Synaptic Silence

Well, today I reached a new level of frustration in my job as a civil commitment investigator.  I evaluate mentally ill people who are being held in the hospital against their will because some physician there thought they were dangerous enough to be placed on an involuntary hold.  In Oregon, the official term is Notification of Mental Illness.  It sounds so beauracratic, doesn’t it?  Like some kind of sweepstakes thing you get in the mail announcing, “Open this letter immediately!  You are MENTALLY ILL!!!”

But what it does is allow a doctor, if he can find another doctor or mental health professional to agree with him, which is absolutely always possible, to keep people in the hospital against their will for five court days.  There really is nowhere in Oregon law that the term “court day” is actually defined, but it’s generally understood to be a day when the court in the applicable county is open for business.  Weekends don’t count.  And holidays don’t count.  And days the court closes because of weather or a flooded basement don’t count. 

So a five court day hold actually sometimes works out to just five days, if you’re lucky and come in on a Sunday and there are no holidays in the mix anywhere the following week, which actually happens sometimes.  But there is so much that make that not the case.  The day you’re placed on hold (Sunday) doesn’t count (it’s essentially day zero).  So the first day that actually counts is the first weekday (Monday – Friday) you’re in the hospital, unless the first weekday is a holiday.  Or if court is closed for some other reason.  If that’s the case ,the first day would be the second weekday, after which you count off weekdays until you come to five.

Let’s say you come in on a Wednesday.  That’s day zero.  The first court day of the five court day hold would be Thursday, and Friday would be the second court day.  Since the weekends don’t count, the third, fourth, and fifth court day would be Monday, Tuesday, and Wednesday, respectively.  Unless Monday is a holiday, at which point everything shifts over a day, making Tuesday, Wednesday, and Thursday days three, four, and five.  Unless of course, Thursday is a holiday which means day four would make Friday day five.  Isn’t that simple?

So, in between court day one and court day three, I have to decide if the doctors were right or wrong  to place a person in my jurisdictional area on a Notification of Mental Illness.  If they were right, but the person clearly wants to stay voluntarily, I drop the hold.  If they were wrong, and the person was just having a bad day and said the wrong thing at the wrong time, I drop the hold.  And f they were right, but the person still wants to leave and kill themselves and everyone on the planet, I have to take them to a court hearing on the fifth court day, whenever that happens to fall in the Monday-Friday time frame. 

That means I have to write up a huge report documenting why I think the person should be court committed for up to 180 days, get witnesses lined up, see the person every day to make sure they haven’t suddenly had an epiphany and turned around, and go to court and testify.

If everything goes right, the judge rules in our favor and the person stays in the hospital on a civil commitment.  If not, the person is immediately free to go.  But to even get to that point, we have to convince our own attorneys to actually take the case to court.

Oregon has a very liberal interpretation of who actually should be civilly committed.  That’s because most of the people that actually count in Oregon, the people who live in Portland and Salem, are distinctly left-leaners.  And because of that, the Oregon Court of Appeals has gradually raised the evidentiary bar that determines if a person is committed or not to somewhere beyond the planet Neptune. Because of that, we now have to expend tons of energy explaining what is in essence a very simple case to an increasingly resistant set of attorneys.  Sometimes that’s very frustrating, since they tend to view these cases more in the criminal court model than the civil court model that it should be viewed in.   And, since they also focus on everything from property tax challenges to building construction codes to animal abuse, they naturally tend  to have competing priorities.  That isn’t right in my mind, because quite honestly, in a world that is reasonably focused, suicidal human beings who needs to be kept from killing themselves should trump cat collectors every time.  Unfortunately, it doesn’t stop just at frustration.  Lately getting them to focus correctly on these cases has been nigh on impossible, which is not only a shameful situation, but unnecessarily tragic for the mentally ill persons involved and their families.

That reached an all time pinnacle for me today.  I had a patient on a hold who everyone directly involved feels should be committed, just as I do.  He’s done some really dangerous things that I had people ready to testify about.  He had all the kind of classic psychotic symptoms that you’ve come to see on CSI and other educational programs that are not just television plots to us.  We see people who have bizarre thoughts every day.  But he is in the category that is pretty much our sole job to identify.  Instead of just hearing voices and feeling afraid of everyone and having delusions, he had begun to act on them.  And, because of that, he was going to hurt someone or himself.  All of his family members, neighbors, and even casual acquaintances were willing to testify to that effect.  

But when I had the case all tied up with pretty strings and bows and presented it to our attorney, I hit a brick wall.  Suddenly all the things that looked so dangerous weren’t dangerous in her eyes.  And all of that hit it’s zenith when I said he was the kind of person who, because he believes he’s invincible, would run out in front of a speeding car, believing he could stop it with his mind.  After which the attorney argued back, in a completely cold and eerie way, “But he hasn’t done that yet.”

