had been sweating on my previous visits, I did not recall.
But at least today I was aware that the room was cool. No one else was sweating or seemed warm. And Zeke, being the catatonic statue that he was, had obviously not moved around enough to work up a sweat. Yet he looked like he had been moving a house load of furniture on a hot summer’s day.
     I put aside my usual barrage of nervous questions. Instead I said, “Zeke, you look so tired. Why are you so tired? I slowly moved closer to Zeke until my ear was a few inches from his lips. After an interminable period of silence, in a quivering tone he slowly whispered, “I’m keeping the Earth from falling into the Sun.”
     I was stunned. First of all I was shocked at the fact that Zeke had even talked to me. I was still more surprised at what he had said. Here was Zeke devoting his whole life to exerting constant concentration and all of his bodily energy to prevent an interplanetary cataclysm.
     I had been searching for some question, some comment, or some observation that would enable Zeke to answer me. It was as though I were looking for a key and that, once found, my connection with a schizophrenic patient on some common ground midway between his reality and mine would exist at last. And the bridge between us could grow and enable me to bring him back to our world. I thought Zeke had given me that key.
     But the next day Zeke was silent . . . .