Chapter 6
Tatum had started her new position on Thursday and this meant she would only get two days of internship before she was already done for the week. Feeling slightly less anxious than she had the day before, she was able to sleep until her planned 6:30.
With just a bit of a headache from her red wine induced web surfing the night before, she rolled over and hesitated prior to raising her head off the pillow. Once her head had adjusted and her stomach had settled, she got out of bed, tied her hair back and headed out for her run. Today was only her second morning run in Wainwright, and Tatum was already realizing that the early morning in Wainwright was sure to be something she would learn to treasure. She had always run in the morning in Chicago, but that was different. People, stores, noise, cars, honking horns, yelling cabbies, etc. etc. etc. littered the streets and prevented any potential effort at solace.
At this time of day in Wainwright, the sun had just peaked over the horizon and the only sounds were the distant hums of lawnmowers and farm machinery, and the voices of shop owners getting ready to serve coffee to their first customers. Tatum was starting to develop a route. Essentially it amounted to running the perimeter of town, including the outskirts of WMI. She could complete her new route in just under an hour, a perfect morning run.
Similar to the day before, when she completed her loop, she returned to the Regency Apartments and bounded up the stairs to Apartment 203. Just like the first day, Tatum appreciated the sunny atmosphere and open view of the apartment.
She showered and then carefully chose clothes appropriate for her second day of work. She had noticed the day before that, overall, dress appeared more casual at WMI as compared to anywhere else she had ever worked. All the staff wore scrubs and the doctors and office staff tended to wear casual wear, instead of the typical dressy business attire Tatum was used to. Although she had always enjoyed dressing up for work, she found herself welcoming the notion of wearing more casual clothes. Her tailored three-piece suit had seemed much more reasonable before she had made the trek home yesterday in nearly 40°C.
Dress slacks, wedged toeless sandals and a cotton blouse ended up being her choice of apparel for the day. In comparison to the day before, Tatum was able to easily negotiate her way quickly down to the first floor of the apartment building. As was becoming her ritual, she sat with Milligan for a bit while she enjoyed her coffee. They talked about the weather and her currently on-hold renovations.
She desperately wanted to tell Milligan all about the day before, especially about the patients she had seen in U3. However, after years of training about confidentiality and ethics, Tatum knew she could speak with Milligan only about things that were already public. She talked generally about the shape of the units and about staff she had met, then she gathered up her well broken-in briefcase and began the short hike from Regency Apartments to WMI.
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The hike to the institution was much shorter than it had seemed the day before, and Tatum made a mental note that comfortable clothing certainly reduced the unpleasantness of the walk. She did however miss the comforting click of her heels as she mounted the marble staircase. The soft soled wedges hardly had the same effect.
Similar to the day before, Anne was waiting for her in the front reception area of Unit One.
"Good morning sweetie!" she exclaimed.
Where does this woman get her energy, Tatum thought to herself.
"Good morning Anne," Tatum replied.
"Looking forward to your first day of real work?"
"You bet. I'm totally ready to see some patients and get my head into some files," she replied.
"Okey dokey. Let's grab a cup of coffee first. Do you want some or have you had your fill for the morning?"
Tatum thought for a second and then decided that, given her slight red-wine induced headache that was still hanging on, another coffee might be a good idea.
"A cup would be great."
"Black, or cream and sugar? Actually, probably best just to show you where everything is, that way if you want some later, you can help yourself. So, here you are," Anne pointed to the Keurig machine on the counter and the tree of different selections set out beside. "We pay a dollar a cup. That way there's always enough in the kitty to get a new selection. Oh yah, and make sure you always clean up after yourself. Best to bring your own cup in; that way you won't get blamed for someone else not doing their part".
Tatum selected a dark roast and put it into the machine. Finally… something that seemed similar to how she'd done things at home.
Anne followed Tatum on the Keurig, and then they both grabbed their mugs and started to make their way into the filing room, a room down the hall from Marja.
