10/13/06

My head is swimming, I’m not sure how to start or if my words will come out “right”, but I’ll give it a shot. I haven’t journaled all week because it’s been a pretty tiring roller-coaster week, one that has ended on quite a downer. In the Center it’s been one thing after another, and this week it has mainly revolved around one girl, Zelda, who has been suffering from severe clinical depression. Although to be honest, I think there’s more to it, there’s more going on inside her mind than depression. She is battling demons we can’t see or understand, and these demons are blocking everything else out, taking pieces of her away until we can’t recognize her.

All the time I’ve been here I’ve found her to be a sweet girl who happens to be ridden with a profound sadness that displays in her lack of social interaction with the other girls, frequent crying, and a look in her eyes that you can’t really describe in words. At the same time, you can see the hope pop out of those eyes, crying for some type of salvation. From the first day I saw something different in her, something that was reaching out, needing something but at the same time rejecting it. She slips in and out of these states, between hope and the occasional smile, and the fitful tears and refusal to cooperate. One minute she’ll be fine, asking us to take her on a walk with us, the next she’s practically mute, gazing off into a world we can’t see or imagine. She has been on medication for her depression for over a month, and at first it seemed to be helping, but the last week has gotten much worse. She began to suspect that they were putting medicine in her drinks, and began refusing to drink anything, so she hasn’t been taking her medication this past week. I don’t know if I can say that is really the reason for what has happened the last 3 days or not, but I’m sure it doesn’t help. On Wednesday, things got worse than the normal agitation and crying. She escaped from the Center in the morning and ran to Ivete’s house, but then fled once she came to the door. She eventually came back to the Center and began throwing fits, threatening to commit suicide several times (they had another suicide scare before she went on the medication), working herself into such a frenzy that she passed out, her eyes beginning to tremor. So they took her to the hospital, where the doctor suggested she be taken to the psychiatrist for further consultation. We were already planning to go to her scheduled consult the next day and it wasn’t possible for us to go that day, so we brought her back to the Center, where the roller coaster continued. For the most part she was under control, only having the occasional crying fit and what looked like momentary lapses of consciousness while she was sitting down. It was as though her brain would shut off and she was semi-catatonic, not responding when you called to her or shook her to get her attention. The environment in the Center having so many girls and so few workers to look after Zelda was not optimal for her, so between Ivete, Ercília, Andreia, and I, we tried to keep her occupied and took her outside when we could. During the afternoon I was put on suicide watch, to stay with her and make sure she didn’t run away, or try to jump out the window. I decided to bring her by my house to find a deck of cards to try and teach her a new game, and to just get some fresh air. She was having one of her good moments, so I had hopes that she was improving and some time out of the Center would do her good. But when we got back and I tried teaching her card games, I realized that her state of mind was someplace beyond what I was seeing in front of me. She couldn’t understand basic instructions I was giving her, and she would frequently lose concentration and start staring into space again. I could see her getting worse, and then she starting getting agitated, talking about how the girls in the Center were making her mad, that she didn’t want to stay there, that she would run away again, just wait and see. One of the monitoras took over the “suicide watch” as it was getting late and I had to return home. The next day, yesterday, we went to Praia with her to have her psychiatric consult. There is only one psychiatric hospital in Cape Verde, and it holds about 30 people. All adults. So he wouldn’t admit her because she was underage, plus he didn’t feel it would be an appropriate place for her (I agree, institutionalization is a pretty ugly thing, especially for kids to experience), so he told us to just monitor her situation and let him know on Monday how she was doing. When we got back, things just got worse. She began severe crying fits, not just with tears, but with forceful screaming and pacing back and forth. She continued like this for awhile, having brief moments of calm, and then starting up again, screaming the same few phrases over and over again, not responding to anyone who would talk to her. I really don’t think she even heard what people were saying some of the time, she was in her own world of misery, fighting those demons that were ripping through her mind. That night, she had several more attacks (for lack of a better phrase, and really they were like panic attacks), trying twice to open the window and climb on the ledge to jump off (from the second floor), though the mães reached her in time. So the mães, particularly the one in charge of her, didn’t sleep at all, having to restrain her and watch her like a hawk. It continued through most of the night, and then resumed this morning. She had been crying and screaming for so long, she hardly had the voice to continue yelling, and her whole body had broken into a cold sweat. She paced and wandered throughout the whole Center, mães and monitoras following close behind to try and calm her down, pull her away from the windows, etc. Having all the girls there making noise and playing around was just agitating her even more. We were in such a tough situation, because really there was no option, nowhere to send her, nothing we could do to help. We couldn’t send her home to her mother because of her terrible family situation, we couldn’t institutionalize her, none of us could take her home, and she showed no signs of getting better or relenting. We had to go to Picos to meet with the President of the ICM during the day (which was a whole other journal entry in itself), so we left her with the mães, only to return and find the situation hadn’t changed. No one was able to control her, so finally Ivete, Andreia, and I decided to take her to the hospital to see if they could give her some kind of sedative. It was so painful, the whole experience. Watching her in such torment, not being able to help. As we approached the hospital, she began screaming “I’m not sick! Why are you taking me to the hospital? Please, I’m not sick!” We consulted with the doctor, who suggested she stay there overnight with a sedative in her system so she could try and get some sleep. She was struggling so forcefully that several nurses had to drag her kicking and screaming into the room where they restrained her hands to the cot and gave her the sedative. It was one of the hardest things for us to watch, we all felt like we were somehow betraying her. She just kept yelling “Tia! Tia! No!” (Tia is what they call those of us who work there, it means aunt and is meant as a term of endearment to help the Center feel more like a family). She was so miserable, and we felt like we were causing it. Just handing her over to a bunch of strangers who were suddenly dragging her across the floor and giving her shots. So unfair, no one should have to experience it. But at the same time, we knew it was the only thing we could do, our only option. We don’t have the resources at the Center to care for that kind of problem, and we have all the other girls to worry about as well. It was just so awful seeing her tied up to the cot, struggling and looking at us with those despairing eyes, asking “Why?” I have no answer. I don’t know why.

I think the hardest part isn’t seeing it all happen, or being shocked by such suffering or such a situation, because in part it is what I expected to see, the kinds of things I studied in college to work with in the future. It’s the frustration of not having any options, not having the kinds of resources we could use at home in the States. There’s nowhere to send her, no one to care for her, and no one who really knows how. The people in the hospital weren’t really sure what to do with her or what was wrong. Several times in the last few days we (meaning those of us “in charge” at the Center) would sit in Andreia’s office talking about what to do with the situation, and no one really knew what to say. And they looked at me, and I had no alternative, didn’t know what to tell them, didn’t know what the options were, if there were any. No magic wand, very little to offer. And they understood, no one expected it. But helpless nonetheless. And so tomorrow I am coming to the Center to bring a movie and popcorn for the rest of the girls to enjoy, just to provide a brief distraction from the craziness that has them all preoccupied and a scared. Small little pleasures are better than nothing sometimes. Still somewhat helpless though.
The strange thing is that even though I am sad and frustrated to see this happen to a girl I cared a lot about, I have a weird sense of calm and separation about it. I have done what I can, but there’s a limit. She’ll be in the hospital tonight, hopefully will get some rest, and we can see what will happen tomorrow. And the next day, and the next. I am somehow encouraged that even though there are moments like these when you can’t do anything, there are other moments when you can. And you draw a sketchy line between work and home, where your heart can stay with the people that need it, but your mind has to stay separate. Is that right, or am I heartless?