Donna looked pleased. "Good, Monique. Very good. You are the first attending shrink that ever understood the system! I'm proud of you." Donna grinned at Dr. Desmonde.
Alex smiled as the nurse and physician high-fived each other.
"I don't know if admissions will ever return to the pre-HMO days when a psychiatric admission actually changed behavior. According to news reports, mental health services are supposed to get better under the new health care system. Supposedly, thirty-two million additional mentally ill people will receive psych benefits and the benefits of the thirty million Americans who already have them will improve. I just don't see how that is going to happen, but it surely sounds good," Monique added. "Of course, I am totally clueless on how we are going to care for them. We have no space for more admissions now and I’m pretty sure we have more than our fair share in Louisiana," she added.
"Yes," Alex agreed. "It sounds good in theory, but it's all determined on how states interpret the "rules" set forth by the President. Some states could make as many as 500 drugs available for the mentally ill, while other states may only allow access to 250 drugs. Benefits will occur on a state-by-state basis. The same will be true for inpatient care for the acutely mentally ill and for substance abuse treatment. Some states may allow longer acute care stays or better rehab programs than others. It remains to be seen how all of that will settle out, particularly in Louisiana."
Monique looked at Alex and repeated, "Yes, particularly in Louisiana. I think we already know and shouldn't look for much to improve. There will be no silver linings for us," she added regretfully. "We'll just have many, many more patients with no place to put them. I’m not looking for any great fixes to occur in the next few years."
"Anyway," Donna continued, "getting back to your question about patients leaving the unit, each staff member is allowed to take five patients off the unit at one time. And, believe me, the patients raise hell if they've earned level III and they don't get to go. It goes back to basic trust in the building of the therapeutic environment. If our psych techs are out with patients, it's hard for the few who are left caring for the others to monitor everything. There are just not enough of us. We do usually monitor the seclusion, suicide, and quiet rooms, though. We’re pretty good at that, unless there's a patient or staff emergency on the floor!" Donna looked a little sheepish.
"I'm happy to hear that," Alex said wryly to Donna. "I'll do my best to get you some more help."
Donna smiled, looked grateful, and said, "Alex, I don't mean to kick a gift horse in the mouth or anything, but Sarah Chassion, the nurse manager who heads the prison unit, is in worse shape than I am. Her patient population is much worse and more violent. Many of them also have medical needs. Lots are HIV-positive and/ or recovering dopers. That's not even mentioning the serial killers, rapists, and murderers they care for over there. As a matter of fact, Sarah swears there is a dope line coming into the prison unit. She has the same staffing ratios I do, and although my job is hard, hers is even worse." Donna looked at her watch. "I gotta go. It's almost 5 o'clock and the daycare gets ugly when you're late picking up your kids. Thanks for your time." Donna waved at them on her way out.
Monique turned to Alex. "I've got to go also. Rose is waiting for me in my office. Do you have time to catch a bite to eat with me in the cafeteria around 6 o'clock? I'd like to talk about things."
Alex nodded. "Sure. By the way, Don refused to meet with us today. Big surprise, huh! He says he has little authority on psych because of the contract management."
"Yeah, gee, what a surprise," Monique agreed sarcastically.
"Sure, I'll meet you. Is it okay with you if I review some of the charts up here? I'd like to know a little about the patients."
Monique smiled at her and laughed, "Alex, you know darned well you don't need my authority to review charts. Help yourself. But, thanks for asking! See you at 6 o'clock!" Monique flashed her a smile as she dashed off.
"Pick me up in the nurse's station," Alex said, watching the elegant Monique Desmonde rush off. She again found herself admiring the psychiatrist and her commitment to the deranged and mentally ill. It's a heck of a job, Alex thought to herself. I'd never do it.
14
There was no one that Alex recognized on the evening shift. She introduced herself to the RN in charge who was supervising level II patients in the day room. The nurse identified herself as Joanne Waters, an agency nurse, who was helping out. Joanne laughingly asked Alex to fill her in on the patients after her review of the patient charts. She admitted she hadn't had a chance to look at any of them. Joanne also reported that one psych tech had taken five patients to dinner in the hospital cafeteria and that the other tech was making rounds. Further questioning by Alex confirmed that Joanne had never worked psych at CCMC. Joanne also admitted she knew little about psychiatric nursing and was pretty scared to be up there after what had happened 'last night'.
