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In the glass Station the Big Nurse has opened a package from a foreign address and is sucking into hypodermic needles the grass-and-milk liquid that came in vial in the package. One of the little nurses, a girl with one wandering eye that always keeps looking worried over her shoulder while the other one goes about its usual business, picks up the little tray of filled needles but doesn’t carry them away just yet.

“What, Miss Ratched, is your opinion of this new patient? I mean, gee, he’s good-looking and friendly and everything, but in my humble opinion he certainly takes over.”

The Big Nurse tests a needle against her fingertip. “I’m afraid” – she stabs the needle down in the rubber-capped vial and lifts the plunger – “that is exactly what the new patient is planning: to take over. He is what we call a ‘manipulator,’ Miss Flinn, a man who will use everyone and everything to his own ends.”

“Oh. But. I mean, in a mental hospital? What could his ends be?”

“Any number of things.” She’s calm, smiling, lost in the work of loading the needles. “Comfort and an easy life, for instance; the feeling of power and respect, perhaps; monetary gain – perhaps all of these things. Sometimes a manipulator’s own ends are simply the actual disruption of the ward for the sake of disruption. There are such people in our society. A manipulator can influence the other patients and disrupt them to such an extent that it may take months to get everything running smooth once more. With the present permissive philosophy in mental hospitals, it’s easy for them to get away with it. Some years back it was quite different. I recall some years back we had a man, a Mr. Taber, on the ward, and he was an intolerable Ward Manipulator. For a while.” She looks up from her work, needle half filled in front of her face like a little wand. Her eyes get far-off and pleased with the memory. “Mistuh Taybur,” she says.

“But, gee,” the other nurse says, “what on earth would make a man want to do something like disrupt the ward for, Miss Ratched? What possible motive…?”

She cuts the little nurse off by jabbing the needle back into the vial’s rubber top, fills it, jerks it out, and lays it on the tray. I watch her hand reach for another empty needle, watch it dart out, hinge over it, drop.

“You seem to forget, Miss Flinn, that this is an institution for the insane.”

* * *

The Big Nurse tends to get real put out if something keeps her outfit from running like a smooth, accurate, precision-made machine. The slightest thing messy or out of kilter or in the way ties her into a little white knot of tight-smiled fury. She walks around with that same doll smile crimped between her chin and her nose and that same calm whir coming from her eyes, but down inside of her she’s tense as steel. I know, I can feel it. And she don’t relax a hair till she gets the nuisance attended to – what she calls “adjusted to surroundings.”

Under her rule the ward Inside is almost completely adjusted to surroundings. But the thing is she can’t be on the ward all the time. She’s got to spend some time Outside. So she works with an eye to adjusting the Outside world too. Working alongside others like her who I call the “Combine,” which is a huge organization that aims to adjust the Outside as well as she has the Inside, has made her a real veteran at adjusting things. She was already the Big Nurse in the old place when I came in from the Outside so long back, and she’d been dedicating herself to adjustment for God knows how long.

And I’ve watched her get more and more skillful over the years. Practice has steadied and strengthened her until now she wields a sure power that extends in all directions on hairlike wires too small for anybody’s eye but mine; I see her sit in the center of this web of wires like a watchful robot, tend her network with mechanical insect skill, know every second which wire runs where and just what current to send up to get the results she wants. I was an electrician’s assistant in training camp before the Army shipped me to Germany and I had some electronics in my year in college is how I learned about the way these things can be rigged.

What she dreams of there in the center of those wires is a world of precision efficiency and tidiness like a pocket watch with a glass back, a place where the schedule is unbreakable and all the patients who aren’t Outside, obedient under her beam, are wheelchair Chronics with catheter tubes run direct from every pantleg to the sewer under the floor. Year by year she accumulates her ideal staff: doctors, all ages and types, come and rise up in front of her with ideas of their own about the way a ward should be run, some with backbone enough to stand behind their ideas, and she fixes these doctors with dry-ice eyes day in, day out, until they retreat with unnatural chills. “I tell you I don’t know what it is,” they tell the guy in charge of personnel. “Since I started on that ward with that woman I feel like my veins are running ammonia. I shiver all the time, my kids won’t sit in my lap, my wife won’t sleep with me. I insist on a transfer – neurology bin, the alky tank, pediatrics, I just don’t care!”

