Every Fifteen Minutes

by Lisa Scottoline

  Eric pulled out a chair at the head of the table while the staff settled into their customary seats. He supervised three attending psychiatrists who sat in a row to his right: the most senior was Sam Ward, their resident intellectual with wire-rimmed glasses, pale blue eyes, and a vague scruffly brown haircut. Sam had published a number of significant papers on newer therapies of ADHD, even though he was only in his mid-thirties. Sam, a married man with a young son, had been at HGH for eight years and was Eric’s personal choice to succeed him as Chief.

  Sitting next to Sam was Jack D’Vergney, though the two psychiatrists barely liked each other, owing to their differing temperaments. As committed as Sam was to the scholarship of psychiatry, Jack made it known that he’d chosen the field because his father was a well-known neuroscientist in France; at one staff Halloween party, Jack had come as his famous father in a tailored suit and a button that read Ask Me About My Father Issues! Jack was handsome, flirtatious, and popular among the nurses for his dark good looks and vaguely European vibe; he’d been a champion NCAA fencer at Yale and kept his well-built frame insanely fit with something Eric avoided knowing about, called kettlebells.

  The third attending psychiatrist was skinny, slight David Chu; he was also single, a decent-looking young man who had the misfortune to be compared most frequently with his pal Jack and found wanting. David had been on the unit for only two years, and like the baby in any family, got away with murder, playing dumb practical jokes and posting silly signs. David’s most recent stunt was to put a sign on every stool that read STOOL SAMPLE. Actually, Eric had thought it was funny. Next to David sat a lineup of four nurses, Pam Susepeth, who was heavyset and sweet-faced, like her best friend, Beverly Gladfelter. The next pair of nurses were both new, hired since the freeze had been lifted last month: Allison Sterling and Sue Barrington, both of whom had short brown hair. The remaining chairs were occupied by staff who rarely had input at staff meetings: two psych techs, two nurse’s aides, a nursing student, an art therapist, two caseworkers, and the two medical students from Jefferson, one of whom was Kristine Malin, whose eye Eric had been avoiding from the moment he’d entered the room.

  “Okay, let’s get this party started, Amaka,” Eric said to his charge nurse Amaka Ademola-Gibbs, sitting to his left behind a tall stack of patient files. Amaka was in her fifties, a West African woman raised in the UK and married to a Brit, with an accent that reminded him of Downton Abbey. She was smart, skilled, and confident, and she had the most demanding job on the unit, which was to monitor the clinical care of the unit’s patients. She was always the first one into work every morning, so she could meet with the nurses getting off the night shift at seven o’clock, get their reports, check their charting, and distill the data in order to update Eric and the rest of the team, now.

  “Fine, Chief.” Amaka sipped her tea. “I’ll begin with Julius Echeverria, who you will remember was admitted ten days ago with depression, arising out of the death of his teenage son in a car accident.” Amaka opened the top folder on the stack in front of her, crossing her slim legs in her maroon scrubs. “Mr. Echeverria had a good night. He slept fully seven hours and was compliant with his meds.”

  Eric nodded. “That’s good. So he’s not trying to cheek them anymore.”

  “No, he’s not.” Amaka shook her head, and her little silver earrings wiggled back and forth. She had a thing for silver jewelry, which looked great with her dark skin and the graying tendrils woven through her hair, which she wore in a short natural cut. “His vitals were fine, and his wife Rosa visited him last night. She thinks he’s improving, too. They had a nice chat.”

  “Good, good, good.” Eric felt heartened. His psychiatry service integrated family members into the treatment plans for its patients, encouraging spouses, significant others, and even friends to join therapy sessions whenever appropriate, as an essential element of the patient’s recovery. It was just another way in which psychiatry was different from every other service in the hospital; the outcome for a patient with a physical disease didn’t depend on anyone else, in that a patient with colon cancer didn’t improve because his family visited every day. He felt sure that Mr. Echeverria’s depression would be helped by the support of his wife, who mourned the same tragic loss.

  “By the way, Mr. Echeverria is almost out of days on his insurance. He has only three left.”

