more feedback….

Twelve new readers are just now encountering the survey and I wanted to share their thoughts, with the hope that it may spark comments right to the blog.

3/4 of the readers work in healthcare, which is an increase from last time but it makes sense because that is the group I have been recruiting.

The story-lines that interest folks are Bridie’s experience; a realistic description of mental health work, and Emergency Dept work; and the relationship between Hattie and Jody

The character most identify with remains Hattie and next is Bridie. One person identifies with Jody and one person with Lowell (this person must have read ahead)

Other comments: would writing the story in the third rather than the first person open space for more analysis of the material – this is a good question and I’m mulling it over. Anyone have any option? Some other people must also have ready ahead and there are an equal opinions about the inserts (poetry and author observation). Two like; two don’t like – 8 are silent.

Chapter 32

It took the lion’s share of the morning to sort thought the practicalities of the situation with Rick and how to manage his transfer, while safely and effectively providing care until that time. Dr. Roger Laskin was the psychiatrist we ‘recruited’ to complete Rick’s assessment. Roger had been around the block more than once and he was the perfect guy to get to the bottom of this conundrum. Also, he had worked over at The North, so he had a better idea about their forensic unit.

The police were prepared to lay the charge of ‘utter threat’ but they were reluctant to proceed based on their concern about Rick’s suicidality. Roger’s assessment could not rule out this risk. There was a special mental health court in the city that could turn these decisions on a dime but here in our small town those wheels turned much more slowly. And this delay meant Rick would either be in the local jail until a judge laid eyes on him, or home on his own recognizance. The officer I spoke with was pretty sure jail was the more likely option, bringing everyone back to risk of suicide.

Roger made some calls. The forensic unit at The North could accept someone on a Form 1, especially since there were charges. The police would apprehend him here and complete the transfer. The only fly in the ointment now, so to speak, was informing Rick and mobilizing resources to make it all happen. I had kept my new Team Leader friend Kim apprised of the negotiations along the way. As Rick had become more impatient about a resolution to his situation, Kim had become more concerned about how this would all go down.

Without ado, Kim had taken the proactive move of deliberately assigning new folks arriving in emerg as far from his bed as possible and had gradually been removing throwable objects or potential weapons. She had arranged for Security to be immediately available. I thought she had done a great job and I told her so. As it turned out, the police had a particularly calming influence. Three officers arrived at about 1145. Kim and I kept our distance. Rick listened to their explanation. He spat a few foul oaths then wordlessly accepted the handcuffs required by police. His uneventful departure brought an intense sense of relief. “Thanks Kim.” I said to the new Team Leader after it was over. “I feel a lot more comfortable dealing with someone who’s raving than such an angry person.” I noticed a tremor as Kim reached out to steady herself into a chair behind the care-desk. “You Okay?”

“I will be.” She replied. “This is the first time I’ve done this, up close.” Reflexively, she took a deep breath. “It’s a big responsibility.”

“Yes it is.” I agreed. “You handled everything well. I was impressed by the way you swept the area around him and lowered the risk. That was some cool thinking.”

“It was, wasn’t it?” She smiled; proud of her work. “I don’t know how but I remembered that from crisis intervention training we had….mmm maybe two years ago. It sat in the back of my mind until now.”

“Funny how we store stuff up ‘til we need it.” I smiled back. “If you like, I can sit here and manage the phones and direct traffic for a bit while you go grab a cup of tea.” I offered.

“My break is coming up at 1200 anyway. Thanks Hattie.” She stood with more assurance but before she walked away she added “Thanks again. I learned a lot today.”

When I arrived back at our crisis office, Karen was on the phone but she made the gesture of ‘sit right here and don’t go anywhere until you tell me what’s been going on’. It was a complicated gesture but I understood and heeded it. As it turned out, Karen’s morning had been relatively light. She was just finishing off a phone conversation with someone who had left a follow up message on our machine. Well, not our machine anymore, our phone system. When she had arranged an appointment for the person on the other end of the line and confirmed their contact information, she hung up and turned to me for details. These I easily provided. It was important to rehash such episodes with a peer. First, it always gave us ideas about what we might do the next time. But also, in the re-telling, we get feedback to allay our fears and worries, mostly worries about aggression. I also had a chance to sing the praises of Kim. Praises that escalated when I logged into my email and found the notice from the incident report system correctly indicating a level 2. I contributed my notes electronically and added Kim’s name and her actions in the section noting ‘what went well’. By now I felt I’d earned my luck break, so I took it.

It was a glorious and sunny day. I pulled on my parka and went for a walk. South Carter hospital was appropriately nestled at the South end of town, in an older residential neighbourhood. Some of these homes had been around since the sea captains and timber barons ran the community. The sun was so warm I unzipped my jacket. It felt like Spring was officially here. This realization drew my mind to baseball and it was a very short leap to Bridie and her plan to celebrate her son’s birthday at the game May fourteenth. The Easter weekend was coming up and after that their adventure would be about three weeks away. I made a mental note to call Bridie this afternoon and check in. Rosy-cheeked and full of energy, I returned to my duties. Well, my first duty was to bolt my sandwich.

After lunch the rest of the day unrolled smoothly. Rudy dropped by to get filled in about the incident this morning. He seemed in good spirits, hanging around after my report to tell war stories with Karen and I. Funny how we all do that after an incident. And it’s interesting how experiences of risk make us laugh after the fact. We are much braver people in retrospect. These precious moments drew us closer as a team. It was a luxury I realized the nurses in emerg didn’t have. This wasn’t a problem I was prepared to tackle today but I stored it in the back of my brain for another time.

My last appointment was the no-show from last week. She had responded to one of my messages and agreed to see me today. In our very brief conversation on the phone, Dawn confirmed her need was not urgent; this was a long-term situation. She denied being actively suicidal, although she endorsed frequent thoughts. She filled in the blank about her treatment history. Dawn had been in our inpatient unit four times in the past five years, each admission she described as “awful”. She had no wish to return. I presumed this contributed to her guardedness. I felt a small twinge of worry, which motivated me to start making calls to her various numbers. I could only leave messages. Five minutes later, when I heard Farrell singing and saw the display with one of the last numbers I dialed, I breathed a sigh of relief. It was Dawn. She had fallen asleep and was running late. She would be here in twenty minutes. Ordinarily, my shift would be finished fifteen minutes after she arrived but after my wonderful walk in the warm Spring sun I was feeling generous.