Sigh.  Now we have to wait until they actually jump into the road to stop moving cars and be run over by them because they think they can stop them with their mind before we can take them to court to stop them from jumping into the road to stop moving cars and be run over them because they think they can control the vehicles with their mind.  I had this brief vision of us having to drag a flattened eviscerated corpse  into the courtroom to prove that, by golly, we’d better let them die before we commit them for their own safety.  So I yelled enough to get the decision changed and then came home.

This should not be so hard.  And someone who counts, which is clearly not me these days, should do something about it.

I often evaluate patients at a local geropsychiatric unit, a locked inpatient facility that specializes in the care of elderly persons with dementia or other mental disorders. Last night I was there late, working on going through someone’s chart to see if he needed to be held involuntarily for a lengthy period, meaning I would have to recommend he go to a court hearing.  I hate having to do that, since it subjects them to an environment that they know means something is wrong. Fear is perhaps more real for people with dementia than it is for someone who has all their mental faculties intact.

There was just something in the air I could sense, maybe because I just turned 55 and it wasn’t too hard to imagine myself there on the ward as a patient…a sense of loneliness and subtle desperation, and the other myriad emotions that people who’ve begun to lose themselves often experience. A woman had just come to the nurses station for the fifth time to ask when her husband, who was dead, was coming to pick her up. I suddenly had the following poem in my head, which I wrote out on the spot.

 

A Song to Sing

By Jeff Rogers

My mother said I wouldn’t like
The job I took in geropsych.
Helping people so in need
Seemed a daunting task indeed.

But it didn’t matter, at the time,
That I might never make a dime.
For the salary I longed to earn
Was helping all my patients learn

That all of us, both old and young
Have songs that yet remain unsung.
I had just one thought to impart—those songs
Could cure an empty heart.

But now I’m old. That’s what they say.
It truly seems to be that way.
My mind, once sharp, now dull with haze
That blocks my thoughts and steals my days.

It’s strange, it seems I know this place,
The subtle things that fill the space,
The smells, the noises in the halls,
The plaintive cries heard through the walls.

Someone told me it was true.
She said, “Of course, I worked with you.”
But if she did, I couldn’t say.
My memories leave me, day by day.

I simply know I’m not the same.
I ask myself who I should blame
That nights seem long, and days fly past.
I wonder what of me will last.

I must have yelled out from my fears.
A woman came and wiped my tears.
I asked her later, why she came,
When I didn’t even know her name.

She said they all had learned to care
From someone who had once worked there.
Who taught them all one simple thing,
“Just help them find their songs to sing.”

I thought I’d heard that long ago
But the one who said it? I don’t know.
Someone wise, of that I’m sure,
Who, in my song, could find a cure.

I was driving back to work today through the snow and ice that’s been part of life here in Portland, Oregon, for the past week. I passed the parking lot for the County Court in downtown Hillsboro, where I work for the County Mental Health service, and then glanced to the right to see if any traffic might be coming out of the parking lot so I wouldn’t accidently get rammed when I turned the corner. There was this delivery truck in the parking lot with this cute little bear or something similar on it there that caught my eye. But what caught my eye wasn’t the truck or the cute little bear. It was the logo…….”Bimbo”.

I mean, look at the van. It’s extremely well done. And the little bear is absolutely lovable. He’s so happy while pointing at all the nice baked goods that the company obviously makes that the Pillsbury Doughboy looks absolutely depressed in comparison. I checked all around the van, but there wasn’t anything that actually explained why the company, who went to all the trouble to have their vans (there must be others) painted very professionally while creating a cute scene with the little bear showing you the wonderful pastries and other available “Bimbo” things, didn’t bother asking someone whether the name was a good idea. Maybe in Mexico it would be fine. But here? I don’t think so.

And if you thought the sides of the van were kind of over the top with the big “Bimbo” logo, it was even better when you went to the back of the van, where you saw….

Read the small print at the bottom that tells you where to go to learn more. Yep, you can find out everything you want to know about their company by going to www.bimbousa.com . You just can’t make that up.

It was all a very good day to end a stressful week. I just checked out the website and found that the little bear is even cuter when he or she gets to move around on the screen in that little hat. The site is just as cute (although irritating as heck) with lots of little Flash animations in addition to the bear. In fact, I’m thinking of adding www.bimbousa.com to my favorites list on my browser at work. That should send the IT guys into a loop when they do their regular checks for porn on the work computers.

Just so you know, Bimbo is not only the name of the company, but also the name of some tasty chocolate pastries the company makes. Which could make for an interesting response if your wife asked what you wanted her to pick up for you when she’s at the store.