  “Duly noted.” Eric filed it away. He knew that about 90 percent of the patients on the unit had some form of insurance, and he and Amaka kept a running tab of how many days each patient had left, trying daily to make progress within the strict parameters of managed-care, fighting the insurance companies for the mental health of his patients. “Whose patient is Mr. Echeverria? He’s yours, right, Jack?”

  “Yes.” Jack nodded, shifting up in his seat and linking his long fingers in front of him. He had on a dark blue cashmere vest over a fitted white shirt, with slim-cut wool slacks and Gucci loafers. Eric remembered that Caitlin always said he could’ve been a male model.

  “How close to discharge is he?”

  “I’d say he’s almost good to go.”

  “So when do you recommend we discharge him?”

  “Tomorrow or the next day?” Jack shrugged cavalierly.

  “Which is it?”

  “Day after tomorrow.”

  “Okay.” Eric let it go. He didn’t say so, but he always felt that Jack was a little too glib for his own good, as if the attending lacked the true compassion required to be a successful psychiatrist, much less a scientist as prominent as his father.

  Amaka retook the floor. “Our next patient is Leah Barry, who is on her third hospitalization after the stillbirth of her child. One of the night nurses noted that at dinner, she tried to slip a plastic knife from the dining room into her pocket, and the nurse worried that she was going to use it to self-harm.”

  “Oh no.” Eric felt it tug at his chest, and the faces around the table went grave. Nobody ended up on a psych unit without a heartbreaking story, and Leah Barry’s touched all of them. There was always one patient they called The Ghost, because she haunted you. This time, The Ghost was Leah Barry.

  Amaka continued, “In addition, Mrs. Barry became very upset when the nurse took the knife away, and she barely slept. She expressed to the nurse that she wants to go home, though she knows she isn’t well yet, and she continues to isolate. In particular she complains about being checked on.”

  “What’s that about?” Eric asked, turning to David. “She’s yours. What is she talking about?”

  “You know how we have the bed checks every fifteen minutes. She finds it annoying. She wishes we could stop, at least at night, but I told her that we couldn’t.”

  “Hmmm, we can’t. But we’ll have to do something else for her.” Eric had instituted the fifteen-minute checking practice after one of the patients at another hospital in their system hanged himself. The patient hadn’t been checked in for an hour, and Eric vowed that would never happen in his unit. At the same time, he knew it could be annoying for the patient to be interrupted by a falsely cheery nurse’s aide, saying “how are you doing” every fifteen minutes. It struck him that it was like Max Jakubowski, performing his ritual every fifteen minutes.

  Eric eyed David. “So what can we do for Leah Barry?”

  “I asked the nurse’s aide who checks at night to make sure she doesn’t shine a flashlight in her eyes. You don’t have a problem with that, do you, Chief?”

  “No, of course not. Can we do better than that? Think about it. Take some of the checks during your rounds, so it cuts down on total interruptions.”

  “Will do.”

  “Good. So, David, do you want to change your treatment plan for her? What would your recommendation be?”

  “I have her on an SSRI, and we can increase the dosage just a bit. I’ll also make a point of spending more time with her off-rounds.”

  “Good,” Eric said, with a smile. David had to be a little less timid in his approach, bu
t Eric knew that would come with time and experience. David Chu was a supersmart kid, but he tended to get in his own way. He turned to Amaka. “Okay, sorry to interrupt you, boss lady. Go ahead.”

  “Unfortunately, Mr. Perino doesn’t present as sanguine a picture.” Amaka went to the next folder on her stack, shifting the first to the bottom. She always presented in order of room numbers because she regarded it as more organized. Eric would have preferred the updates of critical patients first, but he believed in letting his people do their jobs their own way. Amaka opened the second folder. “Mr. Perino was disruptive at dinner last night. He pushed another patient in the dessert line.”

  David snorted. “Watch out. Don’t get between dessert and Chubby Hubby.”

  Jack chuckled. “Like he needs another chocolate pudding.”

  There was chuckling around the room, but it fizzled when Eric didn’t join in. He liked to laugh, but never at a patient’s expense. “So we’ll have to file an event report,” he said. Any type of inter-patient violence, however insignificant, had to be reported to the Commonwealth. “Amaka, will you?”

