Chapter Three – Wounded Warriors

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The next patient up is a twenty-something-year-old married female from an area hospital ER. Before interviewing her, I glance over the ER reports and her alleged suicide plan to overdose. She arrived as an involuntary patient, the involuntary committal form written by the referring ER MD, who committed her here for a psychiatric evaluation. I jot my initials next to her first name on our Birdcage patient flowchart / referral board, suck down another swig of sweet tea, double-check to make sure my K-Mart reading glasses are still attached to the top of my head, and step out into the hallway.

“Sara?” I call her name and smile, hoping to strike a positive rapport.

“That would be me,” she replies with a forced smile.

I escort her back to one of our counseling rooms and close the door.

“Nice room,” she says, referencing the stark white walls, ragged chairs and grimy linoleum floor where a giant roach lay belly-up in the corner.

She sits across from me in blue jeans, sandals and a sleeveless blouse, her shoulder-length brown hair neatly combed, her forlorn brown eyes exhausted from an all-day stay in the ER that referred her here. She crosses her legs and sighs.

“Are you cold?” I ask, always cognizant of the freezer-like temperatures which we have no way of controlling, although such frigid conditions allow me the opportunity to provide the most basic of human needs. It always amazes me what a genuine smile and a heated blanket can do to soften one’s guarded and oft-times hostile demeanor.

I re-enter the assessment room and hand her the warm blanket. She wraps it snuggly around herself and takes a deep breath.

“I’m Joe, one of the assessment staff,” I say. “I’m here to gather information on your case and see what we can do to help you out.”

“Yeah, well, if your brand of help is like the last ER…” She slumps in the hardback chair, her frightened schoolgirl face void of any semblance of hope.

“How’d you wind up here tonight?” I ask.

“You want their version, or the truth?”

“Both,” I say, genuinely curious about her plight. From the medical records that accompanied her, she has no mental health history and has never been admitted to a psychiatric hospital. I lean back in my chair.

She spoke of her marriage of five years to an active duty soldier and their frequent arguments of late. “He goes off without warning.”

I ask her to clarify.

“Oh, like which hand does he smack me with first?” she snaps, folding her arms in front, glaring downward.

“Did he strike you earlier today?” I ask.

She shakes her head, frustrated. “I wish…” She looks away. “He left long before it reached that point. Said he was taking our four-year-old daughter and our dog out to the park.” She went on to say that she didn’t think much about it. “I just assumed they’d be back in an hour or so and he’d come back apologizing…”

“What happened next?” I ask, already sensing the punch line.

“He called and told me he’d make damn sure that I’d never leave him, and if I tried, I’d never see our daughter again.” She looks away again, tears filling her eyes.

I reach for the Kleenex and hand them to her. “What did he do?”

She wipes her nose and shakes her head. “I just figured he was running his mouth again, and they’d be home. I was fixing dinner when someone knocked on our door.” She stops, having a difficult time reliving the moment. “It was the MP’s. They had an order to take me to the ER.”

“Why?” I ask, sitting up.

“Because my loving, honorable husband is active duty military and whatever he says is gospel.”

“What did he tell the authorities?”

“That I was going to overdose and kill myself.”

“And you didn’t make any such comment or threat?” I ask.

 

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“He’s always on edge, and paranoid.”

---

 

“Absolutely not! I’ve never had any thought of killing myself,” she says with great conviction. “Am I depressed? Yeah, I’m sad and depressed that my husband’s not the man I married; that since he returned from his second deployment, he’s not the same…” She slumps in her chair, tears streaming down her face.

“In what way?” I ask.

“He’s always on edge, and paranoid about everything.” She rewraps the blanket around her. “He‘s constantly accusing me of flirting with other men. I feel like I’m being stalked most days. And the night terrors… He nearly strangled me to death one night. We were sleeping just fine and a noise startled him.”

I lean back in my chair and take a deep breath. “So why would he set you up?”

She looks at me with both sadness and disdain. “He’s a scary man when he’s angry or wounded. If he can’t have me, then nobody can, or he’ll make sure nobody will want me.”

“And nobody in the ER would hear your side of the story?”

“In a military town? Are you kidding?” She rolls her eyes. “No one questions their word, especially a decorated soldier like my husband.”

I glance at my clipboard in frustration, not knowing for sure if she’s telling the truth, and keenly aware that it wouldn’t be the first case of spouses turning on each other, especially when kids are involved. Or abuse. Or both…

“So what are my options here?” she asks.

I set the clipboard down in my lap and lean towards her. “They sent you here on an involuntary commitment.”

“Meaning?”

“The ER physician signed an involuntary hold on you, which required that you come here for a psychiatric assessment. You didn’t have a choice about coming.”

“In the back of a police car,” she says, shaking her head.

