by A. F. Brady
Muffled laugher and sarcastic snorts.
“I know it’s been getting a little overwhelming with all the new patients starting, but as you know, there are seasons and cycles that are at play with mental health, and with winter almost here, even though it’s only October—” she shakes her fists at the windows “—with the shorter and colder days come more depression, seasonal affective disorder, hopelessness and the like. I’m not telling you anything you don’t already know. That being said, as you’re already aware, we have another new patient, and he is starting today.”
The staff begins to look around nervously; people start adjusting their shirts, looking down at notepads, trying to disappear into the noise.
“I’ve heard a lot of chatter in the hallways. I understand that it’s natural to speculate, but it’s very difficult to maintain unconditional positive regard, an unbiased attitude and an open mind when rumors are being spread in this manner. You all know what I’m talking about.” She glares at us like we should know better.
“Well, can you give us a little more insight into the story with this guy?” Gary.
“I’m not really privy to any more information than you are, so we’re in the same boat. But I am urging you to put your preconceived notions away, set down these ideas you have about him and focus on the little information that we do have. He is coming here for treatment, for help, and your job is to provide that treatment without making the man into a monster.”
“Look, I’m all for positive regard and unbiased treatment, but isn’t it important to ensure the safety of the staff?” Gary again. “I mean, I heard his file is incomplete because he attacked his last counselor. I heard he refuses to answer intake questions, and won’t discuss his history, and if you pry, he goes ballistic. I mean, he’s forensic, and I’m not sure I’m comfortable treating a patient who is known for attacking his counselor.”
“Well, we are not in the business of turning away problematic patients.” Rachel lowers her head and shuffles out the file. “And there’s nothing in here that indicates he has been violent with staff in the past.”
“That’s because there’s nothing in there at all! The file is nearly empty. It says he is a big dude and wears a hat and doesn’t talk. It says he’s been in jail half his life. But, somehow, it doesn’t say on what charge? Hmm? That’s insane! You can’t have a forensic patient with no history, and no psychosocial, and no diagnosis, and nothing in his file, just waltz in here, and we’re supposed to figure this all out from nothing!” Gary is exasperated. Gary used to be a social worker in the finance world. He worked for a firm that did corporate layoffs, and Gary’s services were offered to those individuals who lost their jobs. He always ended up feeling like the messenger and he couldn’t hack it anymore, so he ventured into something he thought would be cushier, less dramatic, more sustainable on a daily basis. He went from the frying pan into the fire, and he is still looking around, bewildered, wondering how he got here.
“Then what exactly do you think we should do, Gary?” This is David, who usually stays above the fray in these meetings.
“Send him somewhere else!”
“That’s ridiculous. We are the ‘somewhere else.’ This is the last stop. Would you rather he was out on the street? With no treatment? No chance?” Me, wiping coffee stains from the conference table.
“Look, I mean, I just don’t want him on my caseload. I don’t have a lot of extra time on my hands, and being tasked with completing an entire file of pre-intake data in addition to everything else needed for him, for a guy who will probably stab me and doesn’t even talk? No. I’m sorry, but no, thank you.” Gary folds his arms across his chest and leans back in a huff.
“Then why are you working here?” Shirley immediately regrets these words, and she cowers back into her seat, hoping this comment didn’t open her up to the possibility of being the new guy’s counselor.
Rachel jumps in, taking control of the discussion. “It’s important for all of us to have a forum in which we can discuss the concerns we have with the patients, and to bring everything out in the open. These meetings are exactly that forum. We are not here to attack each other. I want you all to talk to me and each other about what you’ve heard and what makes you so nervous about our new patient Richard. But I will continue to caution you—rumors are usually unfounded, and we need to be careful how we color this man.”
Gary slumps farther down in his chair and disengages from the discussion. Julie, the bubbly princess, pipes up that she is fearful for her safety, and she worries that she’s too physically weak and defenseless to effectively treat someone who intimidates her. Other female staff members coo in agreement. Julie has wormed her way out of taking anyone else onto her caseload for weeks.
