Chapter One

Call me Innocent. My name is Innocenza, which in Italian means innocence. In time, my name was shortened to Jennie, but I was still innocent, then. I need to tell you a story about those times, when I was a student learning how to be a nurse, learning how to move carefully in the worlds of illness, fear, and pain. I need to tell the story to sort it out for myself, too; that time in my life raised many questions and forced me to look inside and find direction.

My parents were killed in a car accident when I was a baby, on April 6, 1958. I was raised by my mother’s mother and her great aunts and her sister. Maybe because of that, being raised by people two generations older than I was, I became a bookworm and a serious, old fashioned sort of child. I was born in 1957 but sometimes I think it was more like being born in 1937, in a tightly knit Italian family of recent immigrants during the Depression. It did funny things to my head, but my grandmother and those aunts were my family and did the best they could with this bambina who landed in their laps. I’ll tell you more about them, and their lives, and what I learned through their letters. I’ll tell you the story about the mental hospital, and about how some of those patients taught me more than I could ever learn from anyone. I may wander sometimes, but keep with me, and you’ll get the whole story, and then you can make up your own mind about these things.

It all happened a long time ago, a long way from here. It was the winter of 1979 and I was in my second and last year at the nursing school in Mystic. It was a small town, about 8000 people, deep down in the pine woods in South Georgia, right near the Florida line. My spinster aunt, my widowed aunts and my twice widowed grandmother had moved from Chicago down to Florida to be with another widowed sister and her widowed friends. I needed to be close by, but not too close. All those Italian widows can be pretty intimidating.

So I came down from Chicago, from the big northern lake to the Southern woods, and began to learn. I was 22, tall and skinny and still single, which all the Florida aunts reminded me every time I visited. I also was half Italian and I didn't like grits. I missed Chicago, even the winters, down in the piney woods. I missed the big city, missed the fourth floor walkup where I used to live. Missed the grocery stores that smelled like salami and strong cheese. Missed big thick newspapers and snowy mornings. My connection to that world was the Post Office; every week the letters came, written on thin blue paper in spidery handwriting. The letters from my aunts and my grandmother, my link to the world.

Feeling like an alien in this warm small piney place, I learned to concentrate on the nursing, on the medical language, on the sick folks. Gradually, over the course of the first year and a half, I didn't feel like such an alien because I was good at the nursing. The words and the care came easily, the hospital felt like home. The other students accepted me kindly as a foreigner who didn't know the territory, but who was basically sound. I never learned to say "cocola" which was their way of naming their favorite soft drink, born in Atlanta. I never learned to drink sweetened tea or eat fried okra. Or grits. But I did learn to love the hospital early in the morning, waking up. I did learn to hold a patient's hand, or comb their hair, or just listen to some old person ramble on, telling me about their life when there was no one else to listen. I learned to read the books, the charts, and the orders. I began to put things together, and always watched the patients and gradually learned how the body works. I liked being a team leader, getting the jobs done and taking care of people with my fellow students.

Our nursing instructors thought we were all an odd group, not just me. Lots of the students in the class were older; I was one of the few under thirty. The nursing instructors were mostly women, and had done their training in the nineteen thirties and forties, when no one could be married and stay in school. They lived in a dorm where lights out were at nine thirty, and they starched their uniforms until they stood up by themselves. Things had changed by 1979, changed a great deal. Some of the teachers were men, with master’s degrees and experience in administration. Half the students were married or divorced, most lived in their own houses and took care of families.

I learned a lot in Mystic, and much of what I learned came from some of those older classmates. One of them was Lucas Strickland. He was 39 years old, had done three tours as a medic in Vietnam, and didn't need to be told to wear clean shoelaces. He had done medical care in the field, where saving lives was a question of running under chopper blades with a stretcher and wiping mud away to start an IV. He moved slowly, deliberately, as if moving that way was a pleasure, unfolding clean sheets and stroking the pillowslips was a gift. Where he had been, clean sheets didn't exist and moving slowly meant a life lost.

The other student I learned from was Eunice. She was about 42, an LPN with about twenty years of experience in several different hospitals, and was working toward her RN degree. She and Lucas between them had seen it all. I had seen nothing, but they seemed to think I would work out somehow, and they let me listen to their talk. I learned a lot, just listening to Lucas and Eunice.

Second semester the second and last year we did Psychiatric Nursing, and I looked forward to it. It would be different, because the local hospital did not have a psychiatric unit and we needed to travel out of town. We were to spend two days at a time, every two weeks, down in Enigma, at the State Hospital. We would leave Mystic early in the morning by van around five, and then drive two hours to the hospital, work our clinical hours all day and spend the night in a motel in town, and then work the next day, returning to Mystic by van around seven o'clock. During our clinicals the same rules held as for the other hospital experiences: our instructor would monitor us, we would work alongside the nurses on the shift but were accountable to the instructor. We were to review orders, follow them as much as we could, but whenever something new came up, we needed to be supervised. We couldn’t perform a task that we had never done successfully before. Sometimes we followed doctors and the more inquisitive among us asked questions. We soon learned which doctors and which nurses liked to answer questions.