Dawn arrived a half hour later, apologetic. She didn’t look like she has just woken up, in fact her hair was nicely pinned up and her clothes meticulously ironed. She seemed alert but maybe not so eager to make new friends. I began the usual drill of confirming her demographics and having her sign the appropriate paperwork. I hadn’t had a chance to retrieve her previous file so I asked her to fill me in on the highlights of her history. She provided a concise reiteration of the information she had provided on the phone: some risk of self-harm in the past, not immediate; some misuse of drugs and alcohol and a history of childhood sexual abuse. “Sounds like none of this is new to you.” Dawn nodded. “So why call now? Has something changed?”

“When I called I was having an anxiety attack. It happens now and again. Mostly I can manage it but sometimes I just need to hear someone else say I will be ok. That’s about it.” Her explanation was too neat. I needed more detail to find the real bits.

“How do you usually manage it?’ I used her words to get her talking.

“I try to avoid it. Mostly I try to avoid any situation that gives me anxiety.” And she paused again.

“And how do you avoid situations that give you anxiety?” I presented my quizzical face.

“I stay away from people.”

The pleasant effects of my sunny lunchtime stroll were slipping away. I sat forward in my chair, planted my chin in my hand and waited.

“I avoid people.” She reiterated. “I don’t answer my phone. I don’t answer the door. I don’t go out. Sometimes I stay in bed all day.”

“How long have you been living like this?” Her disclosure had earned her another question.

“I’ve had anxiety all my life. I used to drink a lot more; that brought me out of my shell. I’ve been in my place for six years now and I’ve never really gotten used to living alone, even though I prefer living alone.”

“Tell me about the anxiety. What does it feel like?”

“It feels like anxiety.” She revealed a slight but obvious impression of impatience.

Recalculate. “I ask that because sometimes when people experience a long history of anxiety they lose track of what it feels like to their body; they just get used to reacting to it because it is so overwhelming.” It was true. So many people were unable to actually describe their experience of worry, or the more clinical nature of anxiety. It made it more difficult to tackle when it remained a nebulous threat. When no further detail was forthcoming, I helped her out. “You know like does your heart race, do you feel light headed….”

“Yes.”

It was time for a different tack. “Dawn, when you have been admitted to hospital before, was it because you were anxious?”

“No.” was her immediate response. Followed by “Yes.” Behaviorally, she was getting edgy. She crossed and re-crossed her legs and it looked like she was wringing her hands under the table.

“Hey Dawn.” I said gently. “Something is going on for you. I know its been going on for a long time and I won’t promise we can fix it but maybe if we work together you can manage it a bit more comfortably.” She visibly tensed.

“I will not go back in the hospital. I can tell you this…” Her voice was rising. “…being locked up didn’t help either. I never shoulda come here…” She stood abruptly. I did too.

“Dawn. I have an idea.” She stopped and looked at me, her eyes filled with terror. I felt guilty about my impatience. “Dawn, sit down a sec and let me give you a minute to gather your thoughts.” I was buying time, wondering what Viv would do.

I sat back down as a signal to her to do the same. Miraculously, and with all my gratitude, she did. “Dawn, I agree that the hospital is not the best place to work on the kind of problems you describe.” She drew a long breath. “But…” her fear returned. “But it is a place where you will be safe.” I noticed her running her right thumb rapidly up and down her fingers, as if they were too hot to touch. “I know you are freaked out right now but are you safe?”

She paused for at least a minute before she answered. “Yes. I am safe.”

“Bear with me for a bit longer. I just have a few more questions and then I think we might try something different. Not admission to hospital. I would like you to come in to meet with me every day this week and lets see if by the end of the week we can create a plan that might bring you a little more comfort.” She continued to stare ahead.

“Dawn?” I really wanted to engage her.

“Okay.” Was her only reply.

“Let’s start with this: how did you muster up the courage to come here today?”

“Ativan.” Not an unusual strategy for folks with intense anxiety.

“How much?”

“3 tabs.” Well now we hit less than usual. Three tabs was a fair whack of antianxiety med but she didn’t look over-medicated so I was prepared to entertain it if it worked. “Well, it worked. Do you have enough to last you for a few days while we get started…if not I can arrange for one of our psychiatrists to look at your meds….what other meds do you use?” I was almost reluctant to learn more knowing it might ring some alarm bells.

“I will bring all my pills with me tomorrow. Right now, I have to go. I am safe. You don’t have to worry. I have lived like this for a long, long, long time. I can last another week.” Before she took her leave, Dawn turned and looked me square in the eye. “Thanks. See you tomorrow. Same time?”

At the risk of disrupting our apparent agreement, I said, “Can we aim for 1230?”

“Yes.”

Before her small shadow had disappeared I called after her “I will call to remind you.” Now, how was I going to document this? Sometimes a session starts with a prayer; sometimes, like this one, it ends with a prayer. I had to trust Dawn. She had lived with these experiences for many years. I had to trust she could live through them for one more day. But I would definitely retrieve and review her file before we met up tomorrow. Damn. I thought to myself as I readied to leave for the day. I meant to call Bridie. Maybe emerg would be quiet in the morning and I could do it then.

Chapter 31

This morning marked the first shift that Linda Berwick ought to be working but wouldn’t be. No one mentioned her absence or made any remark to me. Karen was my partner today and I went about my business reviewing the notes and assessing the single person held over in the department while Karen began the process of telephoning the folks that Tom had seen over the weekend and sent home to wait for our follow up calls. The young man waiting for assessment was a young guy, twenty-nine years old, named Rick Morris. He was apparently in a fight yesterday and made threats against his ex-girlfriend and himself. He looked a little worse for wear. His clothes could use a wash and his hair hadn’t seen a comb in a while. A shiner was well established under his left eye. “Did you win or lose?” I opened.

His glare suggested the latter. “Sorry. I shouldn’t have joked.” I attempted to recover. “Hi Rick. My name is Hattie Crawford. I’m one of the crisis workers on duty today.”

