Triage

This happened on 1st February 2007.

This is a continuation of madness takes its toll.

I met with a drowsy Stephen and his mother when they pulled up to their house. I was obviously buzzing at a hundred miles an hour. I wanted to take him straight to his psychiatrist and get him checked out. Like a car I guess. He was broken and he needed to be fixed… right away!

His mother was not so sure. As I have mentioned before, she was more comfortable with pretending there was no problem at all than dealing with it. At my insistence, Stephen called the clinic but didn’t get through. His mother called and she spoke to a nurse.

Now, his doctor had changed his prescription some days ago and he was going to be picking it up the next day. His mother called the clinic and found out he was (apparently) already supposed to be on a stronger dosage of anti-depressants. From one pill a day to four pills a day? It seemed fishy to me. This dosage turned out to be wrong, by the way, had Stephen actually gone on that dosage he would have been high on happy pills.

Jo asked me to take Stephen home with me again, and I agreed. I intended on taking him to the clinic right away to get more pills and speak to his doctor in person. There was obviously something wrong with his treatment and I wanted to find out how to get it sorted out.

Stephen was suspicious of his mother’s motives
“You just want him to take me so Patric doesn’t find out”
“No, of course not” Jo retorted hotly, “I’ll tell him everything”

This, I found out, was another one of Jo’s lies. She never told Patric about this event. I don’t know how she explained it away, but when I eventually told him about Stephen’s attempt, he was as surprised about it as he was about Stephen’s first attempt.

Anyway, so I took Stephen home with me and call his case worker, Theresa. After persisting some time I got through.
“Look, I’d like to bring him in, please, he attempted suicide today and…”
“Has he been to the emergency ward?”
“Um, no, he didn’t actually cut…”
“Well, it’s protocol, he has to go to the hospital and be medically cleared”
“Can’t I just bring him in to see you?”
“No, he has to be medically cleared first, it’s protocol.”
“Oh, ok”

So, the very next morning, I took the day off work and we planned a trip out to the emergency ward. Lacking any proper directions, I found the first place on the map that said “emergency” and drove in there. I must have made a rather comical apparition when I turned up at a random health clinic in Mesquite and asked the receptionist: “excuse me, is this the place where I bring people who have attempted suicide?”

“No”, came her very firm answer, he was to go to the hospital a few miles down the road.

So, we finally made it into the emergency ward. I pulled up into the parking lot and took a steadying breath, looking over to him for reassurance. He was staring off into space, trying not to let his hands shake visibly. He doesn’t like to show weakness. We walked into the ominous glass doors and Stephen filled out a little card. It was quite surreal watching him write “suicide attempt” as his reason for the visit. No sooner had we sat down than we were immediately ushered into a room marked triage: a room for deciding which people needed care now and which people could wait. I guess attempted suicide trumps most other ailments.

A pleasant young female nurse entered the room, introduced herself and started asking questions, writing the answers down on a clipboard:
What is your age?
Where do you work?
Do you have insurance?
What are you here for?
How did you plan on doing it?
Did you actually cut yourself?
Have you attempted suicide before?
Taken any alchohol?
What sort of medication are you on?
Have you been diagnosed with any condition?

Stephen got flustered and confused. I eventually interjected in a long nervous verbal torrent, counting my points off on my fingers as though I was giving a lecture on e-commerce: “He’s diagnosed bipolar, he’s been prescribed Tegretol, Paxil and Ativan by Dr. Starla Harrison at the MHMR, he recently attempted suicide with a box cutter… Wait, I have a visual aid.”

I fished the box cutter out of my pocket and brandished it as an illustration, I am pretty sure my hand was shaking violently.
She turned to me “So, are you Dad, then?” she asked, smiling kindly.

I hung my head and dropped it on my knees.

“No, he’s my boyfriend” Stephen responded with a proud smile “he’s really upset about the whole age thing and you’re not making it any better.” I shook my head in my hands. Just make him better, please God. Just make him better.

We were shunted into one of the emergency rooms and waited. About half an hour later a man disguised as a praying mantis loped into the door. He was ridiculously tall and gangly, with joints in places where most other people’s appendages end. He folded himself into a chair (his knees poking up comically) and he leaned reassuringly in towards Stephen.

