Authors: Jessica Penot
She moved easily through the maze of rooms on the first floor. Each door she opened had to be unlocked and then locked behind her. There was something ritualistic in the constant shuffling of keys. We moved through the men’s intake unit quickly with this method. It was impossible not to look at the patients. Only a handful of them were out on the ward. A few men were sitting in round orange chairs, uncomfortably staring at the green tiles. A few others were leaning over the desk at the nursing station asking the nurses for something. The TV was on, but no one was watching it. There were numerous games, including a pool table, but no one was playing.
“Where are all the patients?” Andy asked as she gazed out into the recreation room.
“This is intake,” Dr. Babcock answered. “The patient load here is in flux. All the patients are usually either in testing, groups, or sleeping. The patients with grounds privileges are probably outside. Sometimes you see a lot of activity here, around snack and medication time, but usually it’s pretty quiet. The people in intake aren’t here long enough to want to spend time together and get to know each other. They usually only spend a few days here.” With that she unlocked the last door that opened up into the expansive lobby.
Down a long hall heading in another direction were a number of offices and snack machines. We followed her to a large, brightly lit conference room. “This room will become your home away from home,” she said. “This is where we spend the bulk of our mornings, in treatment planning. Today is going to be a long day for you. We have a lot to do. In a few minutes, I’m going to walk you over to the human resources building on the other side of the campus. We’re under a legal mandate to train all new staff there. Some of the training will seem completely irrelevant to what you’ll be doing here, but some of it is very pertinent. So listen carefully. Outside of the HR training you’ll also get your name badges, fill out your tax forms, and do some other paperwork. After that, each of you will be introduced to your individual clinical supervisors. Two of you will be working on the acute ward for the first six months, and one of you will be working with Dr. Allen on the chronic ward for the first six months. The rotations will be switched after this time is up. The Robertson Building, which houses the chronic ward, is across the campus from here, so whoever is working on chronic won’t get a chance to work as part of an intern team. This is unfortunate, but it’s where the need is. I would like to give someone the selfless opportunity to volunteer to work at Robertson first.”
I didn’t hesitate. “I’ll do it.”
“Dr. Black,” she responded. “I’m glad you have made this easy on us. Usually, we have to fight tooth and nail to get someone to go to Robertson. Most people hate working on the chronic unit. Most people are not drawn to working with the negative symptoms of schizophrenia."
"I can’t think of why,” I responded coolly. “As graduate students, we get ample opportunity to work with the acutely mentally ill. An average university psychology clinic is packed with them, but we never get an opportunity to work with chronics. I view it as a unique challenge.” As I said this, all I could think was, “And I won’t have to work with Andy.”
“I’ve never heard anyone say it that way.” Dr. Babcock smiled at me across the room. “There it is then. You will all separate after this morning's training. I suggest you exchange phone numbers. You’ll need each other's support and know-how as the year progresses. Don’t be afraid to lean on each other. Are there any questions?”
“What time do we get off?” Andy asked.
"That varies by ward, by director, and by assignment. You'll have to ask your clinical supervisor about that before you leave today. We don't stay much past 4:30, but some supervisors may keep you here later than that to do paperwork. Does anyone have any other questions?"
"What are the differences between the chronic ward and the acute ward?" John asked.
"The acute ward is much more variable and has a larger clinical staff. We have six treatment teams on this ward. Each treatment team consists of a psychiatrist, a psych resident, two social workers, some medical students, a psychologist, the intern, a psych tech, two mental health workers, and whatever nurses decide to show up. On the chronic ward, there is only one treatment team and it is much smaller. There are no medical students, only one social worker, and you’re the psychologist on most days. On the acute ward, our goal is to get the patients out of the hospital and into a group home or whatever outpatient treatment is necessary as quickly as possible. We currently have 200 beds in the acute ward. Our goal is to reduce that number to 150 by Christmas. The teams work hard diagnosing, assessing, treating, and planning to keep the patient population moving out of the state hospital setting. Technically the goal is the same in the chronic ward. However, you’ll rarely do any real psychological testing or assessment. Here we spend a lot of time doing psychological testing. We write reports regularly and that can be very time consuming. Our psychological reports are critical to the treatment plan. On the chronic ward, it’s much slower. Most of the patients there have been there for years. The most you'll do is a rudimentary mental status exam at every treatment planning session. It’s mostly paperwork. They have 100 beds on the chronic ward, and although the goal is to reduce that number to 75 by Christmas, I don't think it’s a realistic goal."