“I’m ready to go home.” The glare persisted.

“Hmmm. First, we need to know that sending you home is the best plan. I understand you were making threats to hurt other people as well as yourself. The notes suggest you were in a fracas and made some threats. The police brought you here. Can you tell me a bit more about what’s been going on?”

He turned away dismissively. I let it sit for a long minute. “Its kind of a light morning here.” I mused, taking a bit of a risk. “I can sit here and wait, or I can come back in half an hour…either way, your departure relies on my assessment. Do you have a preference?”

Nothing. “OK. I’ll be back.” At the care desk I asked Kim, one of the nurses, about Rick.

“He has been cooperative all night. Just laying there. The head-injury-routine shows no outstanding neurological issues. We haven’t been able to get much out of him but what he says is generally coherent and oriented.”

“Who’s the duty doc?”

“Dr. Burton was here all night. I think he’s still in the back room. Dr. Marshall is coming on duty.”

“What do you think is going on with our friend Rick? I asked Kim.

“Honestly, I don’t know. I’m good at assessing if he has a head injury but I’m not the best judge of his…of what’s going on inside his head.”

“Do you know if Dr. Burton did the Form 1?” A Form 1 was an application for psychiatric assessment, which meant a person could be held, more or less, until a psychiatrist either said they were okay for discharge or decided they needed further involuntary care. Because we have our own mental health unit and psychiatrists on staff, our emerg didn’t need to send folks along to the psychiatric hospital the way some smaller hospitals did but that still didn’t mean that it was always so easy to get a psychiatric assessment on someone in emerge.

Before I tracked down the duty doc, I decided to take one more run at Mr. Morris. “Hi again Rick. It’s Hattie.” I started again. “I know you want to go home and I want that for you too but I just need to understand a little more about what happened yesterday.”

When Rick rolled toward me, his demeanor was different. The edge was gone. “Listen, this is hard for me. I can’t really tell you what happened because I was drunk. My girlfriend walked out last week and I found out one of my so-called buddies was banging her.” I tried to stay focused on his words. “I called him up and when he came over I punched him in the face.”

“…and he punched you back….” I ventured.

“And he punched me back.”

“Strange as it seems, I understand that part.” Start where he is. “It sounds like a bit more went on though. Otherwise, I think you would be somewhere other than a hospital…”

“I told you I don’t remember.” The edge had returned.

Time to backtrack. “The police officer who brought you in agreed you’d been drinking. I’m not sure he knew you were so drunk you wouldn’t remember what happened. But he told the doctor that you said you would ‘take her out’ which the doctor assumed was your girlfriend and ‘take out myself’ which he expects is you.” He sat up abruptly and I took a quick step back away from the bed.

My reaction caught his attention and he presented a more reasonable nature. “Listen, this is all blown up. I’m not taking anyone out. I was drunk and I said some stupid things. Now get me out of here!”

“Before we go there, I need you to bear with me while I ask you a bit of history.” Rick Morris was not warming my heart this Monday morning. His clipped answers did not establish obvious evidence of suicidality but did reveal a pretty high index for aggression. He casually noted two short hitches in jail for assault. He denied partner abuse, despite acknowledging he had been ordered to a treatment program typically intended for men who abuse the women in their lives. I didn’t have a good feeling about this guy. “Okay Rick. Thanks for helping me out with this info. Dr. Burton was the physician you met last night. He still might be here but if he’s not, I’ll share what you’ve told me with Dr. Marshall and he’ll come and see you.

I found Larry Marshall gnawing on a bagel in the room behind the care desk, listening to Mickey Burton describe the events of last evening, specifically the patient with a “nasty” GI bleed that he sent off to Kempenfelt for emergency surgery. “Hattie.” Mickey interrupted himself. “…Did you see that guy yet?”

“Rick Morris.” I reminded him. “Yup. Just finished. I don’t have much more than you though.” I turned to include Larry, the on-coming duty doc. “Did you know he has a history of assault and incarceration? He says he never abused his girlfriend but he said he was ordered into the PPA program…” I answered Larry’s question before he asked. “Preventing Partner Abuse. It’s usually a court ordered program for guys who are violent and abusive to their girlfriends.”

“Suicidal?” Larry queried.

“He wasn’t a compliant candidate with the standard assessment but I don’t have that impression.”

“Homicidal” Larry countered

“Angry, aggressive and historically violent. But I don’t get the impression he is homicidal at the moment.” Which was just my opinion. “We do have a protocol to follow when we feel a woman is at risk from a partner though….I just need to pull it up.”

“Well, Larry…I gotta get going now…” Mickey slunk toward the exit.

“Stop right there, Pal!” And Mickey did.

“You’ve been at this longer than me. What are my options here?” Larry asked.

Mickey described the option of a Form 1; essentially relying on a psychiatric opinion regarding the guys risk of harm to himself or others. If that risk was present, it was possible to restrict a person’s liberties. “But there is one other option, based on Hattie’s information.” Now I was curious too.”

“I only know this because we did it last week in the city.” Mickey Burton worked part-time relief as an on-call physician at St Germaine Hospital in Toronto so he saw situations that were more exaggerated to our typical fare. “Call the police and see what the charges are. Depending on their answer, they could request a forensic assessment. I think we would just need to confirm that he is not suicidal, then they would keep him until a judge ordered transfer to the locked unit over at Carter North. Hattie, tell us more about this protocol…”

We re-read the protocol I had pulled up on the computer screen. I was clear that in a situation where we as care providers were aware that a woman was at risk for violence from her partner, we must engage police and notify the potential victim. Even though the police were already engaged, technically, we all agreed we needed more in-depth consultation with them. After that, we would connect with the potential victim, the ex-girlfriend. The discussion worked its way around to a psychiatric assessment first, which I agreed to facilitate. Since knowing how the police wanted to proceed might affect the outcome of the psychiatric assessment, Larry checked in with the police first to determine their thoughts on the matter.

I also advised Larry that the policy was clear that now that he was on duty he was the most-responsible-physician, or MRP, so he was the one to call Rick’s ex-girlfriend and warn her, unless Mickey was prepared to stay and do so. We both leveled a glace at Mickey who shrugged off his coat and sat back down. Again, it might be helpful to talk with her and hear more about the incident than we seem likely to get from Rick before the psychiatrist conducted his or her assessment. I suggested he give the woman our crisis number as well as the number of the local shelter and let her know I was here all day, so if she wanted to call she could ask for me.

