Stephen White - Critical Conditions

“Merritt, sit, please. Let’s talk about this. I’m very sorry.”

I meant for her to sit on a chair, inside the room, but she slithered to the floor precisely where she had been standing. Her limbs were elastic, and she curled into herself with the flexibility of a small child. Her soft hair was mostly down, but a wide clump was rubber-banded into a ponytail on top of her head. The splash of freckles down her cheeks had darkened with her tears.

“It doesn’t look good, does it?” I said. “I’m sorry. I wish there was something I could do.”

She looked at me as if she wanted to talk right then, that she wished she could. But she didn’t say a word.

“I’m sure you’ve decided that not talking is somehow in your best interest, Merritt, but I’m really at a loss as to how it’s doing any good. I wish you could help me understand that. Right now I don’t know how things could look any worse for you than they do.”

She shook her head in one long, slow swipe from side to side. Her hair didn’t swing.

I wasn’t certain what she meant. I guessed. “They could look worse than this? How? It sounds like you’re about to be arrested for murder.”

She didn’t move. She shook her head again. This time her eyes were frustrated. I took it to be a “No, you don’t get it” shake.

She was telling me something important and I fought a surge of anger that she couldn’t just cease her stubbornness and actually speak a sentence or two. This odd dance felt to me like trying to do psychotherapy by playing charades. I also felt that I was exhibiting remarkably little skill at the game, as though I were insensitive, missing something obvious.

“The silence-you keeping quiet all this time,” I said, “are you telling me it isn’t something you’re doing only to protect yourself? Is that it?”

Without moving her head, she looked over at me with wide eyes that weren’t blinking, and she held my gaze as softly as a mother cradles a baby. She smiled a tiny smile. Her shoulders sagged.

I said, “Merritt, is this-the silence, what happened with Dr. Robilio-is this somehow about Madison? I told you I was going to meet with her today and I did.”

Merritt’s eyes narrowed, but her expression didn’t change perceptibly. She waited a good fifteen seconds for me to expound on the meeting. When I didn’t, she shrugged her shoulders as though my words hadn’t mattered at all.

She stood and slowly made her way back to the dayroom.

I flicked around the channels one more time hoping to see another version of Mitchell’s news appearance, but didn’t. I moved back out to the nursing station to complete the required paperwork on Merritt. When my admission note was almost complete, a counselor called me to the phone.

John Trent was on the line. In a voice that sounded tinny and hollow, he said, “I’m glad I found you. Chaney’s deteriorating quickly. The doctors say this could be it for her.”

I didn’t want what he was saying to be true, so I said something stupid. “She had a decent day, didn’t she? Isn’t that what you said before?”

John Trent sighed, weary of having to carry the awkward weight placed upon him by the denial of others. “That was then. Now, I’m afraid, she’s crashing.”

“Is Brenda there?”

“No, I just paged her at work.”

He paused. I sensed he was steeling himself for whatever he wanted to say next. I steeled myself for not wanting to hear it.

Without a note of pleading in his tone, Trent said, “I want Merritt to come down here, Dr. Gregory.”

“I don’t-”

“I know it’s against the rules. And I know that clinical judgment says you don’t take her off the unit after a suicide attempt like hers. The truth is that her baby sister may be dying as we speak, only a couple of hundred feet from Merritt, and it is absolutely criminal not to make an exception to the rules. Right now. Right…now.”

“John, I’m so sorry. Can I have a minute or two to think about this? How to go about it. Certainly, I would have to arrange for some staff to go with her.”

“If I had minutes to give, I’d give Chaney and Merritt a million of them. Take the minutes you need, but the account we’re using is almost empty. Do what you can. Please be humane about this. And please hurry.”

I needed permission from the ward chief or the medical director-or someone with some similar clout-to authorize a radical departure from hospital policy for a patient who was on suicide precautions. But I didn’t have the luxury of time to move the system to compassion.

One of the enduring lessons of my years working in hospital settings is that if you want something difficult, or impossible, accomplished, find a nurse with some courage and cunning. So that’s what I did.

The head nurse of the inpatient unit was a tall woman with wispy hair and a quick smile. As far as I could tell, she was as firmly rooted as a giant redwood. During moments of crisis, only if you looked incredibly closely could you detect the slightest sway in her.

I walked to her office door and found her packing her things into a big canvas bag in preparation for heading home for the day.

“Georgia,” I said, “may I speak with you for a minute?”

She pulled a Toy Story lunch box from inside the canvas bag, shook her head, and said, “I ended up with my eight-year-old’s lunch box today. How did I do that? God knows what he ate for lunch. Do you ever suffer temporary brain death? I’m sorry. I’m rambling. What can I do for you?”

“May I close the door?”

“Uh-oh. Can it wait until tomorrow? I can give you, gosh, ten whole minutes tomorrow. Teacher’s conference tonight, I have to pick up some food for the kids and their babysitter. It’s bad form to either starve the children before a teacher’s conference or to be late. Do you have kids, Alan?”

I shook my head. “I’m afraid it can’t wait; I wish it could. And no, Georgia, no kids yet.”

She looked at her wristwatch and sighed the sigh of overburdened managers everywhere. The one that said, “They don’t pay me enough for this.” She waved me to the empty chair by her desk and closed the door behind me.

She didn’t sit. “It’s your nickel.”

“I just received a call from Merritt’s father. He’s down in ICU. Merritt’s sister, Chaney, is deteriorating, may be dying. He made an impassioned plea for Merritt to visit her. He would like her to come down right now.”

Georgia sat. She dropped her coat and let the canvas bag fall to the floor. “God. God. God. Don’t you hate doing this some days? Listen to me, really, I’m bitching to you about having to run like hell to get to Boston Market before my kids’ teacher’s conferences and look at the alternatives life has to offer. Look out there, in the dayroom. Look at those poor kids. Or God forbid, look down in the ICU or over in oncology. I’m so ungrateful.” She dabbed at her eyes. “I’m babbling again. What do you need from me to make this happen?”

“I need the policies regarding patients being restricted to the unit during suicide precautions to evaporate, at least temporarily.”

“You can’t just d/c the precautions, can you?”

“No. With what’s going on right now, no. She’s still mute. Her sister’s in crisis. And I take it you heard about the arrest?”

She shook her head.

“The Boulder DA went public that they have an adolescent female suspect. Merritt knows about it. And now Chaney may be dying. I can’t d/c precautions or increase privileges with those stressors on the table.”

“Is she about to be arrested?”

“No way to tell. It could happen anytime, I imagine, based on what I saw on the news.”

Georgia’s tongue was between her upper and lower teeth. Her lips were parted. She said, “Don’t worry about the administrative side. That crap won’t jell before tomorrow. Write the order for the ICU visit. I’ll get staff and security lined up to go with. We’ll take her on the road and worry about policy and procedure in the morning if this thing goes south, and hopefully it won’t. There’s no time to discuss it with anyone, right?”