“Now that you are here,” I say, “one of two things is going to happen. You can sign in voluntarily, which is just what it says. You agree to sign yourself into the hospital voluntarily.” I hesitate momentarily. “You also have the right to refuse to sign in.”

“And then what happens, if I refuse?”

I look at her and smile, not wanting to share with her the inevitable outcome. I take a deep breath. “It’s your right to refuse to sign in, and for what it’s worth, I believe your story. But if you refuse to sign in, and you already have one committal paper signed on you by another ER MD, then we have to have another doctor to evaluate you to determine the disposition.”

“I’m not sure what you are saying.”

“The first committal sent you down here, but in order to admit someone against her will, it takes two involuntary committal papers, and the second one has to be completed by a physician. We’re a free standing psychiatric hospital and don’t have a doctor on site at this time of the night. So, in a case like this, where you, the patient, do not want to be admitted and refuse to sign in, our only recourse is to have an ER physician assess you to determine if you need to be committed against your will to our psychiatric hospital for an evaluation, or allowed to return home.”

She looks at me, her eyes seemingly searching my face for answers. “Tell me what you think.”

I explain to her that in all of the years I’d worked in this psych ER, rarely had I seen a physician opt to rescind the first involuntary committal of another physician and allow a patient to return home. “Any time the word suicide is mentioned in an ER, the docs are going to err on the side of safety and sign that second committal. It takes them off the hook and puts it back on the accepting psychiatrist who will evaluate you in the morning.”

“That’s not fair in my case,” she says.

“I don’t disagree with you,” I say, “not at all. But, it’s not such a bad thing to go upstairs and let our psychiatrist talk with you in the morning. The one who’s on call will listen to you. Who knows… it might play out in your favor if you can convince the psychiatrist that your husband set you up.”

“So what are you telling me?”

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“I want to believe your story.”

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“Again, it’s your right to refuse to sign in. But…” I hesitate, waiting on her to make eye contact, which she does. “Our ER doc is simply going to sign another committal paper on you, which, by law, can hold you for up to seventy-two hours.”

She looks at me with eyes that want to cry foul.

“I’m not saying it’s fair,” I say, “but that’s the reality of the situation. And, someone will need to speak to your husband to hear his side of the story, and if possible, speak to anyone else who can confirm or deny your situation. Any time it turns into a ‘he said, she said’ scenario, both sides must be contacted and, if needed, a face-to-face meeting lined up here on hospital grounds.” I again hesitate, hoping the mouthful I just shared sinks in. “I want to believe your story, but unless I have a way to address your husband’s side of the story, then there is that chance that he is telling the truth. You understand what I’m saying?”

She nods and hangs her head.

I lean in and try to comfort her. “Take advantage of the situation. Use our staff and doctors to help your cause so that you don’t wind up losing custody of your child if your husband turns this into something real ugly. Hopefully, he will come to his senses and the two of you can use this time to work something out. Staff will work with you, and your husband, if he’s willing. From what you’re describing, he’s got a lot of issues to work through as well.”

She nods her head, forces a smile, and agrees to sign in voluntarily. I hustle back to the Birdcage where I briefly share my case with teammates, all of whom agree that the patient is in for a tough road ahead, no matter what she decides to do. As convincing as she appears to me, for all I know she may have threatened to kill herself. It wouldn’t be the first time that a scorned spouse threatened suicide with the hopes of bringing his/her spouse back into the fold. Then again, her case is eerily similar to several other cases I’ve had whereby soldiers returned home from deployments, only to discover that their post traumatic demons led them down destructive paths for themselves and their loved ones.

“Can you come with me?” I motion her to follow me into the assessment office. “The last two things we have to do…” I say as I pull my chair in next to hers. “With any valuables you have… money, jewelry, ID’s, credit cards, or sharp objects, we have to lock them up in the safe.”

She leans back, sighs, and looks down at her purse. “You can’t just lock up the entire purse?”

“I wish…” I say, pulling one more chair in to assist with what often takes longer to do than the actual psych assessment — wading through a woman’s purse, making sure every bobby pin, penny, and remnant of make-up is checked to ensure some type of razor or drug is not hidden. And this is just the cursory personal belongings search and list. The first thing that happens when she gets to the unit is a body search. The nature of what we do, sad to say.

 “The last thing,” I say as I reach into my pocket and pull out a camera.

“Your joking?” she says, shaking her head.

“I’m sorry.” I squat down on one knee and raise the camera to my face. “Everybody hates this,” I say. “The picture goes on your chart. Just another safety measure.”

She pulls her hair back and dabs her eyes.

“You ready?”

She nods, a sadness engulfing her face as I count off. She manages a half-hearted smile as I say three and click the button. “Ok…” I stand and grab the valuables envelope. “Give me a second to print this picture off and I’ll walk you up.”