Larry thought the charge might be “uttering threats’ based on Rick’s history. Then, based on where the two points of legal and mental health interest collided, we would mobilize resources to consider specific risk assessments. Mickey finished his calls, reported back to us that the girlfriend already knew what was up. She reiterated what the record already showed. Rick showed up at her place, punched her new boyfriend and said he would ‘take out’ her and himself. She now had Hattie’s contact number and the police had already given her information about the local women’s’ shelter. She seemed ok for now. Then Mickey made hay.

Chapter 29

When I arrived home, Jody and Roland were working away at the dining room table. Jody was hunched over a legal pad with notes, Roland leaned over the same notes, hinged at the hip guarding his flawless posture. He also had a short heap of loose notes to his right. Three stacks of thick and narrow paperback books, probably the novels they were considering as texts, were arranged between them. Two-thirds of a large pizza was cooling in the box on the sideboard. I pecked them both on the cheek and examined the pizza for preferred content. “It’s half veggie.” Roland contributed over his shoulder, solving the puzzle of why I was examining the pie.

“You two been at it long?” I asked as I took my first bite of pizza. The cheese was still warm and left a string of residue as I pulled the piece back from my teeth.

“We got here around four or four-fifteen.” Jody sat back and gave me her full attention. “I’m ready to take a break.” She smiled. “How was your day at the shop?”

“Frau Blucher has transferred and won’t be bothering me again.” Jody caught the use of our code-name for Linda Berwick.

“Frau Blucher? The housekeeper from Young Frankenstein, who made the horses go berserk?” Roland asked.

“A woman very much like her.” I immediately regretted introducing the topic in front of our guest.

“I like Cloris Leachman.” Roland was off on his own tangent now and I could relax. “She was perfect in that role. You know Blucher is German for ‘glue’ and that’s why the horses went apeshit when they heard her name.” Roland continued as he sorted his notes into two piles. One pile was obviously for him and one obviously for Jody. “But I preferred Marty Feldman’s character. His hump was always changing sides.” Roland chuckled, most to himself.

“Any chance you can use Young Frankenstein in your new course?” I was eager to keep the conversation from drifting back to me, and my conflicts at work.

“If there was, you can rest assured we would.” Jody added in mock seriousness. “We haven’t really talked much about films to use. Going with Maureen’s thoughts about pairing the historical with the literary, we are choosing through the novels first. Since Tale of Two Cities was embedded in the curriculum, we ought to find a film about the French Revolution…I can happily research that one.”

“Two Solitudes or The Stone Angel are typical Canadian content.” Roland mused out loud.

“We always called it “Stoned Angel.” I cut in with a snort. Roland was not amused by my adolescent recollection and delivered a look of full disdain.

“Who will rid me of this meddlesome priest?” he muttered under his breath.

“A little harsh Roland.” Jody chastised with a smile. “Remember, Beckett became a saint.”

“Stone Angel has its own movie….so does A Handmaid’s Tale.” I continued, ignoring them both.

“The movie must be a compliment though, a device to highlight the relevance of the story. Not a reiteration of the story.” Jody was talking more to herself than to us. “Mississippi Burning against To Kill a Mockingbird…” Jody was also thinking out loud. Then, with delight she turned and announced “Did I tell you Hattie, Luke McGinn the new History teacher is on board and interested in joining up to develop the pilot course?”

“That’s great news!” I was delighted. This project was something Jody could get her teeth into. “Will he be here next Friday night? We’ll need more pizza!” And I bit into another slice. How about the Art guy?

“Dickie Vereen?” Boomed Roland. He’s still under a rock somewhere!” Both Jody and I were a bit shocked by Roland’s derogation. It was certainly not characteristic. But then Roland collapsed in laughter and we knew he was back to normal.

After we had all taken a few more cracks at films and Art to match the established novels recommended by the curriculum, and after we suggested a few more novels or films to add for good measure, Maureen arrived to fetch Roland, and Jody and I were left to our own good company. I explained the situation with Linda Berwick. By neglecting the nickname Frau Blucher Jody knew I was serious. “I wish we had been invited to talk this through like adults.” I shook my head miserably. “I feel like the problem has just been shuffled away to….I don’t know, like to protect me, keep us apart.”

“Frankly Hattie, I think that’s a good start.” Jody reached for my hand. “You have to trust Rudy. You know that if he thinks there’s a chance this can be resolved any other way he will make it happen. Sometimes….”she paused to chose her words. “Sometimes, you try hard to fix what can’t be easily fixed. Sometimes changing someone else’s mind takes more than you telling them why they should.”

I looked her square in the face. “You think I should let it go when she has made derogatory comments about our relationship?”

Jody’s chuckle surprised me. “If she were the only one, I’d say go catch her up but Sweet Jesus Hattie, we are out there!”

Without getting into detail or naming names, I told her about my conversation with Lowell and his struggles and dilemmas. “He’s not alone in that Hattie. I still get odd looks and I over hear side comments. Sometimes people feel like it’s a good thing to tell me what is said behind my back. It’s just the way things are right now in this stupid world. Let Frau Blucher’s skunk-eyed face freeze that way. You and I are having a pretty good life.”

“Now there’s perspective!” I was comforted by Jody’s disclosures. We didn’t always stumble into conversation about the depths of prejudice that existed. “Do you think it is harder for a guy?”

“Absolutely!” Was her immediate answer. “I can only imagine what that poor cat is going through. People jump to the wrong conclusions over just about everything – especially now that we operate in sound-bites and Facebook posts and not real journalistic critique…”

“Whoa Nellie! You have to sleep in about an hour. Don’t shoot your blood pressure off the map.” I interrupted. “But I do agree.” I resumed the conversation a bit sideways from where we left off. “People take a little bit of information and shape it to fit the common stereotype, even when it takes them down the wrong path. Maybe even especially when it takes them down the wrong path. In mental health, people think they have a bipolar disorder because their mood swings up and down but they don’t stop to think about why and with whom their moods are shifting. Then they argue with me when I suggest otherwise. Like they really want to have a bipolar disorder! They just read a description and don’t do the analysis….and then they want tablets to make it right instead of exploring when and with whom their mood changes…”

“OK.” Jody’s raised hands signaled time-out. “Watch your blood pressure! We can solve all the social problems tomorrow. Right now, I am ready to hit the hay.” As she started toward our room, she turned abruptly to announce: “I sent my poem to Arc poetry magazine…”

“That’s fantastic! How long before you hear back?”