“Why was he in jail?” Shirley.
“I honestly don’t know.” Rachel. “As I said, I have access to the same records as you, and I don’t have that information.”
“But isn’t that weird? Shouldn’t we know?” Julie.
“What difference does it make?” Me. “If he were in jail for racketeering or armed robbery or whatever. It doesn’t make a difference. It could be drugs. It could be the third offense for something small, and with the ‘three strikes, you’re out’ law, he could have been in jail forever. It’s not a sex offense, because he isn’t registered—I looked it up. It really shouldn’t matter what he was in jail for. But it’s important to know that he was in jail. His perspective is obviously altered, and he has probably been subjected to some pretty horrific stuff in there.” As I say all of this, it occurs to me that I am completely uncomfortable with not knowing why he was in prison for so long.
“I heard he doesn’t talk, at all, and that he is very aggressive. He refuses to follow protocol, he doesn’t get along with other patients, he doesn’t do paperwork.” Shirley.
“Well, I think it’s clear that he’s not cooperative with doing paperwork, but beyond that, I am going to ask everyone to chalk this all up to speculation and the tendency to fill in blanks with drama when we don’t have sufficient information. The fact of the matter is he is here, and he is going to be working with us.” Rachel is no longer looking at anyone and getting ready to drop the bomb. She’s stalling. Everyone starts to shift uncomfortably.
“Sam—” she looks up and tightly smiles in my direction “—and Gary.” He slumps back into his chair, defeated. “I’m going to put Richard with you, Gary, and Sam will be your backup. You can learn a lot from this patient, and I think you’re up for the challenge. And, Sam, you have the best success rate with difficult patients, and you’re a ranking member of the clinical staff. I prefer to start Richard with a male counselor and see how that goes. We will all be here for extra support should you need it, but I’m sure you’ll be able to handle this.”
Shirley and Julie give each other exaggerated looks of relief, and everyone breathes a sigh. David gives me a conciliatory squeeze on my shoulder. Gary huffs up to Rachel and lolls his head to the side as she hands him a copy of Richard’s intake materials. He says nothing, and instead looks to me with wide eyes and an impatient bend in his leg.
“No problem, Rachel. I’m on it.” I gather my papers and coffee, and as we all bleed into the hallway, Rachel hands me my own copy of Richard’s file.
Gary assures me that he has no problem taking Richard’s case, and I will not need to participate in his supervision. Gary is an idiot.
“Well, that’s all well and good, Gary, but I’d like you to come to my office so we can discuss a plan of action. Not because I don’t believe you can manage this, just because I want to stay in the loop if I’m going to be your backup.”
“I really don’t have time right now, and I’d like to get an initial meeting with this guy done today.” He stands at the door to the conference room with his whole body and one outstretched finger pointed toward his office.
“Come on. It’ll only take ten minutes.” He expels a giant, frustrated moan and follows me down the hallway to my d
oor. “Sit down,” I say, waving my hand at my patient chair. He flops down dramatically and lets his Gatorade slosh onto the carpet in front of him.
“I’m going to find him on the unit and bring him to my office for a meeting this morning. I’m going to talk to him like a man, and I’m going to treat him like he’s not scary and no big deal. I’m sure all this crap about him being scary is just because he was incarcerated and prisoners scare people. Well, not me; I’m not scared.” He rubs his Gatorade spill further into my carpet with his shoe.
“This is the extent of your plan? You’re going to talk to him like a man?” I’m not even bothering to write this down.
“Yeah. It’s not rocket science, Sam. He’s a patient and I’m a counselor. So, he has to answer me. I don’t see why everyone had so much trouble before.”
I shake my fragile, hungover head to try to clear the stupidity of Gary’s response. “Can you please give me something a little bit more specific? How do you plan on getting through to him when clearly no one has been able to until now?”
“Like I said, by talking to him like a man.” He slowly enunciates the last three words.
“What does ‘like a man’ mean?” I hover my pen over my notebook and avert my eyes. I can’t look at him for fear of his response.
