Universal Table

The cool quiet of my car was blessed solitude before my workday. The drive to Portland began in darkness and silence. I didn't turn on the radio - just listened to the roads and freeways. Although it was still warm, day and night moved toward the balance of September's equinox. By the time I walked onto the ward, bright sunlight filtered through lexan windows onto worn hospital carpet.

Which is to say that that September 11th started pretty much like any other September 11th .  Most of my patients were just coming to life.

By the time they ventured from their beds and were marginally awake and dressed, I knew the rudimentary facts. In a series of coordinated suicide attacks, two jets pierced the World Trade Center's twin towers in New York City, a third crashed into the Pentagon and a fourth was down in rural Pennsylvania.

I obeyed the human imperative to call family in New York, but the lines were down or busy or there was no one there to pick up. A flat electronic voice politely suggested I place my call again later. The ward manager wanted to pray with me. I'm not a believer but that morning I needed a binding ritual. I went along.

In the usual scheme of things, a disheveled shuffling line of patients stopped by the clinical desk to pick up their medications on their way to the community room; then breakfast and a morning news program, followed by the first group session of the day. There was an eerie inevitability to what happened next. In would be just a moment before someone turned on the large screen television.

In the course of eight hours, we - two nurses and three therapists - watched together as an endless loop of video crazily replayed itself and the twin towers collapsed and rose and collapsed again and again in a bizarre demonstration of death and rebirth. We were mesmerized by the spectacle, the upturned faces of New Yorkers, mouths open to receive burnt offerings - the ashes of family and friends.

The most delusional patients incorporated the television images into their illness; they smelled burned flesh and heard screams that we refused to imagine. They watched without the filters we took for granted.         

A young man saw something I could not.

"There, watch, that body exploding." 

He sat up close to the television, close enough to distort any coherent image. His hair wound into a dozen or so thick blond Rasta plaits. Dark stubble sprouted like new mown lawn on his drawn cheeks and his arms and legs were dotted with old or healing needle marks.

He'd been studying literature and philosophy at a small private college in Portland, the domain of the scions of educated well-to-do parents or talent large enough to earn a free pass. His heroin use masked the terrifying paranoia and auditory hallucinations of his psychosis. He was here in the middle of his first relapse  -  after he decided to stop his medications: he'd felt fine, he wanted to lose the weight he'd gained from his pills, he had a new girlfriend, he wanted to fuck, fuck, fuck. All perfectly normal desires, except the interfered with all that, disrupted everything, not just his delusions. He'd been a junior when he stopped taking them and embarked on what would probably be a lifelong struggle with paranoid schizophrenia.    

Another man, this one middle-aged, put his arm around his college-aged peer. His face fell into friendly creases and jowls and he was protective, coming through a vegetative depression - the kind of smothering mood disorder that holds you to your bed. With the help of ECT - electroconvulsive therapy - and medication, he was fully awake. His hairline retreated, the remainder grayed, ambivalent on how to grow old, but he was clear eyed and animated. His relentless depression, now lifted, provided new insight. The two men shared a room and were fast friends. They sat together at meals and in groups. The older man attempted to impart wisdom that had eluded him in his own life: you have to take your meds.      

Both men - in fact most of the male patients - wore athletic shoes without shoelaces, ward policy. During groups, a row of shoe tongues lolled to the side like panting dogs. This morning no one left the community room to wash or dress; pajamas and bad breath were the order of the day. Schizophrenia and major depression were untidy illnesses, and more so on September 11th.   

"How do we know the attacks are over?" one woman asked. Her visit had been preceded by a suicide attempt. A double mastectomy, chemo and radiation damaged that part of her reptilian brain devoted to survival. She was in her fifties, with disheveled gray hair. A bright purple blouse fluttered to her waist like a deflated foil birthday balloon. Residual glue from the ECT electrodes stuck to her temples and tufts of hair stuck to the glue. She huddled into her forlorn body into a chair. We were supposed to help her feel safe. "What if they bomb us here?"

"How do we know this is real?"

"Yeah, what if they staged it?"

They looked to us for answers and while it seemed unlikely that terrorists had much interest in Portland, Oregon, none of us felt safe. We did, however, know it was real and had nothing to offer except words - soothing but hollow, words that didn't reflect our internal landscapes, our churning dread and apprehension.    