“Dunno. I’ll keep you posted.” Her immediate departure from the room signaled the end of the conversation. I knew well enough that she would worry until she heard back, one way or the other, and unlike me Jody was a private worrier.

 

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Chapter 28

Now it was time to find Rudy. I caught him as he was packing away his week of incomplete work that would get some attention over the weekend. “Hey.” I called as I approached the open door. “You were looking for me….”

Rudy motioned me in and sat down, which I took as an invitation to do the same. “I wanted to fill you in on something. Pull the door, will ya?” I reached behind and closed the door, wondering which of my many misdeeds he had become aware of.

With our privacy secured, Rudy began. “I just wanted to give you a heads up. Linda Berwick has transferred from emerg to the medical floor.” My silence, and my shocked face, invited more detail. “This was her request…officially. But in reality, when we met with her to review the incident last week, you know the one: with the cops and the nurse from the unit upstairs…and you…” He punctuated the final word by pointing at me with a flourish. “…she said a few things that led us to believe maybe emerg might not be the best place for her to…exercise her skills.”

This was certainly not the conversation I had been expecting. “Tell me what you can Rudy. I understand this isn’t any of my business….unless it is?” I emphasized the last point with the raised eyebrows of a question when I heard the comment come out of my mouth and realized there could be more to this.

“Well, it is kinda your business.” He hesitated before proceeding. “But really, she has been wanting out of emerg for a while, apparently. This last incident just accentuated the problems with ‘fit’.” He sat back in his chair and I realized I hadn’t properly noted the intensity of his presentation. “Listen, there’s more to this. Some of it is what she said about the incident, some of it is what she said about other nurses, some of it is her wish to reduce her exposure to conflict, some of it is personal for her.”

“Can I even know how this relates to me, since it obviously does? At least, in part.”

Rudy’s long exhale, pulled his face into a serious grimace that told me he wanted to spill. “I’m not at liberty to disclose the details…”

“But you know I will hound you until you do.”

“The facts, as they relate to you, include a derogatory reference to your sexual orientation, which is inappropriate and against hospital policy.” He stated without emotion. “She did not make the reference to you; that is why you weren’t included in the investigation. She made the remark to one of the other nurses in emerg, who brought it to her manager, Dan’s attention. He brought it to Beth-Anne, who was already steamed about the coding of the incident…this was why I needed you to steer clear of the situation until after we completed our investigation. I wasn’t trying to brush you off. Hattie.” That explained his earlier reaction to the incident report. He already knew about Linda’s comment and he had my back.

“I get it Rudy. Thanks for your support.” I was genuinely touched. “I’m grateful for the nurse who turned Linda in too. Can I know who it was?” I wanted to send flowers.

“I’m not supposed to disclose any of this. But I know you will dig around until you get the answers you are looking for, you can be as tenacious as a personal injury lawyer.” I tried to look hurt but in truth I think he nailed me. “Here is what I can tell you: you might want to check back with the people who were directly involved in this incident…”

“Jack!” I deduced.

“I’m not saying.”

“You know what, I need to follow up with Jack to see if he was ok with that incident being changed from a four to a two.” I crowed, while Rudy smiled and shook his head, amused. “But Rudy…” another thought had reached my creaking brain. “Just because Linda is on the medical floor doesn’t mean I won’t cross paths with her again. And, she can’t just get her way with a transfer after comments like that.”

“The only detail I can tell you is that she was transferred. I couldn’t tell you, for instance, if there was any other discipline…or correction.” Rudy’s voice was firm and I knew not to push it. This was code for: she got some other comeuppance that I had to trust was fair but none of my business.”

“Thanks for letting me know Rudy. I expect we will cross paths again and this way I can measure my words.”

“That’s a lot to hope for!” Rudy laughed out loud.

“Cross my heart!” And I did. I understood the way institutions worked. I understood how people worked, mostly. Linda was peeved with me, either because of the incident or because I was a lesbian. I might never know for sure. I wish I was the one in control of handling it with her rather than the hard hand of a transfer. Unless Rudy was right that part of her wish was to get out of a very stressful work-site. Anyway, as the wheels of hospital politics turned, I was but a cog. And I understood that an errant cog can jolt the whole contraption into the ditch. So I let it go, just like Jody had so wisely instructed me, citing the cute monk. “See you Monday, Rudy. As you may have heard, I have a job to do” I added over my shoulder, smugly. With that, I strode back to the cubbies, armed myself with two pens and my binder stuffed with ready-to-access forms, a list of essential phone numbers and notepaper. The rest of the shift was quiet and uneventful.

Chapter 27

After Bridie left, I finished my note and sent off an email to Shirley, the social worker with the oncology team at St. Germaine’s hospital, noting our session and thanking her for the idea about the videos. Lowell was slouched in a corner chair when I walked out to see if he had arrived. The slouch, it turned out, was not an emotional retreat just the affectation of a teacher on a Friday afternoon. “I’m well.” Lowell proclaimed brightly. His connection with the LGB teachers group had bolstered his mood and his confidence. The news he was looking to share was a new relationship that he was a) hoping would be meaningful and b) hoping would facilitate transfer back to the city, where he could exist with a bit more anonymity.

In part, Lowell was justifiably irritated by what he saw as an unjust situation. I was happy to entertain his critique, having travelled that road. “How do you do it?” He mused, casually.

“Do what?” I replied, aiming for innocence.

“I know you are gay. I’ve known for weeks. Why didn’t you say anything?”

“What gave me away? The haircut?” I smiled and fluffed my short, almost-locks.

“No. I ran into people who know your partner – did it escape you that my situation is similar?”