“You wouldn’t understand because you’re not a man.” He stands up to leave my office and pats me condescendingly on the shoulder as he leans down to add, “I’ll make another meeting with you after I’ve gotten some answers out of him, okay?” And he’s out the door.
OCTOBER 23RD, 11:37 P.M.
I have been avoiding garbage day for about a week now, and the recycling bin is overflowing. There isn’t much space under the sink in my kitchen, and since I drink more than I cook, I have the big recycling bin between the front door and the fridge. It looks more like a hamper.
The blue see-through bag has been pulled under with the weight of the bottles, and I need to yank it up by the red strings to get it out of the can. The clattering sound it makes is absolutely insufferable. There is a leak at the bottom, and the putrid stench of week-old wine and booze, mixed with the acidic smell of the Tropicana bottle from this morning’s screwdrivers, is making me gag. There’s a reason I always put this chore off until the last possible minute.
The noise the bottles make as I pull it along the carpeted hallway is not as bad as it would be if I were to pick it up and haul it over my shoulder, Santa Claus–style. I will have to carry it that way when I walk down the old marble steps to the basement.
I push open the refuse-room door, and I see skittering bugs as I turn on the lights. They’ve come inside to hunker down for the winter, and this room is a veritable buffet of gnarly shit for them to feast on. I flip over my huge sack of booze bottles into an awaiting plastic can, and it sounds like several of them smash. I feel the ooze that has spilled down the back of my pajama pants, and I try to dry it off with a rag that was hanging on a hook by the door.
I get back up to my apartment and clean up the smears on the floor. I put the two forgotten bottles of beer into a fresh blue recycling bag and line the can with it. I have two bottles of scotch on my bookcase shelf that I never finish. There’s always at least four fingers left in each bottle so if I have company, it looks classy and sophisticated. I usually have a bottle or two of wine in the fridge, too. Not because I’m saving it, but because I buy in bulk.
OCTOBER 26TH, 3:35 P.M.
Gary is loitering in front of my office door as I return from running a women’s group.
“Hey, Gary. Did you need something?” I can see the desperation in his eyes, and I know what he came here to discuss with me.
“Yeah, I need to talk to you. Do you have a minute?”
“I sure do, come on in.”
Gary slumps low in my patient chair and rakes his sweaty fingers through his hair. “This is making me crazy. I can’t get a word out of this guy, and I’ve had meetings with him every day since Friday.”
“You mean Richard McHugh?” I know exactly who he means.
“Yeah. I brought him in on Friday, like I said, and I tried to start the evaluations and assessments for his patient file, right?” He’s leaning on my desk and waving a meaty paw in my face. “And he doesn’t say a word. Not a word. He just sits there, and I thought he must be deaf or something, because he just didn’t say anything. He didn’t get mad or anything; he just sat there. I kept asking him the same questions, and he just looked at me or looked out my window. So, then I figured maybe he wasn’t ready. I told him about me, tried to relate to the guy, said I would treat him like a man if he treated me like a man, and still nothing.” Gary is genuinely surprised that his presumptuous macho plan didn’t work. Half of me wants to laugh in his face, and the other half wants to be professional and help him develop as a counselor.
“Okay. So, the original plan didn’t work. You said you met with him every day since then. Did you change your approach?”
“Yeah. I mean, I did everything I know how to do. First, I was just trying the ‘talk to him like a man’ thing, and that didn’t work. Monday, I asked him to come back to my office, and he didn’t put up a fight or anything. So, I figured this time I would just be all business and make him answer the evaluation and assessment questions. But he didn’t answer a single question! He started reading the newspaper. He brought this huge stack of newspapers with him to read and wouldn’t even look at me when I asked him questions.”
“Okay, and I imagine the sessions yesterday and today were more of the same?” I’m already tired of hearing this.
“Yeah, total silence. He doesn’t even say hello.” Gary leans back, satisfied that this is my problem now.
“Gary, you’ve made four attempts to talk to a man who apparently doesn’t like to talk much. So, you shouldn’t be surprised or disappointed that conventional methods aren’t working.”
