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“While We Nothing Heeded” – Hope on Ward 3

Ward 3, the locked psychiatric unit where I began my residency in psychiatry, was an utterly unattractive place, a tired fluorescent network of wall fabric and tile, fragrant with cleaning solution and stray bodily fluids. Its pajama- clad inmates, expelled from comfortable 21st century American culture by the demons of chronic mental illness and addiction,

by Warren Kinghorn, MD, ThD
Today's Christian Doctor - Winter 2014

Ward 3, the locked psychiatric unit where I began my residency in psychiatry, was an utterly unattractive place, a tired fluorescent network of wall fabric and tile, fragrant with cleaning solution and stray bodily fluids. Its pajama- clad inmates, expelled from comfortable 21st century American culture by the demons of chronic mental illness and addiction, would stabilize, rest, detoxify, regroup and then—eventually—leave. It was a place of great pain, of small victories and sometimes, astonishingly, of irrepressible hope.

I began work on Ward 3 confident in modern psychiatry and expecting good things to happen to my patients, and I was not disappointed. One of my first patients, Mr. Thomas, was a depressed and suicidal middle-aged man, tormented for many years by crippling recurrent depressions. Because he had responded poorly to a wide variety of antidepressant medications and had responded well to electroconvulsive therapy (ECT) in the past, we arranged for him to receive a course of ECT treatments. Over the next three weeks, Mr. Thomas changed miraculously. His bleak demeanor gave way to a goofy, fun-loving personality. His appetite and sleep improved. His thoughts of suicide vanished, and he was hopeful and confident about the future on discharge. I worked hard for him and with him. But it was all worth the work, I reminded myself. We gave him his life back.

Those were still my thoughts when, four mornings later, I received a page from the hospital operator informing me that Mr. Thomas was on the line and wished to speak to me. I answered with nonchalance and was stunned by the slow, slurred, agonized voice that returned my initial greeting. “Dr. Kinghorn . . . I’m hav-ing trou-ble remem-bering things . . . I can’t live like this . . . I’m seriously think- ing about su-icide.” I suddenly felt nauseous. Uh oh, I thought, I didn’t expect this. I quickly tried to reorient myself into telephone-crisis-management mode and asked if he had a plan for how to kill himself. “Y-yes. . . I have every-thing I need right here . . . a hose-pipe I’m go-ing to hook to a car ex-haust pipe . . . I can’t take this any-more.” I realized with a start that I didn’t have his return phone number and therefore asked him for it. “NO! . . .” he roared, “YOU all did this to me!” And then . . . a click, and then silence. He had hung up the phone, and I did not know how to call him back.

What had started as a pleasant day quickly turned into an anxious race to find Mr. Thomas before he could make good on his suicidal threat. With a colleague, I determined that Mr. Thomas had gone to live with a fellow patient, a known drug user, after discharge. I dispatched police to that address and called that patient’s number. To my relief, Mr. Thomas answered, and I listened to his slurred and incoherent rambling for 40 minutes until the police arrived. When he arrived back at Ward 3, he was intoxicated, uncooperative with the hospital staff and particularly furious at me. He refused to even speak with me, glowering with hostility and shouting obscenities at me which echoed sharply through the tile-clad floors of the quiet ward. I finally arrived at home to my worried wife well after 9 p.m. I was exhausted, emotionally drained, hungry and frustrated at myself for not having somehow prevented the crisis. Most of all, though, I was overwhelmingly angry at Mr. Thomas. He ruined my day. After all I did for him before, he threw it away on alcohol. And to go to live with a known addict even when we gave him other opportunities—he was asking for it! And here I spent my whole day trying to keep him safe and I get nothing but cursed at in return. I am so tired, I thought, of saving people from themselves. If psychiatry was all going to be like this, perhaps I wasn’t cut out for it after all.

When I pulled out of my driveway just after dawn the next morning, still tired and angry, I offered a short prayer which, though it sounded like a confession, was actually a tired expression of self-pity. Have mercy on me, God. I am so tired. Please let me have a quiet day. I did not expect or listen for a word back from God and quickly reached for the radio dial. But my mind would not completely let go of the prayer. Have mercy on me, God, I had prayed. Mercy. Have mercy. Have mercy on me. Why had I prayed those words? As I began to think on the phrase, my mind shifted from the present self- indulgent context of those words to their original context from which I had subconsciously pulled them: the opening lines of the Psalm 51:

Have mercy on me, O God,
according to your steadfast love;
according to your abundant mercy
blot out my transgressions.

