Sunday, March 29, 2009 — The Santa Barbara morning fog was just burning off the coast as I pulled into the county’s Psychiatric Unit Facility (“puff”) to visit my brother, Phil. A sign on the locked front entrance re-directed visitors to a side door, used only after hours and on weekends. Security doors, buzzers, and thick panes of wired glass all conveyed the solemnity of a prison, but when I pressed the visitor’s bell outside and gave my name, the amplified voice of the psychiatric nurse through the wall-mounted speaker was surprisingly friendly. Soon an older woman cracked open the heavy door. She was carrying what looked to be a half-pound loop of shiny keys around her waist, and she graciously admitted me to Santa Barbara’s only public mental facility, where several dozen adult males and females are housed and monitored in a threat-free universe, with three square meals a day and clean sheets twice a week.
A small TV was playing loudly in the rec room, but there was no one watching it. Several patients were crowding around a sliding glass door that opened onto the back patio, where the staff was about to oversee the much-anticipated second smoking session of the morning. Phil, whose hair was now thinner and shorter than I had remembered, was standing off to one side, stroking his short graying beard. When he saw me he said “Bill” fairly loudly, and several of his fellow patients looked my way expectantly. Many of these people smiled and nodded, glad to see a new face on the ward. My brother has never liked to be hugged, not even touched, but his handshake was very warm. He looked to be about twenty pounds heavier than when I’d last seen him, and he was wearing a winter jacket even indoors.
“It’s almost smoking time, Bill,” he said. Phil rocked from left foot to right, anxiously awaiting this daily pleasure. “They only let us smoke out here once every three hours,” he told me. “I can’t really function right now until I get a cigarette,” Phil said. “I can’t talk with you until they let us have a smoke. Do you still like cigarettes,” he inquired. I told him I’d quit, but I reached into a pocket and showed him my new discovery, a tin of six cigarillos, each the size of my little finger. “I smoke again but I don’t inhale,” I told him. When I offered my brother one of these tiny cigars, he began to beam with pleasure, but he was reminded by a staff member that we still had four minutes until smoke time. Phil nodded and continued to rock from left foot to right, and stared at the clock hanging across the day room mounted over the TV. “I can’t function at all right now,” Phil reminded me, staring fixedly at the nurse holding the box of cigarettes and matches. I told him he needn’t bother, we would just wait for the smoke break together. We’d wait out the four minutes.
Phil was in his tenth day at the county “Puff” ward (P.F.F.), where he has been a frequent resident over the past decade. When life at his outpatient board and care house in the heart of downtown gets too complicated, when the daily routine of walking around Santa Barbara begins to feel to Phil less like freedom and more like danger, he opts for Plan B and returns to the locked ward, where his days feel simpler and less threatening.
At exactly 11am a half dozen patients file onto the back patio, and one by one they receive their one smoke and a light from Carmen, a pleasant Latina woman of middle age. Patients are not allowed matches. Caffeine in any form is also prohibited. Nicotine is a controlled substance in here, and for that reason, this tightly scheduled smoke break was reason to celebrate here during an otherwise joyless and medicated day.
Phil drew on his small cigarillo, and seemed to like the new taste. He spoke of his concern for what he had recently witnessed of world affairs on a TV broadcast. “Bill, I think we’re in our last days here on this planet. Do you think that? I do. I think we are probably all just living on borrowed time right now. That, and this place, Santa Barbara,” he added, grimacing. “This place is like a war zone,” he told me. “There are bad cops here, and criminals here, and none of them mean me any good. Being in Santa Barbara is like being in Hiroshima,” Phil said. A light spring breeze was carrying the smell of eucalyptus across the hospital area here on this wooded hillside, and even before noon the temperature was already over seventy degrees. But none of this brought relief for Phil. None of this made his morning a pleasure.
Phil spoke with our older sister Suzy on my cell phone for a few minutes, while his cigarillo burned down to a nub in his right hand. Watching him cradle the small phone as he struggled with his last few puffs, I noticed that Phil was missing one or two teeth now. They were front teeth, so his speech seemed a little less precise. He was my younger brother, the baby of our family, but he was now in his mid-fifties, and the years had not been in any way kind to him.
