Annette Milliron CWA 2005

Annette Milliron will graduate from YSN in the psychiatric-mental health specialty in May, 2005. She comes to nursing from a background in women’s studies and direct-entry midwifery and has lived and worked in Salt Lake City, Utah; El Paso, Texas; and Cusco, Peru. She plans to specialize in the psychotherapeutic treatment of personality disorders.

Transcript of the Reading:

A. R., and Snow

Years ago, at a time when I was feeling deeply overextended and asking for a great deal of caretaking, my partner, who was also needing much support, said, “It’s a time of low water. No one has a well deep enough.”

I have been feeling those sentences acutely this final January of my MSN program, as I drive thirty miles back and forth between my clinical site, a hospital emergency room, and the triage department of the state mental health facility where I work as a recently licensed RN. Everywhere in Connecticut–or at least in those disinfected lobbies that provide temporary respite from the biting cold to men and women who are chronically uninsured or state-insured, often homeless, sometimes housed but without heat–there is a near-manic tension of bodies braced against hopelessness. I can hear the edge of it in pressured voices asking, sometimes rudely demanding, access to a locked room with a telephone reserved for urgent calls only. Every call has become urgent. I can smell it on the alcohol-breath of a man requesting detox for the third time this month. I can see it in the panicked eyes of a woman, thrusting a letter at me informing her that because of increases in her disability payments, her Medicaid now has a spend-down figure, the sum of bills she must amass before her neighborhood Walgreens will refill her prescriptions for free.

I have driven to work in a three-year-old car. I have a hot latte in a thermal mug and a drawerful of nifty pens from pharmaceutical reps. I have health coverage through both the university and the state. What I do not have is a way to look into these patients’ eyes and communicate a lullaby, a sweet reassurance that one of these days they will wake up not only to the services they need but to the surety that their lives and minds can be restored to health. That we will thoroughly understand how the medicines we give them work. That There Will Be A Cure. That they will have access to it. Instead, I know the following: last week, every hospital emergency room within 40 miles was “on diversion,” sending ambulances to other hospitals that also had no beds for these patients–or, for that matter, for any psych patients, even well insured ones. That in that same week, two patients who had presented on a busy night with thoughts of suicide had been evaluated for risk and had been discharged. Both had returned an hour later with the same impulses. That gravely ill patients have been staying 8 days in one emergency room, for lack of anywhere to send them. I think to myself that despite our best efforts at lobbying and networking, no matter whom we elect President, the health care system in this country is fundamentally broken. I think how those of us who are embarking on careers as new providers are stepping forth with trepidation into a landscape that seems driven by factors that seem to leave no room for real health care–that dictate the technical or pharmaceutical “interventions” we may make but that leave caring an activity that somehow we must stuff into the cracks between closed-ended questions and fifteen-minute visits.

But here I am; you sit across from me in a too-big coat which you do not remove, which you tell me was given to you on the street when you were released, thinly T-shirt clad, from prison three days ago. You tell me pleadingly that you need a structured environment, that you cannot stay clean from cocaine left to your own devices in the shelter. That you hear voices. That they worsen with anxiety, telling you to do things, for example to use, or to cut yourself. You tell me the story of your abuse, which was horrific as a child and which remains horrific when you do what a poor woman must to finance a habit like yours.

I sit with you. I assess while I listen. I give you Kleenex when you cry. I reflect what you need and describe what care there is to offer, what referrals can be made. No, there is no inpatient bed. Yes, I can make a referral to a vocational rehab program that might have openings within a few weeks. Yes, a psychiatrist can see you today, and yes, we will give you your medications. No, we have run out of our allotment of bus tokens. I do have a list of soup kitchens and clothing banks. I can connect you with an ongoing counselor and I will meet with you twice a week until that person is available.

I step out of the interview room and into the bustling triage office, add my name to a list of clinicians waiting to present patients to the Medical Officer of the Day. Meanwhile, I paint a rough sketch to the two nurses who head my department. We quickly discuss any options for your care plan that I may have forgotten. What materializes, for the moment, is a voucher for a sandwich in the cafeteria upstairs. When I give it to you, you roll your eyes: this is supposed to solve my problems? But when you leave, you thank me three times. You say you needed someone to listen. You return for your follow-up appointment.

It is January, and it is cold and grim when I leave the hospital. I leave with my head loud with the clamor of case management, chatter of labwork to follow up, records yet to obtain. I walk with a colleague to our cars through falling snow. Passing headlights are softened by the blowing white and the muffled engine noises feel somehow soothing rather than assaulting. I notice as we walk that I have nothing to say. More slowly I notice that something inside me is quieting, and I stop walking to stare into the flakes swirling under a streetlamp. I have never seen snow like this–fire like my grandmother’s opals; crystals distinct as TV rice grains–and I am, for one holy moment, speechless. I stand in the snow, feeling something opening.

This is what I will carry into the muddy-linoleumed ER in the morning–this weight of being gifted by surprise. I think of the holiday party the hospital threw for patients and of the parents gushing with gratitude at being handed a toy to take to a child, something to give. Perhaps this is how nurses keep going, how anyone keeps going. For me it is not exactly faith, but today it is enough: that out of the sky has come something unexpected, something to fill a well in a time of low water.