The Phones Are Restless

This month I’ll be spending one afternoon a week at our local psychiatric emergency room which, rather bizarrely, is called the H____ K____ Psychiatric Pavillion, which is an extension of the county hospital. I'm not sure what definition of the word the architects had in mind here. I guess maybe they hoped, through a chain of connotation, to evoke a wholesome county-fair ambience – if so, it didn’t work. The Pavillion is actually a complex of permanent buildings which are locked and lightly guarded. There is an emergency room where voluntarily and involuntarily committed patients are evaluated, and series of locked wards totalling sixty-odd beds where those deemed to be a danger to themselves, a danger to others, or gravely disabled can be admitted for short stays. Most patients are discharged from the emergency room, and a smaller proprotion are admitted. Of these, a very small proportion may end up as long-term patients in one of the four (4) State mental hospitals which survivied Ronald Reagan’s governorship – although most of our patients are “civil” rather than “forensic,” and only two State hospitals even admit the non-criminally insane, and their beds are divided between fifty-eight counties.

I’m only working in the emergency room. It is very unlike a normal emergency room in that there is almost no medical equipment. There is almost nothing at all, really. The main patient care area is a large square atrium, maybe sixty feet on a side. It contains only some built-in benches cushioned with blue mats attached with velcro, a few heavy articulated chairs that can fold down into beds, and a several smaller molded plastic chairs. The unifying principles of design are 1) that everything should be easy to clean and relatively proof against human body fluids, and 2) that nothing should be possible to use as a weapon. There were about twelve patients there today, milling and lolling around, all wearing unisex blue pajamas and yellow socks. All of them will either have committed themselves or, more likely, been brought in against their will on a psychiatric hold. Along the walls of the atrium are a few side-rooms which have only a single bed equipped with restraints in the middle of the floor. The pyschiatrist showing me around took me into one and pointed back the way we had come, above the door, where there’s a ledge that hides some recessed lighting. “If you don’t see the patient through the window in the door,” she says, “They may be on the ledge. In that case it’s probably best not to go in, especially by yourself…” I don't know what the architects were thinking when they designed locked rooms for violent psychiatric patients with ledges over the door, either.


This is a rather chaotic milieu in which to attempt a psychiatric interview, although the psychiatrists who work there have all evolved their own strategies for dealing with it. I tried seeing a patient today over by the phones – I thought this had the advantage of A) being near the nursing station so that I was easily visible to potential help (a doctor who was interviewing a patient in a private room was actually killed at this facility several years ago) B) being near the window, and therefore maybe attenuating the sense of confinement my patient was experiencing and C) being away from the other patients, since the phones are off a corner of the atrium. I didn’t really need to worry about any of this, since my patient wasn’t concerned about being overheard and was completely non-threatening. He had been picked up by the police wandering in the middle of the street trying to touch moving cars and spitting on payphones, with whom, he had apparently said, he was “at war,” but he wasn’t particularly bellicose at the moment - the phones in the Pavillion are free and can only receive calls, which I guess makes them neutral in this particular conflict.


What I didn’t initially realize about my choice of venue was that these are the phones people call to talk to relatives and friends who have been committed, and that they ring in incredibly shrill electronic tones so that they can be heard in the atrium. Moreover, the reception system is rather singular. The first time one rang, I didn’t realize it was the phone and was glancing around nervously in case it was some kind of alarm - but I took a cue from the nurses, who didn’t seem worried. A tall, elderly man in fifties-style glasses with a thick mustache loped around the corner and shot me a resentful look before answering the phone. “Hello, H_____ K_____ Psychiatric Crrrrisis,” he said in a deep and assured voice. He was wearing blue pajamas. He was an inmate. “Ah, yes, hang on a minute.” He padded back over to the atrium and returned with a teenaged boy wearing only an open-backed hospital gown. The boy picked up the phone, and the old man walked back to the atrium.


“Hey look,” said the boy, “I’m really sorry. I just…my mind was just racing, too fast for me to handle. I don’t even remember half the shit I did yesterday.”


Meanwhile my patient was trying to explain that he had been misquoted regarding the payphones by anti-payphone propagandists, and that while he had, for unspecified reasons, destroyed a pumpkin all he was really trying to do was return a lady’s wallet which he had found in the street, even though nobody had ever returned any of the five wallets he had lost over the years.


The phone rang again. The ad hoc receptionist returned. His look said, You know, I’m sitting all the way out there. It wouldn’t kill you to answer the damn phone.


“Hello, H______ K______ Psychiatric Crrrrisis… Well, I don’t know if he’s….Hang on, I’ll check.” He made for the atrium and returned a second later. “Yeah, I’m sorry. He’s a little too out of it to talk to you now. All right. Sorry about that.”


The patient was now explaining to me that all you really need, in the end, to make sure that “you have the four basic food groups, and dabble in drugs and alcohol a little.” I had been struggling to get a word in during his gregarious redaction of the police account, and I jumped in with the one question you’re always supposed to ask if you forget every other question, which in this case was a total non-sequitur and made me sound like an idiot: “Do you ever have any thoughts about harming yourself or other people?"


The boy was still on the phone: “No, they shot me full of something intravenously…No, after the police brought me to the emergency room…I don’t know, I was blacked out.”


“Naw, man,” the patient was saying, “never that, never that…”


The phone rang again, and the receptionist returned. This time he looked really incredulous – You can see me getting up to do this every time, he seemed to say, and yet you sit on your ass asking stupid questions. What’s wrong with you? Answer the phone!


“Hello, H_____ K_____ Psychiatric Crrrrrisis….Yeah….Oh, no, I think he’s been discharged. Yeah, he’s gone. Sorry.”


So next week, I’m not sitting by the phones. Aside from the constant interruption and the distracting conversations, I can’t deal with the guilt-trips. I assume today’s receptionist will be gone by then, but this seemed to be the standard arrangement so I imagine someone will have taken his place, who will probably be equally apalled by my lack of initiative. I’m looking forward to finding out what other administrative functions are open for impromptu staffing by the committed.

The author would like to R. Eley for her awesome techno-skills, which made this post better than it would otherwise have been.