I can’t run; I can’t hide! “Well, Lowell. You are correct.” Was I imagining his smug look? “My partner and are I are lesbian. She is a teacher at the high school and yes, she has experienced some of what you have. But clearly not all of it.”

“Do you think it might have helped if you had been straight with me? Excuse the pun.”

“That’s an interesting question.” I busied my hands piling up some stray paper on my desk and moving it to the side. “Actually, I wondered myself, early on. But I decided that my job is to hear and respond to your experience and facilitate your own conclusions based on what you are thinking and feeling. Mixing it up with my own experience may not have brought us to this same outcome. What do you think? Would it have made a difference?”

“I don’t know.” His curiosity was genuine.

“Say for instance,” I was curious about this myself. “…say I had shared my experience and inadvertently encouraged you to stay in Carter, to tell your principal the way I told my boss, and it had turned out badly. What if, being ‘out’ at school was a negative experience and made you very unhappy? What if, in despair, you had gone on a bender and harmed yourself. I wouldn’t have served you very well.”

“Do you think there’s a difference between me being a guy and you and your partner being girls?”

I did not want to go there but I didn’t know how to back out. Hesitation on my part would instantly telegraph my opinion. “You know the part you said before about unjust realities? I think the way we gender sexual orientation is similarly unjust…in fact, the way we gender people is unjust. As women, we are seen as less of a threat than a man is – not that I in any way see you as a threat.” I added quickly as I saw a flicker of angst in his glance over my shoulder to the painting on the wall.

“I know. That’s what hurts. I’ve even considered changing my career but I enjoy teaching and I am good at it. If only people could understand. My interest is absolutely adult males!”

“I guess if I were including myself in this discussion, which given your previous comments I am assuming you would endorse, I would say: what can we all do to change it?”

“Don’t even dream of trying to talk me into staying in Carter and making a stand…”He started to laugh…”Carter’s last stand!”

“Pretty good, for a school teacher!”

“Yeah, we can be funny too” Smirking. Then he resumed being serious again. “I can’t do it Hattie. I am not the fighter I want to be. I wish I was. I think I’m a turn-tail-and-run kinda guy. I’m not saying this man I met, this adult male…” He added with emphasis. “I’m not sure this is a relationship that might last but I’m pretty sure after the last few months that I may not find someone to have a relationship with here. I’m not saying I might not return another time but I need to grow a few more thorns first.”

“Thorns?” I didn’t catch his drift.

“I need to get more motivated to pursue my anger in a healthy way. I need to be more prickly – not just a pretty rose.” He smiled. “Right now I’m just angry, and frustrated, and disappointed.”

“And Pretty!” He laughed. “What can I do?” I wondered.

“You and your partner are already doing it. Thanks.”

“I meant what can ‘I’ do to help you with your decision, right now?” I pointed at my chest for emphasis. “Me. Crisis Worker, Therapist.”

“If you are asking about staying on in therapy, I think I’ve worked it through. I’ve made sense out of it all. I don’t like it but I understand the current state of affairs. In retrospect, you were probably right to keep your personal life out of our conversations. I felt safe with you because I knew we were similar but because you didn’t throw your own stuff at me, until I asked, I did in fact come to my own conclusions. And, just to sum up, clearly: I am not an alcoholic, I am not suicidal, I am a gay man looking for understanding. And in looking for understanding, I am moving on to a more anonymous pasture. You can close me out and send the insurance program my bill.”

“Glad to hear it. Lowell, it’s been a privilege to know you. I wish you well.” I stood with my hand out. Instead, he reached over and delivered a hug.

“Thank you Hattie. This did really help.” And Lowell was off to finish the term in Carter, then pursue his other dreams.

Chapter 26 (advocate for comprehensive community withdrawal management)

I readied myself and got out the door in record time. A nice part of living in a small town was the six-minute commute. The office was empty when I arrived. I wasn’t sure if that was a good omen or a bad omen. In general, Fridays were a busy day. First, the emerg was busier because people left worrisome pains and complaints until the end of the week, probably hoping they might go away. Second, we tended to overbook our follow-ups so that we could connect with folks we were worried about over the weekend. We were lucky to have some excellent relief crisis workers who covered the weekend shifts. They were very good at recreating what we ‘regular’ weekday crisis workers would do with folks we were following. Nevertheless, we often sent emails or put ‘flags’ on a file to alert them to risks or remind them of strategies that worked. Amy Brixton was one person for whom this system of inclusion has been very helpful. Since we started comparing our notes and systematically putting the work back on her and her peer supporter Sandy, Amy and Jordon have been managing their typical mother-son conflicts much better and Amy herself has been coping exceptionally well. She joined a Recovery Group that the peer supporters facilitate on Saturdays. Adding that with her other consistent support has really turned the table for her.

Jenn was probably at lunch so I could easily slide into my chair as though I had arrived early. When I logged into the computer I faced 87 emails, among which was a request from Rudy to meet up at some point this afternoon. Last year, we had a summer student in the program who taught me how to code my emails so any message from Rudy came in with a purple dot. That way I could see immediately all communication from my commander. My schedule was jammed so I typed back asking for a ‘drop-by’ if I could manage it, or suggested my breaktime at around 1630, right about the time he would be out the door. If I was losing my break, surely he could delay his departure, I thought wickedly. Such requests from Rudy were not unusual. Because we worked shifts that covered the program from 0700 to 1900 hours many times our overlap didn’t match his schedule. Rather than send out emails or memos Rudy was good at hooking up and telling us what we needed to know face-to-face, which was up my alley in terms of supervision.

Jenn resumed her duties after lunch and I went though my expected appointments with her. Then I settled into a three-hour series of scheduled sessions; three follow-ups and one new assessment. After my break, I had both Lowell and Bridie booked in before I blitzed emerg for new crises. The first fella was a nice young man who was going through a difficult separation and not handling it well. He’d called the crisis line two days ago and after a quick telephone assessment it was decided he was okay until today. Face-to-face, he really was a nice young man but clearly at a loss to understand why he and his girlfriend were separating and not really invested in talking with her about it. It felt like I was giving more of a pep-talk than counseling, so I put that out there. “I’m missing something here. I need a little more detail so I can understand your experience. I feel like I’m just pitching you ideas and you are giving them back to me.” This was an easy trap to fall into in our line of work.

