Conditional Voluntary

Charley was happy to see Patrick at his door, suitcase in hand.

  “Hey-hey! You moving in?”

  “That’s right,” Patrick said, crossing the threshold.

  “Great!” Charley responded, taking a pack of cigarettes from the top drawer of his dresser.

  Patrick dropped his suitcase on the free bed, the one closer to the door.

  “Gimme five!” Charley exclaimed, holding out his right hand, palm up.

  Feeling silly, Patrick went along and slapped down onto his latest roommate’s palm. Charley slapped Patrick’s palm right back when it was offered.

  The a car drove past the window, startling Patrick.

  “What?” Charley asked, noticing the reaction.

  “I didn’t realize we were on the ground floor here,” Patrick explained. “I mean, I forgot.”

  “Oh, yeah! It’s the hill.”

  “Yeah. My last room had a pretty long drop to the ground.”

  “Hey, throw a chair through this window and you can escape! Pretty good, huh?”

  “I don’t think that’s necessary,” Patrick answered with a smile. “Dr. Kearney gave me more privileges so I can go downstairs all by myself now. But I still need a staff member with me to go outside.”

  “Let’s go right now,” Charley suggested.

  “Yeah, I can unpack later.”

  Charley hurried past Patrick to lead their way down the hall. He pointed over at the two pay phones while he was at it.

  “See? We’re the closest ones to the phones so we can get to ’em first!”

  “And be first in line for meds,” Patrick said, nodding towards the nurse’s station. “The shower’s next to us, too.”

  “Better neighborhood, man!”

  “Um, I’d like to see if Justine wants to go with us. She told me to ask for the room change.”

  “Yeah, let’s go get your girlfriend,” Charley said loudly as they passed the day room.

  “Jesus!” Patrick gasped. “Keep it down!”

  He glanced back and forth nervously but didn’t see anyone who was plainly within earshot. Charley giggled and tapped Patrick’s elbow by way of an apology. Patrick was grateful to see that the staff office door was closed when they reached it.

  “I’ll sign us out, okay?” Charley offered.

  “Okay,” Patrick said, distracted by his need to find Justine.

  He also felt nervous thanks to Charley’s indiscretion. How did Charley know? Or was he only teasing, guessing… or what?

  Justine was not in the smoking room and the door to her bedroom was wide open without her in it. Patrick’s “girlfriend” – dare he call her that? – was nowhere in sight. It had been a quick disappearance. Patrick had expected Justine to at least wait long enough to find out whether the move request had been successful. But then again, perhaps her doctor had called her in for a session. After all, hadn’t she just been fighting that nurse over the new pill prescription?

  Patrick caught up with Charley at the sign-in desk. They still needed to find someone with a key to let them out. Hilda the ward clerk was as inexplicably absent as Justine.

  “I’ll go knock,” Charley offered.

  He managed to lure Brenda out of the staff office. Before she would open the door for them, the counselor consulted the patient privilege list. It was kept in a three-ring binder in one of the desk drawers.

  “Patrick,” Brenda said, “you can’t leave the floor by yourself.”

  “He’s goin’ with me, though,” Charley said while Patrick stiffened angrily.

  “I meant he can’t go without staff.”

  “That’s not right!” Patrick sputtered. “Dr. Kearney said he was writing me new privileges! I’m supposed to be able to go downstairs without staff. I know I still have to stay inside but – ”

  “Just relax,” Brenda told him sharply. “I’ll go and check it out with Gloria.”

  “That’s tellin’ ’em,” Charley remarked, watching Brenda complete her brisk walk back to the staff office.

  Guess I picked that up from Justine, Patrick thought.

  After two minutes that seemed longer than that, Brenda came back. Her pace was slower this time and she went right over to the entry door.

  “Sorry,” Brenda muttered. “The privilege list wasn’t updated yet. Don’t go outside, Patrick.”

  Patrick nipped his lower lip instead of reminding the counselor that he had already told her as much himself. Without a word, he followed Charley to the elevator.

  “Want to press the button?” Charley asked.

  “You do it,” Patrick answered without enthusiasm.

  Inside the elevator, he finally broached the subject.

  “What was that, calling Justine my girlfriend?”

  “What, isn’t she?”

  “I… I don’t know. What did you hear?”

  Charley grinned and shrugged his shoulders.

  “Nothin’,” he said. “I just called it from the beginning, remember? I pointed her out to you.”

  The elevator doors opened. Nobody was in the immediate area, which was the emergency department reception desk; like the medical ward, it was seldom put to any use.

  “But Justine didn’t say anything to you about it?” Patrick asked as they headed up towards the lobby.