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The filing room required Anne to use her key FOB in order to get access. Tatum presumed Anne's FOB would work on any door in the institution as compared to the limited access of her own.
"Does mine work here?" asked Tatum.
"Yes, you will be able to get into the general filing area, but inside is broken down by unit and each separate filing room will require appropriate access."
Damn it, thought Tatum to herself.
She thought for a second that getting a look at some files from one of her inaccessible units would give her some clues as to why she would have to wait for increased permissions.
"Our system is not rocket science," Anne said in her typical jovial manner. "We keep U1's files in the main room so that they are accessible by everyone, then all the other rooms are labeled by unit number. See, U2, U3, U4, U5, U6 are posted on the doors. Confused yet?" Anne teased. "Inside each room the cabinets are categorized alphabetically by patient last name. Our conventions are pretty typical, last name, first name, middle initial." Anne kept talking as she used her FOB to unlock the doors to U2 and U3. "I looked up Dr. Glaser's clients you'll be shadowing today and this morning you'll be completing an assessment for a new intake, so that client we won't yet have a file on. That is unless the patient is a repeat offender and no-one knew that when the appointment was made".
Tatum was quickly learning that mental institution lingo closely paralleled that of the prison system.
"If it turns out the patient is a repeat offender, I assume Dr. Glaser will ask you to grab the file. You will find it in here somewhere. As far as the other two go, the first will be a therapy appointment with a patient named Jim MacDonald who is currently on U2 and the second is a U3er named Liz Crandall, oops I mean Elizabeth; all files are under their formal names. Gotta watch for patients that use their middle name too, it's pretty common around here."
Anne and Tatum were standing in the U2 filing room as Anne finished up her explanation, so Tatum immediately got to work finding the M's and looking for Jim MacDonald's file. Once she'd retrieved her first file, she efficiently worked her way through the FOB system and fetched Liz Crandall's file from the U3 filing room.
"Okay. All set?" Anne checked with Tatum.
Tatum nodded and confidently stated "I'm good to go."
Anne led Tatum back through the U1 maze of hallways until she finally realized their destination was the boardroom in which she had met Dr. Fraser the day previous. She and Anne each pulled up a chair and finished the last mouthfuls of their now lukewarm coffees.
Only a few minutes had passed when Dr. Glaser finally joined them. Tatum thought that Dr. Glaser was about as opposite from Dr. Fraser as two people could possibly be. While Dr. Fraser had a commanding presence and a handsome distinguished face, Dr. Glaser looked like many of the really brainy kids Tatum had known in school. His hair was a mousy brown and parted to the side. It was clear he tried to keep it neat, but it sort of stuck up in a variety of different directions, making him look generally disheveled. He was a small, thin boned man, maybe 5'7' and 145 pounds. He had round silver rimmed glasses that certainly did nothing to complement his thin face and deep set eyes. He wore khaki pants, similar to those worn by Dr. Fraser the day before, but they definitely looked nothing the same. Dr. Gla
ser's pants were too large and cinched up at the middle, making them bulge in the front and create the appearance of a low set beer belly. His shirt was tailored to fit but was slightly too small so that it rode up his back when he sat down. Trying to find something positive, Tatum noted that despite the shirt's too small size, it was nicely pressed and its pinky tones added some colour to his otherwise grayish skin. To further reduce his overall stature, Dr. Glaser stood with his shoulders curved and tended to speak with a slightly effeminate tone.
"Well, good morning Tatum" said Dr. Glaser with an inviting smile. "I'm so glad I'm finally getting to meet you in person. I've heard good things," he winked at Tatum. "My name is Tim, Tim Glaser. I'm the Clinical Director of WMI's Psychological Services and I'm really glad to have another set of hands to help out."
"Nice to meet you sir," Tatum replied respectfully.
"Sir? Don't call me sir!" he said with a grin "Tim will do. Although we always used formalities when patients are around, right Nurse Horstings?"
Anne nodded in agreement.
