Live to Tell - Lisa Gardner [39]
“We’re good,” D.D. replied. “Busy afternoon?”
“We’ve had busier.”
“How many kids are out there?” D.D. asked, easing into things. She wanted to take her time with Danielle. She was curious what made the nurse tick—or fidget, as the case might be.
“Fifteen. More crowded than we’d like, but not acute.”
“Acute?”
Danielle had to think about it. “A psych ward is acute when we have more than we can handle. It’s not a specific number of kids; it’s the dynamics of the kids. Eight kids can send us over the top if they’re involved cases that didn’t mix well. On the other hand, we’ve effectively handled up to eighteen.” She paused. “Not that I’d like to do that again.”
“How long have you been here?” D.D. asked.
“Eight years.”
“Sounds like a long time, given the field of work.”
The nurse shrugged. “We’re a progressive unit, which makes us a better place to work than most pediatric psych wards. Some of our MCs have been here twenty years or more.”
“MCs?” Alex spoke up.
“Milieu counselors. Did you notice the guy in the hallway? The one with the great baritone?”
“The gym coach,” D.D. filled in.
“That’s Greg. He’s a milieu counselor. We refer to the environment within our unit as the milieu. Greg’s job is to help sustain that environment—safe, nurturing, dynamic. Mine, too, but I’m an RN. MCs don’t need to have a degree, just a lot of energy and creativity to work with the kids.”
“What makes this a progressive unit?”
“We don’t snow kids—”
“‘Snow’?” D.D. interrupted.
“Drug them senseless. Most of our kids are on multiple prescriptions. Plus we use PRNs—medications given as needed, say Benadryl—to help soothe a child having a bad day. But we medicate to a functional, not nonfunctional, state.”
Danielle fiddled with the straw in her cup. When D.D. didn’t immediately ask another question, letting the silence draw out, the nurse volunteered on her own:
“We also refuse to physically restrain the kids. During an outburst, most psych units will resort to tying a kid to a bed. They tell the kid it’s for his own good, but it’s still a shitty thing to do. Let me put it this way: Once we had a five-year-old girl whose shoulders wouldn’t stay in their sockets because her parents’ idea of babysitting was to hog-tie her so they could go drinking. When the girl was finally admitted to the ER for severe dehydration, an intern ordered physical restraints because the girl kept freaking out. Can you imagine how that must’ve felt to her? She finally gets away from her parents, and she’s still being trussed up like cattle. Eighty percent of our kids have already suffered a severe trauma. We don’t need to add to that.”
D.D. was impressed. “So,” she summarized, “no snowing, no tying. When the kids go all Lord of the Flies, what d’you do?”
“CPS—collaborative problem-solving. CPS was developed by Dr. Ross Greene, an expert in explosive children. Dr. Greene’s primary assumption is that a child will do well if a child can do well. Meaning, if we have children who won’t do well, it’s because they don’t know how—maybe they have issues with frustration tolerance, or rigid thinking, or cognitive deficiencies. Our goal then is to teach the child the skills he or she is lacking, through CPS.”
D.D. considered this. Tried it on a couple of times, actually. She didn’t buy it. She glanced over at Alex, who appeared equally skeptical.
This time, he took the lead: “You’re saying a child goes psycho and you … talk her out of it? Hey, honey, please stop throwing a chair out that window. Now, now, Georgie, no more strangling baby Jane.”
Danielle finally cracked a smile. “Interestingly enough, most of our parents sound just as convinced as you. Example?”
“Example,” he agreed.
“Ten-year-old girl. Admitted with a history of explosive rages and petty arson. Within two hours of arrival, she walked up to Greg—the gym coach—and decked him. Didn’t say a word. Hit first, thought later.”
“What did Greg do?” D.D. asked.
“Nothing. Guy’s a good two hundred and twenty pounds and