In the fall of 2013, a small Vancouver Island literary magazine called The Island Word published a short story I wrote entitled “Detention”. It was about a man I encountered in late 2009 during my stay in Washington’s Western State Mental Hospital. This man went by the name of Tom. Tom was exceptionally vocal about his desire for psychological relief. When he wasn’t given the medication he asked for, he committed an act that almost resulted in the death of a staff member.
I have a difficult time with this story when I read it now. It reads like an experience that happened to someone else. I become aware that I deliberately put these events at arm’s length in order to avoid having to focus on my own experience. To another reader, it looks as though I just happened to find myself in a violent psychiatric facility, and used the opportunity to make a story out of it in my spare time between hiding in my room and the group exercises.
My memory of this particular psychological event (starting from September 2009 and culminating in November of that same year) is astoundingly clear. I’m not sure if this is the result of my inability to let go of traumatic memories, or because I’ve chosen to hang on to them in the event that they may someday prove useful. “Write what you know” is the common adage of the literary academic. “Use it” is what actors say of difficult experiences. Even if the cliché is abused, it’s not wrong. So here’s what I know.
Tom was a person whose suffering and pain represented something that most people never have to experience in their lives. Depression is a terrible condition for those of us with homes and enough to eat, but everything about Tom, from his rotted teeth to his fractured mind, was depression manifest. By contrast, I was just unlucky. It seems mercenary and cruel to invite relativism into the conversation when trying to reckon trauma, but sometimes context is all there is, and it’s easier to cling to an oversimplification than it is to try and identify the exact constituents of degradation.
I was 21 when I experienced my first manic episode. I was living in Olympia, Washington and it was the Olympia police department that was called to take me to the emergency room when my behaviour started to become erratic. I spent three weeks in an Olympia facility. They misdiagnosed me, and in all likelihood administered the wrong medications. I did not recover to any degree while in their care. I remember them saying that I didn’t “track”, which I think is some kind of industry jargon for “this kid is out of her fucking mind and we need to get rid of her”.
So they send me to the state hospital. Ironically, my psychological state started to improve in almost direct proportion to the decline of my personal safety. In some ways I think that the former might be a direct result of the latter, because the state hospital evoked anxiety and fear with a basis in reality, which can have a grounding effect if you have any survival instinct at all. When my psychosis abated, it was replaced by constant anxiety. I dealt with it by observing the pathos of those around me, and in that way, recovered. That’s as close as I can get to explaining it, anyway. I have no real medical insight into why this might have happened. Before, I was a disordered, hyperactive mess. For over a month, my mental brakes had failed me, and I was wandering into oncoming traffic with joyful abandon.
Back in the well-funded Olympia hospital where Thurston County originally committed me, I’d made a pretty good case for insanity. On the first day, I proposed marriage to an attractive male nurse. As time wore on, I become even more unruly. I spent countless hours writhing on the floor in a spiritual ecstasy. I banged doors, ripped up papers, and was utterly convinced that the old English lady who was my assigned state lawyer was actually Queen Elizabeth. Barring the fact that I never actually hurt anyone, I couldn’t have been more unhinged. That I remember these things of my own accord is inexplicable. To the hospital staff, I was an absolute goddamn nuisance.
I never really understood the contempt they had for me until much later, when I looked at the hospital records. They mistakenly listed me as under the influence of psilocybin mushrooms, which was not at all the case, though my divine appeals to the skylights probably looked exactly like a bad trip. I think I might have mentioned I’d once done mushrooms to the emergency room staff, but either I misspoke, or they misapprehended, and I discovered later it was indicated I had taken mushrooms on my intake forms. It might explain the total lack of efficacy of the medication they gave me, and the staff’s punitive attitude towards me.
Or maybe they were just a spiteful group of people. A fellow patient found me on the internet a few weeks after I left the system, and we confirmed each other’s experience of the disdain they showed towards us. My mother had similar memories of their conduct. They told her that I “might never come out of it” and because they were unable to stabilize me with all their high end medications and group sing-a-longs, they washed their hands of me.
The first thing the Western nurses gave me after they let me out of the five point restraints was hot tea in one of those textured paper cups designed to prevent the holder from burning their fingers. It was soft on the outside, like moleskin bandage material, and I remember mentioning I’d never seen one before, and how well designed it was. The two nurses, both women, sat down with me in a shabby room packed with old board games. Did I know where I was? No. Back at the previous facility, an aide had told me I was being transferred to Western.
