rooms we were to use in the ramshackle outpatient clinic, but we’d so far failed tokeep our promises to each other: no posters had been tacked to the walls, no curtains had been hung.
T. harrumphed and straightened some papers. Scott had prepped me for my month with her by suggesting that he found her disagreeable, which made me feel a delectable kinship with her right off the bat despite her apparent commitment to sparing all pleasantries. She and I had known each other, though not well, for a couple of months. She’d been teaching what was so far the interns’ favorite seminar, on inpatient intake. Every Friday since late July we’d been filing down to CPEP—the official name for the G Building’s ER, the Comprehensive Psychiatric Emergency Program—to watch her interview a person fresh to the place. With patients she was often gentle, but when she spoke to anyone else, she almost always sounded as if she were scolding them.
“You weren’t here yet. Dr. Brink was just trying to be helpful,” I said.
“I doubt that,” said T. “Anyway, I will give you the key to my office so you have somewhere to put your things when you arrive before me. You usually come in at nine, right?” I nodded. She reached into her bag. “I wasn’t supposed to make a copy, so don’t tell anyone you have this,” she instructed. There were so many secrets and allegiances to track.
Dr. T. went on to give me a brisk primer in how things worked in the psych ER. Patients could arrive in two ways. About half walked in on their own asking for evaluation or admission. Not everyone who requested admission was granted it, but when they were deemed suitable, they could sign the papers for a voluntary stay. The others were brought involuntarily by police or paramedics dispatched by concerned third parties. Involuntary admissions required an applicant, usually a family member or hospital administrator, and thenthe signatures of two physicians: medical doctors of any variety, but not psychologists. At this I raised my eyebrows, to which T. gave a hurried shrug. She had little time to mind such territorial disregard for her expertise.
“My job here, and the one you will be helping me with, is running the EOB, which stands for Extended Observation Bed unit. It’s for patients who aren’t well enough to leave right away, but who aren’t necessarily sick enough to be admitted upstairs to an inpatient unit. We admit people to EOB when we believe they are likely to become stable within seventy-two hours. At the end of seventy-two hours they ‘time out,’ which means they’re either discharged or sent upstairs. Did you notice the two rooms at the end of this hallway? There are three EOB beds in each. One room is for women, the other for men.
“I see each of the EOB patients every day to talk to them and check on their progress. You will be running a group first thing every morning for the six patients. It’s as much a community meeting as a therapy group. The idea is that EOB is milieu treatment, which means the environment itself is therapeutic. The ER can be a difficult place to be. You’re held here, and there’s no one to ask questions of. The psychiatrist comes by for a minute, a nurse, maybe a social worker. Lots of tension builds up. The group is really important because it’s where patients can get information and have a chance to voice what it’s like to be here. Your job is to help them think about why they’re here and how they can use this environment positively.”
Dr. T. explained some particulars of the group and added that once it wrapped up each day, I would generally spend the rest of my morning in the ER seeing patients with her. She suggested I walk around and get acclimated. “Make sure totrust your instincts out there,” she said, gesturing toward the hallway. “Rely on your feelings. If a patient is making you anxious, walk away. Move slowly, make eye contact, speak soothingly—‘Come, let’s get some
T. harrumphed and straightened some papers. Scott had prepped me for my month with her by suggesting that he found her disagreeable, which made me feel a delectable kinship with her right off the bat despite her apparent commitment to sparing all pleasantries. She and I had known each other, though not well, for a couple of months. She’d been teaching what was so far the interns’ favorite seminar, on inpatient intake. Every Friday since late July we’d been filing down to CPEP—the official name for the G Building’s ER, the Comprehensive Psychiatric Emergency Program—to watch her interview a person fresh to the place. With patients she was often gentle, but when she spoke to anyone else, she almost always sounded as if she were scolding them.
“You weren’t here yet. Dr. Brink was just trying to be helpful,” I said.
“I doubt that,” said T. “Anyway, I will give you the key to my office so you have somewhere to put your things when you arrive before me. You usually come in at nine, right?” I nodded. She reached into her bag. “I wasn’t supposed to make a copy, so don’t tell anyone you have this,” she instructed. There were so many secrets and allegiances to track.
Dr. T. went on to give me a brisk primer in how things worked in the psych ER. Patients could arrive in two ways. About half walked in on their own asking for evaluation or admission. Not everyone who requested admission was granted it, but when they were deemed suitable, they could sign the papers for a voluntary stay. The others were brought involuntarily by police or paramedics dispatched by concerned third parties. Involuntary admissions required an applicant, usually a family member or hospital administrator, and thenthe signatures of two physicians: medical doctors of any variety, but not psychologists. At this I raised my eyebrows, to which T. gave a hurried shrug. She had little time to mind such territorial disregard for her expertise.
“My job here, and the one you will be helping me with, is running the EOB, which stands for Extended Observation Bed unit. It’s for patients who aren’t well enough to leave right away, but who aren’t necessarily sick enough to be admitted upstairs to an inpatient unit. We admit people to EOB when we believe they are likely to become stable within seventy-two hours. At the end of seventy-two hours they ‘time out,’ which means they’re either discharged or sent upstairs. Did you notice the two rooms at the end of this hallway? There are three EOB beds in each. One room is for women, the other for men.
“I see each of the EOB patients every day to talk to them and check on their progress. You will be running a group first thing every morning for the six patients. It’s as much a community meeting as a therapy group. The idea is that EOB is milieu treatment, which means the environment itself is therapeutic. The ER can be a difficult place to be. You’re held here, and there’s no one to ask questions of. The psychiatrist comes by for a minute, a nurse, maybe a social worker. Lots of tension builds up. The group is really important because it’s where patients can get information and have a chance to voice what it’s like to be here. Your job is to help them think about why they’re here and how they can use this environment positively.”
Dr. T. explained some particulars of the group and added that once it wrapped up each day, I would generally spend the rest of my morning in the ER seeing patients with her. She suggested I walk around and get acclimated. “Make sure totrust your instincts out there,” she said, gesturing toward the hallway. “Rely on your feelings. If a patient is making you anxious, walk away. Move slowly, make eye contact, speak soothingly—‘Come, let’s get some
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