She keeps this up for years. The doctors last three weeks, three months. Until she finally settles for a little man with a big wide forehead and wide jewly cheeks and squeezed narrow across his tiny eyes like he once wore glasses that were way too small, wore them for so long they crimped his face in the middle, so now he has glasses on a string to his collar button; they teeter on the purple bridge of his little nose and they are always slipping one side or the other so he’ll tip his head when he talks just to keep his glasses level. That’s her doctor.

Her three daytime black boys she acquires after more years of testing and rejecting thousands. They come at her in a long black row of sulky, big-nosed masks, hating her and her chalk doll whiteness from the first look they get. She appraises them and their hate for a month or so, then lets them go because they don’t hate enough. When she finally gets the three she wants – gets them one at a time over a number of years, weaving them into her plan and her network – she’s damn positive they hate enough to be capable.

The first one she gets five years after I been on the ward, a twisted sinewy dwarf the color of cold asphalt. His mother was raped in Georgia while his papa stood by tied to the hot iron stove with plow traces, blood streaming into his shoes. The boy watched from a closet, five years old and squinting his eye to peep out the crack between the door and the jamb, and he never grew an inch after. Now his eyelids hang loose and thin from his brow like he’s got a bat perched on the bridge of his nose. Eyelids like thin gray leather, he lifts them up just a bit whenever a new white man comes on the ward, peeks out from under them and studies the man up and down and nods just once like he’s oh yes made positive certain of something he was already sure of. He wanted to carry a sock full of birdshot when he first came on the job, to work the patients into shape, but she told him they didn’t do it that way anymore, made him leave the sap at home and taught him her own technique; taught him not to show his hate and to be calm and wait, wait for a little advantage, a little slack, then twist the rope and keep the pressure steady. All the time. That’s the way you get them into shape, she taught him.

The other two black boys come two years later, coming to work only about a month apart and both looking so much alike I think she had a replica made of the one who came first. They are tall and sharp and bony and their faces are chipped into expressions that never change, like flint arrowheads. Their eyes come to points. If you brush against their hair it rasps the hide right off you.

All of them black as telephones. The blacker they are, she learned from that long dark row that came before them, the more time they are likely to devote to cleaning and scrubbing and keeping the ward in order. For instance, all three of these boys’ uniforms are always spotless as snow.

White and cold and stiff as her own.

All three wear starched snow-white pants and white shirts with metal snaps down one side and white shoes polished like ice, and the shoes have red rubber soles silent as mice up and down the hall. They never make any noise when they move. They materialize in different parts of the ward every time a patient figures to check himself in private or whisper some secret to another guy. A patient’ll be in a corner all by himself, when all of a sudden there’s a squeak and frost forms along his cheek, and he turns in that direction and there’s a cold stone mask floating above him against the wall. He just sees the black face. No body. The walls are white as the white suits, polished clean as a refrigerator door, and the black face and hands seem to float against it like a ghost.

Years of training, and all three black boys tune in closer and closer with the Big Nurse’s frequency. One by one they are able to disconnect the direct wires and operate on beams. She never gives orders out loud or leaves written instructions that might be found by a visiting wife or schoolteacher. Doesn’t need to any more. They are in contact on a high-voltage wave length of hate, and the black boys are out there performing her bidding before she even thinks it.