Have mercy on me . . . steadfast love . . . abundant mercy . . . blot out my transgressions. I cannot remember exactly how the chain of associations progressed in my tired mind. But somehow, from my half-witted contemplation of that verse sprung a mental vision, more stunning than any words: Jesus Himself, hanging on the cross, His wrists pierced and His bloody head bent in pain. Have mercy on me, O God, I thought again, and I almost began to cry.

It was not just Mr. Thomas, I realized in that moment, who had disappointed someone who cared about him and who deeply longed for him to enjoy health and life and peace. I thought about my own failings. My mind looked again to the image of Jesus on the cross, looking at me. If I feel this way about Mr. Thomas, I wondered, how must God regard me when, time after time, I mess up? What kind of love must it be that keeps God from abandoning me?

I almost began to cry because I glimpsed, as if for the first time, how painful it must have been for God to suffer for the broken creation, a creation which includes me as well as Mr. Thomas. I realized with shame that I had been placing myself in the wrong role in the redemptive story. In my self-righteousness I had cast myself as a Christ-figure, a humble servant suffering for the redemption of a broken man. But looking at Jesus on the cross, I realized the triviality of my “suffering” and the silliness and presumption of that feeling. In the creation-fall-redemption narrative of God, I am much less like Christ than like Mr. Thomas— a man standing only by grace, evermore in need of salvation from myself. I remembered the words from a mournful hymn I had last sung on Good Friday:

Lo, the Good Shepherd for the sheep is offered;
the slave hath sinned and the Son hath suffered.
For our atonement, while we nothing heeded,
God interceded.

For me, kind Jesus, was thy incarnation,
thy mortal sorrow, and thy life’s oblation;
thy death of anguish and thy bitter passion,
for my salvation.

Therefore, kind Jesus, since I cannot pay thee,
I do adore thee, and will ever pray thee,
think on thy pity and thy love unswerving,
not my deserving.

It costs a lot, I realized as never before, to redeem someone. But redemption is the promise of Christ’s death and resurrection.

When I walked onto Ward 3 a few minutes later, Mr. Thomas was still refusing to speak to me and still glaring at me. I continued to wonder what I could do, if anything, to reestablish rapport with him. But it was difficult for me to be angry at him. While we nothing heeded, after all, God interceded.

Late that afternoon, Mr. Thomas approached me and asked if, finally, I wanted to talk. We stepped out onto the unit’s sun-splashed porch, surrounded and covered by chain-link fencing to prevent escapes and suicides, and sat down at a patio table. His anger, so evident only hours before, had melted into dejection, and he told me that he felt that his life was worthless and that he had drunk a large bottle of Listerine the day before “so that I could get up the courage to kill myself.” He was dismayed that even then his “courage” had failed him. He said he was sure that we would not be able to help him and should just let him be free to die. We talked about his tortured childhood and I quoted him the first few lines of Psalm 13: “How long, O Lord? Will you forget me forever? How long will you hide your face from me?” (Psalm 13:1, NIV 2011). He looked at me with frustrated pleading eyes and asked, “How many times are you going to go get me and bring me in here?” I paused and looked at his face, highlighted in the thick late afternoon July sun. I don’t know, I told him, but if I hadn’t thought that there was hope for him, I would never have done what I did the day before. He looked at me incredulously, “You mean you really think there is hope for me?”

Yes, Mr. Thomas, I do believe that there is hope for you, though I no longer delude myself into thinking I am your savior. I hope that modern psychiatry, limited as it is, may offer you some respite from your suffering, and especially that in the resource-strapped world of indigent mental healthcare you will receive counseling to battle the emotional and familial and sexual demons which overwhelm you and promise salvation in self-destruction. I will hope that perhaps you will reconnect to the faith of your youth and perhaps find an exceptional group of Christians (for it will take an exceptional group of Christians, with all of the Christian virtues of love, patience and forbearance) to support you and to give your life structure and meaning. I hope for your happiness, your life, your peace, your salvation.

But Mr. Thomas, in a much more fundamental way, I am not able not to hope, for to do so would be to deny the promise of my own salvation as well. If you are beyond the possibility of redemption, then so am I. For redemption, after all, is the promise of Christ’s death and resurrection. And although the greatest of all the virtues may be love, it is often only hope which sustains us in those dark places where love seems not to reach.

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