“You’re going up the river,” she had said, not without satisfaction.
Western State Hospital is located in Lakewood, Washington. Lakewood is one of those nowhere towns that straddles the interstate between Tacoma and Olympia, and offers very little of interest besides the antique Steilacoom military installations and the old mental hospital. It also has the distinction of having been the site of the most deadly attack on law enforcement in Washington State. Four police officers were shot to death in a Lakewood café a just a few days after my discharge from the hospital.
Western predates Washington’s statehood by eighteen years. People have been committed there since 1871, and many people have also died there. There’s a very small graveyard inside the grounds that dates back to the hospital’s founding, and a much larger one outside, the Western State Hospital Memorial Cemetery. Most of the headstones have numbers instead of names.
I was able to get some information near the end of my short stay. The old, cheap medication played hell with my digestive tract so I was sent to get x-rays, and the aide assigned to transport me answered a few questions. How many people were in Western? About a thousand, he said. How much did it cost to house them? Maybe $400 a day per patient. How many staff? Something like three hundred. Later, with a little bit of research, I unearthed more facts about the hospital. In 2011, there were over 300 assaults on staff, though they reckon that as about one reported for every five that occur, so the real number is much larger. Staff are discouraged from reporting assaults, because of “patient privacy”, which is the hospital’s most insidious tool for controlling its image and covering its abuses. One staff member tells of being burned when a patient threw boiling water on his face. Another had her back injured in an altercation with a patient. As can be seen from my primary research, the ratio of staff to patient shows the hospital to be deeply understaffed.
They don’t count the number of patient-on-patient attacks, again for “patient privacy” reasons. The number of deaths might not compare with those in the heyday of permanent institutionalization, but they come up now and again. Two more recent incidents include a man whose roommate stabbed him to death, and a woman who committed suicide. The man was stabbed through the ear with a ball-point pen, and the young woman hanged herself on a door handle. In newly constructed mental hospitals door handles are required to be hang-proof, but it was only after this occurred in 2012 that Western had theirs replaced. I can only suppose either a century and a half of operation wasn’t enough to demonstrate the need for this particular feature or the people making the rules are as disassociated as the people for whom they are responsible, and possibly less compassionate.
A fact that is virtually unacknowledged is that Western State Hospital is the Washington’s most dangerous workplace, and psychiatric nurse is the state’s most dangerous occupation. Miners have safer jobs. So do prison guards. They get paid more, too.
“I may have been committed here against my will,” I told the shift leader one night. “But at least I don’t have to work here.”
When I was released into the population of Ward C-2, I was first shown to my room. My roommate was away at a group, and I learned that “groups” were the fastest way to raise your “level”, which allowed you grounds privileges to walk outside unaccompanied. I was not yet in any condition to be allowed outside unaccompanied, but I was left to my own devices for a few hours.
The ward itself was nearly empty because of the daily activities happening elsewhere in the hospital. They are careful to keep the inmates busy with a cadre of helpful “groups”, including one that taught you how to type, and another where you learned about cognitive behavioural therapy from a 1990s VHS tape depicting a man who learns not to get angry when changing a tire. There were also groups dedicated to lying down on mats, and watching videos of soothing images of rainforests and deserts set to calming music. Based on its sophistication, the hospital programming appeared to have been designed before I was born.
Shortly after I arrived, I wandered into my roommate’s side of the room, which was neat and included photos of a little boy taped to the wall with masking tape. There was a pile of yarn through which were stuck a pair of knitting needles. I, in my infinite creative desire, picked up these implements with the conviction that it would only take me about five minutes to teach myself how to knit.
I took them out into the common room, and sat down on the floor near a young bearded man who was sitting on the blocky rubber couch. I flirted with the textbook amore of the manic. He flirted back, suggesting they had brought me in to be his “hospital wife”, which was a pretty strong indication that we were on the same fantastical wavelength. It was about that time that one of the aides noticed me, noticed our discussion, and noticed the pointed knitting needles in my hand. She immediately intervened, brought me back to the room, and I didn’t see the young man again. Presumably he was moved to a different ward. The aide helped me return the knitting needles and yarn to their place. Later, when I met my roommate Christina, she asked me very politely not to touch them.
