Thorazine, Haldol & Coffee: My Life in a Prison Mental Health Ward

Michael Kaiser was awarded First Place in Essay in the 2019 Prison Writing Contest. 

Every year, hundreds of imprisoned people from around the country submit poetry, fiction, nonfiction, and dramatic works to PEN America’s Prison Writing Contest, one of the few outlets of free expression for the country’s incarcerated population. On September 18, PEN America will celebrate the winners of this year’s contest with a live reading at the Brooklyn Book Festival, BREAK OUT: A 2019 PEN America Prison Writing Awards Celebration.

 Thorazine, Haldol & Coffee: My Life in a Prison Mental Health Ward

The idea that I would ever be working in the mental ward of a state prison or any mental ward—or for that matter, be in prison—was totally foreign to me. I was a somewhat successful real estate developer who had also worked for two U.S. presidents.

But then I found myself in prison for 60 months, and I needed a job. The only requirement for the Intermediate Care Housing (ICH) Daily Living Orderly job was that I had no sex offenses in my background. I didn’t, so I was hired.

I had seen One Flew Over the Cuckoo’s Nest. Hell, a fellow Oregonian had written it, and I could look out my window and see what was left of the original state hospital where the movie was filmed. Now I would be tending to men who would have been housed in that institution, but instead they were in prison. My six days of training consisted of learning how to properly lift a man who had fallen and helping to change adult diapers. That was it. As far as the prison was concerned I was ready for work. I had been given more training for the volunteer work I did at a local food bank prior to prison.

ICH is designed as a stepping-stone for inmates with mental health issues prior to either going home or into the general prison population. When the security officer opened the door, and I walked into the unit, I had no idea what I’d find and what to do.

That first day, I half expected to meet at least one Danny Devito or Jack Nicholson type from Cuckoo’s Nest. (That would come later). I imagined there would be a Nurse Ratched on the ward. In fact, there was no nurse at all. In this unit where every resident was deemed unfit for general population because their mental illness made them a risk, either to themselves or others, there was no medical or mental health staff in sight.

For the most part, the unit setup was no different than for the general prison population: one wall lined with 38 6 x 8-foot cells, each with a single bed, a television enclosed in a metal box (I would find out why later) a toilet, and a sink. The doors were barred not solid. What was different was that right outside the cells were seven tables, hot water for coffee and games. The guys had the luxury of being out of their cells twice a day for two hours of dayroom.

After the officer let me in, he went back to watching whatever it was on YouTube that was engrossing him and the other officers. He nodded to the cells like I knew what to do next. I didn’t. But I had to do something. So I went cell to cell introducing myself to each of the 38 residents. There were guys as young as 18 and as old as 75. In the first two cells, the guys were asleep. In cell three I met Barry: balding, big head, big belly, and a great laugh. Think of Homer Simpson. Standing in front of his cell I see at least 10 variations of the same painting taped to his wall: black background, white star in the middle, and a red lighting bolt in the middle the star, each painting a little work of art.

No more than two minutes into our conversation I was hearing about the encounter between heaven’s angels and the demons of hell that Barry had witnessed in August of 2005. Each picture represented what he had seen that night. It was important for him to make sure that I knew all this was real and that he was not a freak.

A few cells later, I was met with the greeting, “Hey Chucky.” My first thought was that someone had told these guys my name was Chucky. Then a second later, I heard “where’s the cheese?” Sitting on the bunk was 350 plus pounds of kid-man with a face that seemed to have never had a worry in the world. Not a wrinkle. Even when he laughed that huge laugh, there were no laugh lines in the corner of his eyes. I couldn’t tell if he was 25 or 55. Later I would find out that he called everyone Chucky, that his name was Kenny, that he was 51 and had been in prison for 31 years, that he had escaped once (or not) and would stop anyone at anytime to tell them a joke (almost always inappropriate).

I made a point that first day to speak to everyone who was awake. That was a promise I made to myself that day, and I’ve carried it through for the past two years.

Thirty-eight cells and an hour later was Howie. The unofficial mayor of the penitentiary, he seemed to know everyone and had never met a microphone that he didn’t like. Whether it is Mass or an Alcoholics Anonymous meeting, Howie had something to say. And that “something” would invariably include that he had spent 23 years in prison, that “some big people had put me in prison and some big people will get me out,” and that he had half a brain and half a heart and could die any minute. I have stopped myself more than once from reminding him if he really had only half a heart and half a brain he would be dead.