“So, what are you here for, buddy?”
“I tried to check out early” Stephen retorted with his (now familiar) brand of cockiness that I detest.
“Attempted suicide” I elaborated “I have a visual aid…” out came the knife again. I kept that knife with me at all times for a whole week afterwards, as if my keeping it would somehow prevent him from harming himself. It’s known as magical thinking and it’s coping mechanism of sorts. Knowing the names of things is also a coping mechanism.

“Aaah,” the nurse sat back with a studied look of concern and caring on his face. He reached over and patted Stephen on the knee
“It’s always sad when someone looks to such a permanent solution to a temporary problem”. He looked Stephen in the eye with what I can only imagine is his very best look of fraternal love.
Stephen turned to me with a sardonic grin
“They teach them that in nursing school” he stage whispered.
“Be nice.” I retorted “he’s only trying to help.”

The nurse (I can’t remember his name, let’s call him John) asked the same questions and we gave the same answers. He dutifully wrote them down, as the first nurse had done and then summarily moved us into another room.

I waited there with Stephen for a good hour or so, holding his hand and reassuring him by rubbing his back or other such touching thing that couples usually do. Despite his bravado and cocky attitude, I knew he was very anxious. He is not a big fan of hospitals. His last visit to a hospital had been after he was found babbling incoherently on the side of the freeway with very bad sunburn. The longer he stayed here, the more he disconnected from reality. That’s also a coping mechanism, known as dissociation.

After a while I got up, leaned against the door frame and started watching the doctor nurses go about their business. That’s doctor, singular. I only ever saw one actual doctor in the whole ward. They say a watched pot never boils, but I find that if you watch every move someone makes, they tend to get uncomfortable and will put effort into making it so you’ll stop watching them. It’s human nature.

Finally, the doctor got around to seeing us. He seemed far more severe than the other people we had seen thus far. Perhaps one has to run the gauntlet of triage from the most nice and caring to the least before you can actually get some treatment.
“So, how old are you?”
“Where do you work?”
“Any insurance?”
“What are you here for?”

By this time I had had enough. “Look, he’s attempted suicide, he’s diagnosed bipolar and he’s on medication, I was told by his case worker Theresa at MHMR in Mesquite that I should bring him here, it’s… whatchamacallit… protocol.”

He harrumphed.

“No, they send you here because they don’t want to have to deal with you.” By the tone of his voice, it was obvious that this doctor didn’t want to have to deal with us either.
“So, how did you attempt it?”
“With a box cutter, here I have a visual aid”
“No, there’s no need for theatrics, we’ve had enough theatrics for today thank you.”

He returned to the questions
“So, did you actually cut yourself” No
“Are you on any medications”

“Look” I said hotly since I was starting to become frustrated “we’ve answered all these questions before and these answers were written down, don’t you have all the answers written down on that clipboard?”
“You don’t understand how they work” Stephen said to me quietly “this is how they work, they don’t care”

“So,” the doctor continued “have you taken any alchohol? Don’t bother lying because we will get a blood test anyway.”

The questions continued.

Finally, the doctor was gone and we waited some more. Stephen was becoming more and more sullen. He started slipping into that scary state where he just sits there like a zombie, staring into space. Dissociation. I can’t imagine what’s going through his head at those times but it can’t be good.

No one returned for another hour. So we waited some more. By now it was approaching mid-afternoon and we hadn’t had lunch yet.
“Let’s just go home.” Stephen turned his puppy-dog gaze towards me “they don’t care and they won’t notice if we go”.
“No, I haven’t waited here all day just to go. Besides, you have to be cleared from here before you can see your caseworker at the clinic.”
“I’m thirsty”

I left the room and walked out to a rather harried-looking nurse at the desk.
“Excuse me, can I have a cup for some water please?”
“Who is it for?” she snapped
“Stephen Atwood, Room 10” I retorted.
“Ok” she left and returned, begrudgingly proffering a small paper cup filled with water.
I took it and gave it to Stephen who drank gratefully. We waited again for what seemed like ages.

Finally, I decided enough was enough, I returned to the irritable nurse from before and asked her in my most polite British accent:
“Excuse me, but I wonder how much longer we’ll need to wait”
I find I always get better results when I affect my British I’m-pissed-off-but-too-polite-to-yell-at-you voice. Sarah says it sounds like I’m about to pull out a gun.