Turning off the telephone, Phil described in detail how much he wanted to escape Santa Barbara, how clear it was to him that the town posed a daily threat to his well-being. He weighed the prospect of re-locating to a facility in the Monterey area, where he would be closer to our sister, who for years now has served as his official conservator. Phil is a ward of the State of California; he has been since he graduated from U.C. Berkeley in the early seventies. His schizophrenia had taken full command of his life even before he was old enough to buy a drink. Since then daily existence has been a challenge. He has never been healthy enough to hold down even a part time job, never been able to enjoy personal relationships, never known which stranger in a crowd would be the one to do him ultimate harm. Fear and doom are his most constant companions, though their size and shape are moderated by his daily medications. At this point, he says, he likes his psychiatrist, and he thinks that the mix of drugs he receives each day is finally right. “I am taking Haldol, Bill, do you know about Haldol?” he asks. “Yeah, well, it makes my brain feel like quicksand, but it’s not too bad. I used to take Prolixin, and that was a devil’s drug. Prolixin,” said Phil, “was created in hell.” Phil had another thought. “Bill, do you like coffee? That’s what I wish they’d give us in this place. You can’t get caffeine, no one can. That’s what I want when I am out of this place, caffeine.” Phil found one more puff in the cigarillo, then dropped it in a patch of sand at his feet.
Phil admitted that this hospital setting was the most successful place for him to be right now, but he seemed to hold out little hope that things would be changing for him in any dramatic way. “You know, this place is depressing,” he said, looking around at his fellow patients, and at the nurse seated across the patio, flipping through the Sunday newspaper at the picnic table. “Bill, all I do is suffer. You know that? I never ever feel what people call pleasure,” Phil said, looking at a long ash at the tip of his second smoke, this one a cigarette. “I never even feel the absence of pain,” he told me. Most of the other patients were done with their smokes, and began shuffling back into the day room.
Talking about his medicine makes Phil think about our late father, whom Phil always refers to as “William F. Kiely.” He asks whether I feel like I am in touch at all with the spirit of William F. Kiely, the gifted but troubled psychiatrist who took his own life thirty years ago. Phil said that he could still feel our father’s intelligence, which he described as “ a real force.” He noted that he was jealous of Dad’s suicide, saying that he wished he too could find a painless way to end it all. “I don’t want to live, Bill,” Phil said. “I’d rather be dead, really I would.” I had been working hard to keep my feelings in check during this visit, but Phil’s honesty cut me short, and left the both of us quiet for a minute.
We were soon talking about what we missed from childhood, and Phil talked about the value of good TV back then. He remembered the tradition of our family sitting together to watch the Ed Sullivan show every week. “That was real good, Bill, you know? Remember? We saw the Beatles, we saw Elvis Presley, we saw some really really great stuff on the TV when we were young.” He was still grinning slightly when another thought occurred to him. “I saw Ed Sullivan have a nervous breakdown. I did. Right on TV,” he said. “I‘ve had nervous breakdowns myself,” he remembered, and his thoughts drifted away.
Phil and I agree that our father is someone we both think of all the time. I ask Phil whether he feels the absence of our mother, who died just over two years ago. Without even pausing to consider the question, he nods and says, “Constant Comment tea. Sourdough waffles. And we also had apple pie, always with some cheese on the side,” he recalled. It was clear Phil had considered his boyhood days in this town to be a small blessing. “Life here used to be really good, don’t you think, Bill?” he asked. “When I was a kid I used to sail small boats and work at the marina during the summer. Remember? But sometimes when I was sailing it could get cold,” he said with a frown, pulling his jacket tighter around himself and peering up at the bright noon sky. “Aren’t you freezing, Billy? You ought to have a jacket, because it can get really cold in Santa Barbara. I think Santa Barbara is a hell hole,” he said. Phil once again reflected on the memory of our mother, admitting that he didn’t find her very easy to like. “She didn’t give a damn about me,” he said flatly.
Phil wasn’t seeking comfort or family warmth this morning. He was just acknowledging some simple facts, and doing his best to stay warm. To smoke while he could. And certainly to find a way to get more of these little cigars somewhere, along with a strong cup of coffee, black, no sugar.