  “Like she ever talks to me,” Charley replied with a big smirk on his face.

  That was a point Patrick couldn’t argue with. It was probably only an impression Charley had picked up from watching the two of them together. They’d seemed like an obvious potential couple to Charley and why not? Patrick was eager to tell his friend about how Justine had broken up with Todd and how she’d tongue-kissed him to celebrate. But the wacky shepherd was to much of a motor-mouth to be trusted with that kind of information.

  “Hey, I’ll keep a lid on it for you,” Charley promised when they turned right at the lobby to access the snack bar.

  “Keep a lid on what?”

  “Exactly!” Charley shouted with delight.

  But Patrick wasn’t reassured. Who else knew about him and Justine, or thought that they knew?

  Patrick called Scott before going to bed that night, just to let his brother know that he was feeling better. Perhaps a discharge date was imminent, although Dr. Kearney hadn’t said anything about that so far. Patrick didn’t want to tell Scott about Justine. It was not whether Scott could keep it a secret that made Patrick withhold the news, rather he feared his brother wouldn’t like the idea of Patrick having a mentally ill girlfriend.

  Justine had been glad to hear that Patrick had moved to what Charley called the “better neighborhood.” She had squeezed Patrick’s forearm and told him that he was learning.

  “The only bad thing is that we’ll be sleeping farther apart,” Justine had observed with a wink.

  Since Patrick was able to go downstairs without supervision, he finally took the opportunity to have a “date” with Justine in the snack bar. They signed out an hour after supper. While it turned out that they had to put up with the company of other patients, Patrick and Justine got to ride the elevator all by themselves both ways.

  They stood and necked in that bit of seclusion, glad that the machinery was moving the elevator so slowly. Justine let him touch her breasts through her shirt. Somehow, Patrick had expected those little things to be firm but instead they felt as if they were stuffed with downy feathers. At the same time, her nipples perked up like grateful pebbles.

  They’d parted at the sign-in desk, Patrick hurrying off to take a shower twelve hours early. In the privacy of an even smaller space, he had yanked at his swollen cock until a shuddering erection relieved him. The warm water spray from the showerhead eliminated the evidence. It had been some night.

  “Glad you’re feeling better,” Scott said as they wrapped up their call.

  “Thanks,” Patrick replied, watching Wyatt shamble out of the day room. “Well, good night.”

&nb
sp; “Good night.”

  After hanging up, Patrick warily observed Wyatt move out of his sight, apparently going back to his room. He thought about how odd it was to find one patient to be afraid of. Not even a week ago, most of the patients had made him a little uneasy. Now they were simply people to him, perhaps not ordinary, but then neither was he. No matter how screwed up they might be, none of them had seemed likely to be violent. Not until Wyatt had shown up.

  Charley didn’t seem intimidated, however. They had talked about it in their room early that afternoon.

  “He socks me, he’ll get it right back!” Charley had proclaimed. “Pow! We’ll see who hits harder!”

  Patrick wandered back into the day room. There was about an hour left before lights out and Patrick wanted a cup of milk. He wasn’t going to wait up until the last minute; if nothing else, his masturbation had relaxed him more than usual. Besides, he had been going to bed before eleven o’clock for the past few nights, anyway.

  Patrick had been a bit concerned about Charley’s mania in terms of getting some sleep at night. But Charley was already slumbering heavily and Patrick supposed that the nurses gave him an extra level of sedation for Charley’s nine o’clock meds. For that matter, Patrick couldn’t remember seeing Charley out and about later than ten o’clock, anyway. Sipping his milk, Patrick figured he could expect Charley to wake up before dawn, farm boy that he was.

  He smiled at Linda, who was watching the TV and then noticed Albert stride in to join them. They exchanged helloes. Patrick appreciated these more mature, quieter patients. As much as he liked Charley, his friend had a tendency to drain the energy right out of other people and use it for himself. Of course, Justine drove Patrick wild with desire so it wasn’t all that comfortable to get near her.

  Patrick threw away the empty Styrofoam cup and turned around. There was Wyatt coming back into the day room. He was far enough away that Patrick wasn’t taken aback. But he started to take the long way around to avoid getting near Wyatt and then decided it was taking caution too far, all the way into cowardice.

  Should give him a chance, Patrick thought hopefully.

  He walked right up to Wyatt and gave him a slight nod.

  “Hi, how are you?” Patrick asked.

  Wyatt broke into a sickly grin and raised his head high enough to meet Patrick’s eyes.

  “I wish I was on a better planet than this one,” Wyatt said softly.

  “A better planet?”

  “Yes… This is a gutter planet. Shit planet.”