She referred to the nurse behind her.

Now, I’ve seen some butch women in my time, but this one took the cake. I literally had to check a couple of times to make sure this wasn’t a man standing before me. I am not trying to be mean, that’s just how she looked.

“Well,” she checked the clipboard, her jowls jiggling impressively “we’re waiting on the results of the blood tests.”
“Blood tests?” I asked incredulously “what blood tests?”
“No one’s taken any blood tests” one of the nurses confirmed.
“I asked John to do it” the gender ambiguous woman retorted..

“Excuse me” I piped up “I wonder if those blood tests could be done, we’ve been waiting a very long time.”

“Didn’t you just hear me say I asked John to do it?” she retorted hotly. I bristled.
“I’m sorry, but I am not the one responsible for blood tests around here.” I responded as calmly as I could.
I was beginning to wonder if we were purposefully being given short shrift. I’d been holding Stephen’s hand and holding him close, maybe we were to receive substandard treatment? Surely no one is that short-sighted as to discriminate in emergency health care based on sexuality?

Finally, one of the other nurses, completely uninvolved in our case thus far piped up: “I’ll do it. I offered to do it before, after all”
“Don’t go in there!” the masculine woman warned as the nurse entered room 10.

She did anyway. I think her name was Julie. Julie turned out to be the nicest person of the lot. She took the blood and urine samples and did her very best to make us feel comfortable while we awaited the results. Her face was almost completely covered with red blotches
“It’s not contagious” she reassured us when she caught us staring uncomfortably. “I don’t tell everyone that, you know, if I don’t like someone I don’t tell them and let them worry they might catch something nasty” she winked at us, I grinned.

“So, you share a name do you?”
“Yes” I replied, thinking she meant the first name, only to realise she was probably referring to the fact that we had been holding hands earlier. I mentally covered my eyes with my hand in shame.
“Aww, that’s sweet.” She said with a smile.

She was not the only one who seemed to think so, during the whole fiasco, one of the junior nurses (I guess she was a student) had entered the room under false pretenses, just to gawk at us in incredularity. I guess it’s not every day you get to see guys kissing.

Finally, after another hour of waiting, we were told the test results were in (normal as can be expected) and that we could expect the psychologist in shortly.

The psychologist turned out to be a man named Shawn. We would have more dealings with Shawn later. I had climbed up onto the hospital bed with Stephen and was holding him tightly. For some reason, the longer he stayed in this place, the worse he seemed to feel. I don’t blame him, hospitals are desperately dreary places.

Shawn asked the same old questions and I didn’t have the energy to argue that he already should have all these answers written down. By now it was around 5pm and all we wanted to do was just leave. Then Shawn deviated from the pattern and started to ask more interesting and varied questions:
“Ever heard voices?”
“Yes” I turned to Stephen in surprise. He’d never told me that one.
“Ever had hallucinations?”
“Yes”
“Paranoia?”
“Yes”
I looked at Stephen as though seeing him for the first time.
“You would know all this if you’d read my book” he chastised me gently.

Then, Shawn asked me to leave for a while. He wanted to ask Stephen a personal question. I returned to find that he had asked Stephen if he’d ever been sexually abused. I knew the answer for that: “technically, no”. His first stepfather had made sexual overtures to Stephen when he was 6 years old, but he had (as far as he can recall) been able to fend him off.

Finally, after being in the hospital for about a whole day, we were discharged with instructions to take Stephen in for observation at Timberlawn the following day. Timberlawn is a mental health facility. Let’s call it what it is: the loony bin. Stephen didn’t want to go (hell, no one wants to go to one of those places), but between me, the doctor and the psychologist, we managed to convince him that this is what needed to happen. He reluctantly acquiesced.

I will write about the following day as soon as possible. The word “Triage” originally meant “to sort” or to “pick out” and usually refers to a three-tier grading system (high, medium, low). Its modern usage came into effect during the first World War when doctors sorted wounded soldiers into three groups according to the severity of their wounds. That word is still used today to describe the first step in the process of dealing with in-patients in the emergency ward of modern hospitals.

I find it fascinating that the first room you enter at the emergency ward of a hospital (the triage room) is thus literally called the “sorting” room.