Thomas is a frequent flier in our ER, a bespeckled 40-something with coke-bottle glasses, a man who seems to run, like a dog out for a joyride, right into the arms of the dogcatcher. The police bring him in, one man on each arm, his legs limp. Thomas has schizoaffective disorder, dives into the fountain at the mall, screams at strangers at the YMCA, paces outside the grocery store. In a way, I understand-sometimes behaving according to convention can be a little dull.
Thomas always comes into our ER in the same way, accompanied to one of our dedicated psychiatric rooms. They're easy to strip and you can lock the cabinets with a key affixed by a strong magnet to the Pyxis at the nursing station. This is a tech's job: to strip the room after getting him vitaled and find a plastic bag for his clothes. I wear gloves. He's stopped taking his Seroquel, was picked up for hassling customers outside a Life Time Fitness franchise.
"Listen," Thomas says, irritated that he's with us again.
"Yes, Thomas?" I stuff his clothes into the bag. When it's not a psych patient, I usually fold them-patients complain. Besides, they're filthy.
"I need," he says, exasperated, "a sandwich!"
We look each other in the eye, hard. In some ways, his life seems easier than mine: I'm working at this hospital so that I'll be covered under a group health insurance policy that allows me-for about $100 a month plus copays-to see my psychiatrist, 232 miles away. I've tried to find someone closer to home, but so far no one seems right. (Later, it will turn out that my complaint is medical rather than psychiatric, but for now, I go with it.)
Thomas has no job, no worry of an ability to pay for service rendered. There is no question of financial insolvency-here he is, a ward of the state, resplendent in two gowns, one forward, one backward to cover the gap. And he wants a sandwich.
I look up at the ER board. His nurse is Sara. Across the ER, Sara holds a kidney basin to the chin of her patient, an elderly woman, who pukes into it. A practical person, a graduate of a diploma nursing program, Sara's trying life in the big city. I ask her if I can get Thomas a sandwich.
"Sure," she says. I go to get the sandwich. One of the other techs sits outside the psych room, keeping an eye on Thomas.
Hours later, when Thomas is admitted, I accompany him to his room. He has some kind of heart problem, a little gallop, maybe an electrical issue, which is why they send him to a monitoring floor instead of the psych ward. But they need a sitter, a body to stay in his room all night. They're short on float pool nurses and Mary, one of the ER nurses, has volunteered me. Built like a washing machine or maybe a narwhal, she disimpacts 98-year-old dementia patients with ease, throws iv pumps at unsuspecting techs. I'm afraid of her, which is why I say OK. Plus there's overtime at stake.
But it's a bad idea-I need sleep to metabolize the medications I don't need.
When they set us up on 3-West, I worry: 3-West is known for strange lapses in care, for people coding in the middle of the night, gasping for air or water like antediluvian animals. None of the rooms are really private, which means we share ours with an empty bed on the other side of the curtain. I find a chair and settle in.
Tomorrow, Thomas will be released to the adult psychiatry ward, which will release him back outside. His sleep apnea will persist, and those small Seroquel tablets pressed into his palm before bed will disappear from his system just 18 hours after he leaves our little community hospital. There are other ways of administering the Seroquel so he'd only have to show up at his group home or community service agency once a week or even twice a month. Still [horizontal ellipsis]
He shudders in his sleep. He's 43 years old, and in this dark room, illuminated only by a strip of incandescent light from the parking lot, he mumbles softly, like a child. I'm exhausted. When the traveling nurse comes to relieve me in the morning, I mumble incoherently. Thomas sleeps on, fueled by the Seroquel. I stumble out into the harsh morning light, struggle to find my car, and drive home to my apartment, where I examine my medications before taking them, two little eyes, staring up at me: chalky pills in my palm.