"Why are you trying to reduce beds?" Andy asked.
"That is a question that shapes our daily lives here. The answer is embedded in all of our biggest frustrations, and you’ll have a two-hour lecture on it in your HR training. The easy answer is that in the ‘70s someone sued the Alabama Department of Mental Health and Mental Retardation. They had been wrongly institutionalized and they sued the entire state. A thorough investigation followed and it was discovered that the two state facilities were keeping patients institutionalized who didn’t need to be in order to support the staff. The feds came in and took over the two institutions until the year 2020. If, by 2020, the number of beds in each facility has been reduced to 200, then the state can take back management of the facilities. If not, the feds will come in and cut patients themselves."
"That seems like a fairly arbitrary number," I said.
"Completely arbitrary. It also completely ignores the fact that at least 100 of our patients cannot function independently. Some need help going to the bathroom and cannot even think to feed themselves or stop themselves from pulling their own hair out. Nor can they communicate. Some are here because they are dangerous. We could talk about it for hours now, but this is a discussion that you’ll have over and over again in treatment planning. We should begin walking over to human resources now."
Dr. Babcock told us various facts about administration and policy as she led us from the modern building that was the acute ward. She opened the front door onto the campus and I was blinded by the daylight. I flinched, reaching for my sunglasses, but was stopped by the view from the steps of the building. In front of me and across the cobblestone road, loomed a seven-story, redbrick, Victorian building. Its windows were closed and dark. It was crowned by a tiny copula that seemed to watch the entire complex from its dark vantage point. The building seemed wrong. It didn’t belong in the courtyard. The patients avoided stepping on its manicured yard and the staff walked around it no matter how far out of their way it took them.
"That's creepy," Andy said.
"That is the old admissions unit," Dr. Babcock responded coolly. "We haven't used it since the ‘70s. It’s filled with asbestos and lead paint. I wish they would tear the thing down, but supposedly it isn’t in the budget."
"It’s beautiful," Andy replied. "It would be a shame to tear down a piece of history like that. How old is it?"
"It was built in 1875. It may be a piece of history, but it’s dangerous and it needs to go."
We walked between the old admissions unit and the new one. Dr. Babcock pointed at different buildings and named them as we walked. The old tower and the building at its base housed vocational rehabilitation. In the center of campus was a small modern building that she called the cantina. Residents could buy cigarettes, snacks, cosmetics, and other necessities there. About 60 patients sat at tables around the cantina smoking cigarettes and talking. The patients sat in long rows on the benches outside. They smiled and laughed like a group of children at recess. All of them smoked, but outside of this, they came in all shapes and sizes. There were men and women of all ages and races chatting like old friends. They all stopped and stared as we walked by.
"Hey, Dr. Babcock, you got the new doctors there with you?" a man yelled at her.
"I sure do."
"When are you gonna let me out?"
"What did they tell you in treatment planning?"
"I dunno."
"You have to listen in treatment planning. We said as soon as they could find a group home for you, right? Do you remember that?"
He smiled brightly. "Oh yeah, I remember now."
"I'll see ya later," she said as she walked away.
She leaned over towards us and pointed at several doors built into the white walls of the oldest part of the building. Large black plaques in front of each of the doors labeled them as historic sites. One was the site of the original medical facility at Fort Laconse circa 1715. Another was the site of a munitions storage. All the doors were labeled and most were closed and locked. Only a few had been renovated and were being used.