Howie had spent a lifetime in and out of minor trouble, all connected to mental disease. Added to his schizophrenia was paranoia and added to that were homicidal thoughts. In early October 1995 his probation officer asked the court to remand Howie to a psychiatrist who, after meeting with him, was concerned enough that he asked a judge to order a six-month stay in a psychiatric hospital. Twelve days into his stay and seven days before Christmas, after the state had refused to continue paying for the private hospital where he was housed, he was released. Three days later he killed the first person he felt had disrespected him. Then he sat on the sidewalk and waited for the police to arrive. His first words to the officer were, “I told them not to let me go.”

I don’t remember the day I met Roger. He was transferred into the unit from MHI (Mental Health Infirmary) months after I began working. A thin man in his fifties with glasses so thick his eyes looked the size of quarters, Roger could be the nicest guy in the world or the worst. His mood revolved around a cup of tea. If he had one, all things were good. If not: Watch out, I have seen him attack the first person he sees. I have seen him break a television into countless pieces (he’s the reason the televisions are housed in steel boxes with protective glass covers). He was one of the few people in the unit the courts had originally sent to the state mental hospital. He spent six years there before the state, in a cost cutting measure ($150,000 per year vs. $40,000) decided that he was okay for prison. He fought the move and actually won a court case, but he remained in prison. His original 70-month robbery sentence has turned into a 16-year stretch because of minor—and some not so minor—infractions, almost all connected to his mental instability. Now he has spent so much time in solitary that the openness of the ICH unit scares him. He is afraid to be around people. When it becomes too much he goes to extremes to return to the Mental Health Infirmary. He has assaulted fellow inmates, swallowed six radio batteries (interesting X-ray), and even ate a radio, which resulted in a hospital run and surgery. Even though it’s not part of my job, I have the tea ready for when he returns.

One thing I learned quickly was that everyone on the unit is not seeing things, hearing things, or sitting on their beds rocking back and forth. Some act as “normal” as anyone, usually thanks to massive doses of antipsychotics. These are usually the saddest stories and often the most dangerous guys. Miguel is one of these people. He was about to finish his undergraduate degree in Japanese Studies, had a job, his own house, and a family who loved him. That all changed on a September morning 10 years ago when he was 22. While working the graveyard shift at a local market, the shirt of a customer became a hologram. From there, things progressed to him believing that he was a god who had special powers to make his college team win or lose games. I asked him if he thought all this odd. One second you’re selling a guy a pack of cigarettes and the next you’re a god. He told me that in his mind all this was normal and to him it was just the way things were. For two years the disease progressed to the point where he saw conspiracy and insults in everything said to him. Eight days before Christmas, he knew someone had to die. The next day he murdered his roommate as she was sitting at her laptop writing an email to her daughter.

Schizophrenia doesn’t discriminate.

Some are born with it; many others like Miguel experience symptoms in their early adulthood. I worried about him the first day we met. I still do. His medication has stopped the symptoms, but it has allowed him to look at and relive every action he has taken as a spectator. One night months after we first met he looked at me and asked, “Am I going to Hell?” How do I answer that? One thing I knew for sure: Theological questions were not part of my weeklong training. I don’t lie to these guys, so I answered as honestly as I knew how, “I don’t know, but I hope not.” I wish that I could say that I had told him that God forgives everything, and all you have to do is ask. I didn’t. If God made these guys minds, he has to take some responsibility for them. Miguel has the possibility of leaving here after serving a 25-year sentence. He will be 49. But he’s a “Dreamer,” not a citizen, and Immigration has put a deportation hold on him. He came to America at age five. His three sisters are United States citizens. If he is deported, he will be alone with a mental disease in a country he doesn’t know.

And then there is Gene. He is never going to be mistaken for just one of the guys, not even by ICH standards. Unless it’s for medication or a meal, he never leaves his cell.

There are days when Gene does nothing but sit on his bed and stare at his cell wall. It took me more than a year of talking to him every day on my rounds just to get him to acknowledge that I existed. To Gene, some days I am Michael, some days I am Matt. Michael is the guy who, after a year, Gene handed a bottle of strawberry jam as a gift, told him that he was the only friend that he had ever had in prison and that he loved him.

