Chapter 22: It Wasn't You

March 10, 1983, Chicago, Illinois

I returned to the waiting room, and shortly before 7:00am, I was surprised to see Lily come through the doors.

"Shelly called me," she said after we exchanged a quick hug. "How is Violet?"

"I haven't been able to see her," I said. "They gave her a sedative, and she's sleeping. I'm waiting for her to wake up so the doctor can speak to her."

"They won't let you see her?"

"I'm not sure. I'm not family, but she doesn't have any family. They called Doctor Lochner, who said I shouldn't be allowed to see Violet."

"But Violet doesn't want to see her!"

"I know that, and you know that, but the doctors have their club, and I doubt they'd take the word of a civilian, so to speak, over the word of a member of the club. Unfortunately, they found Doctor Lochner's card in Violet's purse, so they assumed she was still seeing her. They found mine as well and called me to see if I could direct them to a relative."

"There aren't any," Lily said. "Well, you know what I mean."

"I do."

"Do you know what happened?"

"I can only speculate that it was that she sat in my lap and hugged me. She kind of freaked out after that, but by the time we left for class, she seemed fine. And she was fine when I walked her home. Maybe an hour later, she called the paramedics because she was having trouble breathing and her heart was racing. The nurse said she thought it was a panic attack."

"So now what?"

"Once Violet wakes up, Doctor Baum will speak with her. Beyond that, I don't know what will happen. My biggest fear is that Doctor Lochner will show up and claim she's still Violet's psychiatrist. I can't think of any way to prove that's not the case."

"Wouldn't there be treatment records, appointment notices, bills, that kind of thing?"

"I would think so, but the fact that I don't have any proves nothing. The same would be true if I went to Violet's house and searched and found nothing. As the training manuals at Spurgeon say — absence of evidence is not evidence of absence. If Doctor Lochner claimed she's been treating Violet, I can't prove that's not the case without records Doctor Lochner controls, and I bet dollars to doughnuts she'd claim 'doctor-patient confidentiality' to prevent me from getting a look at them."

"So what happens if Violet says she doesn't want to see Doctor Lochner?"

"I have no clue. I was considering calling my attorney, who's also a friend, and asking him. He's a business attorney, but as another attorney pointed out, he'll know the rules and procedures in Illinois because he had to in order to pass the Bar exam."

"I think I'd call him. From everything Violet said, Doctor Lochner is a control freak."

"That was the exact phrase I thought of but didn't use when speaking to the nurse. I did my best to try to avoid disparaging Doctor Lochner while making it clear I didn't agree with her. Let me go use the payphone and see if I can catch Nelson at home before he leaves for the office."

I went to the payphone, dropped in two quarters, and dialed Nelson's number, which I had in my pocket address book. His wife answered and called him to the phone. I quickly explained the situation.

"Generally speaking, a patient is in control of which doctors they see, even if they stay in the hospital," Nelson said. "That said, they could put her on what's called a 'seventy-two-hour psych hold', which means she's not free to leave and also limits her ability to select her doctors."

"They can just do that?" I asked.

"If they deem she's a danger to herself or others, yes. It's pretty standard. After seventy-two hours, they would have to go to a judge to extend the hold."

"Can they keep me from seeing her?"

"Yes," Nelson replied. "You aren't a relative, and if she's on a hold, they could exclude anyone, including relatives. If she's not on a hold, it would be up to her, but only during visiting hours. I don't know the policy at Rush-Pres, but in theory, they could say there is no visiting in the Emergency Room."

"Wonderful," I replied. "What can I do?"

"Not much unless you have power of attorney, and the one you have for handling financial matters doesn't count."

"Who makes decisions for her if she can't?"

"The Cook County Public Guardian," Nelson replied. "Basically, a social worker, usually with an advanced degree. Does Violet have a social worker?"

"Yes, though she hasn't seen her in at least six months."

"That's where they'll start. I doubt the state closed the files on Violet, which would mean her case is still active. If I were you, that's the approach I'd take. If they won't let you see Violet, insist they call her social worker. She, and I'm assuming her social worker is female, will have the final say, coördinating with the Public Guardian."

"How can this be fixed in the future?"

"Healthcare power of attorney," Nelson said. "It's fairly straightforward and would be effective so long as no blood relative challenged it. Even then, it would most likely be effective, but you might have to fight it out in front of a judge. Once Violet is out of the hospital, if she's willing, she should sign a power of attorney for someone because otherwise, the State of Illinois will make every decision for her in a medical emergency or in case she's incapacitated."

"So there's nothing I can do now?"

"Legally? No. All you have at the moment is your power of persuasion and Violet's wishes, if they can be expressed, assuming she's not on a psych hold."

"On that, what does it mean to be a 'danger to herself'?"

