After Hours (2 page)

With a combination of a swipe and deft punching at a keypad, Dennis preceded me into
a more welcoming hallway, lined on one side with tall windows, weak morning sun glinting
off its clean linoleum floor. Another swipe and code and we were inside a nurses’
station, with a counter and a wired glass window for handing out meds, lots of shelves
arranged tidily with boxes and equipment, a scrub sink, and a half-dozen filing cabinets.

The station looked onto a plain room with beige couches and chairs, two big windows;
a high-ceilinged space lit equally with overhead bulbs and sunshine, as square and
adequate and inoffensive as a Saltine.

There was a patient dressed in the requisite gray in the lounge, leaning a hip on
the deep windowsill with his large arms crossed over his equally large chest. He stared
over his shoulder into the yard beyond the glass, a placid expression suggesting he
hadn’t noticed the cage of white bars marring his view. His head was shaved to brown
stubble, and even from twenty feet away I could make out the scar running from beneath
his ear down his neck. More an inmate than a patient, he seemed to me, fresh from
a brawl in the exercise yard. I eyed the glass of the nurses’ station window, suddenly
doubting its un-shatterability.
Jesus, what on earth have I signed up for?

Salary,
I reminded myself.
Insurance.
And cheap rent,
for as long as I could stand living in the drab little apartment I’d been offered,
in the transitional residence just across the road. It primarily housed adults who
were enrolled in or had completed programs at Larkhaven, a stepping-stone toward truly
independent living. I’d been sent photos. Its walls were painted cinderblock, the
space tiny, and I’d be sharing a communal bathroom and kitchen. In all likelihood
it would feel far too much as though I were going home to another ward, after I’d
clocked out of this one.

“Shouldn’t he be supervised?” I murmured to Dennis, staring at the lone resident and
trying to guess his diagnosis.

Dennis laughed, freeing a clipboard from a hook on the wall. “That’s not a resident.
That’s Kelly.”

A frown tugged at my lips as I processed the nested facts: he wasn’t a patient, and
he had a girl’s name.

“Kelly Robak. We call him ‘the Disorderly,’” Dennis went on, gaze skimming his clipboard.
“He can wrestle down a psychotic like nobody else. Of course we like to have three
men on hand for the job, but he’ll do on his own in a pinch.”

“For sedation?”

He nodded. “De-escalation’s always best, but failing that, we’ve got Kelly. You two’ll
be working together plenty.”

I eyed my new colleague with guarded curiosity, realizing that at some point in the
indeterminate future, Kelly Robak and his beefy arms and shaved head might be the
only thing that stood between me and a grown man in the throes of a violent psychotic
episode.

“I hope he’s good. Why isn’t he wearing scrubs?”

“He’s the best. So good we let him wear what he likes. And he likes gray, to keep
himself on par with the patients. I wish he’d just get psych tech certification already,
but he seems to prefer to keep his role as minimalist as possible. I’ll introduce
you.”

Dennis set his clipboard on the desk and unlocked the metal door that separated the
nurses’ station from the lounge with a tap of his keycard. It locked behind us, the
sound heavy and hard and confident. Kelly Robak’s body looked much the same.

“Kelly.”

He turned at his name and stood, meeting us halfway across the room.

Up close I saw the gray he wore wasn’t a uniform, after all, or rather one of Kelly’s
own making—thick canvas pants and a tee shirt, the latter snug not for stylishness,
I suspected, but to give his charges as little fabric as possible to grab hold of.
Same strategy with the hair. I saw scars on his head, small streaks of white skin
where his brown hair hadn’t grown back so densely.
From fingernails?
I wondered.
Or from broken bottles in rowdy bars, off the clock?
He looked the type, though looks occasionally deceived.

“Kelly Robak, this is Erin . . . sorry, Erin. I’m hopeless with names.”

“Erin Coffey,” I supplied, and Dennis slapped his forehead to say,
duh
.

I accepted Kelly’s shake. His arm was a huge python, massive hand swallowing my tiny,
mousy one whole. He gave it two firm, businesslike pumps, and his warmth lingered
long after he let me go. I rubbed idly at my knuckles, noting the bruises decorating
Kelly’s arms, like smudges of paint, yellow and olive and dark purple.

“Our new LPN,” Dennis added.

