"It was Always You"

"Ambulance fifty-six, 5-6, make it the NEMC ER for a female 12 going to Bournewood."

Psychiatric transfers represent a significant fraction of the runs undertaken by private ambulance companies.  Patients with suicidal ideation or those who have attempted suicide cannot be taken directly to a mental health facility, but must first be evaluated and cleared medically at an emergency department.  Once a patient has been cleared medically, they can be transferred to a psychiatric hospital.  Since they could potentially be a danger to themselves, and are often medicated or sedated in the emergency department, the preferred transport vehicle is an ambulance, where the patient can be supervised, or, if absolutely necessary, restrained.  In Massachusetts, the commitment papers and process is called a "Section 12," commonly referred to as a "section," or a "12."  My company makes it a rule to send a truck with a female EMT to transfer female sectioned patients, mitigating the risk of accusations of inappropriate behavior by male EMTs in the back of the truck.  

I normally relish the challenge of comforting emotionally distressed patients.  Each panic attack, each suicidal ideation call, and each suicide attempt is an opportunity to improve the tact and empathy it takes to handle this distinct breed of call.  Some patients are despondent, they don't want help, they don't want to talk, and they sure as hell don't want to go to the hospital.  These patients are the most challenging, and by far the most frustrating.  

In the non-emergency setting it's a little different.  You're not coming into the situation at the crisis point.  The biggest hurdle, getting the patient committed to seeking help, has already been overcome.  It can be a little awkward.  That doesn't mean comforting the patient isn't important.  They're about to be committed to a psychiatric facility, many for the first time.  Anybody who has seen or read One Flew Over the Cuckoo's Nest is bound to be at least a little apprehensive.  

As we pulled into the NEMC parking lot, I had no idea that this "female 12" would scare me far more than any raging-drunk, 250-pound football player ever could.  What's that?  Calling me a wuss?  You just wait and see.

My partner, another college student, and I pull the stretcher into the ER.  "She's not going to be ready for another minute," our patient's nurse tells us, "but here's the paperwork."  I glance through it before handing it to my partner so that she can copy the information down.  Some parts catch my eye: "Borderline personality disorder," "the patient became violent," and in the physician's notes: "PATIENT HAS THOUGHTS OF HARMING HERSELF AND OTHERS."  The nurse comes back and gives us a short report:

"Apparently she had some kind of fight with her boyfriend.  She presumably just found out she was pregnant while she was here, but might have taken a home test and found out.  That could have caused the break or the fight that caused the break.  We don't really know because she won't talk to us."

"She won't talk to you?" I ask.

"She hasn't said a word since she got here.  I think she talked to the psychiatrist who came down for a consult, but that's it.  Look, she's been fine since she's been here, and she's been told she's going out, but I don't know how she's going to react when it's time to leave.  I think you'd better get your restraints."  I nod, and tell my partner I'll go out to the truck to get them.  Eventually, we get the ball rolling, and follow the nurse into the room.

As soon as we hit the door, I feel it; the unwavering stare of the patient.  She's tall, but petite, and very pretty.  Her eyes remain locked on me.  "Janet, these are the people who are going to take you to the other hospital," the nurse tells her.  

The stare is not hollow, but penetrating.  Uncomfortable, I avert my eyes.

"It was always you," the girl says in a quiet voice, barely above a whisper.

"What?" the nurse asks.

"It was always you," she repeats, still staring at me.

The nurse turns her head to look at me, eyebrows raised.  The expression on my face speaks for itself; I have no idea what she's talking about, either.

"Okay," my partner says after an awkward pause, pulling the stretcher next to the bed and moving the seat-belts off of the mattress.  "Janet, can you move over to the stretcher for us?"  She doesn't mind, and pushes herself up to slide over onto our stretcher from the hospital bed.  To my dismay, she manages to do this without breaking her stare.  I find it hard not to react to the absurdity of the situation by laughing.  If I had had a choice, I would have pushed the back of the stretcher, out of the patient's view, but the tight quarters in the room meant that I would be pulling the foot end.  As we leave the room, the nurse mimes to me "I think you'd better drive."  No kidding, I mouth back.  

Pulling the stretcher out of the ED, I can feel the patient's eyes on the back of my head.  When I turn backwards to negotiate corners, I find her unrelenting gaze again and again.  I am relieved to finally load the stretcher into the truck and close the door.  I can't help but feel a little weirded out, and want to get the 30-minute drive over with.  

I hear my partner ask unanswered questions in the back of the truck ("Are you comfortable Janet?... Do you want a pillow?")  A few minutes into the trip, I can feel the hairs on the back of my neck stand up.  I glance at the rearview mirror.  I have to keep myself from shuddering when I see the patient turned 180 degrees on the stretcher, hand on the corner of the frame, eyes peeking over the mattress, staring at me.  I do my best to shake it off and keep my eyes on the road.  I don't think she maintained that necessarily uncomfortable position for the whole ride, but I definitely look back a few more times only to find her still staring at me.  

I'm relieved when we arrive at the receiving facility.  After removing the stretcher, I make a somewhat obvious play for the back end, so that I'll be behind the patient.  We are met by a security guard, who accompanies us into an elevator.  I maintain my strategic position behind the stretcher.  The security guard carries a radio that has "SECURITY/B-TEAM" written on it.  "Not quite good enough to make the cut for the A-Team, huh?" I ask him.  He chuckles and looks down at the radio.  "No, I guess not."

We arrive on the floor and exit the elevator into a small anteroom.  "You can let her off here," the guard says.  We drop the stretcher to within a foot of the floor.  "Janet, why don't you lean forward and I can tie your gown behind you," my partner says.  When she leans forward, she exposes a black tattoo of a dragon that spans her upper back.  I gulp.  Scenes of the tattooed serial killer from Red Dragon flash before my eyes.  

Finally, gown secured, Janet stands.  The security guard starts to walk forward and unlock the door to the unit.  "Come on," he says.  She turns, facing me, eyes locked on mine, and shuffles slowly backwards through the door.  She stops as the door slowly closes, staring, unmoving, detached but focused.  I think I catch a hint of a wry smile at the corner of her mouth.  A chill runs down my spine.  

The door closes, and my partner and I get back on the elevator.  We laugh because, in the moment, it's the only immediate way we have to deal with the situation.  

Later, I call my girlfriend and tell her about the call.  "Creepy," she says.  "You'd better check your closet when you get home," she teases me, "she might be waiting for you there."

"Stop," I tell her, "you're creeping me out."

"Seriously, you better watch out!  Creepy staring girl is going to get you!"

I check my closet before I go to sleep.