  “Seems that way sometimes,” Patrick replied as he started to move on. “Well, good night.”

  This time Wyatt didn’t reply. They parted company, Patrick telling himself that it hadn’t hurt to be cordial.

  The psychiatrists’ treatment teams met once a week. The doctors would preside over the review of each patient’s progress with the nurse team leader, social worker, occupational therapist, and the team counselors. The Kearney team gathered on Tuesday mornings, usually around ten o’clock. Since Dr. Kearney’s office was so small, the team would go upstairs to the office shared by the occupational therapists and social workers.

  Both Simon and Kris had a little work to do before the meeting since each had a new patient to present to the group. Although everyone on the team knew who Patrick and Wyatt were, neither had been discussed in a weekly meeting before. Just like residents participating in medical rounds, the counselors had to recite the case histories of the new additions to the caseload. Sitting quietly in the staff office, the two of them scribbled in their notebooks, transcribing data from the patient charts.

  Once done with that task, Kris and Simon went upstairs using the south fire door by the lockers and washing machine. The south stairwell took them directly to the third story offices and they avoided the secure ward altogether, something each of them preferred.

  Dr. Kearney was the last one to join the meeting as usual. Gloria, Kris, Simon, Erin, and Tom the social worker were gathered in a semi-circle of chairs in what looked like a miniature ward assembly.

  “Good morning, all,” Dr. Kearney said, smiling as he closed the door behind him.

  His grandfatherly demeanor was not limited to interaction with patients. The team members smiled back at the doctor as he took his seat next to Gloria. She was holding the black binder containing the doctor’s order forms.

  Simon took one last proofread of his open notebook, getting ready to deliver his report. He would have to instantly translate the abbreviations, acronyms, and nursing note symbols while he spoke. For example, APE stood for “acute psychotic episode”.

  “Well, let’s get started,” Gloria said after the brief initial pleasantries. “Would you like to go first, Simon?”

  “Yeah. We all know this one.”

  Simon cleared his throat.

  “Patrick Coyne. This is the first Hillside admission and also the first psych hospitalization for this twenty-three year old white male, admitted last Wednesday night through the Cambridge City Hospital E. R. Admitting diagnosis was acute psychotic episode. Patrick was taken into protective custody secondary to being seen wandering through Central Square in a disoriented state. He was apparently expressing paranoid delusions and was initially thought to be under the influence of drugs and/or alcohol. When no trace of either was found in his blood, Patrick was evaluated for psychiatric care and subsequently referred to our facility.

  “Patrick lives in Waltham with his older brother Scott. Neither parent is involved; Patrick’s mother has been dead for three years and his father’s whereabouts have been unknown since Patrick’s early childhood.

  “He is negative for suicidality and has contracted for safety on the ward. Positive for paranoid ideation, although on the one hand he hasn’t been very open about it… outside of his sessions with Dr. Kearney. On the other hand, the severity of delusions appear to have been in decline since his medication regimen began.

  “No documented psychiatric history prior to his break and no therapy. Apart from his paranoia, Patrick is high-functioning and intelligent. He socializes well and has made… friends among the patient population.”

  Kris snorted at Simon’s dryly clinical phrasing. Simon paused to smile at her.

  “We’ll get to Patrick’s social interactions later,” Gloria said.

  Dr. Kearney thanked Simon and took over the Patrick Coyne discussion. He detailed the substance of Patrick’s delusions, making Simon smirk. The counselor was no stranger to marijuana himself, although he kept away from harder narcotics. On the topic of legally prescribed drugs, Dr. Kearney talked about the pills he’d ordered for Patrick. It was “so far, so good” as far as the medication was concerned.

  “Now I understand that Patrick has found himself a girlfriend on the ward,” Dr. Kearney said. “Is that right?”

  “Seems that way,” Simon replied.

  “More than ‘seems’,” Kris interjected. “It’s that borderline, Justine Edwards.”

  “Any inappropriate behavior?” Dr. Kearney asked.

  “Nothing we’ve caught them doing,” Kris reported. “But they’ve been spending a lot of time together. They could be touching – kissing – when nobody’s looking.”

  “He hasn’t even been here a week and this is already going on?” Erin spoke up in surprise.

  “I think it’s mostly been her pursuing him,” Simon remarked. “But anyway, you know how it is: they’re here for a short time so things happen more rapidly than they would on the outside.”

  “Can’t we do anything to stop this?” Kris asked.

  “Like what?” Simon reacted. “I mean, they have privileges that they earned legitimately. If they get together off the ward, well, then it’s beyond our control.”

