by Cara McKenna
“Shouldn’t he be supervised?” I murmured to Dennis, staring at the lone resident and trying to guess his diagnosis.
Dennis laughed, freeing a clipboard from a hook on the wall. “That’s not a resident. That’s Kelly.”
A frown tugged at my lips as I processed the nested facts: he wasn’t a patient, and he had a girl’s name.
“Kelly Robak. We call him ‘the Disorderly,’” Dennis went on, gaze skimming his clipboard. “He can wrestle down a psychotic like nobody else. Of course we like to have three men on hand for the job, but he’ll do on his own in a pinch.”
“For sedation?”
He nodded. “De-escalation’s always best, but failing that, we’ve got Kelly. You two’ll be working together plenty.”
I eyed my new colleague with guarded curiosity, realizing that at some point in the indeterminate future, Kelly Robak and his beefy arms and shaved head might be the only thing that stood between me and a grown man in the throes of a violent psychotic episode.
“I hope he’s good. Why isn’t he wearing scrubs?”
“He’s the best. So good we let him wear what he likes. And he likes gray, to keep himself on par with the patients. I wish he’d just get psych tech certification already, but he seems to prefer to keep his role as minimalist as possible. I’ll introduce you.”
Dennis set his clipboard on the desk and unlocked the metal door that separated the nurses’ station from the lounge with a tap of his keycard. It locked behind us, the sound heavy and hard and confident. Kelly Robak’s body looked much the same.
“Kelly.”
He turned at his name and stood, meeting us halfway across the room.
Up close I saw the gray he wore wasn’t a uniform, after all, or rather one of Kelly’s own making—thick canvas pants and a tee shirt, the latter snug not for stylishness, I suspected, but to give his charges as little fabric as possible to grab hold of. Same strategy with the hair. I saw scars on his head, small streaks of white skin where his brown hair hadn’t grown back so densely. From fingernails? I wondered. Or from broken bottles in rowdy bars, off the clock? He looked the type, though looks occasionally deceived.
“Kelly Robak, this is Erin . . . sorry, Erin. I’m hopeless with names.”
“Erin Coffey,” I supplied, and Dennis slapped his forehead to say, duh.
I accepted Kelly’s shake. His arm was a huge python, massive hand swallowing my tiny, mousy one whole. He gave it two firm, businesslike pumps, and his warmth lingered long after he let me go. I rubbed idly at my knuckles, noting the bruises decorating Kelly’s arms, like smudges of paint, yellow and olive and dark purple.
“Our new LPN,” Dennis added.
Kelly nodded. “Welcome aboard.” His voice befitted a man of his size, the words dark and deep from tumbling around his broad chest. He made me feel small and vulnerable, dependent. Not sensations I liked, but given our relationship they seemed somehow essential. After all, this was a man who’d keep me from bodily harm—if not emotional damage—if this job did indeed seek to break me. I didn’t like feeling reliant on men, but concessions could be made, considering the context.
“Nice to meet you,” I said.
A nurse arrived, then a pair of orderlies in mint green scrubs, toting paper cups of coffee.
Everything looked like a weapon to me—pens to stab, hot drinks to scald, drawstrings to choke, just about anything a ready projectile. But they seemed bored, if anything. I was introduced and their names and titles immediately fell out of the back of my head, so preoccupied was I with the immense mistake I must be making.
No. Not a mistake, merely a challenge. With training and patience, I could do this.
Another nurse arrived, somehow managing to look harried and tired at once; a doctor in a white coat, and then another; then two fresher faces who must be just coming on duty, both orderlies. I forgot all their names as well.
The senior of the two doctors led the brief meeting, which took place standing, most people balancing clipboards and coffees. I noted the bolted brackets pinning the armchairs and sofas in place, precluding the assembly of a cozy circle. The docs ran down their notes on the patients from the latest one-on-one and group sessions, then the senior nurses put in their two cents, then the LPNs and techs and orderlies were allowed to ask for clarification or share their own thoughts on the residents.