She nods and sinks into the old chair.

I rush into the Birdcage, pull the camera chord from a co-worker’s computer, plop down in my chair to print the pictures and call the unit to let them know we’re on our way up.

I gently knock on the half-closed office door. “You ready?” I say.

We ease towards the side door as a packed house watches the TV mounted to the wall. I key the door and lead her down the back hallway.

“Where are you from?” I ask.

“Pittsburgh, originally,” she says, walking beside me as we enter the back hallway.

“Steeler fan?”

She smiled momentarily. “Definitely.”

“Have you had to move much in the past five years?” 

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“So how long will I have to be here?”

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“Not really. We’ve been in this area for the past three years, although he’s been deployed two of those years.”

I key the last door leading out to the main hallway and the elevators. Moments later, we step out of the elevator and start down the seventh floor hallway leading to an adult psych unit with non-violent, non-psychotic folk from all walks of life.

“So how long will I have to be here?” she says nervously.

“It’s up to you and your psychiatrist, and the treatment team,” I say as I round the corner, the unit’s, secure, double doors plastered with two hideous signs: one blood-red octagon-shaped sign which says “Elopement Risk” in large white letters; the other sign a brilliant yellow with the words, “Heightened Elopement Risk” in large black letters. I knew what was coming next.

She stops about fifteen feet from the door and turns towards me. “You said that this unit…” She turns and reads the signs again, then points at them. “You said…” Tears stream down her face. She tries one more time to speak but can’t.

“Hey…” I gently touch her arm and direct her past the entrance to a less traveled part of the hall. “It’s okay. The one sign is always up to remind housekeeping and food services staff…”

“Remind them of what?” she stammered, her fear turning to anguish and anger and a depth of hopelessness few genuinely know.

“There are always patients who don’t want to be here, okay?” So, yes, there may be someone who has threatened to leave, or perhaps their discharge ride is late. It could be that staff forgot to take the sign down, I don’t know.” I wait on her to give me eye contact.

She obliges.

“Staff is here around the clock and always aware of what’s going on, okay?”

She nods and hangs her head.

“It’s a good program,” I tell her. “Staff will listen to you and try to help. That’s all we want to do here – get you back on your feet and back home as soon as possible. But…” I wait again for her to look up.

She hesitates, wiping her eyes before turning her troubled gaze towards me.

“Use this time to figure out what you need to do, okay? These people can hopefully help you get on the right path.” I pat her on the shoulder and slowly start back down the hallway towards the stress unit entrance.

“Hey…” she calls out to me.

“Yes ma’am…“ I turn and nod.

“Thanks…” She forces a smile.

I smile and nod again, cueing her to proceed. I unlock the entrance and escort her onto the unit, relieved, as always, that we made it.  “C’mon…” I say to her, well aware that she is back in fear / panic mode after hearing the door close behind her and looking down the hallway to see four or five patients standing around the nursing station. “It’s okay…” I say, prompting her onward.

“What’s going on?” she asks, appearing genuinely afraid, and probably for good reason that she’s not aware of, given the number of personality-disordered bipolar patients with addiction issues on the unit at any given time. Live with a hundred-bucks-a-day drug habit and one learns to hustle with the same Hollywood façade that I utilize to survive another night in the Birdcage.

“Probably getting their night time meds,” I say to her. “You’ll meet with the nurse here shortly, just the two of you.” I stop about ten yards from the harried nursing station where one older male patient whines endlessly about needing something for his nerves and his pain. I turn towards her. “Be sure and tell the nurse everything you told me. And now’s not the time to be shy, okay? Use this time, learn from it and solicit their help in your fight to keep your daughter, if that’s the way it plays out.” I look right into her sullen brown eyes, holding her gaze for the moment. “Don’t give up hope… And faith… You do what you need to do.”

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Tears stream down my face

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She nods and smiles one last time.

Three minutes later, I stand outside by my old oak friend in the dark of night, its massive century-old trunk standing stout, like a proud father. I gaze westward, towards the city lights. Tears stream down my face, a mixture of raw, pent-up emotions, always grateful and thankful for the opportunity to genuinely reach out and touch a troubled heart, if only for the briefest of moments. The caring is there. However, I’m always in my “closest I’ll ever get to Hollywood” mode of operation, a behavior management magician who knows how to work the patient and the situation, get a disposition, and move on to the next case. It’s the art of the moment for me – to quickly interview and interact with individuals in such a way so as to glean information and disposition accordingly, all the while making each patient feel cared for by me. Until I hand them off and move on to the next case. Ninety-five percent of the time anyway. It’s cases like hers that touch me deeply. Scenarios that, regardless of where the truth lies, play havoc with peoples’ lives and rip families apart, all too often leaving the children scared, splintered and hopeless in the process.