  “But it’s bad for both of them,” Kris insisted. “They’re here for treatment, not romance. It’s a hospital, not a singles’ resort.”

  “Isn’t it bad for their progress
to get so involved in each other that way?” Tom suggested.

  “That’s true,” Dr. Kearney said, taking the order book from Gloria. “It can’t help but be a distraction for both of them. But they’re both very young and they probably lack impulse control.”

  “Well, we can’t just restrict them to the ward,” Simon muttered impatiently. “It’s not possible to protect them from each other. Not entirely.”

  “Might as well put them in the same room so they can sleep together, is that it?” Kris asked acidly.

  “Of course not,” Simon snapped. “I understand that we’ll need to chaperone them as best we can. There’s just no cause to punish them without catching misbehavior first.”

  “Simon, you may have to talk with Patrick about this,” Gloria said.

  “Me?”

  “You’re his primary,” Kris reminded him.

  “I know that but – ”

  “You’re his age,” Gloria interrupted. “You could talk to him like a brother.”

  “Maybe,” Simon responded unhappily.

  “I’ll talk to Patrick,” Dr. Kearney declared. “That is, I’ll bring it up with the boy, see what he has to say about Justine. I don’t expect him to take advice from staff about this, however.”

  “Okay,” Simon murmured. “If we do catch them doing something, then I’ll have a talk with him.”

  “All right,” Gloria said with a nod. “Right now, Patrick has the privileges to go downstairs by himself but he’s not supposed to leave the building without a staff member.”

  “Should we raise his privileges?” Dr. Kearney asked.

  “He’s just had one increase yesterday,” Gloria reminded him. “We don’t want to advance him too quickly.”

  The psychiatrist nodded.

  “Make sure he doesn’t abuse what he has now,” Gloria went on. “Then we’ll see about raising his privileges in time for the weekend.”

  “Very well,” Dr. Kearney nodded. “I believe that we should be at a point by this time next week where we can discuss discharge planning for Patrick.”

  “That’s good,” Simon commented.

  “Let’s go on,” Gloria said. “Kris?”

  “Wyatt Halliday. First admission for this thirty-eight year old white male. Diagnosis was acute exacerbation of schizophrenia. He had been decompensating at his halfway house so they found a place to dump him: right here.

  “Wyatt has a long psychiatric history with several admissions to Metropolitan State Hospital and other state facilities since his first psychotic break at age eighteen. His halfway house placement was done six months ago.

  “No family involved; parents dead, siblings not interested. Wyatt is not suicidal and it’s hard to tell how paranoid he is because of his isolative behavior. But he is beginning to talk more. His decompensation at the halfway house apparently was because he’d stop taking meds. He’s been on liquid meds here so maybe it’s been building up in his system now.

  “But Wyatt still looks pretty scary. The other patients seem to avoid him as much as possible. The halfway house sent a big stack of incident reports, twenty-two of them, documenting assaultive behavior. We think it might only be a matter of time before he goes off in here.”

  Kris finished her report with a scowl on her face.

  “Maybe he won’t turn violent,” Tom said. “I mean, if he can’t hide a pill under his tongue, the meds could be working now, like you said.”

  “Wyatt did get a lot of Thorazine injected into his butt at the emergency room,” Gloria commented. “Enough to make him quiet for the first few days. If what Wyatt’s getting right now isn’t adequate, we might not know until he demonstrates it by throwing a punch at somebody.”

  “He’s a time bomb, doctor,” Kris said, boldly seeking his eye contact.

  “We have to give the medication a chance to work,” Dr. Kearney replied calmly. “I believe it’s already been determined that the secure ward has no vacancies at the moment. Under the circumstances, we have to keep Wyatt right where he is and hope for the best. I know that won’t sound good enough, especially to you and Simon. You two are on the front line and I know what that’s like; I was an attendant myself after the war. But in those days, we didn’t have the medications we have now, not even Thorazine.”

  Simon nodded. He’d heard the story from the doctor before.

  “Unfortunately,” Dr. Kearney continued, “you’ll just have to deal with the situation as it is. We all have to. I’m not saying we have to wait until someone gets hurt but as long as Wyatt’s behavior is just frightening, not disruptive, it’s unfair to send him elsewhere.”

  “His behavior is disruptive, though,” Kris insisted in her final appeal. “It’s like there’s a reverse magnetism when he’s walking around the ward. The other patients shy away from him. It’s bad.”

  “Might be a good thing,” Tom remarked. “If Wyatt’s potentially violent and nobody’s close enough for him to hit, he’ll take it out on an object instead.”

  Kris shook her head but kept quiet after that. No one mentioned Wyatt’s privilege status. His restriction to the ward would continue.