Authors: Judith Townsend Rocchiccioli
It
was after two am when Angela finally stood in front of the first of two locked
metal exit doors. This one bore the scars of countless chair and table strikes.
The institutional grey paint was scratched and the graffiti had not been washed
off for a week. She fumbled with her keys and finally got the key in the lock
and urged the heavy tumbler to turn. "Damn," she cursed glancing at
her watch and noting the time. She wished she had called the child care center
in the main hospital to tell them how late she would be picking up Jessica. Oh
my God, I am three hours late, she thought. They're going to kill me over
there. She felt her pulse race with anxiety as she considered how upset her 16
month-old daughter was going to be when she woke her up to take her home.
I've
got to get a new job
, she thought. This psych unit is
killing me. She closed the door and heard the reassuring click as it
locked. She walked down the short hallway to the second of the two locked
doors. This one only bore a couple of scars, but they were deep. She didn't
remember who it was or when, but one of the patients had followed a staff
member through the first door with a broken off chair leg in hand. Most of the
blows had landed on the unlucky staff member. A few had landed on the door.
The door had survived - the staff member had not.
I
never get off on time
, she thought. She glanced behind her
just once to make sure nobody was in there with her, then she unlocked the second
door. Once through that door, there was a long hallway, then an exit door
with a push bar. The second door closed behind her and she made sure it was
locked before she walked down the long hallway. Boy, it’s dark out there, she
thought as she peered through the glass windows of the hallway. Sensing
freedom, she pushed on the bar to open the door to the outside. The elation
was short-lived.
The
heat smacked Angie in the face as she walked into the August night. The air
was close and heavy. A crimson-tinged bolt of lightning highlighted the sky
for an instant, then things went dark again.
Thunderstorms
, she
thought. “I've got to get home soon. Jessica is scared of thunderstorms and
lightning and she will freak out if it happens in the car.” She walked quickly
through the darkened path towards the parking lot. She looked around and told
herself she was alone. It's pretty spooky out here, she thought. For a
moment, she considered calling security, then she remembered that it would take
at least thirty minutes for the guard to get over to the Pavilion. Besides,
if he were busy, it could be twice that time.
With
the cutbacks heralding the new health care act, there was only one security
guard on the night shift now. There used to be three or more guards, even on
weekends and now there was only one roaming guard and one - Jason - in the
forensic psych unit where Angie worked. After all, it is New Orleans and even
post Katrina, the crime rates were startling.
Angie
continued the trek to her car,She continued to reflect on the Pavilion as she
walked to her car. Now psychiatry was a money-loser, a liability to the
bottom line -- and CCMC, a world-class hospital, wasn't about to spend large
sums of money to safeguard patients or staff. Managed care payment systems
made it almost impossible for you to be crazy, have a breakdown or recover from
prescription or street drug abuse or alcohol. Reimbursement had all but
disappeared and with health reform on the horizon, it would only get worse. The
mental health system in the US was sadly and severely broken, irretrievably so,
perhaps. In fact with everyone getting care under the new reformed system, it
was predicted that mental health care would increase steadily with shorter term
admissions. Angie shook her head when she considered just how awful the mental
health system was in the US. Depressed, deranged and addicted psychiatric
patients could no longer come in for a few weeks of therapy, get their meds
regulated, have a few art classes and play some board games to learn to control
their anger. Why, just last week they had discharged a newly diagnosed
Bipolar II female patient who had attempted suicide and been in a coma for 10
days with an aspiration pneumonia. She only stayed on the psych unit for two
days, because the patient promised, "I'll never do it again. I don't know
what came over me." Of course, her insurance didn't want to pay either
but the hospital would have been ethically bound to keep her if she had asked
to stay. In Angie's mind, that bordered on gross negligence. Suppose that
woman went home and "offed" herself with her small children in the
home? Worse still, suppose in her psychosis, she killed herself and her
family? It had happened before. What safeguards had been put in place? Oh,
I forgot, Angie admonished herself. She had two days of counseling and three
days of Lithium. At least that’s what the attending shrink had told Angie when
she questioned the discharge. That should do it. Yeah, sure Angie thought. She
was disgusted with the entire US mental health system. How in the world could
anyone get better in only several days? These poor, mentally sick, often
physically ill patients, were discharged back on the streets of NOLA or even to
their homes with no regulated medicines or skills to fight back against the
demons that endlessly plagued their minds.