The attacks resonated with my own terror of being trapped on an airliner that was going down, and my fears went back to my childhood. In third grade we trained to 'take cover' during air raid drills. It was cold down there on the floor under our small desks, but not as cold as the Cold War. The desks were barely wide enough to contain our length, scalp to feet. We covered our heads with our arms and tucked our legs up under our bodies. I was young, but not so young as to believe that this would help if an atom bomb fell on us. Depending on what we were made of - brick, glass, flesh - and how far we were from ground zero, we would incinerate, liquefy or vaporize.

Sometime that afternoon, my father called. I kept him in a nursing home in Portland, as if I owned him and had that right. In the twilight of our relationship, he was hobbled by dementia and didn't remember how to use the remote control or how to end a phone conversation. He was a captive audience. He wept about the city we knew so well we could walk its streets in our dreams and never get lost. I called the nursing station and asked them to hang up my father's phone and turn off his television. Other than that morning he'd been doing well, the charge nurse told me.

When I left the ward that afternoon, a hunger overwhelmed me. I wanted to hold tight to something innocent, a void so young and pure it was untouched by breath or fingertip; it had no history, no double helix, no DNA. What I did was visit my father.    

The next morning everyone was haggard. The emergency room had filled and emptied and filled again during the night. We had no empty beds. Disturbed sleep and dark dreams prevailed. The hospital ramped up staffing as aftershocks shifted our roots from shared foundations - the common expectation of safety on our own soil. The first group on the first morning after nine-eleven tallied nightmares - a ground-zero litany for the mentally ill:     

"My house crumbled with me in it. I was buried alive."

"I was on fire."

"A baby floated through the air toward me. It had no arms or legs."

"I had to jump out of a window but I woke up before I hit the ground."  

 In the big picture, I was a bit player, an editor in the narrative versions of their lives. I entered in the middle of the story, did a brief cut-and-paste, and moved on. My tools were limited: medication and conversation, as much art as science. I was a conduit: the scalpel, the IV bag, the splint that held the fractured psyche together until the crisis passed and the patient could stand on his own.

And there was always this question: what separated us from them, staff from patients?  Any answer anchored in hard science was a long way off. Other than that, there were different answers on different days. On some days what separated us was a matter of degree. Anyone who experienced the loss of a parent or child or job, a life-threatening illness, the turmoil of divorce, knew how fragile sanity seemed at times, and rested well when the chill of danger passed. One morning you woke up and understood you had averted disaster.

I knew I would likely not experience the horrors that brought men and women to the ward, because whatever trigger, genetic marker or errant DNA, whatever neurotransmitter in whatever area of the brain did this to them, did not do it to me. Whether by luck or design, I remained upright. My patients were not that fortunate.

The emotional and physical boundaries that were essential on September 10th, meant less on September 11th . On September 10th, the physicians, nurses and therapists on the ward had the power to say who was mad. It was easy  - anyone who slept on this thirty-bed ship of fools was mad. What separated us on September 11th was just this: precious little. For a brief period of time, shared disaster obliterated the biological and cultural contexts of mental illness. What we had in common was greater than what distinguished us from each other. Jets crashed into the familiar landscape of my childhood and carefully established roles changed, patients and staff coalesced, one superimposed on the other.     

On September 10th sanity was a worldview, a consensus. Madness required witnesses. On September 11th we were all witnesses, sane or mad.

At this writing, six September 11ths have come and gone. Life has moved on and away for those of us who shun the political drama and morally confused pageantry of what is now a more private sorrow.

On another brilliantly clear, splendidly warm day in Portland, in another clinical setting, it was September 11th again. A young man entered my office. There were outward signs that he took antipsychotic medication: tremors, fatigue, a broad abdomen, but vestiges of the handsome boy remained. Although he was making progress toward his goals, this morning he was sweating profusely and hypervigilant. He startled when my phone rang. Then he requested a 'prn' - a medication that could be dispensed as needed to treat transient symptoms of anxiety or agitation.

"It's September 11th," he said. On the television in the day room, another group of patients watched the towers fall.