Let me stop here to say that as mental hospital roommates go, Christina was nothing short of a miracle. While she was not fully in possession of her faculties, by the standards of C-2 she was remarkably sane. I credit her stability, patience and kindness (as well as my growing realization of just how hostile my environment was) with my rapid return to my senses. She was about ten years older than me, 30 or so, and was a heavyset woman. Her face was pretty and her skin was good, and she had long curly ash brown hair. Because her mood and behaviour were so regular, she’d been allowed to have the knitting needles and the yarn, items that were contraband in the hands of any of our other ward mates. She knitted hats for the patients, the staff, and one for me that I still have.
If I’d had to room with Melissa, the babbling compulsive head-shaver, or the old lady who listened to “Green Sleeves” at top volume during all hours, or meth-addled Stacy (the self-styled reincarnation of Christ) I don’t think I would have made it out so quickly. Telling psychiatric ward staff that your roommate is driving you insane is about as useful as registering a complaint about the dampness on a sinking ship.
Christina had photos of her son and her husband, and told me she had worked in a nuclear monitoring facility, where she and her husband also lived. I’m not sure exactly how accurate that was. She had experienced schizophrenic delusions of an ex-boyfriend hiding under her and her husband’s bed, delusions she still believed at the time of our meeting. She was a Seventh Day Adventist and interested in molecular science, though paradoxically she was anxious that her son should not be taught evolution. Vegetarianism was also part of her faith, but the hospital’s idea of “vegetarian” identified chicken an acceptable substitute to red meat. It was a detail I noticed at the time, and while I don’t know whether the discretion for that policy lay with the ward, or whether it was hospital-wide stupidity. As for the quality of the food, prisoners in Washington get better meals. I checked their website, and meals include vegetarian, kosher and halal options.
Because of the difficulty of arranging a stable living situation for her, the hospital had warehoused Christina for months, renewing her detention after 90 days and then increasing it to 120 days. By that time I had a better appreciation for the scope of Christina’s optimism. The kind of fear that comes from living in violent environment does things to an already vulnerable mind. I experienced some post-traumatic stress, but it was limited due to my limited exposure to the violent atmosphere. Christina was in it for over four months, and conducted herself with good-natured fortitude and grace. She would have made an excellent combat nurse, or even a good ward nurse. There isn’t much to choose between the two except that the latter actually works in a more dangerous environment.
I first met Tom not long after my arrival, when he, large and soft bellied, embraced me in a bear hug. I normally would have recoiled if hugged by a large mentally ill man, but I was still cognitively distorted, so it didn’t seem out of the ordinary. An aide was there to separate Tom from me, but I found him amiable enough and I didn’t feel threatened by him. Unlike the other male patients, who openly stared at any young woman, and offered sexual harassment at every opportunity, Tom was mostly just interested in being friendly.
Easily the most violent incident came about halfway through my short stay, when Tom (or I should say, Tom’s voices) tried very hard to break the psychiatrist’s spine with a two-hundred pound chair. It came as a surprise to both Christina and me. Tom was actually one of our more pleasant dinner companions. He was in his late fifties, rotund and tall, and had short cropped salt and pepper hair. Because he was not to be trusted with a razor, his face was stubbly, and while his teeth were ground down to rotten stumps, he smiled often. He talked about science with Christina, and told us he had once been a med student, declaring, “biochemistry, that’s what separates the mice and the men.”
I asked him where he had come from, what he had done after he’d failed out of medical school. He’d “had” a wife and son. He referred to both in the past tense, as though they were gone from him and not the other way around. Before he was detained, he had lived in a tent out in the woods, though he never said where. Probably in some wooded green belt near enough to civilization to scrounge for a meal (or a fix) but far enough away to avoid being picked up- or so he must’ve thought.
A lot of the Western patients had similar origins, and a significant amount of the population came directly off the Seattle and Tacoma streets, or out of rehab facilities that could no longer handle them. I found out later that some of them even deliberately committed minor infractions in order to get detained so they could avail themselves of three square meals and a bed, such as they were. The hospital has a revolving door. A huge number of their inmates return after being discharged.
“Just tell them to bug off,” one of the nurses advised when I told her of the sexual advances. It was so astoundingly contrary to everything a woman brought up in a liberal society is taught to believe. From the age we can walk, we’re told, “if a man touches you, tell an adult” and that someone will stand to your defense if you’re threatened. It was a rude awakening to have that security taken away so casually, especially by the people in charge.
I’d never experienced the stomach-dropping fear of having to run for my life until after Anton, one of the crazy-eyed non-stop talkers, chased me across the ward, screaming that I was going to “hurt his family.” He was about 6″3 and probably weighed 250 pounds. I’m not sure why he singled me out, and it was a close thing. They caught him just before he set foot in the women’s side of the ward, but they didn’t trouble to restrain him or otherwise prevent him from making a second attempt if he felt the need.