Her
walk in the black night seemed endless. Even this late, the southern air was
stifling and viscous. She was sweating, but she felt cold on the inside. Angie
continued to think about the dangerous patient population at the Pavilion. Many
of CCMCs psychiatric admissions were initiated at the hands of the New Orleans
Police and the local magistrate who had them committed after they had been
picked up for a crime or some sort of outburst. Angie quivered again when she
thought of some of the deeply psychotic patients trying to live on their own. They
also had to medicate several of the most violent patients prior to bedtime. Angie
had doled out six Thorazine slurpees like they were health food drinks but even
then, the brutality was awful. She thought about it and then deliberately
pushed it from her mind.
When
she was honest, Angie admitted to herself that she hated working on psychiatry.
She hated it because she was afraid. And she knew the patients knew. It
was almost as if they could smell it on her. She could see the recognition in
their eyes when they realized it. They seemed to give her a secret smile. Many
of their eyes seemed to have an evil glint. Besides, on the critical care
units or in the emergency room, you could predict physiological changes in
patients. You knew if a patient was going to "go bad" and have a
heart attack or throw an embolus. You knew what to expect. But, in psych!
You just couldn't tell. You couldn't anticipate the interworking and short
circuitry in the minds of the profanely and criminally insane. They'd go off
at the drop of a hat over nothing. You could hand them their fork the wrong
way and they'd come after you. It was frightening. Many of the patients
were violent, criminals who had committed heinous crimes, yet CCMC cared for
them and she didn't mind caring for them. She just wanted to have enough
staff to work in a safe place.
Angie
continued her musings on the way to her car. Her background was critical care
and emergency department but there'd been an opening on the psych unit where
she could work just weekends and get paid for full time. This was ideal in
many ways as it allowed her time with Jessica. She could be the kind of wife
her husband wanted--at least most of the time. Besides, the money was good. Everybody
at CCME knew the Psychiatric Pavilion was the armpit of the hospital and that
nurses were paid a premium to work there because it was dangerous. The Pavilion
was also isolated, turbulent and chronically understaffed, especially now
because nobody really knew what health reform was going to do to psych care. Usually
Angie didn't mind so much. But the past three nights had been particularly
stressful for her, more so than usual. She had been on a different unit each
night and besides, Jessica had a cold and she always felt bad leaving her baby
in daycare when she was sick. Her Catholic guilt kicked in every time.
It
was darker than the blackest of nights, as an ominous feeling of dread hung
thick in the night air. Thunderstorms earlier in the evening had created a
mass of low, overhanging clouds that completely obliterated the moon.
Suddenly, Angie felt a chill come over her. She looked over her shoulder as a
quiver ran up her spine. Her legs tingled. Did she hear someone breathing?
She strained her ears. She didn't hear anything. The hum of the cicadas and
other night insects was deafening. Angela picked up her step, making a pact
with herself never to walk to the parking lot alone again. Not ever. It was
scary and unsafe. What in the world was wrong with her? Why had she made
such a reckless decision? After another minute or so she heard another
noise. It sounded like a set of keys hitting the pavement or, perhaps, like
metal hitting metal, she thought. Then, she heard a cough and a sigh of what
seemed like satisfaction.
Angie's
autonomic nervous system kicked in. Fight or flight! She started running for
her life, but was no match for her assailant. He quickly overtook her,
grabbed her by the hair, stuck a rag in her mouth, and pulled her over into a
crop of trees to the right of the road. Her attacker seemed huge and had a
large scarf tied over his face. His head was covered with a hat. Angie
looked into her attacker’s face as he leered over her. As her eyes adjusted
to the darkness, her pupils widened in disbelief. She knew this man! Her
heart was firing erratically and she was dizzy and weak with fear. Her
assailant looked at her and laughed.
"So,
you recognize me, you little slut bitch. We can't have that now, can we?”
Her assailant spat the words at her.
Angie
was paralyzed with fear. Her hands were pinned down and the assailant's knee
was in between her legs. Her captor outweighed her and was strong. She
couldn't move, but struggled against him anyway, trying to overcome his
strength. He let one of her hands go for a second while he pushed one of the
metal spikes into the soft ground. Angela's hand ripped the hat off her
assailant's head and she dug her nails into his hair, pulling as much hair out
as she could. She had wanted to poke out his eyes, but had missed.
"You
little bitch, I could kill you for that! How dare you touch
me
. You
are
one of them. The man slapped her, dislocating her jaw. Angie felt the
bone pop near her ear. The pain was overwhelming and she started to vomit.