"I guess Stan explained that our internship program is a trial-by-fire type of system?"
Tatum looked at Anne, "Stan?" she mouthed to her trusted ally. Anne mouthed "Dr. Fraser," back to Tatum from behind Tim where he couldn't see.
"Oh yes, yes he did. That suits me just fine" replied Tatum.
"Did Anne explain today's clients?"
"Well we just picked up the files and I haven't had a chance to read through them yet, but I will. And I understand this morning is an intake? What does that involve?"
"Our client this morning was in a bad boating accident in some lake in Northern Manitoba. As you know there are no seat belts or helmets in boats, so now he's brain injured. Family tried to take care of him for a couple of years, but he's too much for them to do it long term. Families get tired you know."
Yah, I sure do know, Tatum thought, but kept to herself.
Tim continued, "Anyway, he needs a comprehensive, full cognitive, neuropsychology, family interview; the whole nine yards. You ever done anything like that?"
"For sure. I actually chose neuropsych as my specialty in my PhD. I trained first as a generalist so I could work in many different settings and could do some therapy, but I kept neuropsych as my primary area of expertise. This case sounds right up my alley."
"Well alrighty then. We'll go over the tests I would typically use. Anything that you feel you're okay to go ahead with, you can be the doctor and I'll be the observer. Sound good?"
"Nothing could sound better," Tatum replied.
Anne excused herself with a quick "Well, I've got work to do Tatum. I'll leave you in Tim's experienced and capable hands."
And with that, she grabbed the used coffee mugs and was gone.
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Under Tim's careful watch, Tatum worked her way back to the administration unit, where she put together a new patient file. The family was bringing in the history when they came, and there was yet to be any formal assessments, so the file was thin.
Tatum had checked with Marja and all they knew for sure was that he was a twenty-seven year old man who'd been injured in a serious boating accident and that his name was Kory Atchinson. Thin file in hand, Tatum worked her way towards U2, where she now understood intake assessments were completed.
She hesitantly put her FOB up to the sensor and was pleasantly surprised to find that she seemed to have unlimited access to Unit Two. Judy, the unit head she'd met previously, directed her toward one of the smaller rooms on the bottom floor. She assumed it was typically held as a training room since it was intended to function as an observation suite with a small observation room available through one-way glass.
She had assumed yesterday that she would be the observer, but Tim seemed quite happy for her to move right in. The room was set up similar to those Tatum had worked in before, except that the table was set in the middle of the room so that she would sit on one side and Kory on the other. Tatum preferred for the table to be pushed against the wall and to test from the long edge while the client sat perpendicular to her on the short edge, but she wasn't about to exert her preference this early in the game. She was certain that at some point soon moving the table would be entirely appropriate, but not yet.
"Okay, set the file down, and I'll take you to our test library," said Tim.
The test library was a small locked storage room, just behind the observation room.
Tim explained "We leave the standard stuff right in the test rooms, but if you need something a bit less well used, you'll find it here. What are you used to?"
"Well, I would say that back home we tended mostly to stay with the Weschler cognitive and achievement stuff, and then the NAB for adult neuropsych," she responded.
"Right" said Tim as he reached up above his head. "Here's the NAB. It tends to be one of the ones that's not used so much, many of us are old school and still do neuropsych piece by piece. But, whatever's your pleasure. Okay, so WAIS, NAB, then WIAT. Is that your plan?"
"Sounds perfect," said Tatum.
She was feeling much more confident now that she knew all of her test materials would be familiar.
"So are you good to go then? I'll just watch?" he asked.
"I think so," said Tatum.
She totally understood the need for supervision time and she'd been the recipient of supervision many times in the past. But, she couldn't think of a single time where being watched wasn't just a wee bit nerve racking for her.
"We can just wait here," explained Tim. "Marja will bring Kory and the family to the unit, and then one of the orderlies will direct them to us".
Tatum busied herself with reviewing and preparing her test materials.
"Right in here, folks," said the orderly that led the Atchinson family into the testing room.