Other women were not as lucky as me. I was there to witness as a psychotic African American man targeted the only African American woman in the ward. He shoved her down on the floor, and kicked her repeatedly in the ribs with brutal force. The staff’s intervention was agonizingly slow, and the best they could do was herd the man down the men’s dormitory hall. Because his term had ended and by law could no longer be renewed, they released him the next day. That was good for us, but it has frightening implications about the state’s commitment practices and their impact on society.
The “code blue” announcement went over the PA at least five times a day, alerting staff to altercations in different parts of the hospital. Generally these acts of violence were committed by male patients against other male patients, but I witnessed assaults by women too. A pregnant girl was admitted to our ward, and because she was pregnant she could not be medicated. I remember her very distinctly and I knew right away she was trouble by her wide, unblinking eyes and the sharpened pencil which she carried in her fist like a shank. Items like these were given out on a discretionary basis, in this case by a staff member who must have been irretrievably stupid. Someone took it away from her before she got to use it, but it didn’t stop her from lashing out. One day she confronted my favourite nurse about a nicotine patch and then slapped the nurse across the face because she didn’t get it fast enough.
The general punishment for this behaviour was nylon restraints and isolation. However, there were often more offenders than there was space, so the pregnant girl was strapped to a chair and left in an open door way so she could be monitored. She watched us as we walked by with wide cow eyes that didn’t blink, her mouth hanging open slightly, her deceptive vapidity almost concealing the fact that she was rattlesnake crazy.
“Why are you so unhappy here, Victoria?” Stacy the meth addict once asked me in a tone that suggested I was ungrateful.
“Jesus loves you,” she told me.
“The voices are getting really bad,” Tom confided to us over dinner. “I keep asking them to put me back on my anti-psychotics.”
It was easy to see something was wrong with him. The ward had a compulsory meeting every night, and anyone who wanted to keep their level had to attend. During these meetings, Tom would stand off to the side, twist his body and flutter his limbs like a tree in the wind. It was almost like watching Tai Chi, but without the quality of peaceful meditation. It was a ritual he performed to keep his demons at bay, with only limited success.
Nobody liked the psychiatrist. His name was Dr. Jawad. He was small and squirrelly, and he tended to regard all patients as equally mentally incompetent. He made it clear he felt he was slumming. He’d dismiss us whenever we tried to ask him anything. He forgot my name repeatedly, told me I would be inside past my birthday (which was three months away) and when he saw the copy of Sophie’s Choice I was holding, suggested with a chuckle that I read something less depressing. The ward had maybe five other books, all bad granny detective novels covered in melted purple crayon. Finding this book, a book I had always loved, was an incomparable gift. Jawad had evidently seen the movie once a long time ago, and thought I was relating to the crazy Kevin Kline character. I doubt he’d ever read the actual book. I also didn’t tell him the added benefit of a dense hardcover was that I could hit with it if necessary.
I was not the only person who was frustrated with the doctor. Tom was struggling to make Jawad recognize his need for anti-psychotic medication. I don’t know exactly the reason why Tom might have been denied these medications, though it’s possible there was a bad drug interaction, or the side effects might have affected his heart. While I was there, I took a meds information group offered by the hospital, where the myriad of horrific side effects were described gleefully by a hospital staff member. Some medication made your eyes roll back in your head. Some just made you shake uncontrollably. Some made your blood toxic, and caused your organs to fail.
My experience with extreme side effects of bad, cheap drugs happened a year or so later, right after my release from Overlake Hospital. It culminated with my sudden loss of vision from the drug Cogentin, itself a side effect manager for the effects of Halperidol. The overall effect of Halperidol is much the same as wearing a lead blanket on your head. It was the same time that I stopped being able to read small print that I realized that unless I wanted to spend the rest of my life being recycled through hospitals and fighting for access to hundreds of dollars worth of medication, I was going to have to move out of the country.
For Tom, I’m not sure that any of these speculative risks were worse than what ultimately happened. And I didn’t witness his attempt on the doctor, but arrived just in time for the aftermath. Christina told me how Tom had lifted one of the solid block rubber chairs and hurled it at Jawad. The chair was at least 200 pounds, and but for Tom’s bad aim, Jawad would have been paralyzed or killed outright by the impact. For the rest of my stay, the doctor did not come out from behind the nurses’ high barricade desk unless it was unavoidable. When he did, he looked over his shoulder like he was hurrying through a bad part of town.