Matt is someone from his past who was an important part of his life. One day he will ask Michael to help him write a letter to Matt. The next day he will give me that letter telling me “Hey Matt, I have a letter for you.” I wonder why and how Gene ended up in prison, and what his old life was like. I know for a fact that the Gene I know is not capable of taking care of himself. When and if he speaks, he is incoherent. His conversation can go from monster trucks to butterflies in a matter of seconds and make total sense to Gene.

Did mental disease hit him in his twenties like it did Miguel? There are times he will tell me about things that he has done, jobs he’s had in such detail that I know he can’t be making it up. I also know that there is no way the Gene I know is capable of doing any of these things. Who could have thought that prison was a better place for Gene than the state mental hospital?

The first time I met Michael, another man in the unit, I showed him a picture of Grant Wood’s painting American Gothic. I thought he looked like the skinny guy with the pitchfork. Michael told me he was better looking and would never wear overalls.

Michael came into the unit not long after arriving in prison. He was one of those guys who the corrections department didn’t know where to house. He had mental issues, so mainline wasn’t an option, but he was also highly functional. He had a relatively short sentence of 70 months with 20 percent deducted for good time and just wanted to get back home to his dog. Michael was a pain in the ass. He was all about his schedule. I had put a list on his cell wall giving times for everything from meals to evening medication line. To Michael when I had put 6:00 as the time for evening dayroom it meant 6:00pm not 6:01. If things happened even a minute late he would start yelling that he had been forgotten. Trying to explain why the door hadn’t opened was an exercise in futility, 6:00pm was 6:00pm, period.

In the unit when one guy gets sick they all get sick. A cold can start at one end of the unit, go from cell to cell, get to the end and start all over again Even though each man has his own cell, the guys are together many hours each day for meals, dayroom, and showers.

You can’t live in such close proximity to 38 other people and not catch something. Late January was one of those times. Michael didn’t look good. He complained of vertigo and that something was “wrong” with his breathing. It was not part of my job description, but I made a medical appointment for Michael the last Friday of January. When you are in prison and sick, you seldom see a doctor. You see a nurse, or if you’re lucky a nurse practitioner. Michael thought he got lucky. His appointment was with a nurse practitioner who was pretty new and hopefully was not yet jaded. He didn’t think he could walk from the unit to medical so I grabbed a wheelchair and we headed to the appointment. The appointment was at 2:45 but she was running late, which became a big issue for Michael. When he finally got in, his first words to the nurse practitioner were “help me, I can’t breathe, I need to stay in the infirmary.” She listened to his chest. His vitals were not great but nothing to worry about, she told him. She knew that Michael had come from the mental health unit. Maybe she thought that Michael was overreacting. She told him she would prescribe an antibiotic, that he should drink plenty of water, and he could go back to the unit. That was the first time I saw Michael cry, begging to be allowed to stay, sobbing as I wheeled him across the control room floor back to the unit.

Wednesday he wasn’t any better. I had made sure he was drinking water and would help him sit up on his bed, but something was still wrong. I asked the officer to call medical and see if I could bring him up. Same story, different day: Michael crying asking to stay in the infirmary. This time a nurse telling him that he was “too sick” and she didn’t want him in “her” infirmary getting other people sick. He was told to continue drinking water and go back to his cell. On Sunday afternoon, when I checked on him, Michael looked awful. His skin was gray, and his breathing labored. When I woke him, he said he had not eaten or drank anything since I had left the day before and that no one had checked on him. I noticed a dinner tray from the night before had been pushed under his door and was sitting on the floor untouched. I sat him up on his bed, got him a glass of water and made sure that he drank as much as he could. He knew who I was, but something was different; I could tell he was afraid, but he didn’t cry or ask to go to the infirmary. For the next four hours, I did what I always did, walk up and down the tier talking to the guys who want to talk, getting cups of hot water for the guys who wanted it, and also checking on Michael to make sure he sat up and had water. Three times a day a nurse who that day had been assigned to the ICH unit wheeled a cart full of pills into the unit and distributed whatever medication the psychiatrist or medical doctors had prescribed the guys. I call it med line; the guys call it “Happy Hour.” She arrived at 7:00pm, the same time I needed to leave the unit and shower. (In prison showering is like peeing, you do it when you can, not when you have to.) I asked the unit officer to make sure that the nurse knew that Michael was unable to walk to the medication cage to get his meds and that I would be back as soon as I could. You would think that the security staff would have special training to work in a mental health unit. They don’t. In fact, some security officers bid on the job thinking they’ll have an “easy” shift where they can hide out for eight hours and play dominoes with the guys. But there are also some officers who really care about how inmates in special housing are treated and try their best. When I returned to the unit from the shower, I saw the nurse at Michael’s cell and Ms. Steele, a security officer who was only in the unit for that Sunday night, sitting on Michael’s bed, rubbing his hands and telling the nurse that “this man has to see a doctor.” Michael’s hands and arms had swollen to almost double in size in the 20 minutes I had been gone. He was still aware but becoming less so.