Kelly Robak didn’t have a clipboard and didn’t take notes—his role seemed less reliant on dosages and exact times than most people’s. The overnight staff walked me and Kelly and the other day-shifters through any “incidents.” The patients’ names meant nothing to me, and my skittish brain eagerly filtered out the words that validated my fears. Outburst, belligerent, episode, agitated. And these were the men I’d be jabbing full of sedatives. Not a function that seemed likely to endear me to them.
“How was Don?” Kelly asked the overnighters.
A meaty female tech with eyebrows plucked into slashes of permanent annoyance shrugged. “Quiet. But he got a dose at nine. Before that he was his usual effervescent self. I’m sure he’s saving up his energy just for you, Kel.”
Kelly nodded, expression perfectly neutral. I stole glances at him as the meeting went on.
His irises were pale with a dark ring, gray like his self-designed uniform—almost as though he were withholding color on purpose, lest he paint this place as anything other than the stark fortress it was. Clear eyes, pretty and cold as ice. Pretty eyes, pretty name, those ugly scars and bruises along the arms he recrossed.
And a gold wedding band on his left hand.
I wondered idly what Mrs. Robak was like, and whether she occasionally enjoyed getting wrestled into submission by her gigantic husband.
The meeting broke up, and suddenly my workday was starting. Dennis reintroduced me to a nurse practitioner named Jenny—a sturdy gal of early middle age, with tight blond braids like a milkmaid and cheeks stained by rosacea into a look of constant mortification. She spoke briskly. I could sense her patience had bounds, and I didn’t care to ever mess up enough to discover them. She was my supervisor, and I was going to shadow her closely for the first few days as I got accustomed to the ward’s routines. Routines were everything, I’d learned over and over in school.
“Routines are a promise that must be kept,” Jenny echoed, prepping dosage cups at the nurses’ station counter. And with doctors, nurses, techs, and orderlies all on staggered shifts, falling out of sync with the ward’s rhythm was a ready invitation for chaos. “The second we break the promises the ward rules make to our residents, we’re back to square one. Especially with the paranoid cases.”
The patients had to bathe—or be bathed, depending on how lucid they were on a given morning—shave with single-blade safety razors under exceedingly close supervision by the Kelly Robaks on duty, dress, then be led to the dining area.
There were fifteen male residents in the S3 locked unit, plus a handful of women on the Starling building’s second floor. Most arrived in the midst of major psychotic or substance abuse crises—or often a combination of the two—and weren’t expected to stay long before being cleared to move to more lenient programs, other facilities, or back home to their families.
Of the fifteen men in my ward, nine had potentially dangerous disorders and were prone to lashing out, verbally and physically. Contrary to pervasive popular belief, most people suffering from serious psychological disorders, if a threat to anyone, are only a danger to themselves. But our unit specialized in the minority of patients who were subject to fits of deep paranoia and resulting rage. If they acted out, they did so with the fervor of men whose very lives were in danger. Because in their minds, that was exactly the case.
The morning was quiet, which Jenny told me was typical. Patients had a half hour to eat breakfast and come up to the nurses’ booth to accept their little plastic cu
ps of pills. Some were sullen, a few friendly, a couple completely blank. At least five demanded in tones of varying suspicion to know who I was, and somehow I retained their names far more ably than I had my colleagues’.
Carl. Thirty-six, paranoid schizophrenic, said the clipboard I glanced at as I helped Jenny with the meds. He was cheerful, with sharp eyes and a too-eager smile.
John B. Forty-three but looked to be pushing sixty, with a gravelly chain smoker’s voice. He had PTSD coupled with bipolar disorder, and after he left, Jenny told me he often woke thrashing, screaming his brother’s name.
Lonnie. Sixty-one, another schizophrenic. Lonnie was chatty, moving with quick, birdlike twitches accenting each gesture, an effect that didn’t match his doughy frame. He wore thick glasses strapped to his head with an athletic band, dividing his frizzy, graying hair into two lobes.