This further enraged her captor and he slammed her face into the dirt, ripping
off her uniform pants. His intent was clear, but all Angie could do was lay
there and focus on the smell of the rotting vegetation on the side of the
road. She tried to detach herself from her surroundings. It didn't work.
She
heard him grunting while he pushed three more stakes into the ground, singing
quietly to himself as he moved methodically through his tasks, clearing old
leaves and trash out of his way and away from her. It was like he was
cleaning house. For a moment she thought he had forgotten about her and she
felt a bit of hope. But it was far-fetched. He turned to her, smiled
sweetly, and bit her on her shoulder. Angie screamed and then her attacker
hit her in the head with a piece of metal pipe.
Angela
felt the searing pain rip through her head and down into her neck and shoulders
with the first blow. The second blow didn't seem to hurt so much. Her last
conscious thought was how pretty the twinkling lights looked in the intensive
care unit in the main hospital building. She could see them clearly from
where she was and she wished she were working a double shift up there where
everything was predictable, where the patients were harmless and appreciative.
Then, finally, blessedly, she lost consciousness.
“Oh,
no, no ... no .... Oh, no ..., it can't be. It just can't be. This has to
be a joke and it isn't funny. Stop telling me these things. Angie's at home
right now taking care of the baby. She worked last night, she only works on
the weekends. Today is Monday," Bridgett insisted.
A
short silence followed as Bridgett continued to listen to the voice on the
other end of the phone. Her voice was confused, skeptical as she responded,
"You've got to be kidding me. This is wrong, wrong, WRONG! It's not
funny! " Bridgett's voice reached a fevered pitch as she continued to
argue with the person on the other end of the phone for playing games with her
about her sister. Finally, she slammed down the phone down and marched into
Alex's office, all legs, high heels, and long, blonde hair.
Alex
, the legal counsel for Crescent City Medical Center, looked up from her desk,
startled to see her normally good-natured, fun-loving secretary glowering at
her, full of rage. Bridgett could best be described as a blonde bombshell.
She was tall and beautiful. She wore bright colors and survived a full day in
the highest stiletto heels Alex had ever seen. Bridgett's big blue eyes
flashed anger and her voice was clipped as she addressed her boss.
"I'm
so mad, in fact, I'm pissed. Somebody from the E.D. just called and told me
Angie is a patient there and is all beaten up. It really isn't funny and it's
a sick joke. I know Angie's at home taking care of Jessica." Bridgett
glanced down at her watch and added, "Besides, it's 10:00 in the morning
and she worked
last
night over at the Pavilion. I know, because I
talked to her."
Alex
stared at Bridgett, confused by the conversation. "Who called you,
Bridge,” Alex asked, her voice soft and concerned.
“I've
no clue. I didn't hear their name. I'm sure it's a mistake, but I am still
pissed because they got the wrong person. They need to be more careful over
there. Besides, I'm too busy for this stuff today. I love to have fun and
cut-up, but not about sad stuff. This just isn't funny. It pisses me
off." Bridgett fumed, her blue eyes stormy with anger.
Alex
and Bridgett heard a knock in the outer office and stared as the door to Alex's
private office slowly opened. Crossing the threshold into her office were Dr.
Monique Desmonde, the chief of psychiatry at CCMC, Commander Jack Françoise of
the New Orleans Police Department, and Alex's old nemesis, Betty Favre, the
chief nursing executive at CCMC.
Alex
felt a cold, numbing twinge in the pit of her stomach and the hair on her arms
began to rise. She knew something was very wrong and surmised what was coming
next. Dr. Desmonde gave Alex a hard look, shook her head negatively and
turned her attention to Bridgett. Jack moved into a position behind Bridgett
and gently directed her towards the elegant sofa grouping in Alex's office.
Alex felt as though she were watching a perfectly choreographed production.
Betty Favre stood uselessly to the side of the group for a moment, studying her
bright red manicure, and then took a seat in a Queen Anne chair.
Alex's
heart was thudding as Monique motioned for her to join them on the sofa.
Bridgett seemed transfixed, unable to talk. She looked like a tall, beautiful
Barbie doll. Dr. Desmonde began slowly, "Bridgett, I'm afraid I've some
bad news for you."
Bridgett's
eyes were blank as she stared at Monique, a beautifully groomed, dark-haired
woman in her forties. Dr. Desmonde began gently, "Bridge, can you hear
me? We must talk, now."
