The following essay serves as the sixth chapter of One Grew Up in the Cuckoo’s Nest.
After graduating from high school in the spring of 1967 I had a decision to make. Do I follow up on my acceptance to the University of Massachusetts or do I take my Selective Service card in hand and volunteer into the Army. Well I took the student deferment offered that year and committed to Amherst for the next four plus years. That decision needed to be paid for so I switched into nursing at the Hospital and became a professional attendant. (How did I know was a professional? Well I had to carry a few more keys, wear black shoes, white shirts, and white pants with a black belt! Wow! ) I have already highlighted one day as an attendant in the chapter, The Autopsy. This chapter summarizes my recollections of daily events over three summers working as a nurses’ attendant on three different wards at Medfield State Hospital.
Eleven to Seven
Recollected and Written
by
Mark R. Ellsworth
The State Hospital was located on over five hundred acres. Most of that acreage was open fields dedicated to the dairy farm and and other agricultural endeavors producing milk, vegetables, and poultry for the thousands of patients living and being cared for in the wards. The produce and milk also supported a few other state run institutions in and around Boston. My summers’ work as an attendant were spent in two of the many buildings,(wards), placed on the large rectangle of streets surrounding a large athletic field, a canteen, a gothic church ending with a brick building, the Administration Building. I’ve listed these in order back to front of the campus. The Administration Building was the first building located at the top of a long drive. This road began at the two stone gates guarding the entrance on Hospital Road.The majority of these buildings were built between 1896 to 1914. When first opened it was called the Medfield Asylum for the Insane. At its height the complex included 58 buildings, on a property of some 1.4 sq mi, and a capacity of 2200 patients, and generated its own heat, light, and power. ( Wikipedia)
Of all the State Hospitals designed and built in the 1800’s, Medfield was the first designed on a college like campus. The 1st asylum built using the cottage plan. (Wikipedia) Other State Hospitals across Massachusetts and other parts of the nation were built following the Kirkbride plan. ( See the earlier essay describing Danvers State Hospital.) My tenure working as an attendant, began in the locked wards on the fourth floor of the Clark Building. My shift was the 7 to 3 pm. shift. The four story Clark Building was the youngest structure on the hospital grounds. It was built in the late 1950’s. It was demolished in July, 2012. My tenure there started in the late sixties and lasted until 1970. I’ve explained the overall configuration of the Clark building in past chapters. Clark was an over sized H. On the fourth floor one wing of the H had a locked door with a thick wired glass window. This was the entrance to the Men’s Ward. Turning around and reversing your gaze back down the connecting hall the twin to that door came into view. That locked door was the entrance to the Women’s Ward. The hall that connected the two wards was shorter. Its features were floor to ceiling windows, a stairwell, and an elevator. ( It should be noted that heavy wooden locked doors were also located at each end of the wards. These doors opened to other stairwells.) The Clark building was visible to the public traveling down the old Route 27. The front lawn spread from the left gate almost two football fields in length before finally reaching two parking lots and the main entrance to the Clark Building. That lawn had many maple trees planted along Route 27 standing at unbroken sentinel-like attention facing across the expanse of green saluting much older trees lining the aforementioned main hospital entrance. The Clark Building was located to the left as you drove up the main drive. It’s location was lower than the main campus of the Hospital.(See the essay titled The Ice Rink at the Bottom of the Hill.)
Two of my summers as an attendant were spent on the fourth floor of the Clark Building. My time was divided between the locked women’s and men’s wards. Both wards had the same floor plan. Their entrances were into the one hall running the length of each ward. Scattered toward the end of the hall were one and two bed rooms, a lounge, a TV room, and a larger bathroom and shower area. The shower areas were locked. I cannot remember if the lounge was locked but I believe the TV room was locked. Next to the nurses station was a smaller locked room. A wooden dutch door was its entrance. At designated times a nurse would open the door’s top half and the patients would line up to receive their prescribed medications followed by a chaser of water or juice. My job was to escort the patients to the dutch door for their scheduled pills, escort those with privileges to the dining room located one floor below for breakfast or lunch and escort and attend regular group therapy sessions led by the head nurse. Later in the morning I would unlock the TV room and attend to the few patients that wanted to watch the latest soap opera or game show.
At the start of each shift I would meet with the incoming nurse and the other attendant working with me and receive report from the 11-7 RN. She, (and in the late 60’s early 70’s most nurses were female), would quickly summarize the few dozen patients and their current status while highlighting any over night incidents of behavior or medical episodes. (I have to note here the Director of Nursing for the entire hospital was a man. He was an RN and he had been a nurse for a few decades at that time. To me he was the exception to the nurse gender stereotype of that time. Over my fifty year healthcare career to follow, that ratio of female to male nurses changed dramatically as can be ascertained by any visit to a medical setting today.)
After report was given by the prior shift’s head nurse, the 7 to 3 nurse gave us our day’s assignments that were not usual. Accompanying a patient to a doctor’s office on the first floor for a one on one meeting, or escorting a patient to a session of electro shock therapy, (electroconvulsive therapy ECT), or attending an autopsy scheduled where an attendant was needed were some of my unusual tasks. ( See the essay titled, The Autopsy.)