Alex shook her head as she entered the nurse's station, taking several records with her into the staff lounge. She hated temporary agency help. Why not pay their own nurses more and not spend $150 an hour for temporary nurses? This type of care is unsafe, she thought to herself. This place is a catastrophe waiting to happen. At least Farve could hire agency nurses with a background in psychiatric nursing! Of course, as Alex remembered, Farve was a believer in the warm body theory. As Farve saw it, if you had a warm body and a nursing license, you could practice anywhere in the hospital. Alex continued to reflect on the unsafe, risky environment in the Pavilion, imagining how catastrophic things could become. Her imagination in no way prepared her for the reality that was to set in a few short hours later. Psychiatric services at Crescent City were explosive, to say the very least.
Alex had reviewed about three charts and was looking at Jim McMurdie's chart when a voice behind her asked coldly, "Who, may I ask, are you?"
Alex turned around in her seat and saw a tall, cold-faced man, who was obviously furious. His face had the appearance of cold granite, his dark eyes looked like chipped, black ice. She stood up to meet his stare. She felt a bit unnerved, but her voice was strong. "My name is Alexandra Destephano. I'm the lawyer for the hospital. Who are you?" Alex's voice was equally cold and formal.
The man had soft features. His black hair was thick and curly, with abundant grey at the temples. His nose was sharp, and his lips were thick and pouty. He had a high forehead. All in all, his appearance was effeminate and Alex didn't like him. She didn't like him at all.
Alex squirmed under the man’s scrutiny. His cold black eyes canvassed her tall, graceful body. Alex suppressed a shudder as his eyes stopped and surveyed her breasts, and then continued down to stare at her hips and long legs. The man was positively undressing her before her very eyes. She was totally humiliated and furious at the same time.
The man extended his hand. "Oh, I should have known. I've heard about the beautiful, auburn-haired CCMC lawyer ever since I arrived. I am Lester Whitset, the onsite contract manager over the psych, oops, I mean behavioral health department here at CCMC. I'm surprised we haven't met before."
Alex accepted his hand. It was cold, so cold Alex likened it to a corpse. It had a clammy feeling and gave her the creeps. Lester Whitset was so white he looked positively dead. Ugh, she thought to herself, as she shivered slightly in disgust. There was something malevolent about him. He totally grossed her out.
"I believe I was out of town when your group took over the operation of the CCMC psychiatric services. That was in March, wasn't it?" Alex knew she was right. That was when she, Jack, and Robert Bonnet had spent three weeks in Virginia, resting up from Mardi Gras in New Orleans.
"Yes, it was. I've heard a lot about you, Ms. Destephano. The grapevine has it that you're a pretty good sleuth. Are you looking through the patient records so you can find our rapist?" Whitset eyed her carefully, a thin smile on his lips, his eyes cold and unwavering.
Alex was stunned by his question. "Actually, no. I witnessed a potential disaster
here today, a fight between the patients, Mr. Whitset. I'm glad we've met each other. We have some work to do up here."
"Please, call me Lester. We're colleagues, are we not? I'd be pleased to call you Alex."
Alex was uncomfortable at the thought of Whitset being a colleague. "Yes, I guess we are. In a sense." She stammered her reply, caught off guard for a moment. The man repulsed her and she wasn't sure why. He gave her the chills. She began again. "Mr. Whitset, I'm concerned about the staffing levels here on the behavioral health units. I understand you cut staff twenty percent when you took over?”
Whitset glared at her and said nothing.
"I'm convinced that staff numbers aren't appropriate to provide safe care to patients or protect the staff. As a matter of fact, I'm not sure we're meeting a minimum standard of care." Alex continued to belabor her point, uncomfortable under his stare.
Whitset's look froze Alex in her tracks.
