“John, I’m so sorry. Can I have a minute or two to think about this? How to go about it. Certainly, I would have to arrange for some staff to go with her.”
“If I had minutes to give, I’d give Chaney and Merritt a million of them. Take the minutes you need, but the account we’re using is almost empty. Do what you can. Please be humane about this. And please hurry.”
I needed permission from the ward chief or the medical director-or someone with some similar clout-to authorize a radical departure from hospital policy for a patient who was on suicide precautions. But I didn’t have the luxury of time to move the system to compassion.
One of the enduring lessons of my years working in hospital settings is that if you want something difficult, or impossible, accomplished, find a nurse with some courage and cunning. So that’s what I did.
The head nurse of the inpatient unit was a tall woman with wispy hair and a quick smile. As far as I could tell, she was as firmly rooted as a giant redwood. During moments of crisis, only if you looked incredibly closely could you detect the slightest sway in her.
I walked to her office door and found her packing her things into a big canvas bag in preparation for heading home for the day.
“Georgia,” I said, “may I speak with you for a minute?”
She pulled a Toy Story lunch box from inside the canvas bag, shook her head, and said, “I ended up with my eight-year-old’s lunch box today. How did I do that? God knows what he ate for lunch. Do you ever suffer temporary brain death? I’m sorry. I’m rambling. What can I do for you?”
“May I close the door?”
“Uh-oh. Can it wait until tomorrow? I can give you, gosh, ten whole minutes tomorrow. Teacher’s conference tonight, I have to pick up some food for the kids and their babysitter. It’s bad form to either starve the children before a teacher’s conference or to be late. Do you have kids, Alan?”
I shook my head. “I’m afraid it can’t wait; I wish it could. And no, Georgia, no kids yet.”
She looked at her wristwatch and sighed the sigh of overburdened managers everywhere. The one that said, “They don’t pay me enough for this.” She waved me to the empty chair by her desk and closed the door behind me.
She didn’t sit. “It’s your nickel.”
“I just received a call from Merritt’s father. He’s down in ICU. Merritt’s sister, Chaney, is deteriorating, may be dying. He made an impassioned plea for Merritt to visit her. He would like her to come down right now.”
Georgia sat. She dropped her coat and let the canvas bag fall to the floor. “God. God. God. Don’t you hate doing this some days? Listen to me, really, I’m bitching to you about having to run like hell to get to Boston Market before my kids’ teacher’s conferences and look at the alternatives life has to offer. Look out there, in the dayroom. Look at those poor kids. Or God forbid, look down in the ICU or over in oncology. I’m so ungrateful.” She dabbed at her eyes. “I’m babbling again. What do you need from me to make this happen?”
“I need the policies regarding patients being restricted to the unit during suicide precautions to evaporate, at least temporarily.”
“You can’t just d/c the precautions, can you?”
“No. With what’s going on right now, no. She’s still mute. Her sister’s in crisis. And I take it you heard about the arrest?”
She shook her head.
“The Boulder DA went public that they have an adolescent female suspect. Merritt knows about it. And now Chaney may be dying. I can’t d/c precautions or increase privileges with those stressors on the table.”
“Is she about to be arrested?”
“No way to tell. It could happen anytime, I imagine, based on what I saw on the news.”
Georgia’s tongue was between her upper and lower teeth. Her lips were parted. She said, “Don’t worry about the administrative side. That crap won’t jell before tomorrow. Write the order for the ICU visit. I’ll get staff and security lined up to go with. We’ll take her on the road and worry about policy and procedure in the morning if this thing goes south, and hopefully it won’t. There’s no time to discuss it with anyone, right?”
“Right.”
“I’ll leave a message for Joel, he should know what we’re doing. And I’ll have my players together up here in, like, five minutes. You get her ready, okay? Let her know what’s expected of her and let her know that she’ll be surrounded by sumo wrestlers.”
I wanted to kiss the head of the head nurse. I said, “Thanks, Georgia, a lot.”
“The karma price is too damn high for some omissions in life. Refusing this visit, I’m afraid, would be way off the negative karma scale. No thanks are necessary.”
To ensure against omissions of my own, I phoned down to the ICU, identified myself, and asked to speak to Chaney’s nurse. The ward clerk said she wasn’t available.
I asked, “How is Chaney doing?”
Quick exhale. “Bad. Real bad.”
“Thanks, I’ll call back.”
I felt guilty for checking on John Trent. But at least I knew that he hadn’t been lying.
Nineteen
My feelings were jumbled, which is not a good posture for a clinical psychologist during a crisis. The strongest feeling I had was that I wanted to protect Merritt from the world. From death, and tragedy, and neglect, and hostility, and loss. Right then, I didn’t much consider the atrocity she was accused of committing. I only wanted to shield her from the horrors that hovered nearby. I knew my feelings were paternal, and not therapeutic. But they were as big as life and I couldn’t ignore them.
Paradoxically, my actual job was to protect Merritt from herself. Despite all the objective evidence-and given a near-fatal suicide attempt, I didn’t require much more objective evidence-I was having trouble convincing myself that she was actually in grave danger of self-destruction. If there was any ambivalence on my part about permitting Merritt to visit with Chaney in the ICU, it wasn’t about fear that she would attempt suicide while free of the safety of the adolescent psychiatry unit. Rather, it had to do with an ill-conceived sense that nothing awaited her downstairs but further pain and suffering.
I didn’t want her to have to experience that anymore.
If Chaney survived this night, it was likely that a night where she didn’t survive was lurking on a near horizon. The cards determining this baby’s eternal life were being dealt by fate, or by some callous God I didn’t want to contemplate, or by some bureaucrat at MedExcel. I felt an absolute helplessness that I could do nothing to prevent Merritt from feeling the pain of watching her sister die. All I could do was help her prepare for it.
In the meantime, though, I was charged with keeping Merritt alive during the visit to the intensive care unit.
With that I had some help. Three counselors who had volunteered to stay after shift change and two uniformed hospital security guards accompanied Merritt and me on the journey from the fourth floor to the second. One of the guards used a key to make sure we had an elevator to ourselves on our way down to the ICU.
As we made our way down, I had an eerie sense of having come full circle with Merritt. I had met her days before in an intensive care unit and now she and I were on our way back to one. The circle, I hoped, wasn’t really complete. Being surrounded by benevolent guards and having a little sister near death was no way to complete it.
Merritt’s poise was remarkable. She hadn’t panicked when I told her that her sister was in a new medical crisis. Merritt had stood from her bed as soon as she heard my words, expecting to be taken immediately to her sister’s bedside. Assuming it was her right to be there.
Which it was, of course. I wasted a minute or two telling her about suicide precautions and warning her that staff would be with her at all times.