Bridgett
nodded her head slowly. Alex could feel fear and uncertainty crawling up her own
spine. Her knees began to shake and her heart was pounding madly. It was
the same feeling she always had when something bad had happened. Alex felt her
knees jerking so badly that she was sure they would cause her feet to jump out
of her 4 inch heels. Jack touched her knee, realizing Alex's discomfort and offering
support. Alex gave the police Commander a small, tight smile.
Dr.
Desmonde continued, her voice soft, her eyes meeting Bridgett's straight on.
"Angela worked yesterday, Bridgett. She worked the 11am to 11 pm shift on
the psych unit."
Bridgett
interrupted Dr. Desmonde. "Yeah, yeah, I know. I tried to call her last
night. . I called early in the evening, but she was working on the prison
or forensic unit or wherever. We never spoke," Bridgett continued, the
irritation in her voice unmistakable. "The idiot from the E.D. said she
was over there and had been beaten up or something, said she couldn't speak so
I didn't believe them." Bridgett turned and noticed Commander Jack
Françoise at her side and addressed him, her brilliant blue eyes full of
anger. "Commander, can you do something about this? Someone is harassing
me about Angie,” Bridgett said as she started to rise from the sofa.
"I've got to go. I have a ton of work to do." Bridgett rose from
the sofa to leave, as if nothing real had just happened.
Jack
looked over at Dr. Desmonde who gave him a thumbs-up sign. He took
Bridgett's hands in his own and said, "Bridge, it's not a joke. Someone
hurt Angie after she left work last night. She was attacked and we didn't
find her until this morning and ...."
Alex's
heart lurched at the sight of Bridgett's big blue eyes. They were filled with
terror and uncertainty. Her pupils were huge, surrounded by liquid pools of
white. Her long blonde hair created a halo around her head. Alex wasn't
completely sure if Bridge understood what the police commander had said.
Dr.
Desmonde interrupted, "Angie's over in the E.D. They're going to take
her up to surgery and I thought you might like to see her before she
goes," Monique's voice trailed off, uncertain of Bridgett's level of
comprehension.
"Yes,
yes, I would. Is she OK?”
Monique
continued, slowly as she shook her head, "No. Not really. She is very
sick. In fact, she is in critical condition. She has a machine breathing for
her, a ventilator, and she has some head injuries. She has lost a lot of
blood. She also has some internal injuries and Dr. Goshette wants to do an
exploratory to be sure she isn't bleeding on the inside," Monique said.
"How'd
she get hurt?" Bridgett asked in a dazed and child-like manner as she
looked around the room. It was clear to all of them that Bridgett really
wasn't getting it. Alex couldn't help but be amazed at how good the brain was
at screening out bad news.
Being
the psychiatrist that she was, Monique tried hard to work through Bridgett's
shock and denial. She started again, "Bridgett, Angie was attacked and
beaten last night after work. She is very ill. Do you understand?"
Bridgett
nodded impatiently, "Yes, you told me. I'd like to go see her now, if
you don't mind. You said she was going to surgery, right?" Bridgett
stared at Dr. Desmonde as if she was a moron for not understanding her.
"Yes,"
Monique sighed. "Bridgett, you must understand that she has bruises and
cuts on her face and that ....” Monique stammered, searching for words,
"You must understand that she looks very different. Someone beat her
badly. Are you sure you're up to seeing her?"
Bridgett
nodded her head impatiently, "Of course, Dr. Desmonde, of course I am.
But it isn't all that bad, not nearly as bad as you say. Angie and I are
twins. If she were hurting badly, I'd be hurting too. It's always been like
that, since we were babies." Bridgett smiled and continued, "I'm
really not worried, let's go," she said looking around the group.
"Hurry up! I just need to get my purse."
Alex,
Jack, and Monique looked at each other while Bridgett went into her office.
Betty Favre had completely removed herself from the situation and was flipping
through a copy of "Architectural Digest” she'd removed from Alex's coffee
table. What an uncaring bitch, Alex thought silently to herself.
Monique
rolled her eyes at Betty, shrugged her shoulders and said, "Well, Bridgett
doesn't really get it. Angela looks pretty bad, and believe me she is really
hurting. The reason Bridgett isn't feeling any pain is because Angie is in a
coma."
Alex
was startled, "Oh no, is it really that bad?" She searched the faces
of her good friends and colleagues. Her crystal blue eyes locked with
Commander Françoise’s dark ones. "Please say it isn't, Jack," she
implored.