We gathered in the classroom the day before the clinicals were to start. The schedule was on the board with instructions about when to go to the dormitory porch to board the van, what to bring for the overnight in the motel, how we were to pay the motel bill, and all the other details of our adventures in mental health.

Mr. Charles Maddox and Mr. Lester Wallace taught the class, and traded clinical duty every other year. Maddox was on leave, getting a doctoral degree in nursing. So our teacher was Mr. Wallace. We didn’t know him well, and from I could see, most of us didn’t want to get to know him too well. He was a small, balding, very tidy little man and he had sort of a prissy look around his mouth. He wasn’t a nurse, he taught psychology at the college. Mr. Wallace seemed fairly comfortable with the classroom lectures but we heard him call clinicals “hell on wheels” enough times to know he wasn’t looking forward to it.

Mr. Lester Wallace passed around a “Things To Remember” handout, as he called it. It told us most of the things he had already told us, written down on a piece of three hole paper to keep in our notebooks. Details like how much money we would need for the motel, how we were to keep our journals, what kind of clothes we should wear. On this rotation we were not supposed to wear our uniforms. In the other hospital settings we all wore a student nurse uniform made of cotton, with sort of a mattress ticking pattern and a cobbler’s apron.

We always wore that uniform during our regular hospital clinics, and even though we griped about it, it set us aside from the regular staff nurses. That uniform with the cap was a badge that said we were students, learning yet, and not completely accountable, not yet certified to take complete charge of patients. It was easy to spot us in the cafeteria, or cruising down the hall; all in a group, a gaggle of students wearing mattress ticking and nurse’s caps. And when we heard that we couldn’t wear the uniform at the mental hospital, it bothered some people.

“How will they know we’re students?” (I figured people could tell just by the way we acted, we didn’t need a uniform.)

“What if they get us confused with the patients?” (Hopefully we knew the difference and so did the patients.)

“I’ve gotten so used to the apron with the pockets, I can’t manage without it.” (Get a grip.)

The older students smiled and were glad to be able to climb out of that uniform for a while. One of the older ladies told me that it would have looked good on her about twenty years earlier. The older students had a better sense of themselves than some of the younger ones, and didn’t mind wearing street clothes. They also didn’t mind writing a journal.

“Why write it all down? We don’t have to do that in the regular hospital.”

“What if someone reads it?”

“How do we write it? Just like a chart?”

Mr. Wallace explained that writing the journals was a good way for us to reflect on our experience, and we could use it to go back and see how our patients had changed. I knew about journals, had been keeping one for a long time. I felt comfortable writing things down, always had. Had to, living with the women in my family. The journal had been a friend and confidant since high school, so now I kept two, one for Wallace and the class, and the other for me.

The journals were a big deal with Mr. Wallace; I wasn’t sure why at the time, but I figured it out later. With the journals he could sit down and read, he didn’t have to talk to the real student in front of him. The journals were easy to correct, write in the margins, and give back with no real conversation, no feedback except what he wrote in his little tight, spiky handwriting in the margins. He reminded us that they were about a third of the grade in this course, and told us what kind to buy at the book store. For some of my buddies, buying a journal that would be graded was like asking a condemned man to buy his own rope.

Things To Remember During Clinicals

Lester Wallace, MA

1. Wear warm street clothes, no uniforms. These people are easily upset by uniforms.

2. Bring a notebook for your journal: 8 x 11, three holes, wide ruled, no narrow “college” rule. The instructions for writing in the journal are as follows:

a. Do not use colored pens, only black ink ball point.

b. Do not draw, doodle or otherwise deface the journal.

c. Put in the journal everything that happened to you on a particular day, and only that day. Do not add extraneous material from your own experience or others.

d. Do not use unfamiliar abbreviations.

e. These journals are 33.5% of your grade; treat them accordingly.

3. Bring at least $25 for the motel bill and meals, but not more than $50 in case of theft.

4. Bring a change of clothes, overnight personal items, toiletries, etc., in a soft sided overnight bag, to be stored in the back of the van.

Do NOT bring any item that would scratch or otherwise mar the floor of the van.

5. Remember you are guests at this facility, act accordingly and do nothing that would reflect badly on your school.

Mr. Wallace stood at the podium on a little step stool. He was a small, slight man, nervous. He was a dandy dresser, though. He was proud of his highly polished Italian shoes, and his gold cufflinks. He fiddled with the cufflinks while he told us about These People at The Mental Hospital, and how careful we had to be. He told us that there were two things that we needed to learn about working with Them. One was how to make each encounter a Worthwhile Learning Experience and the other was to learn how to listen therapeutically. Our textbook for the course defines therapeutic listening as “allowing the patient to express emotion and work through grief using silence and empathy.” My definition was that the nurse hears the words that the patient didn’t say. What Mr. Lester Wallace really meant was we were to keep our mouths shut and not mess up too bad.