  “Yes, I’ll take care of it.” Amaka checked her notes. “After the incident, Mr. Perino isolated in his room and at bedtime, he coughed up his meds. When they tried to readminister, he declined.”

  “How exactly did he decline?” Eric enjoyed Amaka’s polite Britishisms, but he needed facts. “I’m guessing it wasn’t just a ‘no, thanks.’”

  Suddenly, there came the sound of shouting from the hallway and the loudspeaker crackled, “Dr. Parrish and Dr. Ward to Room 505, Code Gray. Dr. Parrish and Dr. Ward to Room 505, Code Gray.”

  “Let’s go.” Eric leapt to his feet just as the door was flung open by a frightened nurse.

  “Dr. Parrish, it’s Perino!”

  Eric was already in motion, racing for the door.

  Chapter Fourteen

  Eric raced down the hall with Sam and David on his heels, then Jack behind. A Code Gray meant a security risk and the unit went into automatic lockdown, locking patients in their rooms because an outbreak of violence destabilized the entire unit. Some patients were already sticking their heads out to see what was going on, and a patient with a severe anxiety disorder, Mrs. Jelik, was coming down the hall from the opposite direction, wringing her hands. Eric could hear Donald Perino screaming in his room, then came a loud crash of something metallic hitting the floor.

  “No! No! NO!” Perino raged at the top of his lungs. A blonde nurse and two orderlies were backing out of Perino’s room in fear. “Get away from me! Get AWAY!”

  “Get back, please.” Eric reached the doorway to Perino’s room and ushered the blonde nurse and the orderly out of harm’s way. “Did you call security?”

  “Yes,” the nurse answered, shaken, and Eric knew she was relatively new, so he placed a steadying hand on her shoulder.

  “Tina, stay calm and we’ll be fine. What happened?”

  “He was fine, at least I thought he was.” Tina’s brown eyes rounded with fear. “I went in to give him his meds and for no reason, he slammed his head into the bed table.”

  “Got it.” Eric steered her to Mrs. Jelik, pointing. “Tina, please put Mrs. Jelik back in her room. We’re in lockdown.”

  “Yes, okay.” Tina hurried off, as Eric turned to face Amaka.

  “Amaka, get me five milligrams haloperidol and two milligrams lorazepam.”

  “On it!” Amaka turned on her heel and rushed away.

  Perino kept yelling, “No, no! NO! Get away! Get AWAY!”

  The orderly shouted to Eric, “Doc, what you want me to do?”

  “Nothing—no matter what happens, don’t go in that room.” Eric wouldn’t consider endangering an orderly, and hospital procedures were clear in case of patient violence—utilize only trained professional staff, as few as possible, and stabilize the situation until security arrived. He turned to Sam, behind him. “You stay here, too.”

  “Eric, he’s my patient and he trusts me. I should help. Plus, he’s big. You’re gonna need an assist. I should go in with you.” Sam blinked, his grayish eyes grave behind his wire-rimmed glasses.

  “No, stay. Pass me the syringes when Amaka gets back. Don’t come in until security gets here.”

  “Understood, but be careful.” Sam nodded, and they both knew he had to stay behind for safety’s sake. Psychiatrists, psychologists, and mental heath workers in hospitals had an assault rate of 60 percent, six times higher than other healthcare professionals.

  “Donald, please settle down,” Eric said calmly, entering the hospital room where his patient stood raging on the other side of the bed. Donald Perino was in his mid-forties, six feet two inches and 350 pounds of paranoia. Perino had been admitted two days ago after a break, ironically caused not by his mental illness, but by the abrupt withdrawal from one of his medications for depression, Klonopin or clonazepam. It was psychiatry’s dirty little secret that many antidepressants did more harm than good when the patient abruptly stopped taking them, which was unfortunately common behavior among the mentally ill.

  “No, no, leave me alone!” Perino yelled, his dark eyes blazing in terror. Blood dripped down his forehead from where he’d injured himself, matting his brown hair and making a gruesome freshet. Fortunately, the wound didn’t look serious, just bloody. The bed table lay on its side, and his breakfast tray, eggs, toast, and coffee cup were scattered on the floor.