My memories of attending electro shock therapy sessions are highlighted by the patients and their demeanor. I remember a quiet serene passive response by most after the session. During the session they were induced by the electric current into a state of rapidly increasing tremors and shakes. The doctor and nurse were positioned at the patient’s head manipulating the padded connections near the temples, and if I remember correctly, placing a padded tongue depressor stick in the mouth so the tongue was not bitten or worse swallowed. My task was to stand at the patient’s feet and restrain his/her’s ankles loosely. If the ankles were held too tightly and I resisted the rapid shaking with too much force, a potential fracture might be the outcome. These sessions were (mercifully) over in approximately 5 or 10 minutes. This procedure is still used today and I understand the recipient is anesthetized before the shock therapy begins. However my limited experience has recollections of the patient being in a treatment room with out anesthesia. They might have received a drug that calmed them necessitating a gurney to transport patients to the treatment room. Honestly as an attendant I did not have a need to know all the nuances of prep performed by the nurses and doctors. My focus was transport and following orders from the nurse. The gurney was definitely used after the treatment to transport patients back to the ward. I do remember that this therapy was a go to tool after drugs and other treatments were not effective enough to mitigate severe depression. I also remember patients were very quiet days after the treatment. But I do not want to imply that they behaved like they just had a lobotomy. The people I helped care for appeared to come out of a personal fog after a few days.
Two rooms on each ward I have not mentioned yet were located near the nurses station. These rooms were called seclusion. The rooms had tiles, institutional green in color with a heavy door with a small thick glassed window as its entrance. I remember small reinforced windows that allowed some light to enter in these rooms. Medfield State Hospital was developed to care for the chronically ill person with various diagnosis; schizophrenia, paranoia, depression, manic depression, different psychosis, autism, addictive behaviors, but not the criminally insane. To this day the criminally insane are sent to Bridgewater State Hospital. I do not mean to imply that the Medield State Hospital population was immune to moments of violent behavior. Each ward up on the fourth floor had panic alarm buttons that, when pushed, alerted other areas of the building, help was needed immediately. Patients didn’t just volunteer to wear a straightjacket. I cannot remember a patient welcoming a stint in seclusion after he or she had an incident the doctor’s and nurses judged seclusion the remedy. My job and that of other male attendants was to always accompany a nurse into seclusion to enable her to administer a needed injection or apply a restraint. I remember, one incident involving a large muscled man, a few inches taller than me, standing in the center of the seclusion room surrounded by me, three other attendants and the head nurse. He slowly rotated while staring at each of us. He asked us, in turn, the same question, Are you afraid? The first three of us including myself looked straight back into his eyes and said No! The attendant after me was from the Fernald School. I first mentioned him in the essay titled The Autopsy. When the patient pivoted to him after I lied and said No, this attendant had the fortitude to say the truth and answered Yes! Well with that, the patient turned to the nurse and said So am I. He promptly laid down and let the nurse deliver her needle to further calm him down. I have never forgotten that moment. It taught me at a young age that no matter what, the truth is always powerful.
Before I conclude this chapter highlighting my time working the over-night shift, I want to reiterate that to my knowledge the Clark Building was the location of patients that had shorter lengths of residence in the hospital. Whether it was on the alcoholic wards on the second floor or the acute locked wards on the fourth floor, many of the patients were younger and in some cases more verbally or physically agitated. I have a few memories of sudden outbursts that resulted in a thrown television or a patient bull rushing me as he exited the elevator. Not to be too dramatic but it taught me the value of working as a team.
The third summer I worked as an attendant, I was reassigned to a women’s ward on the main campus of the hospital. It too was locked but it had an older chronic mental illness diagnosed population. This building consisted of an enclosed porch and two floors of mostly open wards. The nurses station was located on the 1st floor across from the main staircase to the second floor. Like the alcoholic wards on the second floor of the Clark Building the beds were positioned in very large rooms, sectioned off with half walls. As an attendant, during the overnight shift, my main task was to do regular rounds visually checking on the mostly sleeping patients. I was directed to use my ears also. I remember listening to the rhythmic breathing, the occasional snore, but most importantly the soft crying or quiet question that seemingly would float above a half wall. In those instances the nurse was always summoned to attend to the patient. Team work the policy.
I heard stories of the self harming or suicidal incident but thankfully in my brief time working the over night shift on this ward an incident of that sort did not occur. I do remember one patient who would regularly awake around three in the morning and appear at the station’s door fully dressed with an oversupply of facial makeup. She was middle aged, in her forties, and from a local town. I learned about manic depression from her and the head nurse. The few weeks I worked on that ward I only saw her in the manic stage. I remember how self aware she was of her condition and how articulate she was. She helped me learn to respect the courage a person needs to have to walk a walk of self introspection guided by a psychiatrist and therapists hopefully to a calmer balance in life.
But I leave you with two memories of my summer working 11 to 7. Yahtzee is one memory! Every night after report and rounds, we started a game of Yahtzee, throwing the five dice and scoring our way to a victory or loss! Usually us three employees including the nurse would come to work and share snacks and play the game, softly calling out Yahtzee when the occasional five of a kind was thrown. The other memory was the sound of the lock turning in the main door and the sound of many keys chiming in rhythm to the march of the Night Supervisor tripping our ward. Wow did that Yahtzee game disappear in a flash as we assumed our professional positions! I remember this supervisor was wise as she never tripped the wards at the same time each night!
The seventh chapter in this series of essays is titled, The Morning My Father Cried.
Thank you for reading.
Be in peace and joy!
Mark