His response was partially productive “I don’t know what happened…all I know for sure is she is moving out. I think she might be seeing someone else but I’m not sure.” I kept pushing, hoping to find an edge to grab. The couple had been together only a few months. They hadn’t known each other well. Sounds like they didn’t talk much to start with. Maybe they just ran out of gas. I posed a few other questions, embedding my risk scales in as insidious a way as possible but when I still couldn’t get very far I started asking more obvious questions related to self-harm and safety. As it turned out, the most pressing issue for my guy right now was housing. Go figure. There were resources for that and after helping him make a plan to negotiate staying in their apartment until he found something else, he left happy. I did agree to call back in a week and see how things transpired.

The second fella had shown up in emerg a few days ago, intoxicated and rambunctious. When he sobered up enough and agreed to this meeting, we sprung him. Here was where I expected my no-show. I just finished my note on fella number one when Jenn rang to say “Duncan is here for his 1:30 appointment”. When I walked into the waiting room to fetch him I was shocked to see his condition. He looked like he hadn’t slept since he walked out our door. His hair was messy and I wondered if he had showered. Inwardly I suspected he had continued his bender. I was happy to learn however that he had not had a drink since the police hauled him into emerg. His family had stepped in and pointed out to him that he was on the wrong train and had to change his ways or else. His presentation might be indicative of alcohol withdrawal so I had another series of questions to ask to assess that risk. Yes Duncan was experiencing physical illness, nausea, vomiting and diarrhea. He had ‘the shakes’. He felt confused and had tightness in his chest. Duncan revealed quite a heavy history of alcohol abuse that confirmed for me he was very likely in withdrawal. The next question was the extent of the withdrawal and what the best response was. There was no detox centre in Carter but we had a back-door phone number to the detox in Kempenfelt, the larger town further South. I explained to Duncan that we needed to check this out and he sat with me while I called my colleague.

The detox counselor took my information then asked to talk to Duncan directly. He took the phone and I could hear him answering questions that resembled the scales I had already asked him. The answers remained the same. I wasn’t sure where the next questions were headed but I heard Duncan saying “yes, that’s right, OK. And OK.” Then he handed the phone back to me and the counselor informed me that Duncan was a good candidate for transfer. Duncan agreed. “Let me work on it and I will get right back to you.” I hung up the phone and Duncan and I considered options to drive him to detox.

“How did you get here today?”

“My mom drove me.”

Is she waiting for you? Could she drive you to detox? Is there someone else who can drive you?”

Duncan made a call and several texts. Finally, his mother returned a text saying she would be back there to get him in 15 minutes and yes, she would drive him to Kempenfelt. He gave her a quick call asking for some basic supplies like toothbrush, shampoo, a change of clothes. Hearing him now, I realized this was part of his instruction from the detox counselor, given how he rattled them off in a way I thought was beyond his current cognitive ability.

Detox was a good start for folks sometimes. It can make for a smoother referral to a rehab program but it can also scare people off a bit. One sees some wild things in detox, this I knew for sure. But Duncan was serious about changing so I validated his worries and bolstered his hopes. I wrote out some phone numbers and on-line links to local and regional rehab programs but suggested he follow the advice of the detox staff, they would know the quickest referral and the best match for him. I gave him a card with a follow-up appointment with me for next week, letting him know he could call and reschedule it if his treatment got in the way.

Duncan’s phone dinged indicating a text that his mother was on her way. As I walked with him to the back exit, I gave him the stock ‘you can do this’ routine but I also thanked him for his honesty. Honesty is the biggest hurdle for people with addiction. They spend so much time hiding, covering up and lying that being efforts to be straight about their use and their struggles to quit get lost in the weeds. Duncan’s hand was shaking as he held it out to shake mine. I took it in one hand and covered it with my other hand. “I’ll be thinking of you; stay in touch.” He crawled into his mother’s car, they both waved and he was gone.

My new assessment was the no-show. I called both numbers listed in the package. I figured the first number was her cell phone because she stated her name. With this identifier, I left a message identifying myself by name, saying I was calling from ‘the hospital’ and I left her my number. The second number did not convince me this was her own line so I left a vague message for her saying I already left a message for her on her other line and asked if she could she call me back. I checked the information I had about her. It was vague. She reported some risk of self-harm but not immediate; some misuse of drugs and alcohol and a history of childhood sexual abuse. I couldn’t tell about her treatment history. Complicated.

Sometimes once the crisis has subsided folks with this pattern back away, either in fear because revealing or re-telling their story is too painful or because they want to believe the calm after the storm is the end of their problems. Either way, it wasn’t unusual to have a push me-pull you engagement in these situations. I wasn’t worried yet and I was glad to have the chance now to dig up Rudy. When I checked my emails quickly for purple dots, I found that Rudy was in meetings the rest of the afternoon. He would be swinging through the office at the end of the day and see me if I was available.

With my new-found free time, I started the phone calls to people I wanted to connect with before the weekend. I checked the schedule to see which of the weekend crisis workers was working this weekend. I saw it was Tom. He is a new social work grad but he has fallen into this work as though he’s been doing it for years. I sent him a brief email noting Duncan’s name as a person to keep an eye out for, on the off chance detox sent him back our way Saturday or Sunday. Karen, the crisis worker who usually worked the opposite shift to me, arrived in the office, carrying four referral packages, a paper cup likely filled with flavored coffee and a white, waxed bag concealing a cookie from the snack bar. “Hoo, hoo!” I sang out when I saw her. “You look like you had a busy day.”

“Ya figure! I earned my cookie today.”

“I’ve had a no-show. What can I do to help you out?”

“This is my first sit-down.” Karen sighed as she dropped cautiously into the rollie chair by her cubby and took a long swig of her coffee. “Your manic gal…” Karen canvassed her files. “…Jill, Jill Marshall. Remember her?”

“Yup. She’s living with Craig Betts, n’est pas?” I could love the French too.

“Was living with Craig Betts. From what I can gather, the Team found out he was crashing there, saw him as a threat to her wellness and put enough screws in their life that he skedaddled.”

I joined Karen in the adjacent rollie chair. “And?”