“I don’t think it’s my methods, I think it’s me. I think he just doesn’t like me.” Gary is saying this to appeal to my ego, so that I offer to take over for him and he doesn’t have to ask me.
“How would you like to proceed?” I’m not letting him off that easy.
“I think you should take him. I don’t have this kind of time to waste on someone who doesn’t talk, doesn’t want to be helped.” He is crossing his arms and shaking his head in fast, erratic twitches that make him look like a frightened woodland creature.
“I can’t make that call. You’re going to have to speak with Rachel.”
“Oh, come on, Sam, can’t you just take this one for me?”
“I’ve already taken Shawn for you.” I sigh. “But if Rachel signs off on it, I will take him. Until then, he’s yours.” I close my notebook for effect and open my door, allowing Gary to go find Rachel and deal with this.
OCTOBER 28TH, 9:12 A.M.
We have a 9:00 a.m. staff meeting most mornings to discuss our patients and any administrative nonsense that needs to be addressed. Everyone usually drags ass in the meeting except for me and my boss, Rachel.
Rachel is a linebacker. She is a formidable presence, and her booming voice and sharp intellect scare the shit out of everyone. She was born to run an institution, and her lack of a private life really helps her excel at her job. Her stringy, mousy brown hair is pulled back with a velvet scrunchie and she is always wearing a sweater set and chinos that are too tight in the hips and it makes the slash pockets stick out like little ears.
Rachel likes me because she needs to believe that I really am always energetic and positive and a barrel of sunshine. Whenever I am out on the unit, I am a superhero. I am a troubleshooter, and a problem solver, and the go-to gal to get stuff done. My coworkers hate this about me. Until I cover their groups, or take their patients to the ER, or finish their case reviews/progress reports/treatment plans; then they love this about me. I make self-deprecating jokes as a defense mechanism. I always ask people about their weekend and how they’re doing because people are narcissistic and won’t a
sk me how I’m doing in response. This way I don’t have to lie to anyone.
“Frankie’s back in the hospital.” Shirley begins her report. “Apparently he was standing in the middle of the street trying to direct traffic. This was an intersection on Broadway, and it’s amazing that he isn’t dead. Supposedly, when the police tried to stop him and arrest him or whatever, he started running away from them, bouncing off of cars, running in between them… It was a mess. Eventually they tackled him, I’m not sure, and they brought him to the psych unit at Columbia University Medical Center. He is on suicide watch right now, and I keep getting calls from the docs telling me that he’s not cooperating. I’m not sure what I’m supposed to do about this.” Shirley is both disengaged and disenchanted and ran out of empathy years ago.
“You go to CUMC, Shirley,” Rachel responds, irritable, frustrated, possibly menopausal. “You talk to the doctors. You make sure they know you’re the point person in his continuing care. Eventually, Frankie is going to be coming back here for inpatient services once he is cleared to go, and he needs to be aware that he wasn’t abandoned in the psych unit at CUMC.
“Remember, all of you.” She is looking at us like bad kids who ate all the cookies. “We are the only resource for many of our patients here. We are their mothers and fathers, their caretakers and confidants…”
I didn’t sign up to work on this unit to be anyone’s mother or father and I resent her for saying this as she drones on with the lecture she has delivered so many times. I sip my coffee and stare out the only window in the conference room. There is construction going on across the street; I can hear it a little bit, but mostly I just watch the men in jeans and reflective vests glide up and down this building as they work the planks and rods of the scaffold, and I wonder what would happen if someone jumped off.
“In other news,” Rachel continues, “I’m announcing a caseload change this morning, as well. Gary has been working hard to reach our newest patient, Richard McHugh, but unfortunately, he hasn’t gotten anywhere. I met with Richard yesterday to discuss a change in his counselor, and he asked for you, Sam, by name. So, tag—you’re it. Good luck.” Rachel told me about this before the end of my shift yesterday, so this is nothing more than a performance for the rest of the staff.