His voice was equally as cold. "I assure you, Alex, that safety and standards are being met here in psychiatry. My company was hired to reorganize the psych department and to make it fiscally sound. I've been successful in doing just that. We are experts in Behavioral Health and behavioral health care. Behavior Health at CCMC was a money loser before we took over. I've managed to put it back in the black in six short months – an accomplishment greatly appreciated by your CEO, Donald Montgomery."
Alex was not to be bested. She gave Whitset a hard look. "Perhaps you have, but at what cost? I'm not so sure. I plan to assess the conditions here, do a risk assessment, and determine just what the care is like, from a risk management perspective, of course. I may hire a team of risk appraisers from outside of Louisiana to review our practices." Alex watched his face darken, suffused with anger, and then continued, "Furthermore, I'd like a copy of your management policies and documents to review as part of the investigation."
"Anything you want, Alex." Whitset's voice was controlled, and only the pulsing of his right carotid artery gave any indication of his rage. He continued, "My office is your office, any time." His eyes wandered over her body. "Anything else you need?" The man was positively leering at her and his intent was clear. His voice remained cold. He gave her a sly smile as he touched her hand.
Alex was startled by his touch and pulled her hand away. The man was positively vile. There was something about him that was malignant. "No, nothing. Please send your internal documents to my office ASAP." Alex turned away from him to continue her chart review.
Whitset persisted, "Alex, "I'll be happy to. Can I interest you in a cup of coffee in my office? It's a gourmet blend, one of Louisiana's finest."
"No, thank you. I'm leaving shortly." Alex didn't look at him. Her reply was short, to the point.
"Don't work your pretty little head too hard now. All work and no play makes Alex a very dull girl." Whitset's voice was hushed and Alex could feel the chill of his body behind her. Finally, he left the room, his heels clicking in a military-like fashion.
What a weird dude, Alex thought to herself. It took her several moments to relax after he left. Her heart was hammering so hard her chest wall was hurting. There was something about him that was repulsive, but she couldn't articulate it. She continued to think about him for a few minutes then returned to Jim McMurdie's chart.
She was surprised to learn that Jim was a former New Orleans police detective. He was presently on disability from the department due to mental illness. The chart indicated that he had snapped when his wife of twelve years left him several months ago, taking along their six-year-old daughter. His wife had been pregnant with their second child at the time she left. An interview with Mrs. McMurdie revealed that Jim had become more and more aggressive in his behavior towards her. In fact, he had suddenly begun accusing her of having extramarital affairs when she was three months pregnant. It was documented that Mrs. McMurdie had become increasingly frightened of Jim and had gotten a restraining order against him. Jim had become so angry at this that he had tried to beat her, which is what had precipitated her filing for divorce. Jim's medical record indicated the treatment team was hopeful that he could control his rage, anger, and jealousy through psychotherapy and with psychotropic drugs. Alex was about to read the physician progress notes in the chart when Monique Desmonde tapped her on the shoulder.
Alex jumped at the touch.
"Good Lord, Alex. I did not mean to scare you! Are the charts making you nervous?" Monique laughed at her.
"No, Monique. I guess I was just so engrossed in Jim McMurdie's chart that you startled me. Let's go. I'm famished."
As Alex and Monique left the attending chart room, Alex was surprised to see Lester Whitset sitting in the day room talking with the patients. He was joking with Jim and Anthony, who were both still pretty doped up, but out of seclusion. Both patients were laughing uproariously with the administrator. Alex moved a little closer to the entrance of the day room and saw that the three were playing cards. Rose was looking at them disdainfully, in obvious disapproval. Mrs. Smithson was knitting a sweater and smiling benevolently at them.
Alex nudged Monique’s shoulder. "Is it usual for Whitset to converse with the patients? I think that's inappropriate."
Monique's eyes traveled to the day room. She shrugged her shoulders and shook her head in disapproval. "Yep, he comes in most every evening. The nurses hate it. They say he usually stays until after bedtime. Sometimes he's here all night. He's available in the late afternoons and evenings mostly. Angie told me several weeks ago that he seemed to upset the patients from time to time. I've asked him not to be so friendly, but he maintains it's part of his system of quality assurance."
"That's total BS. Can't you keep him out? It seems unprofessional to me that he should visit with them."