Tim stood up, "Good Morning. You must be Mr. and Mrs. Atchinson," he said.
The older people, who looked remarkably like the aging couple Tatum had seen her first day in town nodded. They looked tired.
"I'm Dr. Glaser, and this here is our new recruit Dr. O'Neill. She's from Chicago," he explained as if it meant they should afford her some kind of special respect. "She will be doing Kory's testing today, and I will observe her work from the small room that is just behind that mirror. You are welcome to watch from there as well".
They nodded again.
Tatum could faintly hear the sounds of their voices talking, but mostly she was completely distracted by the activity happening at the other side of the room. Kory, who had followed his mother and father into the room, was angrily yelling at his parents and swearing obscenities. They ignored him; it had obviously happened many, many times before.
Tatum could tell that prior to his accident he had been a young, good looking, chiseled farm boy. But that had all changed. He now had many scars on his previously handsome face, most of them disfiguring. His hair had been burned off in patches and his right arm now hung like a limp piece of spaghetti at his side.
But, Tatum supposed, his lost physical appearance was the least of the family's concerns. She suspected that his now angry outlook on life and lack of appreciation for social convention were their most difficult issues. She also noticed, only because she was familiar with potential symptoms, the top of a pair of adult diapers peaking out over the tops of his trousers.
Tatum had worked with brain injury victims before and she was really hopeful that today was going to be a good day for Kory. A bad day might mean she would need to call security for a restraint.
Mr. and Mrs. Atchinson handed over a thick pile of papers and Tatum spent a few minutes browsing through Kory's history. Not much to read really, a bunch of medical tests that she couldn't decipher and some family therapy notes. Nothing had previously been assessed with respect to Kory's cognitive functioning.
Once Tim and Kory's parents finished up making small talk, they excused themselves to the smaller adjacent room and Tatum got to work. Tatum and Tim had discussed it beforehand
and decided that he would work with them on the family report stuff while they sat with him next door.
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Tatum went through her usual process of rapport-building, making some small talk and trying to make Kory feel comfortable.
"Hi Kory, my name is Dr. O'Neill and we're going to spend several hours together today. What we need to do is probably not like anything you've ever done before, but basically I'm going to do a variety of different tasks with you while trying to figure out what areas you have strength and what areas you might need more help in, okay?" Kory nodded.
She could tell he was trying to keep himself in order. He sucked his hand in a self-soothing manner. Tatum was thankful his hand was in his mouth. As long as his mouth is full, he can't swear at me, she laughingly thought to herself.
"Okay, let's get started. The first thing I'm going to show you is some blocks. Some of the things that I will ask you to do might seem kind of silly, but they all have a purpose. Also, they will all start out easier and then slowly get harder and harder. Here's the first one, see if you can put these blocks together just like this picture."
Tatum continued through her morning working her way through the variety of tasks psychologists often used to try to figure out how a patient's brain was working. Years of practica and other forms of clinical experience had taught Tatum the requisite 'poker face' required to do psychological testing, especially when working with patients will highly atypical behaviors. So, when Kory let out a random "Screw You," told her that he "Hated her and every other asshole doctor," or sucked his hand until slobber ran down his arm, she held her professional presentation and waited before providing the next task, or, if necessary, handed him a Kleenex.
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When Tatum had completed the morning session with Kory, Tim explained to the family that he would need to return in the afternoon, but that it would be a shorter session, probably about an hour and a half. Kory responded to his request to return with a very typical "I'm not coming back here, these doctors are idiots. This is the stupidest thing I've ever done," as his parents led him out of the unit and down towards the cafeteria.
Tatum was unsure of what to do next. Yesterday, she and Anne had eaten lunch outside together, but she suspected Tim would have other ideas. She was right.
"Well, I'm off to my office to catch up on some paperwork," he said, "Meet back here in just under an hour?"
"Okay, see you then," Tatum replied as if she knew exactly what she would be doing until that time.