The resident Kelly had asked about in the morning meeting, Don, was plump and pale, as chipper as one could expect of a middle-aged man at seven thirty. I asked Jenny why Kelly had inquired about him, of all the patients.
“Don and Kelly have a . . . special relationship. When Don goes into a psychotic episode, Kelly’s the only one who can ever seem to settle him down, short of a jab.”
“What does he do?”
She shrugged. “Nothing extraordinary. Nothing any other orderly wouldn’t. But Kelly’s got a certain calm about him. Like a wall. You can fight a man and maybe win, but you can’t fight a wall.”
“How often do Don’s episodes happen?”
“He’ll have a violent one twice, maybe three times a week, nearly always in the early afternoon. Kelly shadows him between lunch and about four, and just knowing he’s there seems to keep Don under control. I think Kelly’s a comfort to him. Some people like having a wall near them, especially paranoid people. Something to lean against. Some sense of security at their backs.”
Junior nurses’, techs’, and orderlies’ shifts were long and irregular. Mine were all 7:00 a.m. to 7:00 p.m., two days on, then one or two days off in between. One week I’d work Monday, Tuesday, Friday, Saturday; the next just Tuesday, Wednesday, and Saturday. Plus Sundays on a rotating, monthly schedule. After six years with an exceedingly rigid daily routine, I found it all at once confusing and luxurious. Weekends? What were those? And some weeks I got four entire days to myself? I might need to cultivate some kind of social life. Whatever that was.
“How does Don do on Kelly’s days off?”
“Worse,” Jenny said, melancholy in her voice. “But what can you do?”
Some of the patients lingered in the lounge after receiving their medication, gossiping in small groups or staring out the windows, but most eventually disappeared down a hall, to the recreation room, I was told.
The rec room had a television, mounted below the ceiling in one corner. It was tuned to a game show when Jenny took me there after post-meds paperwork. Beneath it stood a shelf stacked with books and a small selection of board games. No Monopoly, no cribbage board. Nothing with sharp metal bits, basically, nothing that required a pen to record scores. It didn’t leave much.
“But a lack of variety beats a tiny metal knife in the eye,” Jenny told me, surely dooming me to tear up every time I thought of playing Clue again.
Kelly had been off doing his orderly rounds in the patients’ residential wing, but he appeared in the dining room toward the end of the breakfast period, accompanying a slow-moving older man I hadn’t met during morning meds. Once again, I mistook Kelly for a patient at first, in his light gray shirt and pants.
They could have been a father and son having a friendly talk, except for the way the man’s hands and elbows jabbed the air as he spoke . . . just a bit off. Just a bit manic, if you knew how to spot it. Kelly led him to a table, then commenced patrolling the room’s periphery, strolling silently with his hands clasped behind his back. It’d take more than that show of deference to make a bruiser like him pass for nonthreatening, I thought, but he looked as calm as he did alert.
We were in a sliver of downtime before the various morning therapy sessions and support groups began, one of a limited number of unstructured “social” periods that peppered a given day. Kelly circled like a prowling animal—fluid and silent, watchful. His sharp eyes scanned everything, but they didn’t dart. Nothing about him promised sudden movement, and I could understand what Jenny had meant. He was an impenetrable, unscalable presence, gray and huge and immovable. Comforting to everyone in the room. Me in particular.
There were lots of boring lulls between intermittent administration and meds prep, and I passed much of it—too much of it—watching Kelly Robak. He was on general duty, playing UNO with two patients during the pre-lunch break, until one became agitated. Such a normal scene suddenly launched into crisis.
“Here we go,” Jenny said, getting to her feet beside me. I followed her into the rec room’s little nurses’ booth, where she prepped a Haldol dose with shocking speed—those shots were a bitch to draw, but she snapped the vial open and switched out the needles, smooth as a close-up magician.
“We’ll wait and see if he calms first,” she said, discarding the sharps, “but knowing this one, he won’t.”
