Sunday, March 7, 2010

The CIA in a Styrofoam Cup

Seal of the Central Intelligence Agency of the...

"Time," Joe muttered, "began with the expansion of the universe."

Not certain I got the connection between his comment and the clinical note I was writing, I asked, "Run that by me again?"

"Time," he said, "it's all about time. You think you never have enough, but we've had time since the Big Bang."

"So, that explains all the psychotic patients we have on the unit today?"

"It doesn't explain why we have them, but we certainly have the time for them."

Joe was forever coming up with bits and pieces of trivia, especially at the end of a tiring shift on the inpatient psych unit. And this had been a long one, beginning with a close encounter with a paranoid patient who had been admitted that morning. Convinced the CIA was after him and his wife, he approached me and asked if I'd accompany him to his room. "I've got something you have to see," he said, and intrigued, I agreed.

We'd just gotten to his door when he stopped and pointed to a styrofoam cup sitting on the floor. "That's what those rats have been doing, and they've been doing it to my wife and I."

I asked in my best and softest therapist's voice, "Who are the rats?"

He thought for a moment -- I wasn't certain if he'd answer -- and whispered conspiratorially, "The CIA -- shh, they're listening."

"Would it help if I took that (gesturing toward the cup) away?" I asked, quietly.

He threw his arms around me and cried, "Thank you! Thank you! You're my friend." I disentangled myself and suggested it would be helpful if he were to lay down on his bed and take some time out. He agreed and I took the "listening device" with me on my way out. Generally, you try to resist cooperating with a patient's delusions, but in this case, he was likely to escalate further unless someone did something about that blasted cup.

It would be a few days before his medication began to work and when I saw him on the day of his discharge, he didn't seem to recognize me. I was standing at the nurses' station, watching him gather his belongings and hand them to his son, when he reached across the counter for an empty styrofoam cup. Oh, no, I thought, wishing I'd anticipated his possible reaction and thrown it away. Turning it over in his hand, he shook his head and smiled, then looked up at me and said, "Funny thing about these cups. You never really know for sure where they come from, do you?"

No, I guess you don't.

(Public Domain image via Wikipedia)
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