“Smoke Break” by James Damiani

Image courtesy of Dariusz Klimczak

For three straight days, I stepped around the man lying in the middle of the hall. All the staff did and I followed their example. On the fourth day, something made me stop and speak to him. Maybe I had finally decided to actually acknowledge being the new psychiatrist on the ward.

“Why are you lying on the floor?”

He didn’t answer my question. I tried again. No response. I tried again. His head twitched as if my words were a mosquito, bothering him. His thick white hair lay spread out on the tile floor above him. He resembled a mop one of the staff had dropped on their way to an emergency.

I changed my question into a warning. “This is a hallway here at the hospital and people might step on you.”

Still, he said nothing.

A puddle of urine formed under him.

“Is that your urine?” I asked. Not the most ingenious question, but born of a more spontaneous impulse than the first few.

“Of course it is.” The anger oozed out of him. “Who would ever lay in someone else’s urine?”

“Good point,” I said. He believed he had silenced me with his sarcasm, but one of my best traits is being able to follow up one dumb question with a second even more inane one. I have found it can be very helpful for a psychiatrist to be a little off socially. My patients are trying to manage hallucinations and delusions in hidden worlds. They don’t have time for the polite lies and the confusing social niceties the sane world asks of them. Unbowed, I came back.

“So what are you doing lying in the middle of the hall in your urine?”

”I am trying to meditate, and achieve Nirvana by not breathing.” Bam. He might as well have said, “Take that, Uninvited Doctor Shrink Who is Trying to Fit Himself  Where He Doesn’t Belong.”

“Oh.” I nodded. How could I have forgotten this common piece of medical school wisdom? Still as his new physician and responsible for his health, I wanted him to be more interested in breathing. Admittedly it was self-serving, as it would make my job as his doctor easier if he continued breathing, but my motivations weren’t all selfish. My mother had suffered from depression my entire life. Watching her had given me an understanding of broken brains and a heartfelt acceptance of their plight. Taking care of mentally ill people seemed to be where I fit best.

I paused and carefully thought about what response to give, how best to let him know I could “relate.” I wanted to impress him with just the right healing words. Just then, one of the staff came by, prodded the man with a foot and said, “Smoke break Monk, let’s go.”

Monk’s eyes flashed open. He resurrected himself with a hop to his feet. Standing, he was about 5’5”, but you could add four inches if you counted his still erect hair. The worst and stiffest case of bed head I had ever seen. How his long fine white hair could stand straight up and defy gravity seemed to me the craziest thing. Thinking of a cigarette took his toothless face from long and drawn, and folded it into a squishy wide smile. Monk took in a deep cleansing breath, rattled himself like a boxer before a fight and then bumped me as he headed to the patio for his hourly cigarette.

While the patients were outside smoking, the floor got cleaned, beds were made, and trashcans emptied. Monk, after being dried to a crusty stink by the Florida sun, came in, got his clothes changed, lay back down on the floor and people once again stepped over him. Meanwhile I kept trying to find those magic words.

(There is a chaotic balance that exists on the psychiatric ward of a state hospital, a fragile harmony between people and ideas. I hadn’t known if I was going to last long enough at my new job to justify inserting myself into the equation. Adding myself to the mix would require the ward to come up with a new balance and I wasn’t sure I wanted them to go to all the trouble of fitting me in if I wasn’t going to last. But with nowhere to go and a family to feed, I decided to stay, or at least not leave right away. Monk, the other men and I began our negotiations. I first needed to learn more about them.)

Besides meditating, Monk got his nickname because he claimed to possess a divine ability. He didn’t bi-locate or levitate or live without food on a pole for six straight years like other famous saints—make him go more than an hour without the earthly pleasure of a good smoke and he got mad as hell. No, according to Monk his unique other worldly ability was that he would never defecate again.

I had seen and heard stranger things than Monk’s story. But the sane thing about Monk’s insanity was that, he told the truth, sort of. Our emaciated saint had survived surgery for colon cancer but been left with a colostomy. As a result of his operation, he would, as promised, have a permanently closed rectum.

As the days grew into weeks at my new job, I learned to follow the patients out on to the patio during their smoke breaks. I told the men about the hazards of smoking and how we could help them quit if they wanted to. Given his past history of cancer and how unfiltered Camels were delivering new carcinogens directly into his lungs daily, Monk became the focus of my anti smoking campaign.