Monique shook her head. "I couldn't agree more, but the answer is no. I can't keep him out. I've asked him not to be so familiar with the patients, but he just smiles at me. He knows it makes me mad, so now I don't say much about it. Actually, most of the male psychiatrists disagree with me. They've heard positive things about him from their male patients. The female patients don't seem to like him. I can't garner enough support from my male colleagues to complain to Don. The whole thing actually disgusts me. Some of the male psych attendings are such pissers," Monique said, obviously piqued by her male colleagues’ behavior.
Out of the blue, Alex retorted, "I don't like the man. He gives me the creeps. I just get an uneasy feeling from him. He's so cold. Yuck."
Monique looked at her curiously. "What do you mean cold? Why does he give you the creeps?"
Alex shrugged her shoulders. "I don't know for sure. I guess it's the way he looked at me. He pretty much undressed me with his eyes."
"Yeah, I know that feeling," Monica intoned. "You, me, and all the female staff. I agree. He’s inappropriate as hell, but how can you reprimand someone for looking at you, not that he comes under my review? All he ever does is look. He never says anything lewd or vulgar. I wish he would because I'd love to get him out of here on a sexual harassment charge," Monique replied. "That would make my day."
"I'd love to help you, but the guy is way too smart for that. My guess is that he plays it to the hilt without ever doing anything wrong. I just don't like him. And he is so cold." Alex shivered when she remembered her conversation with him.
"What do you mean 'cold'? You've said that twice now," Monique asked.
"Well," Alex thought a moment, "When he extended his hand in greeting and I accepted it, his hand felt cold, dead, like there was no blood running through it. You know, like somebody who's had a stroke or something. It was just gross, like touching a dead person." Alex shivered at the memory.
Monique nodded. "Not sure I noticed that. I try my best not to touch him. Thank goodness, I don't see him much. He's mostly around when I'm not. By the way, Jack's going to eat with us. I didn't think you'd mind."
"Of course not. How did that happen? Does he have any info about Angie or the rapist?"
&nbs
p; Much to her surprise, Alex saw a faint blush crawl over Monique's pale face. Her friend looked a bit guilty, as if she had been found out.
"Well," she said with some hesitation, "Jack and I are pretty good friends."
"Yes, well Jack and I are pretty good friends, too, but I don't blush when I talk about him," Alex retorted, confused by Monique's response.
"Well, we sort of decided ... well, we're special ...." Monique rambled, stumbling for the best way to describe the change in her feelings for Jack.
Alex was losing patience. Then she slowly began to understand. "What? Great day, you and Jack!" She could hardly believe it. Commander Françoise and Dr. Desmonde! Jack and Monique! Two of her favorite people. They were an item! She hugged Monique in her excitement.
Monique couldn't stop smiling. She was ecstatic.
"I just can hardly believe this. What a surprise!" Alex smiled brightly at her friend, and the oppression of the Pavilion lifted for the moment. She continued, "Monique, tell, tell, tell. Are you and Jack seeing each other?" Monique didn't respond, so Alex continued to prod her. "Your non-verbals are telling on you, Dr. Desmond. Now, spit it out!"
Monique smiled and turned bright red. "It's not what you think, Alex. We're just good friends. We've had several dates. Well, I guess you would call them dates. Do people date at my age or is it called something else?"
"Of course you date. You can date when you are ninety years old. How did it happen? Oooh! This is the best thing I've heard in days. Tell me!" Alex retorted, unrestrained in her excitement.
"Shhhhh. I'll tell you downstairs. Way too many ears up here. Let's get the elevator." Monique hushed her as she eyed one of the psych techs staring at them.
As the unwieldy elevator labored up to the second floor and then down towards the lobby, the two women chatted excitedly. Taking a seat on a drab, grey bench located in the lobby of the Pavilion, Monique reached for her purse as her iPhone beeped a text message signal. She checked the text message and said, "It's him. He's gonna be late. I'm going to call him back and see when he thinks he can get here. I'm just going to step over here so I can hear a bit better." Monique walked away from the bench and stood near a large potted plant in the corner of the lobby.
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