Most of the teachers at the school were pretty good, and we watched them carefully around patients, learning what to do. They had years of experience, and handled patients like we wanted to, calmly and smoothly. They knew what to do and taught us through example as much as words. This Mr. Wallace knew his book stuff, too. That wasn’t the problem. The problem was that Mr. Wallace had a mean look in his eye, a stiff sort of way about him with people. He seemed to pay more attention to the chart than the patient.

We met on the porch of the dormitory around five the next morning, those of us who would ride in the van. Lucas and some of the older students were to drive down in their own cars since there wasn’t room in the van for everyone. Besides, Lucas told me his overnight case had a buckle on it and he didn’t want to deface the van. We drove down to Enigma, down from Mystic early in the January morning.

We all got in the van, put our luggage in the back under Mr. Wallace’s watchful eye, and we drove to the Green Frog coffee shop in Waycross for breakfast. Everyone but me had grits, and I kept wondering why they insisted on putting those white things on a white plate, and why no one here ever heard of a fresh bagel.

Mr. Wallace kept counting us. I wondered why he didn't just put red paper signs with our names on our chests with a straight pin, like kindergarten. He looked around and counted us for the fifth time, and said, "On the van, everyone, time to go. Time to meet the crazies. Remember don't litter in the van, it belongs to Mrs. Wallace, and she's a stickler, you know." Little giggle; like I said, nervous.

"Got your journals?" He cleared his throat, as if talking to ten people made him talk louder, and more serious. "Remember those journals, they'll get y'all an A."

We climbed into the van with our journals, ten of us, in the wet damp dark of a Georgia January morning. Sun coming up, the pines were dark and stately against the lightening sky. Mr. Wallace sat behind the wheel, put his seat belt on, looked around and counted us again, and said,

"Off we go." He shifted gears, and finally, off we went, in Mrs. Wallace's van. She had the money, the talk went. Mr. Wallace liked to tell us about the seats on the fifty yard line they had for every one of the University of Georgia football games, and the cruises to Puerto Rico they took every year. But it was her daddy had been the richest man in the county.

We pulled up in the van to the mental hospital, in the early morning light. We all sat there, quiet, looking at the low, squat buildings where we would meet the crazies. Around the hospital were acres of tall pine trees, a forest of silent guards. It was gray, damp, and cold; the place did not invite us.

Mr. Wallace turned to all of us and said, "We'll meet at around eleven in the conference area near the Dayroom, and then have lunch in the cafeteria, unless anyone has any Big Problems." His look around the van told us that no one would have any Big Problems. "Then we'll discuss your morning. Remember, don't do anything but listen, and watch and keep notes. That's your prime job now, just listen and watch. The people who work here know what to do, and they've had lots of experience with these patients. You’ll be pretty confused by all of this for a few days, but don’t worry about it. Just keep quiet and then we'll meet for lunch. Remember your name tags. You don't want to be mistaken for one of Them!" He laughed his little nervous laugh and several of my fellow students got real white and nervous. They wanted their uniforms.

We piled off the bus, and I wondered, if we were only to watch and listen like paper on the wall, what we were doing here? We were expected to intervene with patients on the floors of the other hospitals, why not here? Why was mental illness so different from regular plain old medical illness?

We straggled out of the van and collected in clumps at the entrance. Wallace opened the door, and motioned for us to follow him. We walked down a long drafty hall towards a suite of offices, where Wallace knocked on one of the doors. It was opened by a secretary who stared at Wallace without a smile.

“We’re from the school, the nursing school in Mystic. Today is our first day for clinicals....” Wallace looked past the secretary to the administrator, who stood up to greet us.

He was a tall, thin gentleman, gray all over. His hair, his suit, his eyes, were gray. He had thin lips and rimless glasses, and looked at his watch about twenty times during the few minutes we were in his small cluttered office. Wallace had let a few of the students into the office with him, but the rest of us stood outside, craning our necks to see and hear. We got a few words and phrases, the administrator, whose name we never knew, said he wanted to welcome us. Phrases like “make sure your experience is valuable” and “let the staff know who you are” and “if you have any questions” drifted past the group of students to those of us behind. He nodded and took his gray self back into his office. Wallace turned and repeated the instructions about the conference room, which was down that hall, he pointed to the door. He shooed us off and told us to find our patients and he would see us later, and went back into the administrator’s office and shut the door. We stood in the hall and looked at each other, and wandered back into the Dayroom.

