In Catholic elementary school, we sat at our school desks, and the nuns had us pray for the lost souls in purgatory every day.

If we prayed hard enough, we would pray them out of purgatory and lift them into heaven.

Before I clock in, I say my anti-assault prayers to the gods. I pray for safety. I pray for the next 12 hours to be uneventful.

I thought I would give ICU nursing a break after 33 years. No one lasts 33 years in ICU — but I did.

I thought I would find something easy and non-eventful to slide into my retirement.

ICU vs. behavioral health … kind of apples and oranges.

I encounter psychotics, people with bipolar, borderline personalities, and schizophrenia. They come homeless or from prison or their tattered lives — repeated admissions for the rest of eternity.

In the adolescent unit, a patient grows up, and after turning 18, they come to join us. In their outside world, there’s noncompliance with medication and noncompliance with their therapists. They re-enter their toxic environments from their homes before they enter a somewhat safe zone, a pretend sanctuary, i.e., the hospital — the behavioral health unit.

The young female in her 20s or 30s who was sexually assaulted in her youth by known family members or abusive boyfriends, the men who for years were diagnosed with schizophrenia but had zero medication compliance. A lifetime of verbally, mentally, and physically being beaten down, never having a chance to get up for air, and drowning.

I offer them their medications for the night. Some are gracious and polite. Some talk to the walls or talk to the TV blaring or stare out their window seeing imaginary people that are real to them, drifting in the clouds.

The psychotic ones can’t focus. They talk rapidly non-stop to their invisible person.

The violent ones lash out randomly.

Was I a trigger? Do I look like someone from their past? Did I say something wrong?

I have been hit in the head several times at random. I’ve been placed in a wheelchair after a female patient hit me repeatedly in the head, all random, all unprovoked, CT scan of my head because I became dizzy.

Despite our mandatory non-violence crisis intervention training class, learning exact twists and turns to prevent an assault altercation, I don’t know how to defend myself; I don’t know how to swat a fly.

What have I learned these last three years in behavioral health?

Drug abuse, narcotics, cocaine, benzos, opiates, amphetamines, meth, alcohol, cutting, banging your head against the wall, cutting on your arms and legs, self-mutilation. Or banging their fist against their head, making the voices go away. Make it stop.

And they repeat, “I want to kill myself,” “I want to jump into traffic,” “I want to kill my mother.”

In this controlled environment, I pray they’ll take their medications without incident.

I pray they won’t harm themselves or others or us.

The mind can be a very dark place, a place that has stored unresolved years of abuse, anger, and neglect.

It’s a different world of nursing.

My valuable lesson seems to carry me through day after day.

And that is to respect them. Be gentle. And most of all, be kind.

Because kindness is something they haven’t felt in a very long time.

And I continue to pray for these poor souls.

Debbie Moore-Black is a nurse who blogs at Do Not Resuscitate.

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