“He will be okay. Just make sure he has liquids,” I heard the nurse say.

“No, he needs a doctor,” Ms. Steele said. “If I need to contact the Officer in Charge, I will. Look at his arms!” Ms. Steele wasn’t a nurse, but she knew sick when she saw it.

The nurse didn’t budge. “He has an appointment tomorrow morning, and he will be fine till then.” she said. When the nurse left, Ms. Steele made that call to the officer in charge of the prison. I don’t know what she said to him. It was after 8:30pm and work was over. I had been in the unit on and off for almost 11 hours by then and had to be back early the next morning to take Michael to his medical appointment.

Five hours before I was to officially start my shift, I was back in the unit with a wheelchair ready to take Michael to his appointment. His skin was gray, his limbs were puffy. I asked the officer to open his cell so that I could wake him. He knew who I was. 

He wouldn’t take a drink of water. I helped him into the wheelchair for the three-minute trip to medical and what I hoped would soon be a trip downtown to the city hospital.

When we were less than 10 feet away from the cell, his head slumped to the right, he started gasping for air, and piss started running from the seat of the chair to the floor. I yelled for the Sergeant, who called “man down” (the prison equivalent to stat in a hospital), Medical was called. Twelve minutes later they arrived. Michael was put on a stretcher and wheeled out of the unit. That was the last time I saw him. He finally got that hospital trip he had been asking for. He died there the next morning.

Michael’s death hit me hard, not because we were great friends, but because it was unnecessary. Three different medical staff ignored or downplayed the pleas of a very sick man for the help he surely would have received except for being in prison and—even worse—being in prison with a mental disease. Could I have done anything differently? Did Ms. Steele do all she could? Will his family ever know the story of what happened? How many Michaels have there been in this institution? At other prisons around the country?

It’s been more than two years since I walked onto the ICH unit. Half the guys who were there then still are. A few others have done well enough to go to general population.

Some of the others have been lucky enough to go home. More than I’d like to think about have gotten worse. I’ve stopped asking questions of the staff. They ignored them, told me to mind my own business, or sometimes gave me truthful answers that wish I hadn’t heard. Why did Barry spend three years of his life in prison only to have all his charges dropped three weeks after his release? Why is Gene spending five years in prison for a crime he has no recollection of? Now that his sentence is coming to an end, the state has decided to commit him, involuntarily, to the state mental hospital. Why does the system work this way?

A few decades ago there were 325,000 people in mental hospitals in the United States. Today that number is fewer than 50,000. Have 275,000 been cured? Or are tens of thousands of them in prison? Those with mental illnesses who might come to prison for a short sentence sometimes end up staying for decades. They don’t get consistent counseling. They don’t get consistent medication. They act out. In the depths of schizophrenia, seeing monsters, cowering in the corner of his cell, a man spits on an officer. Punishment for an assault against a staff is added to the end of his current sentence, each infraction adding more time. Why is it that officers can work in a mental health unit with no extra training? Why is it that if one of the guys has a mental meltdown after 8:00pm or anytime on Sunday there is no mental health staff at the institution?

Why was Michael allowed to die?

I can’t tell you the day that my work in ICH changed from being just a job. Michael’s death had something to do with it, but it wasn’t only that. These men on the unit are friends. I look forward to seeing them each day. Maybe in some small way, I am making a difference. But it also may be that I get more out of being with them than they do by having me there. This job is helping me survive prison.