Tom was immediately put in restraints, and locked down in the isolation room. He screamed all night, howling the single word “nurse!” with as much sustain as he could manage in a single breath, dragging out the word in one wail after another. In the morning they let him out, and we sat with him at breakfast.
“That broke something inside me,” he said, his red eyes mournful, and his hulking shoulders rounded. “The voices tell me what to do. I don’t want to hurt anyone, but I can’t stop. But last night broke something inside me.”
Most people have never looked at this kind of despair in another person, the kind that represents the absolute rock bottom, a confessed total loss of self-control. Looking at Tom, I could see the fractures inside him. I tried to imagine the young medical student who was flunking biochem. Not a month before, I had been enrolled at a college with a full scholarship, and I’d been committed a few days after the start of term. That was more than a little hard on my pride, so I could empathize. But something else had shaken his foundations, maybe heroin or crystal meth. His post-hole teeth were good evidence, as was the sagging structure of his face, which looked like it might slough off his skull into a fatty pile in his lap at any moment.
His family had given up on him. He had wandered into the margins of society and had gotten irretrievably lost. It is impossible to know now where he might be. I don’t think I could find him if I tried. The possibility that he is still alive is remote, and if he is, he might very well be back in Western State Hospital right now. I have no way of knowing. I don’t even know for sure if his real name is Tom.
Compared to most inmates, I got out of Western in record time. I set up a plan to go to Ohio to live with my mother, which was less than ideal, but was the only way I could secure my discharge. Before I left, I walked around the campus with Christina, strolling around the tiny little antique cemetery that was situated in the inner quad. The stones were too weathered to read. They were the kind of markers that evoked the name “tombstone”, thin slabs with scrolling silhouettes, some of them snapped clean in half as though by a hurricane wind.
There was also a morgue, a white octagon-shaped building that had peeling paint, and was overgrown with blackberries. I wouldn’t have known what it was if Christina hadn’t told me, and it surprised me that the hospital hadn’t knocked it down. It was a reminder that even though the practices were not necessarily better, the hospital was once a strong, organized institution that was functional and disciplined, if not wholly beneficial. Back then, the staff would never have gender mixed the wards, or allowed the showers to break down so that forty men and women had to share one between them. Society took it for granted that such institutions needed to exist, and therefore, society paid for them. That is not the case today, and while the consequences are legion, it is the hospital itself that is complicit in hiding them.
Just before I was discharged, I was asked by one of the shift leaders, a tall, imposing black man whose name I wish I remembered, why I didn’t tell him I was being released. If I had told him, the patients on the ward could recognize and celebrate my achievement, which was the tradition.
“I don’t want to draw attention to myself,” I told him. He understood.
The next fall, I returned to Olympia to try and go back to school. Almost a year to the day of my first breakdown, a combination of bad medication and bad personal choices caused me to experience another manic episode. I was on my mobile phone, in the midst of a maniacally fueled text argument when the person with whom I was arguing threatened to call the police on me. In some combination of spitefulness and uncanny foresight, I told that person to fuck themselves, and did it myself.
I credit my memory of my experience of involuntary commitment as the driving instinct that allowed me to recognize that I had a very limited time window in which to decide what to do before I was no longer in control of my faculties. I had just enough presence of mind to pack a bag, and then went to sit down on the side of the road. It took about five minutes before I was surrounded by police officers, firemen, and paramedics. The paramedic that took my vitals told me my heart rate was dangerously high, and that I was in danger of having a heart attack. I gave myself over to their custody, and went through a condensed version of my 2009 experience, only I skipped Western State, and was instead sent to Overlake Hospital in affluent Bellevue.
I was there for about two weeks. I still have almost total amnesia, and remember very little of what went on. But I do recall asking, against medical advice, to be released. I told them I wanted to go to Vancouver, because I was born there and I thought it was time to go back. They told me I was going to Vancouver, put me in a cab, and sent me to a homeless shelter in Seattle. Once there, my reason started to creep back, though I was still at a manic pitch. It dawned on me just how vulnerable I was. I was locked in and surrounded by hundreds of homeless people. I was addled, wearing borrowed clothing, without a wallet, a phone, or any kind of identifying personal item. But again, this sudden adversity seemed to aid my natural instincts for survival, and very slowly, I recovered some function.