“You know smoking is really not good for you.”

Monk laughed. “These Camels are good for me. Every time I smoke, I cough up more and more phlegm. Camels clear my chest.”

How could I argue with his logic? Smoking did cause him to cough up phlegm. Truthfully I secretly didn’t want to, because once an hour, while smoking, he looked so normal, so peaceful. All the men did. The General, a man constantly at war with his own labile moods, professionally scissored his cigarette between his index and third finger and waved it about reminiscent of a movie star. Smooth would pinch his between his thumb and first finger, especially when trying to suck out the last little bit of pleasure. Quincy used his to blow halos like my dad would, a magic of the tongue I still don’t understand. Somehow, for a brief time, the delusions which had been running rampant, lessened. We were an average group of men enjoying the breeze, ogling women and wondering what was for dinner.

I have never smoked, but I would sit out on the patio risking cancer with my patients, just to be with them. In time, Monk’s choice of Camels made perfect sense. All the men’s choices made sense. It got to the point that when a new man came I could guess if they were a Lucky Strikes guy, or a Marlboros man or a Kools fellow. My dad smoked Winstons. He and I might have found at least one way to connect had I been able to tell him I understood, at least about the Winstons.

Monk always sat on the edge of the bench, crossed his legs, and became a Rodin Thinker. He rested his left forearm on his thigh and drew lazily from the Camel held in his right hand. He would let the ash grow on the end of his cigarette. Just before gravity spilled it all over the ground, he would employ his thumb and with just the right amount of pressure flick the burnt tobacco into an ashtray. Monk loved his Camels and even shady love heals. The whole experience fascinated me, and it cost me.

“You owe me ten trillion dollars.” Monk blew a cloud of smoke off to his right.

“I don’t have that much on me.” I countered.

“That’s okay. You can pay it in installments.”

The degree and nature of Monk’s mental illness shifted often. His insanity had a dial. Each day the knob got spun and landed on a new setting. One day the pointer would land on the traditional: don’t breath until Nirvana happens, and he would lie on the floor for hours. The next day the meter might read: march until one o’clock, which he would do faithfully. He had, lean to the right days and even perform the odd religious ritual day.

“Monk what are you doing?” Emma the housekeeper screamed.

“I am sprinkling holy water on the ground.”

“That ain’t holy water from a cup, that is your colostomy bag and yuck.” She called for help and got the staff to replace the bag on Monk’s side. A blessing for all us rats maybe?

Life wasn’t all healings, sacraments and riches though. Sometimes the other residents reached inside Monk’s head and grabbed his thoughts. To defend himself he hit them as they walked by. Monk didn’t have many friends on the ward.

But Monk didn’t care about other people’s opinion of him, he had too much else to deal with. There were days when the evil stuck, when people stayed in his head, not just stole his thoughts. Those times Monk shut down, focused on not breathing and lay in his puddle. One especially dark day, I encouraged him to leave the ward for some fresh air, hoping a change of scenery might loosen things up for him. Five minutes later, he came back panting so hard it scared me.

“What happened?”

He didn’t answer. A long line of snot reached from his nose towards the ground. No amount of cajoling worked. He walked away and in a rough whisper said, “Demons.” The devil often tried to possess him. Trying to rid himself of evil drove Monk to act in unusual ways.

“What you doing, Monk?” He stood in front of the mirror performing jumping jacks.

“I am exercising the demons out of my head.”


He flopped to the floor, did a few push ups, and popped back up. As he jogged in place he watched himself in the mirror, waiting for the demons to fly out. The devil might be in the details, but according to Monk, Satan could be exorcised with exercise. Now, I understood his search for Nirvana through not breathing. Devils can’t possess a brain filled with nothingness. No one could steal his thoughts if he didn’t have any.

I had my own demons and my own emptiness. A neglected childhood and a genetic predisposition to depression left me in a lifelong battle with the mood disorder. For decades I said rosaries every night, went to mass several times a week and prayed endlessly. In public, I hid behind career and achievements. But over time the loneliness had grown and slowly bled me of my will to live. This new job at the hospital was, in many ways, my settling into my seat on a train headed for a bridge where the tracks had been washed away by a raging river. Monk had gotten on the train earlier, but now we sat together and realized how similar our life journeys were.

