When I met Dorothy, she was always counting. Her chapped lips moved nonstop as she chanted random numbers. She'd increase the speed, as if that would help her to reach the end quickly-but since the numbers didn't appear to be in any sensible order, this loomed before her like an impossible task. Her nonsensible counting seemed to be her manner of trying to keep pace with the nonsensible thoughts racing through her mind, and her eyes bore the agony of the marathon.
She'd press her hands against the glass surrounding the nurses station, the window fogged as she panted with desperation. The sprint from her room to the nurses' station wouldn't allow her to outrun the demons haunting her thoughts. Her brow furrowed with frustration, as if the glass barrier was the only thing preventing her from conveying a message only she understood.
I was a new nurse at the state psychiatric hospital, so there were many unusual things that I soon accepted as the new normal. The chaos in Dorothy's mind commanded her full attention and overrode all other needs. It leaked out and clung to her in damp perspiration stains, preventing her from completing basic tasks. She didn't seem to know how to ask for help, and as a new psychiatric nurse I wasn't quite sure how to provide it.
As her anxiety peaked in her struggles with the abnormal, I tried to tether her to the normal. I'd take her hand to help her care for her external needs while she worked on healing internally. She'd meet my gaze in the mirror as I helped her complete basic tasks we often take for granted. Her haunted face appeared disturbed at the image that greeted her. I smiled and spoke to her while brushing her hair, caring for her as lovingly as I would my own mother. Dorothy didn't contribute to the conversation-instead she continued to chant more random numbers.
Like many other chronically mentally ill patients, Dorothy had few visitors. It seemed many avoided their severely ill family members. Often they couldn't understand, or bear to watch, their loved ones' struggles with regaining their sanity. Perhaps this is why Dorothy's daughter rarely visited during this period. It had to be difficult to helplessly observe as an illness crept in to hold the person you knew and loved hostage. I could only imagine how hard it must be for her to see her mother in this state-again. This wasn't Dorothy's first admission, nor the first time she'd cycled through this extended phase of her illness.
As the weeks passed, Dorothy slowly responded to treatment. She'd enjoy long lapses of silence, and then gasp for breath, as if trying to swallow the numbers longing to burst from within. Her responses became more coherent, and eventually she could walk by the nurses' station without clinging to the glass.
I'd never realized just how much a mental health crisis could steal someone's identity and overwhelm their self-control-not until I observed the dramatic change in Dorothy as she emerged from the cocoon her illness had shrouded her in.
Dorothy no longer required my help to dress, and she did a much better job of it than I could. She expanded her wardrobe beyond nightgowns; elastic waists; and loose, formless tops. This Dorothy didn't resemble the woman I'd met months ago. It was unlikely she'd recognize herself now if she saw herself in that former state. Her face was artfully painted with cosmetics and she walked with poise and grace. She appeared a little embarrassed around me, as if she didn't want to recall her behavior during our time together.
I completed the visitor's card, and Dorothy lingered after I finished signing her daughter in for a weekend visit. She placed her hand on mine. I glanced up. She stood in front of me, her calm gaze seeking mine. It was the first time I'd seen her smile, and this small miracle filled me with joy.
"Thank you," she said. Her smile was easy and relaxed, as if she wanted to savor the sensation. Her eyes conveyed to me that her gratitude encompassed not just my completing this simple task, but all those little everyday tasks that had meant so much more.
I've had countless patients since that time, but I never forgot Dorothy and the lessons she taught me: how you can show care and compassion even if you can't verbally communicate with or understand someone-and that sometimes that's exactly when a person needs you the most, and can hear you the best.
When I think of Dorothy, I hope that she's doing well, and I wonder if she's smiling.