Beyond the booth’s glass, the angry patient was on his feet, as was Kelly. Kelly listened patiently to the vitriol suddenly streaming from the older man, nodding with his thick arms locked benignly across his chest. While my body vibrated with adrenaline, his looked positively serene.
“Red cards!” the man was shouting. “Six reds cards in a row! Six six six! Red like the Devil! He’s leading me into sin!” He pointed at the other patient who’d been playing. The accused was so stuporous, he looked close to dropping off to sleep, which seemed to enrage his fellow resident more. He made to lunge, but Kelly had his arms behind his back in a blink, holding him in place as two more orderlies ran over. The man kicked, the table jumping and a stack of cards fanning across the wood. In seconds they had him belly-down on the ground, a man securing each arm and one his legs. I hurried out of the booth behind Jenny, heart thumping.
Often a physical restraint was enough to calm this type of episode, but Jenny had called it—this guy was not soothed. Quite the opposite. Normally the shot would go in the patient’s shoulder, but with a table and two orderlies in the way, we had to go to Plan B.
“Pants,” Jenny ordered me, and in a robotic, unthinking daze, I knelt to pull the elastic waistbands of the patient’s pants and underwear down. Jenny scouted the injection site in a fraction of the time I’d have needed, and gave him the dose.
And just like that, I’d taken part in my first restraint and sedation.
It happened so fast, I hadn’t had time to register my fear as much more than a chemical rush. In its wake I felt high, but knowing maybe I did possess some modicum of instinct was a relief beyond measure. I got to my feet, shaky but proud, feeling like a part of a team.
“Well done,” Jenny said, once the patient was calm and settled once more and his doctor had been paged.
“Thanks.”
Back in the booth, she jotted a note on a clipboard. “Dennis said this is your first psych gig.”
“Kind of. I was my grandma’s live-in caregiver for six years. She had dementia. My psych hours for school were at an outpatient substance abuse facility. So no hands-on experience with . . . you know. Nothing this intense.” Nothing this dangerous.
“Ambitious,” she said, scribbling.
Ambitious wasn’t quite the word. This position was the only one I’d found within an hour’s drive of Amber. I’d have far preferred to get work in a nursing home, but I didn’t think it’d curry me much favor to tell Jenny I was only here as a matter of complete desperation.
“I saw on the roster you’ll be doing restraint training the next three days,” she said.
“Yeah.” And I couldn’t for the life of me
decide if I was pleased about it. This was restraint as in wrestling a patient into submission in order to calm him or administer a sedative, not restraints like you’d use to strap him to a bed. Mastering the drill in the event of an outburst was essential, of course, but I worried that after I’d completed the training, the danger would feel all the more acute. The training would also take a bite out of my days off, Wednesday and Thursday, which I could have used to process all these changes, get my things unpacked, and explore my new town.
“It usually takes place in the gym in the Warbler building,” Jenny said. “You’re the only new hire from our ward who’ll be taking part, but Kelly helps teach, so there’ll be one familiar face, at least.”
As if I could call anyone’s face familiar yet. And as if I’d be able to relax, counting down the hours to when six-feet-several-inches of Kelly Robak would likely be pretending to assault me. The thought of his massive arm locked around my neck made my southerly lady region flutter to sudden life.
Oh dear. That wasn’t right.
Kelly Robak was not my type. He was too big, too covered in bruises, and far too married—just too much. Most worrisome of all, he looked an awful lot like Amber’s type, which meant I’d already spent years fostering a grudge against him.
Still, he drew my eyes from across the rec room, some obscene muscle or other flexing in his forearm as he reached up to change the channel on the television. Knowing my luck, I’d seize up and faint in his demonstrative choke hold, outing myself as the neophyte I was. Though perhaps I’d ought to be more worried that some sexual monkey wrench would jam my good sense during a drill and my body would refuse to fight him off. In any case, all the logical, northerly regions of my being decided restraint training was something to dread.