Like Monk, I was anxious at times.Also, we each prayed endlessly, unclear about the effect of our petitions and we both got spontaneously aggressive with others for no logical reason. Finally, we both had hopeless times where we just wanted to disappear. Actually, Monk was me, multiplied. The small but crucial difference was that my brain chemistry just happened to be a little more predictable.

After this realization, even more tender feelings filled in the background of my dealings with Monk. I saw him “exercise” his demons and wished they would leave him alone. He let me watch him. Once, he stared at himself in the mirror and told me a cab driver had just driven into his eye and he couldn’t get him out. I didn’t know how to evict stubborn cab drivers that ride into brains, but I knew how a crazy idea could get in your head and stay there. I listened knowing what it felt like to have a painful thought bully me into sadness.

I made it my mission to be kind to Monk. I used a lesson I had learned from becoming a father and having children. Every morning I greeted him with the same genuine enthusiasm my family greeted me with each day. When I walked up to him, a warm feeling would spread through me, and I would say.

“Monk, how is the meditating going?” My smile would have disarmed most anyone.

Monk responded to my greetings with no more than a grunt. I didn’t care. It did me good to value him. No matter what the other voices said I knew he would hear one voice saying kind things to him. It comforted me to believe the evil things we believe we see in our reflections aren’t always accurate. Monk and I belonged, even if it was to a group of two outcasts. My mission made me immune to Monk’s frequent rejections. I kept wooing him any chance I got. I, his doctor, even lit his Camels at the hourly smoke breaks (sometimes more than one an hour but don’t tell anyone).

As much as he could, Monk warmed to me over time. I changed in a way too. I grew comfortable with a new reality. “I know Monk, I can’t believe some asshole put crap in your colostomy bag, let me help you clean it out.” “Yes, I imagine lying in your urine starts off warm but ends up being cold.” “I never knew Jumping jacks were the best exercise to exorcise demons.” These lines fell off my lips with a tone that bordered on boredom.

Thoughts of changing or curing him of schizophrenia never entered my mind. Not what you want to hear from a psychiatrist I suppose, but him being healed didn’t seem realistic. Forty years of non-stop psychosis outweighed any realistic expectation medications might suddenly work. No, a more reasonable first goal seemed to be greeting him happily for one straight year.

Our relationship stayed “normal” for several weeks until one particular day. We had stepped outside for a smoke break. Monk wore a frayed straw hat, a floral patterned shirt with a ripped pocket and massively wrinkled blue shorts. He also wore a pair of those flimsy oversized sunglasses people wear after having cataract surgery, though I had no idea how he got them. In short, picture a scarecrow on vacation in Hawaii who just stepped out of a hurricane.

The strangeness began when one of the more disorganized and psychotic residents, Ed, started begging Monk for his cigarette. The staff and I gasped. Was Ed suicidal? How could anyone dare try to get between Monk and his Camel? Monk looked at Ed and got very still.

I panicked when I realized we weren’t going to make it to Ed in time to protect him from the coming blow. Monk raised his hand, and gave Ed his one and only Camel. Not only that, Monk zipped Ed’s pants, buttoned and tucked in the disheveled fellow’s shirt and straightened Ed’s crooked collar. Having soldiered up the beggar, Monk blessed Ed’s shoulder with a warm squeeze as he walked past him and went back inside.

The pride pricked the hair of my arms. The schizophrenia had lifted long enough for Monk to connect to another person and that was a miracle. Monk’s eruption of innate kindness forced me to reconsider where prayer led. It also asked me to reassess if the train tracks, instead of being washed away, might still be there.



James Damiani’s work has appeared in The American Journal of Geriatric Psychiatry, The Gainesville Sun, and Journal of American Academy of Dermatology, and has been anthologized in Flashlight Memories.

Read an interview with James here.

4 thoughts on ““Smoke Break” by James Damiani

  1. A wonderful combination of humor and tenderness. Really loved Monk and the end? Wow – An awesome read.

  2. Pingback: Interview with James Damiani | Rkvry Quarterly Literary Journal

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