Thought you'd never see another "Ward Philosophy" entry? Me too. It's not like I have nothing to write about. Believe me, there is PLENTY to write about...it's just that I've been a little hesitant in writing about it. I want to say it's the new HIPPA laws and the constant fear that hovers above everyone in the medical field about disclosing patient information. But when I look back over the entries I've written about tales from the psych ward, you would never know the person I was writing about. Hell, the patient probably wouldn't know. So, it really isn't that. I think, honestly, that I am just totally burned out and that instead of seeing the tragic beauty of mental illness, I come home with stories of bowel movements and room searches and staffing issues.

One of our patients, for example, just INSISTS on giving me constant updates about what is coming (or not coming) out of her ass. I really don't want to know. Tell me you're constipated, I'll give you a pill. Tell me you have diarrhea, I'll give you a pill. But please don't give me a blow-by-blow of the smell, the color, the shape, the consistency and the amount of your shit. It doesn't matter what I say to this patient. "How was breakfast?" "Well, it was good, but I think it might stop me up...my stomach is already tightening a little bit and last night after supper I had to sit on the toilet and strain and strain and strain...."

"Did you like the group today?" "I really enjoyed it, but I had to leave early because when I laughed, I squirted some feces out and had to go change my pants. I left my underwear on the counter in the bathroom so you could go look at it."

*call light goes on from her bathroom and the stench can be detected from half-way down the hallway* "Do you need help in there?" I ask, already knowing the answer. "Yes, can you come in here so I can hold your hands? I need to really bear down and I can't get a good grip on the side of this john."

Sometimes she will just ask for a laxative. But before I can get up to get it, she'll start telling me why she needs it. She'll follow me to the medroom, talking the entire time. "My stools were light brown last night and now they're kinda black. I think this means I have blood in my poop. There is a little hemoccult card and one of those sticks that the nightshift was so nice to leave for you today. I'll just shit in the hat they put in my toilet so you can get a sample."

This is why I so seldom write about ward philosophy. Jaded? Burned out? Exhausted? I was pondering this the other day, sitting in the middle of our chaotic nurses' station, completely worn out from dump-diving, when a very psychotic patient approached the desk and motioned me to the hallway with a tilt of her head. When I met up with her in the hall she whispered, "I need to show you something in my room...just you." This is never good.

She beckoned me to the center of the room, right next to the bed, cocked her head to the side a few times and said, "There...on the wall." There was nothing on the wall but a picture of a landscape. It was a Monet-type landscape with muted shades of orange and pink, reflections of flowers and trees on water. "What?" I asked. "The picture?"

"Shhhhh," she said and took my hand. We approached the picture and she pointed to the bottom left-hand corner. "This woman right here. Look."

If you tilted your head a certain way and squinted your eyes, you could maybe make out what could be a woman's face. It might even appear that she was running because her hair was blowing straight out behind her. "It does look like a woman, but it's the reflection of this flower in the water. It's just muted by the fluid of the water."

She stared at the picture and put her hand over the corner. "She's trying to get out."

I spent the next twenty minutes talking to the patient about her delusions, about how medication side-effects can make us see things that aren't there, about how our own fears are sometimes projected onto other people...or other things. In the end, I tried to tape a sheet over the picture, but it wouldn't work. Our pictures are bolted into the wall and there was no space behind to work with. I finally had to call Engineering to come up and take the picture down.

The patient watched all of this activity and said nothing at all, but she was standing in the hallway when I came out of the locker-room (where I had put the picture). "You put the picture in there?"

"This room is always locked," I assured her. "And I put a note on the picture to return it to the wall after you've been discharged."

I thought she'd relax. I thought she'd feel safe. And once again, what I thought about what my patients were thinking was wrong. "Yes," she said, "but who is going to take care of her in there?"

I guess if you dig long enough through coal, you'll find a diamond. If you sort long enough through oysters, you'll get your pearl. But does the beauty of it all outweigh the ugliness and the smell? Does the madness of innocents overpower the absolute shit the sociopaths and borderlines drudge through? You bet your sweet ass it does.