Kelly nodded. “Welcome aboard.” His voice befitted a man of his size, the words dark
and deep from tumbling around his broad chest. He made me feel small and vulnerable,
dependent. Not sensations I liked, but given our relationship they seemed somehow
essential. After all, this was a man who’d keep me from bodily harm—if not emotional
damage—if this job did indeed seek to break me. I didn’t like feeling reliant on men,
but concessions could be made, considering the context.

“Nice to meet you,” I said.

A nurse arrived, then a pair of orderlies in mint green scrubs, toting paper cups
of coffee.

Everything looked like a weapon to me—pens to stab, hot drinks to scald, drawstrings
to choke, just about anything a ready projectile. But they seemed bored, if anything.
I was introduced and their names and titles immediately fell out of the back of my
head, so preoccupied was I with the immense mistake I must be making.

No. Not a mistake, merely a challenge.
With training and patience, I could do this.

Another nurse arrived, somehow managing to look harried and tired at once; a doctor
in a white coat, and then another; then two fresher faces who must be just coming
on duty, both orderlies. I forgot all their names as well.

The senior of the two doctors led the brief meeting, which took place standing, most
people balancing clipboards and coffees. I noted the bolted brackets pinning the armchairs
and sofas in place, precluding the assembly of a cozy circle. The docs ran down their
notes on the patients from the latest one-on-one and group sessions, then the senior
nurses put in their two cents, then the LPNs and techs and orderlies were allowed
to ask for clarification or share their own thoughts on the residents.

Kelly Robak didn’t have a clipboard and didn’t take notes—his role seemed less reliant
on dosages and exact times than most people’s. The overnight staff walked me and Kelly
and the other day-shifters through any “incidents.” The patients’ names meant nothing
to me, and my skittish brain eagerly filtered out the words that validated my fears.
Outburst, belligerent, episode, agitated.
And these were the men I’d be jabbing full of sedatives. Not a function that seemed
likely to endear me to them.

“How was Don?” Kelly asked the overnighters.

A meaty female tech with eyebrows plucked into slashes of permanent annoyance shrugged.
“Quiet. But he got a dose at nine. Before that he was his usual effervescent self.
I’m sure he’s saving up his energy just for you, Kel.”

Kelly nodded, expression perfectly neutral. I stole glances at him as the meeting
went on.

His irises were pale with a dark ring, gray like his self-designed uniform—almost
as though he were withholding color on purpose, lest he paint this place as anything
other than the stark fortress it was. Clear eyes, pretty and cold as ice. Pretty eyes,
pretty name, those ugly scars and bruises along the arms he recrossed.

And a gold wedding band on his left hand.

I wondered idly what Mrs. Robak was like, and whether she occasionally enjoyed getting
wrestled into submission by her gigantic husband.

The meeting broke up, and suddenly my workday was starting. Dennis reintroduced me
to a nurse practitioner named Jenny—a sturdy gal of early middle age, with tight blond
braids like a milkmaid and cheeks stained by rosacea into a look of constant mortification.
She spoke briskly. I could sense her patience had bounds, and I didn’t care to ever
mess up enough to discover them. She was my supervisor, and I was going to shadow
her closely for the first few days as I got accustomed to the ward’s routines. Routines
were everything, I’d learned over and over in school.

“Routines are a promise that must be kept,” Jenny echoed, prepping dosage cups at
the nurses’ station counter. And with doctors, nurses, techs, and orderlies all on
staggered shifts, falling out of sync with the ward’s rhythm was a ready invitation
for chaos. “The second we break the promises the ward rules make to our residents,
we’re back to square one. Especially with the paranoid cases.”

The patients had to bathe—or
be
bathed, depending on how lucid they were on a given morning—shave with single-blade
safety razors under exceedingly close supervision by the Kelly Robaks on duty, dress,
then be led to the dining area.

There were fifteen male residents in the S3 locked unit, plus a handful of women on
the Starling building’s second floor. Most arrived in the midst of major psychotic
or substance abuse crises—or often a combination of the two—and weren’t expected to
stay long before being cleared to move to more lenient programs, other facilities,
or back home to their families.