After Tim left, Tatum sat for a minute in the test room. She absentmindedly organized Kory's file and replaced some of the items she'd used for testing that morning. Then, she started on her way down to the cafeteria, unsure of her actual plan once she got there.
She bought the same to-go lunch that she had purchased with Anne the day prior and then, thinking that she wanted some familiarity in her day, she started navigating her way through the maze of corridors that she remembered led to the outside staff courtyard. Then, as Tatum passed by the heavy security door into Unit Three, her plans changed.
Using her FOB to enter the unit, she was hopeful that no staff member who would question her entrance was on the other side. Looking around Unit Three, she saw only nurses and orderlies going about their business. They seemed neither surprised nor concerned about her presence.
Tatum glanced around the full care unit and saw many of the same types of activities as she'd seen the day before, rocking, yelling, tapping, brushing. Eventually Tatum's glances landed on that for which she had come. James was in his usual position, sitting near the wall with his hands in front of his face.
In his own little world as always, James did not seem to notice Tatum approaching him, nor did he acknowledge her presence in any way when she introduced herself.
"Hi James. I'm Dr. O'Neill, Tatum. Do you mind if I sit with you while I have my lunch?"
Tatum pulled up a chair beside James and started to unload the to-go bag she had purchased.
She knew well that an introduction and being in his space would be more than enough for the first day, so she ate her lunch in silence, simply sharing the air. In time she would talk with him. She knew she would be back.
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Tatum made sure that she was back at her assigned location before Dr. Glaser returned.
"How was lunch?" he asked politely upon his return.
"Very nice thank you. I just grabbed a to-go from the café. You?"
She gave no indication about her little lunchtime rendezvous to Unit Three.
"Ate at my desk like usual," he responded with a touch of sadness or frustration in his voice, she wasn't sure which.
Tatum finished setting up for her afternoon session and shortly after, Kory and his parents arrived back at the assessment room.
"Should be a bit easier now," Mrs. Atchinson softly told Tatum, "He's taken his lunchtime meds".
She was right.
Mom's always know, Tatum thought knowingly to herself. She remembered in grad school Dr. Zubert teaching her that if you want to know something, always ask the mom.
At the time, Tatum though Dr. Zubert was being incredibly sexist, and remained convinced that all third-party informants should be given equal consideration. Now, with some actual clinical time under her belt, Tatum nearly always took a patient's mom as the primary source of information.
As his mom had expected, Kory did very well in the afternoon session. He only swore at Tatum three times and his hand sucking required a single Kleenex.
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The rest of the afternoon Tatum was an observer. She observed for two reasons. First, Tim had existing rapport with his current counseling clients, and second, Tatum was generally much less comfortable with counseling, as compared to her preferred assessment.
Tim saw Jim MacDonald on U2. He was a middle aged man with depression. Not a depression attached to any identifiable reason to be sad, but just a lifelong struggle with a low mood. Tim mostly followed what Tatum knew was a cognitive behavioural approach; he tried to help Jim change the way that he saw his world.
Jim had self-referred to U2 and was not required to stay. As a result, if at some point his medication and therapy helped him get to a point where he once again could make it on his own, he would likely check-out. Tatum felt hopeful for him, but knew that even if he did manage to leave, he'd likely be back. A probable re-offender, Tatum thought to herself, surprised at how quickly she too was adopting the prison lingo.
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Liz Crandall turned out to be the woman brushing her hair and singing that Tatum had seen on her tour through Unit Three. She quickly realized that Liz was OCD and that her hair brushing was her compulsion.
From her now closer view, Tatum was able to see the blood encrusted into her hair where she had brushed until her head bled. Tim went through the motions of trying to help her with 'response prevention', in other words not brushing her hair, but Tatum could tell by his body language that he really held little hoping of being successful.
Tatum knew full well that sometimes therapy was provided primarily so that families thought that something, anything, was being done to help their loved one. Liz struck Tatum as a 'lifer'.