We were assigned to two patients that first day and were supposed to follow them for the whole semester, unless they were discharged. We were supposed to meet them and talk to them, introduce ourselves and explain why we were there. After we did that Mr. Wallace had told us that we were to go to the nurse's station and get the charts and read about their histories, why they had been brought there, and what medications they were taking. All that had to go into the Journal, after work, after we finished writing the medication cards that were every student's little Bible. And of course, we could only watch and listen, like posts stuck in the floor.

My first patient was Leo White. I had another patient named Elam Jefferson. We were supposed to call them "residents," though, not patients. We pretended that everyone here really wanted to be here, patients and nurses and techs alike. Leo White, named in the true Southern way, was black. He was strong looking, tall and lean; he had bright green eyes and straight thin features and high cheekbones and looked like an American Indian. He moved restlessly, tapping his fingers and moving around, always moving.

Leo was sitting on a couch in the Day Room when I walked in. I watched him for a while before I introduced myself. His long legs were sticking out across the floor and he was jiggling one foot constantly. He was frowning and talking fast to a man sitting across from him.

"I don't know about being a king, all I know about is I need to get out of here. All of you guys are nuts, crazy, you got it? I'm not, I'm fine, as fine as I can be in this crazy world. But I gotta get outta here. You hear what I’m saying to you, outta here."

He wore a baseball cap, and kept taking it off and rubbing his hands through his dark kinky hair. He put the cap on and twisted the bill around to the back of his head, and then twist it back to the front. I watched him get up and walk around, gesturing at this man who sat on the couch. I watched the man on the couch for a while, too. He was my other patient, according to the assignments that Mr. Wallace made, and his name was Elam Jefferson. This second patient was older; he had wild sort of dark hair, thick, combed straight back without a part, like an actor or a senator. Down the right near the center of his head there was a white streak as if the hair had no color or was bleached. He was dressed in a wrinkled pin stripe suit, with a brocaded vest and a silk Paisley scarf wrapped around his throat like an Ascot. He wore boots with thin fine leather tops. He was talking to Leo, and he gestured with his hands in the air.

"Of course you're not crazy, my dear, the rest of us are. But you are the King, so it doesn't matter." He took a little flute out of his pocket, and played softly for a minute. Leo stood up and paced around the couch, and stared at Elam Jefferson. He began to shout, and acted like he was going to grab the flute and break it.

“King? King of what, a whole country of crazy people? Stop saying that.....” he turned a table over in his anger and threw sofa pillows on the floor. The man with the flute played, softer and softer, eyes closed.

“Ah, hell with it.” Leo swore and then began walking rapidly toward the door. The older man played his little flute faster and faster, as Leo walked faster out the door. Then the tune turned softer again, slowly, like a march for a funeral as Leo left. I had to decide fast which way to go. Follow Leo, or stay with Elam Jefferson? He watched me stand there, stopped playing, and smiled at me. He waved at me as I walked after Leo, and followed him to see where he was going. I spent a lot of time following Leo in those days, half running to keep up with him. I found him rounding the corner, heading down a long hallway. He turned around and looked amazed that a skinny white girl was chasing him.

"Hey little lady, you lost?"

"No, I'm the student nurse with you today. Stop for a minute, I need to get my bearings. Where does this hallway lead?"

He put his head back and laughed. Whatever anger he had shown in the dayroom seemed to be gone, now.

"Lead? No where, little lady. No where at all." He looked down at me, and I saw how green his eyes were, and how the cheekbones were high and how square and firm his jawline was. "Where have you come from you don't know that?"

"This is my first day. I don't know my way around." I also can't keep my mouth shut like the instructor said.

He shook his head and looked amused that they would have someone looking after him who didn't know their way around. I learned later that he knew every corner of this place, every closet, every turn, every room, every hidey hole.

"You see, Missy, the Army built this place a long time ago, for soldiers. I was a soldier, and I know. The Army just goes straight until someone says "Right face!" because they don't how to turn corners. So the state took it over in the 1930's to put crazy folks in. They must figure that crazy folk don't mind never turning corners. They must think crazy folk don't notice."

"How do you feel about crazy folk?"

He looked at me with those green eyes, like jade rock, and spat on the floor. "These folks? They don't mean no harm, but I'm not crazy like them. Not like Elam and Jesse, nor Auntie Bea. Those folks are really crazy, they can't find their way around no way."

He looked indulgently at me, and smiled. "I don't mean like you, they couldn't find their way around if you told them ten times. They're stuck in some kind of weird world, like Elam and his play. You ask him about that play, I gotta go. Don't follow me, Missy, you go back there and I'll see you later. I gotta go for a walk."

He turned and started to walk fast, down the long dim hallway, chilly now in the Georgia winter. He walked fast and straight and tall, and I wondered what errand took him. I wondered where his anger had gone, and where it came from?