I didn’t eat at Overlake. I remember looking at the wheeled tray racks where people put their used trays, but I couldn’t figure out how I was supposed to access food, and I don’t remember anyone helping me. In the emergency shelter, I ate for the first time in two weeks. I shoveled a pile of red meat sauce and pasta into my face, a dish that any veteran of the institutional food line knows as a familiar and comforting staple. It was a start.
When it was time to sleep, I entered the warehouse sized women’s’ dormitory. I realized, after the lights went out, that in spite of the hundred or so other people in the room, I was completely alone. No one knew where I was. I didn’t have any identification or possessions, and I was wearing clothes that weren’t mine. When I started sobbing, some woman (a person whose face I never saw, whose name I never knew) asked me what was wrong. When I told her how abandoned and confused I felt, she put her arms around me. She rocked me, and told me everything would be okay. We sat in the pitch dark and she held me until I calmed down. It is hard to quantify how profoundly healing that act of simple kindness was for me. I slept that night, and for a person in the grips of manic psychosis, that was a gift from the darkness.
I was rescued by my friends the next day. Those same friends had helped me after Western when I found myself with no job, no place at school, and no home. This time they enlisted the aid of compassionate mental health professionals, and gave me a place to stay while I recovered enough to make a decision about where I would go from here.
I gave up on going back to school and decided to move back to Canada. After experiencing the myriad of debilitating side effects from the limited supply of outdated drugs the state had prescribed, I knew there was no possible way I would be able to function as an adult if I had to battle for care with the American health care system, or with that monster, Social Security Disability. I sought out my Canadian family to help me, and moved to Vancouver Island in November of 2010.
Months after my discharge, I had to order hospital records for my BC disability application. It was the first time I had an opportunity to find out what the Overlake staff had written about me, and to find out what I had reportedly said during my two week fugue. The document states that I, the patient, reports hearing voices, and that “the voices tell me bad things.” Dr. Mathiassen despairs of my improving, and remarks that my condition is rapidly deteriorating. There is even a recommendation that I be transferred from the well-equipped facility to Western State Hospital. The wording is more impersonal than “you’re going up the river” but the sentiment is inescapable.
At this juncture, I feel I owe my old ward mate Tom more in the way of charity. I feel that I owe him the benefit of the doubt. Perhaps he really was a medical student who did everything right and still lost his way. Despite what my records say, my experience with genetic bipolar disorder was not ushered in on a tide of hallucinogenic mushrooms. When your ability to communicate is taken from you, any rights you have become subject to interpretation and you lose ownership of your history.
If I hadn’t requested release against medical advice from Overlake Hospital, they would have sent me back to Western State, almost exactly one year to the day of my admission there. But for the grace of pure coincidence and my stubbornness, there I would have gone through the doors over which the words “Dedicated to Mental Health” have been paradoxically set.
I wouldn’t try to reckon the comparison of experience, but that paradox is not without precedent.
Maybe Tom has never used methamphetamine or opiates. Maybe it was his unlucky biochemistry that failed him, sickened his brain and wrecked his life. It doesn’t matter. The only thing that matters is that he was aware of his inability to prevent himself from causing harm to himself or others, and when he asked for help, the people charged with providing it denied it to him. In the short time that I knew him, he did everything right, and even if he hadn’t, it still doesn’t matter. The tallying of just desserts does not ennoble suffering, nor does it illuminate pathos. As much as I hope that he was able to find help and support, I recognize that there is a very real possibility that he passed away in obscurity, under a bridge or in the woods along I-5, and that his cremated remains sit unclaimed on a shelf somewhere.
A hundred years ago, the hospital buried its inmates. Yes, it stripped them of their identity and buried them anonymously, but at least it provided consecrated ground and the strong hands to carve out the earth, and lower the pine box, or the shrouded body, or however they did it in pioneer Washington territory. Words were said, and some small measure of respect was paid.
These days, Western denies its patients identity in order to deny responsibility for the condition in which those patients are both housed and discharged. Tom will be remembered by their records as having assaulted the psychiatrist. But assaults made against him or by him against other patients will not be recorded. The notes Jawad will have made about Tom will not account for the fact that Tom asked him for anti-psychotics so that he could have the agency to control himself. They will only say that Tom was a violent patient. If he returns to Western, it will only be a matter of time before it ejects him, not on the basis of his mental competency, but because of an arbitrary time limit set for budgetary reasons by state politicians who prefer not to know what goes on inside Ward C-2, and do not care that Tom may never receive the treatment he needs to recover.
Practical considerations, like burial, will be left to others.