"This is the salon," Dr. Babcock said as she pointed at one of the doors. "Residents can come here on Tuesdays and Thursdays and get their hair and nails done. A lot of our lady residents really appreciate this service. And this is the dentist's. On Fridays, they can come here and get any dental work they need done. For many of our residents this is an opportunity they may never get again. We provide all these services free of cost regardless of whether or not the residents are insured."
Andy had stopped to look at each plaque as we walked by. "This place dates back to 1615?" Andy asked.
"Oh, yes. You should ask Dr. Allen about that. She’s our resident history buff. She knows the complete history of every nook and cranny of this place."
"So this was a fort?" Andy asked.
"Yes. I think it was originally a French fort and then a Spanish one and finally an American one. There’s a door in the administration building that they say was used for Geronimo's cell."
"I had no idea," Andy said. "Are there any books on this? I would love to know more about it."
"Like I said before, ask Dr. Allen. You'll have six months with her when you work on Robertson. She’s an amazing woman and a wellspring of all kinds of bizarre facts."
Andy smiled and continued reading the black, historical foundation plaques. The rest of us moved forward. John and I listened to Dr. Babcock droning on in a monotone about this room and that. The library was here and there were a hundred rooms and buildings that seemed to be dedicated entirely to storing old records. Finally, we reached a building that looked like it had been built at the turn of the century. It was part of a cluster of Victorian buildings by the old watch tower. They hovered together in various states of disrepair. The paint was chipped, and ancient looking air-conditioning units hung precariously out of the small, cracked windows. The lawn was tidy but barren and the door groaned angrily as we opened it.
"Look," Dr. Babcock said pointing behind us, "Do you see Bubba?"
"Who’s Bubba?" I asked.
"One of our resident peacocks. You know, years ago, during my internship, I worked at a hospital in Iowa and they had a peacock there too."
I turned around and saw Bubba wandering around, pecking like a chicken, in front of the library. He didn't seem quite so surreal with his tail feathers down, rooting through dirt for crumbs left behind by the patients.
"This is an amazing place," Andy said with a smile. "Peacocks and historical places and fog so thick you could spread it on a cracker. If you have to go crazy, I guess it should be someplace like this."
Dr. Babcock gave her a hard look. "I don't like the word
crazy,
and most of the residents here wouldn’t agree with you. There is no romance in the illnesses most of these people are afflicted with. And I promise you, there is no romance in this place."
Andy did not know when to let go. "I'm just saying that this is an interesting place."
Dr. Babcock ignored her and walked into the human resources building.
* * * *
Dr. Babcock was right. Most of the HR training was pointless to the point of being frivolous. We watched a film on the history of mental illness. The film was hopelessly out of date and was clearly made for the staff that had no prior training in working with the mentally ill. It gave mundane facts about how the mentally ill were not "crazy" and that they deserved respect and help. We also watched three films on how to dispose of needles, something we would never do, what objects could never be brought into the facility (such as cans of coke, plastic bags, knives, and rope), and how to take a sanitary and clean urine sample. This was a film that was clearly designed for nurses and nurse's aids, but the training curriculum specified that we had to watch it.
The only part of the training that was even vaguely useful was the final lecture on the C.R.C. Donald's Hospital itself. A very large nurse perched on a stool in front of us and spat out a list of facts about staff and administration. For the 285 residents at C.R.C., there were 832 staff members. A hundred of these were mental health workers, the modern term for orderlies. Another hundred did cleaning and gardening. There were 200 nurses and nurse's aids, 50 vocational therapists, art therapists, recreational therapists etc., 20 psychiatrists, 34 psychologists, psych techs, etc., 42 social workers, a handful of medical doctors, a few lawyers, and a plethora of business administrators.
This entire world of people revolved around the few patients that were left and we were such a small part of this world that it was almost intimidating. We did not make the rules, nor did we enforce them. We were watchers. We gave advice and hoped that it was followed.