by Jamie Mackay
Chapter 9
Monday morning was the beginning of Tatum's first full week on the Units. She found herself once again awake before her alarm. The morning air was a bit cooler than it had been the week before, allowing her to make better time on her morning route.
After she showered, she chose a tan colored pantsuit that she once again paired with a pair of very reasonable shoes. For under her blazer, she chose a sleeveless pink blouse in place of the typical camisole choice she might have made. She was planning ahead to ensure she had something appropriate on underneath if, when, she needed to remove her blazer in the heat.
Downstairs, Milligan was waiting with a fresh cup already prepared. Both he and Tatum knew that this morning's conversation would be short, much less fulfilling than the leisurely weekend visits they had recently enjoyed. The cooler morning air had brought additional residents down for a morning java so that, even if they had more time, their discussions would have been superficial. Knowing coffee this morning would simply be a beverage Tatum finished her brew quickly and started to make her way toward what she now thought of as the Units.
.
Only two days on the job and already Tatum was expected to find her own way upon her 8:30 arrival. After saying good morning and making some polite chitchat with Marja at the front desk, Tatum swiped her FOB and headed toward one of the computer terminals in the administration office. Anne had shown her the week before how to log on with her account so that she could access schedules, files, and other hospital information from virtually anywhere in the institution.
For the time being, she was responsible to follow Dr. Glaser's schedule and she could see that throughout the week ahead her schedule would look very much like the previous Friday. Essentially, it seemed that her days would be a mix of assessment and therapy.
Tatum grabbed a notepad and jotted down the names of the clients she was to see during the day ahead, then she moved on to the filing room and went through the motions of collecting the appropriate files.
.
Tatum waited patiently in the administration boardroom until eventually Tim joined her. Typical of what she was beginning to expect, he looked disheveled, his hair poking up in every direction.
"Good morning Tatum. Do you want to wait here while I go and see what we have on tap for today?"
Tatum tapped the files in front of her.
Tim understood that she was already way ahead of him.
"Alrighty then. You tell me. What's on tap for today?"
"Well," she explained "There are two assessments this morning, but they are both mental health only, so they should be fairly quick. From the referral questions, it sounds as if the therapists are feeling a bit stuck and would like to consult on where the patients are at. The other two are your existing therapy clients, Ben and Sue if I remember correctly."
Tim nodded knowingly as he recognized the names.
"Okay then, we might as well get started. Where are we off to first?"
"The first assessment is U2 and the second, U3."
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As she suspected, Tim followed behind Tatum on her way to U3 to meet with the first patient. Tatum was becoming quite certain that any work Tim could pass off on her, he certainly would.
Larry wasn't working so Tatum stopped and introduced herself to the alternate unit head and then made her way to the U3 observation suite. Although she had yet to complete an assessment on U3, the layout was identical to U2 making it easy to find her way around. She had no need to go to the U3 test library, for the assessments today her primary tool would be the booklet she used to guide herself through the clinical interview and her notebook on which she would record patient responses.
Tatum's first client for the morning was a 52-year-old man named Doug. Doug had been on and off the units most of his adult life but, for the last several years, Unit Three had become his permanent residence.
Essentially, Tatum understood her job as completing an assessment of Doug's current level of functioning so that his therapist and psychiatrist could reevaluate both his therapy and medication regime.
.
Doug's appearance struck Tatum as inconsistent with what she had expected. She had taken little time to skim his file prior to meeting with him, but, given the size of his file, she had expected to meet someone who looked much less typical. Although he was dressed in the peach colored issue clothing that all the patients wore, his presentation was initially appropriate and his speech articulate.
One thing that Tatum had learned during her clinical training was to never judge a book by its cover.
Tatum started with her typical questions about his social history, including some questions about his early childhood and others about his social environment prior to moving onto the unit. Doug answered Tatum's questions quite willingly, but as he answered he slid his chair closer and closer into the table so that his hands were nearly touching hers. Then, he proceeded to begin interjecting his own questions in amongst those he was being asked.
"So, Dr. O'Neill. Are you married? Do you have a boyfriend? Do you want a boyfriend?"
Tatum stood her ground.
"We are here to talk about you, not me. You need to back up and answer my questions."
Having been challenged, Doug backed off, sulking about having been put in his place.
Tatum continued on with her questioning and eventually covered her structured series of questions about depression and a variety of other clinical symptoms. Then, she followed with her usual questions about symptoms of obsessions and compulsions.
"Do you ever have any thoughts that come back to you over and over again, even when you try not to have them?"
Soon enough, it became clear to Tatum why Doug lived here on Unit 3.
"I have the typical, counting up to 24 stuff. You know. Everything had to come to 24. But that's not why I'm in here. I thought you'd know that already from my file. I'm a smearer."
"A smearer?" Tatum asked, thinking that she was fairly certain she already knew.
"Yah, you know. A smearer. I poop and smear. Oh, and, of course, I smear 24 times," Doug said with a grin.
Tatum had been right; she did know what he meant.
"I used to be able to prevent myself, but not now. That's why I'm a Unit Threeer."
Tatum found she was a bit surprised that even the patients seemed to use the descriptive lingo she was quickly becoming accustomed to.
She made a mental note that she would recommend a psychiatric consult for increased meds and some very structured cognitive behavior therapy.
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The next patient was from Unit Two and required Tatum to once again switch meeting places. She presumed that once Dr. Glaser was no longer required to observe all of her work, she would be assigned to rooms outside of the observation suite.
Tatum suspected that she would be working independently relatively soon; Tim mostly seemed tired and distracted during his supervision times. At the end of the session with Doug, she was fairly certain she saw him napping in the quiet dark environment provided by the observation side of the learning rooms.
The day's second patient was a twenty-four year old woman who was struggling with Panic Disorder. This was her first time in the hospital. Nearly a year prior to her admittance she had stopped leaving her home to prevent her panic attacks. Her agoraphobia had become so severe that she was unable to buy groceries, take her children to school, or do any other daily task that required leaving her own home. Once again, Tatum made a mental note for medication and Cognitive Behaviour Therapy.
.
The morning had gone quickly. Tatum realized that it was nearly 1:30 by the time she was finished with the second patient and Tim finally called for her to take some time for lunch. Once again, Tatum headed downstairs, grabbed a to-go bag, this time with tuna fish, and headed back up to Unit Three. No one seemed concerned that Tatum was making a habit of eating her lunch with a patient, so she headed back over to the corner by the window and pulled up a chair.
James stared at his fingers moving in front of his face.
"Hi James, it's me Tatum. Okay if I eat with you again?"
No response.
"I'm having tunafish today, instead of egg. I get kind of tired of egg. Do you like egg?"
Again, no response.
Tatum continued, "I met a lady named Anne the first day I worked here. She was very nice, rosy, smiley cheeks. Oh, and I met Dr. Fraser and Dr. Glaser, I'm sure you know them both. I've been on Units Two and Three, but I don't yet have access to Units Four through Six. I hope I get into Unit Six fairly soon though, I'm supposed to have a research component to my program, and I understand that U6 is where all the research takes place. You'd know that. You've been here a long time, haven't you?"
Tatum rattled on for nearly an hour without any expectation that James would reciprocate.
"Well, I've gotta get back to work," she finally concluded. "See you tomorrow."
She realized at her last comment that she would be back tomorrow, and likely every day after that.
.
The afternoon was shorter. Two counseling clients that Tim saw and Tatum observed. She realized that soon enough, she would likely begin seeing therapy clients independently as well. It seemed as if Tim didn't miss a beat - the earlier she took over some therapy stuff, the sooner he would have more time during the day to nap.