"Wish
I could Alex, but I can't. It's bad. It’s real bad. I'll fill you in
later. Let's get Bridge through this part first." Jack lifted his
large, bulky frame from the chair and moved into the outer office to help
Bridgett gather her things.
Dr.
Desmonde added quickly to Alex, "Jack's right, Alex. Angie is pretty
beat up. She may be bleeding internally. She has a skull fracture and some
seriously broken bones. Her jaw is broken, as well. She laid out there for
hours before anyone found her. She lost a lot of blood and Lord knows how long
she has been unconscious. Her crit, CBC are way down.”
Shsssst!"
Monique put her finger to her lips as Bridgett and the Commander returned to
Alex's office. "We'll catch up later.”
Betty
looked up from her magazine and spoke for the first time. "My secretary
called Bridgett's husband and he'll meet us in the E.D. They're looking for
Angela's husband. He is supposedly on his way. Favre's voice was flip and
tinged with sarcasm. Alex immediately moved into Betty Favre’s personal space
to confront her, but Monique waved her away while she motioned for Jack and
Bridgett to wait in the hall for them.
"Later,
Alex," she cautioned, "We have enough going on here and you're not
dying on the Betty Favre hill right now." Monique glared at Betty Favre,
"See me later, Ms. Favre. I want to discuss the concept of empathy with
you. And I
do
mean it.”
Alex
smiled to herself as she watched Betty bristle with anger and then felt ashamed
for enjoying the exchange. Dr. Desmonde was probably the only person at the
medical center who disliked Betty Favre as much as she did and this behavior
was so unlike Monique it was a bit shocking. They both had Favre’s number and
supported each other when the nurse executive ran rough shod over the staff.
Betty was uncaring, incompetent, inept and not very smart. Unfortunately, the
CEO, Don Montgomery, didn't share their opinion of Betty -- most likely because
they were very much alike. If you were to believe the hospital scuttlebutt,
they were lovers. Gross, yuck, is all Alex could think about that rumor. It
made her feel slightly sick.
As
Monique and Alex joined Jack and Bridgett in the hallway, Alex began to feel
angry about what had happened to Angie. For three years, Alex repeatedly
asked the hospital executive committee to at least move the psych units closer
to the main hospital, if not into the main medical complex itself. Of course,
Don had a shit fit over that one. He would never tarnish his
"world-class, prestigious medical center, soon to be a health sciences
center" with the likes of the crazy lowlifes of New Orleans and criminals
with HIV. He had even declared at the Board of Trustees’ meeting that he
would never turn CCMC into an insane asylum or increase the number of beds for
the psychiatric community. Alex doubted if he ever knew how much he had
appalled the Board or that he had made an enemy of Monique Desmonde for life,
which was probably not a good thing.
Needless
to say, Alex had met massive resistance from both Favre and Montgomery, who
had issued a joint press release suggesting that “psychiatry, while a
necessary albatross to any hospital, was CCMCs gift to the sick, poor, and
disenfranchised mental cases of New Orleans." Monique had seethed with
anger and it had taken her and Alex several bottles of Virginia wine to settle both
of them. Alex had always been afraid that an accident like Angie's would
happen and that someone, whether a patient, visitor, or staff member, would be
seriously attacked in or around the Pavilion. Now it had happened.
All
four were silent as they waited for the elevator to the ground level E.D. The
elevator seemed to take forever as it stopped on each and every floor. They
were met at the nursing station by Sandy Pilsner, the nursing director of the
emergency department. Sandy eyed her friends for some nonverbal direction.
She moved close to Bridgett, took her hand, and said, "Bridge, Angie looks
bad. Her face is black and blue, her eyes are swollen shut and she is hard to
recognize. We have IVs and bags of blood hanging and she has a tube down her throat
that is hooked to a machine that is breathing for her. She'll be going up to
surgery in a few minutes. We think she is bleeding internally because her lab
results are so bad.”
Bridgett
smiled brightly at Sandy. "Is Angie talking you to death. I know how
she is. She has never even been in the hospital, except for when Jessica was
born. Do you think we can even count that?" Bridgett seemed totally out
of it.
If
Sandy was surprised at Bridgett's lack of understanding, she didn't let on.
She said very clearly, "Angie is not talking. She's not breathing on her
own and she cannot talk to you. Bridge, do you understand me? She is very
sick. Maybe she can hear you, but she cannot talk to you. There is also a
possibility her assailant raped her."