Funny, frank and beautifully observed, We Don’t Use Words Like Crazy is a ‘professional confessional’ from Elliot Sweeney, a community psychiatric nurse who works on the frontline of mental health services. His memoir lifts the lid on the realities of the profession, and – as this recollection of his very first wayward attempt at administering an injection demonstrates – the moments of humour that puncture the drama of the day-to-day.
‘You’ve done this before, right?’ he says.
‘I’ve practised,’ I assure him, and add, ‘don’t worry, you won’t feel a thing.’ Sam doesn’t answer, but his lips keep moving and his stare is unwavering.
In general, patients are put onto a depot when taking tablets isn’t working out. For some, remembering to take a pill daily is too much for them to manage; for others, there is an aversion to taking mental health meds in general, and this is the only way of ensuring they receive what’s prescribed.
Sam falls into this camp. If he swerves the fortnightly injection he could be recalled to hospital, where he’ll be restrained and given the medication by force. Sam, for good reasons, isn’t happy.
‘I’m not happy,’ he says.
‘Why’s that?’ I ask.
‘I don’t like that stuff.’ He points at the syringe.
‘What don’t you like about it?’
‘How’d you feel if a stranger jabbed you in the arse every fortnight with chemicals?’
I take a moment. ‘I’d feel annoyed.’
Sam hesitates. I’ve made a dint. ‘What do you know, Florence Nightingale?’ he mutters, and the guard returns.
What do I know? This past year, I’ve swapped Chandler and Hammett for dense books on psychopathology and the aetiology of mental disorder. I can talk shop about dopamine models of psychosis, schizophrenogenic parenting, the impact of socioeconomics and stigma. I’d love to tell Sam about all this, explain exactly what’s wrong in his head. But he doesn’t seem keen. Especially with me.
I return to my task, comparing the drug I’m about to give with Sam’s medication chart. This is basic nursing. Right patient – check. Right medication – check. Right time – check. Right dose – check. Right route of administration – check.
I look at Alan. Another nod.
‘OK,’ I say. ‘Ready?’
‘Just get this over with,’ Sam snarls, his mouth like a gash in a piece of bad fruit.
The favoured place for depots is the upper-outer gluteal, that dense meaty muscle beneath subcutaneous fat located on the buttock. Sam unbuckles his jeans belt, lowers the hem, and then pulls his boxers down to his groin, exposing a sizable chunk of flesh. The skin has been injected into many times and looks hard, cratered, heavily scarred.
Saying nothing, he lies on the gurney bed, chin on the mattress, hands at his side. I approach, place the injection equipment on a side table. Sam watches my every move. I pull gloves from a dispenser and plunge my hands into the latex. The sweat on my palms makes the skin stick, and two fingers on my right hand tear through the thin material.
‘Clumsy,’ Sam says.
Now my cheeks are a conflagration.
‘No bother,’ Alan says. ‘Happens to us all.’
I peel the glove off, deposit it in the clinical waste bin, remove another set.
‘Chop, chop,’ Sam says. ‘Got places to be.’
My mouth twitches. Carefully, I insert my hand, each digit slotting into place neatly. Then I take the syringe and step up to the gurney, hovering over Sam’s behind. His exposed buttock is like a landing pad. His still, dark eyes bale at me.
I visualise drawing a cross on the skin, then another cross within the top-right box, the upper-outer zone. I pinpoint a dot marked in the skin, next to a mole. This is where I will insert the needle. I look at Alan, point to this area. Nod.
Syringe ready, I place my hand on Sam’s skin. He tenses. Gently, I stretch taut the skin with thumb and finger. It whitens.
‘OK?’ I say.
‘Just do it.’
The syringe is huge, a .44 magnum, locked and loaded.
Do you feel lucky, punk?
I pull back my wrist, inhale . . .
‘Sharp scratch . . .’
Then I fire.
Many times I’ve gone over what went wrong. Perhaps Sam coughed or jerked; perhaps I slipped, or mistargeted? I still can’t really explain it. Whatever, I know immediately that I’ve messed up. A steamy belch of shame pumps through me. And then my right hand starts to throb something awful.
This is bad. Really bad. Worse than the time I barged over a blind kid as I was rushing to catch a bus; worse than the time I asked a female friend who’d put on a few pounds when the baby was due.
I haven’t injected Sam. The needle has impaled the loose flap of skin between my thumb and finger, going deep, very deep into me. I’ve stabbed myself.
‘Everything all right?’ Sam says.
The blue glove sheathed over my right hand fills with red, as if claret is being drip-fed into the latex. I look over at Alan. My breath rasps. My vision fogs. I feel sick and want to run. But I can’t run. Because I’ve got a patient lying prone and a syringe loaded with antipsychotics nailed into me.
‘Oh,’ Alan says, stepping over, looking at my hand. ‘Whoops.’
‘M-made a mistake,’ I stutter.
‘What mistake?’ Sam says. ‘The hell you done, student?’
‘Nothing, Sam,’ Alan says. ‘Relax.’
Dark thoughts plunge into my head. What if I’m stuck this way forever? What if some of the meds have entered my bloodstream?
With my left hand I grip my wrist and step away from Sam. The syringe wobbles like a tent peg in the wind but stays rooted. I shuffle towards the medication cabinet. The glove is saggy with blood. I feel sick. I want the floor to eat me.
‘Easy,’ Alan says, stood beside me. Carefully, he holds the top of the syringe between thumb and finger and then pulls.
‘Aah,’ I say, as the metal slithers out, ending with a pool of fresh blood spilling from the latex. My knees are shaking. My mouth tastes of warm Parmesan.
Alan disposes of the syringe in a sharps bin. ‘Run some cold water over it,’ he says.
I peel the glove off, hold my hand beneath the flowing tap, watch my blood dilute and swirl down the sink.
The hole is small, a perfect circle from which a beautiful blossom of spidery red keeps appearing.
‘Am I going to–’
‘You’ll be fine,’ Alan says. ‘You’ll need to get a tetanus. Write an incident report. And you won’t do that again, aye?’
I grab a paper towel from the dispenser, squeeze the wound hard. Gradually, the bleeding stops. I look over at Sam. He’s now sitting up on the gurney, his jeans pulled back up, his lips muttering again. Between words, a toothy grin stretches across his mouth, and his eyes light up for the first time.
‘You were right,’ he says. My expression must show my confusion.
‘I never felt a thing.’ He begins laughing.
Pride sizzles in my guts like a rasher of bacon hitting the pan. I look at Alan for support but he’s turned away, his shoulders juddering.
‘It’s not funny,’ I say, and laugh too.
