August 10 Once upon a time a therapist had a patient who was planning to kill some people and then herself. She was very intentional and very much in control, so he sent her to be admitted to inpatient psychiatry. Shortly thereafter he got a phone call from the admitting psychiatrist, who said that he could not admit her because he would not be able to work with her.
“And why would that be?” asked the therapist
“Because she uses inappropriate language,” replied the psychiatrist.
“And what was it that she said?” asked the therapist.
“She used an inappropriate word to describe sexual activity,” replied the psychiatrist.
“You mean she said ‘fuck’?” asked the therapist.
“If you must use the word, then yes,” replied the psychiatrist.
People being admitted to inpatient psychiatry have high levels of frustration, anger, pain, fear and terror. Their language accurately communicates their distress. You accept it because it is theirs, and you don’t force your moral judgments on other people. You might say to the patient, “I’m not used to that kind of language and it makes me feel defensive and like I want to distance myself from you. You might want to think about dialing it down.”
Alternatively, you can be a mature professional, recognize the patient’s autonomy, and simply let it go. In the past five years there only have been two times when I told people they “couldn’t talk that way” in my presence. One occasion was when a computer technician in my living room called an Indian a “towel-head.” The other was in a medical transport van when the company owner, who was driving, referred to one of his employees as a “nigger.”
Yesterday a medical director at St. Joseph’s Hospital decided that because there are no immunologists here, I should be referred to Cleveland Clinic in Ohio for higher level evaluation. He left my room saying that he would ask the discharge planner to work on getting me to the Cleveland Clinic. I didn’t hear from Liza Ebert, who is a really capable, reasonable, logical, hard-working discharge planner, as well as a really, really nice person, so this morning I asked for her.
Instead I got Brendan, who identified herself as the head of case management/discharge planning. Pretty lady wearing a pink suit, stockings and high heels. She said that Liza is off today, and that my doctor has to call Cleveland Clinic and make the referral before Liza can work on the discharge. That makes sense to me, but I told Brendan that it would have been nice if somebody had told me that yesterday—you know, keep the patient in the loop.
Well, we had a chit-chat about this and that, which led to the fact that St. Joseph’s Home Health Care won’t follow me when I go home. They won’t follow me because St. Joe’s has filled my chart with all this psychiatric history. St. Joe’s has blackballed me with their own agency. I get mad and tell the pretty lady in the pink suit that I want St. Joe’s own screener to put her ass in the chair in my room and go eyeball to eyeball with me.
The pretty lady in the pink suit turns and flounces out of the room, saying, “I won’t be talked to like this!” She would rather have you, the taxpayers, continue to pay $1200 a day to keep me inpatient than listen to an angry patient who just wants to get the hell out of her stupid hospital. Instead of accepting the patient where she’s at, Brendan is demanding that the patient talk nice and help her pretend that everything’s all right. That’s one person’s moral judgment and it has no place in another person’s discharge plan.
August 11 The Good Guys at St. Joe’s
My morning usually starts with Josh. Around 6:00 a.m. I push the call bell and he comes in to empty my catheter bag. He comes in quietly and maintains a low demeanor. He says good morning. If I’m awake enough to want to talk, then we do. If not, then he leaves me alone. This is excellent behavior for a night nurse. He should give lessons. Half the night staff workers go around booming and stomping and turning on lights. They need to be reminded to use their “night voices.”
Josh was a Marine, then an EMT, now a nurse. You don’t see many nurses with the array of tattoos that Josh has—a lot of Navy, some mid-east mystical kinds of things, and a row of figures that I don’t recognize around his bicep. I ask what they are and he answers, “Pac man.” Sheesh. You gotta have a sense of humor and a sense of balance. He practices yoga and comments on the Bhagavad Gita on my table. Mature spirituality is a necessity for the good life.
Then there is Brandiss, a young sassy black woman who was at my bedside with Teresa. From their conversation, it was clear that Brandiss was a newly minted registered nurse. It was a Thursday evening and Brandiss was about to stick a Foley catheter in me. I asked her when she got her R.N. and she said, “Tuesday.” Freak! You really seriously never expect to hear “The day before yesterday.” Brandiss and I had some good fun while she worked, and she honored me with the declaration that—if I wasn’t so pink—I’d fit right in at her family reunion.
Brandiss came to me one day when I was in utter, unbearable torment. She held my hand while I wept, comforted me, and listened to learn what the problem was. Then she went out and sort of built a protective shell around me until I was better. Brandiss is a whole person—laughter and comfort and hard work all fully integrated. She is a complete woman who works as a nurse; she brings her whole self to the job, which is delightful and reassuring.
Then there is Christina, who is the Foley Queen. That might not seem like a great title but, trust me, having a nurse who can insert a Foley catheter on the first try is like knowing the Seal 6 team has got your back. The job will get done and it will get done right the first time. Christina would like to become a hairdresser, too—be a nurse-hairdresser who can make the patient feel better in lots of ways. She says she likes taking care of people. I don’t get that. I can’t stand having people be dependent on me, but I’m real glad there are people who are into that. Christina’s a stand-up woman. She knows her own mind, and uses discretion in speaking it. . .