“And…Jill has fired the Team, in a big show-down outside her building.”

“Have you talked to anyone in the Team?”

“Aren’t you the Rhode scholar”! Karen laughed at me mockingly. “If I’d had six minutes, that might have been the third call I have made today.” She waved her free hand over the stack of packages she had placed on her desktop. “Actually, as it turned out, one of them arrived in the department right after she did but having them together seemed to stoke the fire rather than calm her down. The guy from the team backed out before I could find out more.”

“Gimme.” I motioned, wriggling my fingers in her direction.

“Gladly!” Karen responded, handing me the folder I presumed was related to Jill. “She’s still down in emerg. They’re trying to decide if she needs an admission.”

“I’m all over it.” I smiled at her. “You reinforce yourself with caffeine and sugar. I’ll let you know what’s up.”

I read the information from emerg. The name of the support worker was not noted so I had to call the general number. I did so, found out that the guy involved in the showdown with Jill’s landlord was Jeff Palonski. I knew Jeff. Not well but we’d shared some work in the past. According to the admin person on the phone, he had likely returned to emerg now. I could hear Karen talking on the other line and it sounded like she was explaining a medication to someone. When she hung up I let her know Jeff from the Team was back to see his gal Jill.

“I can go down and meet him but you’ve got your fingers on this pulse. I have someone else coming in about 20 minutes. Give me something else to do while you get at it. I’m here ‘til 1900, though so load me up.”

“Shit, shit, shit” Karen jammed a hunk of ginger cookie into her ready maw and washed it down with the cooling coffee. Her usual hippie-calm evaporating. “If you can connect with these last two referrals it would be great. If they need more, or if they can wait, Tom can see them on the weekend. I just need to do up the notes. I’m on my own with that. But thanks for the offer…and thanks for calling the Team, it gave me the cookie break I needed.” Karen hauled herself to her feet, retrieved Jill’s folder from me and strode back out the door.

I finished my note to Tom and readied myself for Bridie. She was a little early, so we had a head start.

Bridie wasted no time diving in after she sat down. “I had my conversation with Doug…the conversation about dying in hospital; that I don’t want the kids to be there.” She seemed relieved to have gotten those words off her chest and continuing seemed a bit easier for her. “I know I’ve been shutting him out but I don’t want to burden him with more to think about. And its hard to get a private moment these days, there’s so much going on.”

“How did it go?”

She smiled to herself as she paused to consider her answer. “It started off kinda rocky.” She chuckled out loud.

 

“Not the emotion I expected in this description.” I was certainly curious about where this was headed.

“It is funny to me now. It wasn’t so much at the time. I introduced the idea of him remarrying…” She caught the movement as my eyebrows shot up and my lips disappeared. “I know. It was risky but when I explained it all it made sense.”

“I’m listening…” I managed to match her smile. “Sometimes this job can amuse me.” Bridie laughed out loud.

“Remember I told you about making those cards for the kids, so they would have messages from me later on? Well the social worker at St. Germaine told me they have a studio there where I could record some messages and I liked the sounds of that. But then I got to worrying about whether Doug’s new wife would be ok with the kids getting them. She’d have to be part of their support and comfort if the messages upset them….I know, I know…” She waved off my questioning look. “It all worked out. He understands what was bothering me. Anyway, he’s convinced me that he won’t remarry anyone who doesn’t accept that my kids will get messages from me.”

“Good grief! I wish I’d been a fly on that wall!”

“It felt so good Hattie to get all that off my chest. Its like it freed up space for me to get moving on other things. And now I am ready to share more with Doug. I’ve been carrying this burden on my own because I didn’t want to hurt him more but it turns out he’s been doing the same. He even had the same thought as me about protecting the boys from….” Bridie drew a deep breath and held it. “…from the end; watching me die.” She exhaled with a sigh.

“Sounds like it was a relief to you both to talk these things through. It is also Doug’s pain to bear, so he shares its weight.”

“That’s what I realized. I can’t do this alone, as much as I want to shield everyone.” She settled back in her chair and gingerly crossed her long legs. “It also struck me, while we were talking, how much of Doug I’ll miss. Until now I’ve been re-running all the moments I will not have with my kids. But as I sat there, running my fingers through his hair, I realized I wouldn’t see him go grey…” her attention faltered. “…or even bald. I knew Bridie well enough by now to appreciate that when she felt overwhelmed she moved quickly to lighten the subject.

“I won’t see him get a little paunchy…or help him with a hip replacement.” She smiled meekly, knowing I understood her motivation. “Busted.” She acknowledged. “I can’t stay with it too long or I will cry.”

“You wanna cry? Cry. You said it. You and Doug are bearing this pain but as your witness, I can also share some of its weight.”

“Thanks Hattie. It means so much to me just to have another person, someone who’s not … not so tangled up in this mess, to talk to. I feel like I can be myself here. I don’t need to protect you from my worries and my fears. I think I’m getting close to that point now with Doug but I had to iron it out here. This disease is consuming me, one bite at a time. Chewing on my soul from the inside out. It takes all my emotional gumption just to put one foot ahead of the other. So, I pack it away as much as I can. But Hattie, I’m afraid I’ve made the mistake of thinking I had more time. There are basics I need to get done. Now, while I have the physical strength.”

“Deal.” I nodded. “What’s next?”

“I’ll make those videos. I’ve been thinking a lot about what to say. I already started the cards, so I won’t repeat all that. I think I’ll just let things roll without a lot of preparation. I don’t want it to look rehearsed. Maybe I can include Doug in a couple….that way his next wife can’t say no.”

“Rascal!”

“I know.” She laughed. But her laugh also produced a cough and she hovered her hand over her right side.

“You OK?”

“I’m good.” She replied but I noticed that as she answered her head was shaking what without words would mean ‘no’. I took her at her word but I was skeptical.

She abruptly changed the subject. “Did I tell you we have Blue Jays tickets for Jamie’s birthday. They weren’t home on May 16th but we were able to get really good seats for all of us on the 14th. We are even taking Lynne. Doug will take lots of pictures and videos. He won’t explain why all the paparazzi to the kids, but we know why.”

“Well I want to see those pictures!” I didn’t feel it was a good time to prod about her health.