  “Donald, relax, please settle down.” Eric kept his tone calm, remembering his training. He approached Perino from a forty-five-degree angle because it was less confrontational. He stopped before he violated Perino’s personal space, which was a leg’s length, because it would escalate his agitation. He made eye contact but he kept it like casual observation, not a fixed stare. He held his arms at his sides, not only because it was less threatening, but they’d be available to fend off a blow. He cleared the doorway so he’d have an escape route.

  “No, no, no! Go away!” Perino backed up against the reinforced windows. He raised his meaty arms as if warding off a blow, his gaze so wild-eyed and unfocused that Eric wasn’t sure Perino recognized him.

  “Donald, it’s Dr. Parrish, and I need you to sit down in the brown chair.” Eric pointed to the chair, having been trained that simple commands would help him regain control of the situation. He couldn’t let Perino hurt himself, the staff, or his fellow patients. “Please, sit down and tell me what’s happening. I need to see that wound on your head.”

  “No, no! ARGGGHHHH!” Perino bellowed, throwing back his head, baring his teeth, and roaring like a raging animal. Blood poured down his face, a horrifying sight.

  Eric stood his ground. Security still wasn’t here. Perino was going from bad to worse. Eric didn’t move or do anything that could be misinterpreted as aggressive. Paranoia among schizophrenics typically caused combativeness, and Perino had a history of childhood aggression and disturbing behavior, like starting fires.

  “No, no, no!” Perino started shouting again. “I know who you are! You don’t fool me! Don’t you come near me! Don’t come near me!”

  “Donald, I’m Dr. Parrish. Please sit in the chair and tell me what’s going on.”

  “You’re not Dr. Parrish! You’re a liar!” Perino hollered, spitting the blood that ran past his lips. Veins bulged in his neck.

  “I am Dr. Parrish.” Eric pointed to the chair again. He didn’t know what was taking security so long. “Please sit in the chair. I need you to sit down. I’ve been treating you here. I remember that your wife Linda brought you in. You had stopped taking your medication, do you remember? You said it made you feel lethargic. You gained weight, almost thirty pounds?”

  “You’re a liar! You’re with the CIA! You all are! So’s that blonde! She said she’s a nurse but she’s a liar! She’s trying to take the thoughts out of my mind! You give me pills! You poison my blood! You make me crazy!”

  Eric glanced at the doorway. Jack’s expression was oddly impassive, but David’s young face l
ooked stricken and flushed. Security was nowhere in sight. Amaka had returned and was passing the syringes to Sam, who held them discreetly in his left hand, waiting to slip them to Eric. But Eric couldn’t subdue Perino and administer two injections without security to hold Perino down.

  “That’s why I’m here!” Perino took a threatening step toward Eric, advancing on him. “You make me angry! You make me want to kill somebody!”

  “Donald, please sit down in the chair.” Eric edged backwards toward the door, hiding his hand behind him so Sam could pass him the syringes. In the next moment, Eric felt a syringe in his palm, but it was only one, not two. Sam was sending him a signal. “Donald, please, sit down in the brown chair.”

  “No, no!” Perino kept coming, his face a blood-soaked mask. “You’re making me a killer! You want me to kill for the CIA! Get out of my way! I have to get out of here, right now!”

  “I can’t do that, Donald. You need to stay here and talk to me.” Eric stood in front of the door. He couldn’t let Perino out of the room to harm his staff or other patients. He braced himself for a takedown. He couldn’t wait for security. “Please sit down in the—”

  “No, no, NO!” Perino screamed in Eric’s face. “If you don’t let me out of here, I’m going to kill you!”

  “Donald, stop—”

  “Move!” Perino lunged for Eric, and Eric reacted instantly, grabbing Perino’s burly right arm at the wrist, forcing it down abruptly, then quickly stepping backwards, yanking Perino off-balance and simultaneously injecting him with the sedative.

  “No, no, don’t!” Perino howled, as Sam charged from behind, wrapping his left arm around Perino’s beefy chest, injecting him and continuing to pull him backwards.

  “Donald, it’s Dr. Parrish and Dr. Ward, we’re here to help you.” Eric and Sam sandwiched Perino, taking him down in a controlled fall, with Sam protecting Perino’s head with his hand so it didn’t hit the floor.