Of the fifteen men in my ward, nine had potentially dangerous disorders and were prone
to lashing out, verbally and physically. Contrary to pervasive popular belief, most
people suffering from serious psychological disorders, if a threat to anyone, are
only a danger to themselves. But our unit specialized in the minority of patients
who were subject to fits of deep paranoia and resulting rage. If they acted out, they
did so with the fervor of men whose very lives were in danger. Because in their minds,
that was exactly the case.

The morning was quiet, which Jenny told me was typical. Patients had a half hour to
eat breakfast and come up to the nurses’ booth to accept their little plastic cups
of pills. Some were sullen, a few friendly, a couple completely blank. At least five
demanded in tones of varying suspicion to know who I was, and somehow I retained their
names far more ably than I had my colleagues’.

Carl. Thirty-six, paranoid schizophrenic, said the clipboard I glanced at as I helped
Jenny with the meds. He was cheerful, with sharp eyes and a too-eager smile.

John B. Forty-three but looked to be pushing sixty, with a gravelly chain smoker’s
voice. He had PTSD coupled with bipolar disorder, and after he left, Jenny told me
he often woke thrashing, screaming his brother’s name.

Lonnie. Sixty-one, another schizophrenic. Lonnie was chatty, moving with quick, birdlike
twitches accenting each gesture, an effect that didn’t match his doughy frame. He
wore thick glasses strapped to his head with an athletic band, dividing his frizzy,
graying hair into two lobes.

The resident Kelly had asked about in the morning meeting, Don, was plump and pale,
as chipper as one could expect of a middle-aged man at seven thirty. I asked Jenny
why Kelly had inquired about him, of all the patients.

“Don and Kelly have a . . . special relationship. When Don goes into a psychotic episode,
Kelly’s the only one who can ever seem to settle him down, short of a jab.”

“What does he do?”

She shrugged. “Nothing extraordinary. Nothing any other orderly wouldn’t. But Kelly’s
got a certain calm about him. Like a wall. You can fight a man and maybe win, but
you can’t fight a wall.”

“How often do Don’s episodes happen?”

“He’ll have a violent one twice, maybe three times a week, nearly always in the early
afternoon. Kelly shadows him between lunch and about four, and just knowing he’s there
seems to keep Don under control. I think Kelly’s a comfort to him. Some people like
having a wall near them, especially paranoid people. Something to lean against. Some
sense of security at their backs.”

Junior nurses’, techs’, and orderlies’ shifts were long and irregular. Mine were all
7:00 a.m. to 7:00 p.m., two days on, then one or two days off in between. One week
I’d work Monday, Tuesday, Friday, Saturday; the next just Tuesday, Wednesday, and
Saturday. Plus Sundays on a rotating, monthly schedule. After six years with an exceedingly
rigid daily routine, I found it all at once confusing and luxurious. Weekends? What
were
those
? And some weeks I got
four
entire days to myself? I might need to cultivate some kind of social life. Whatever
that was.

“How does Don do on Kelly’s days off?”

“Worse,” Jenny said, melancholy in her voice. “But what can you do?”

Some of the patients lingered in the lounge after receiving their medication, gossiping
in small groups or staring out the windows, but most eventually disappeared down a
hall, to the recreation room, I was told.

The rec room had a television, mounted below the ceiling in one corner. It was tuned
to a game show when Jenny took me there after post-meds paperwork. Beneath it stood
a shelf stacked with books and a small selection of board games. No Monopoly, no cribbage
board. Nothing with sharp metal bits, basically, nothing that required a pen to record
scores. It didn’t leave much.

“But a lack of variety beats a tiny metal knife in the eye,” Jenny told me, surely
dooming me to tear up every time I thought of playing Clue again.

Kelly had been off doing his orderly rounds in the patients’ residential wing, but
he appeared in the dining room toward the end of the breakfast period, accompanying
a slow-moving older man I hadn’t met during morning meds. Once again, I mistook Kelly
for a patient at first, in his light gray shirt and pants.

They could have been a father and son having a friendly talk, except for the way the
man’s hands and elbows jabbed the air as he spoke . . . just a bit off. Just a bit
manic, if you knew how to spot it. Kelly led him to a table, then commenced patrolling
the room’s periphery, strolling silently with his hands clasped behind his back. It’d
take more than that show of deference to make a bruiser like him pass for nonthreatening,
I thought, but he looked as calm as he did alert.