So after the nurse gets her staff, efficiency locks the ward like a watchman’s clock. Everything the guys think and say and do is all worked out months in advance, based on the little notes the nurse makes during the day. This is typed and fed into the machine I hear humming behind the steel door in the rear of the Nurses’ Station. A number of Order Daily Cards are returned, punched with a pattern of little square holes. At the beginning of each day the properly dated OD card is inserted in a slot in the steel door and the walls hum up: lights flash on in the dorm at six-thirty: the Acutes up out of bed quick as the black boys can prod them out, get them to work buffing the floor, emptying ash trays, polishing the scratch marks off the wall where one old fellow shorted out a day ago, went down in an awful twist of smoke and smell of burned rubber. The Wheelers swing dead log legs out on the floor and wait like seated statues for somebody to roll chairs in to them. The Vegetables piss the bed, activating an electric shock and buzzer, rolls them off on the tile where the black boys can hose them down and get them in clean greens…

Six-forty-five the shavers buzz and the Acutes line up in alphabetical order at the mirrors, A, B, C, D.… The walking Chronics like me walk in when the Acutes are done, then the Wheelers are wheeled in. The three old guys left, a film of yellow mold on the loose hide under their chins, they get shaved in their lounge chairs in the day room, a leather strap across the forehead to keep them from flopping around under the shaver.

Some mornings – Mondays especially – I hide and try to buck the schedule. Other mornings I figure it’s cagier to step right into place between A and C in the alphabet and move the route like everybody else, without lifting my feet – powerful magnets in the floor maneuver personnel through the ward like arcade puppets…

Seven o’clock the mess hall opens and the order of lineup reverses: the Wheelers first, then the Walkers, then the Acutes pick up trays, corn flakes, bacon and eggs, toast – and this morning a canned peach on a piece of green, torn lettuce. Some of the Acutes bring trays to the Wheelers. Most Wheelers are just Chronics with bad legs, they feed themselves, but there’s these three of them got no action from the neck down whatsoever, not much from the neck up. These are called Vegetables. The black boys push them in after everybody else is sat down, wheel them against a wall, and bring them identical trays of muddy-looking food with little white diet cards attached to the trays. Mechanical Soft reads the diet cards for these toothless three: eggs, ham, toast, bacon, all chewed thirty-two times apiece by the stainless-steel machine in the kitchen. I see it purse sectioned lips, like a vacuum-cleaner hose, and spurt a clot of chewed-up ham onto a plate with a barnyard sound.

The black boys stoke the sucking pink mouths of the Vegetables a shade too fast for swallowing, and the Mechanical Soft squeezes out down their little knobs of chins onto the greens. The black boys cuss the Vegetables and ream the mouths bigger with a twisting motion of the spoon, like coring a rotten apple: “This ol’ fart Blastic, he’s comin’ to pieces befo’ my very eyes. I can’t tell no more if I’m feeding him bacon puree or chunks of his own fuckin’ tongue.”…

Seven-thirty back to the day room. The Big Nurse looks out through her special glass, always polished till you can’t tell it’s there, and nods at what she sees, reaches up and tears a sheet off her calendar one day closer to the goal. She pushes a button for things to start. I hear the wharrup of a big sheet of tin being shook someplace. Everybody come to order. Acutes: sit on your side of the day room and wait for cards and Monopoly games to be brought out. Chronics: sit on your side and wait for puzzles from the Red Cross box. Ellis: go to your place at the wall, hands up to receive the nails and pee running down your leg. Pete: wag your head like a puppet. Scanlon: work your knobby hands on the table in front of you, constructing a make-believe bomb to blow up a make-believe world. Harding: begin talking, waving your dove hands in the air, then trap them under your armpits because grown men aren’t supposed to wave their pretty hands that way. Sefelt: begin moaning about your teeth hurting and your hair falling out. Everybody: breath in… and out… in perfect order; hearts all beating at the rate the OD cards have ordered. Sound of matched cylinders.

Like a cartoon world, where the figures are flat and outlined in black, jerking through some kind of goofy story that might be real funny if it weren’t for the cartoon figures being real guys…

Seven-forty-five the black boys move down the line of Chronics taping catheters on the ones that will hold still for it. Catheters are second-hand condoms the ends clipped off and rubber-banded to tubes that run down pantlegs to a plastic sack marked DISPOSABLE NOT TO BE REUSED, which it is my job to wash out at the end of each day. The black boys anchor the condom by taping it to the hairs; old Catheter Chronics are hairless as babies from tape removal…

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