"It's purely subjective, and doctors have a lot of leeway. It could be anything from not taking care of herself to threatening suicide. It's a huge grey area, and generally speaking, the courts won't overrule the doctors. You would need to hire an independent doctor, then get a court order for him to examine her, and then fight it out in front of a judge. And most likely you'd lose, if you could even make that happen before the seventy-two-hour hold expired."

"Thanks, Nelson. Sorry to bother you."

"It's all part of the service! I'll bill it against your retainer, but you'll make it back in commissions and fees faster than I can bill!"

I laughed, "Not according to Noel Spurgeon!"

"If it will make you feel better, I could bill you $500 an hour as if I were a senior partner."

"Hard pass!" I chuckled.

"Thought so!"

We said 'goodbye', and I hung up, then went back to Lily.

"He didn't have any good news for me," I said. "We're at the mercy of the psychiatrist here in the hospital, who can basically have Violet held for seventy-two hours against her will if he thinks she's a danger to herself or others."

"Violet? Dangerous? Not even!"

"I agree, but it's a subjective opinion, according to Nelson, and could be as simple as them saying she can't take care of herself right now."

"That's BS!"

"I agree, but in the end, my only option would be to lawyer up and sue, and that's expensive and would probably take longer than the hold, not to mention that's a sure way to lose the debate with Doctor Baum. Somehow, I think if I were to sic a lawyer on him, it would cause him to have a bad reaction."

"Probably," Lily agreed.

Things were bad, but got worse as Doctor Lochner came into the waiting room. She saw me, glared, then went to the admit desk. I considered trying to prevent her from going in but realized I'd have no luck when she showed a medical ID card. They admitted her, and I sank down in a chair, completely frustrated.

"Was that her?" Lily asked. "The woman who glared at you?"

"Yes. And you see right there why we're at a serious disadvantage. I wish I knew who Violet's social worker is, but I suspect I couldn't get hold of her before 9:00am."

"Isn't there an emergency number?"

"I'm sure there is, but I don't know it, and I can't imagine they'd share information with me."

"I think there are social workers assigned to the hospital," Lily said. "One talked to my mom when my dad died. Maybe they could help?"

"Maybe. I think, before I do anything else, I'll wait to see what happens when Violet wakes up. I need to make another call and let work know I'll be late or maybe not in at all."

I went to the payphone, dropped in another pair of quarters, and dialed Rich Chamberlain's direct line. I quickly explained where I was and what had happened, and he said he'd let Mr. Matheson and Anna know as soon as they arrived. I thanked him, then went to sit by Lily.

I remembered I had a lunch date with Marcia, and I'd need to call her to cancel if I couldn't make it. Fortunately, the restaurant was only about six minutes from the hospital, which meant I could wait until 10:45am or so to make that call, though I wondered how Marcia would receive that message.

Finally, just before 8:00am, the medical student, Ben, came to get me and once again took me to the consultation room to meet with Doctor Baum.

"How is she?" I asked.

"Awake, alert, and calm," he said. "You were right in that Violet refused to see Doctor Lochner."

"So now what?"

"Doctor Lochner and my Attending, Doctor Jepsen, are meeting. He'll decide what to do. Doctor Lochner is insisting on a seventy-two-hour hold."

"On what grounds?" I asked.

"Danger to herself, and specifically, danger from you."

"Do you believe that, Doctor?"

"I don't know at this point."

"Can I see her?"

"Not until I hear from Doctor Jepsen."

"Did you speak with Violet about her panic attack?"

"Not yet. I was waiting for her to have her breakfast before I did that. Doctor Lochner showed up while Violet was eating and insisted on the hold."

"Isn't an exam of some kind necessary for that?" I asked.

"Yes. A standard psych eval, except in the case where there's a treating physician, which Doctor Lochner claims to be."

"She's not," I said firmly. "Is it against the rules for you to talk to Violet?"

"No."

"Would you? Ask her again about Doctor Lochner and ask her about what happened last night. And can you do the psych eval?"

"Normally, I would do the eval, but I have to wait for Doctor Jepsen because Doctor Lochner intervened."

"Then just talk to Violet, please."

He was quiet for a moment, then nodded, "Wait here, please."

He left and was gone for about ten minutes, then returned.

"It wasn't you," he said.

"What?!" I asked in surprise.

"I can't share the details right now, but it wasn't you. Let me go see Doctor Jepsen and tell him what Violet just told me. I think it might resolve things in your favor. Wait here, please."

He was gone for twenty minutes and returned with a much older doctor he introduced as Doctor Peter Jepsen.

"Would you explain your relationship with Violet, please?" he asked.

I'd done that twice already but wasn't about to be snide or snippy, so I explained everything I had said to Nurse Cahill and to Doctor Baum. I did add a bit about the social worker, hoping that might help.

"Thanks, Jonathan," Doctor Jepsen said. "Let me confer with Doctor Baum and the social worker assigned to the hospital. This is complicated because you aren't related to her, and she has no relatives we can contact."

"I understand."

"Just wait here, please."

Another fifteen minutes passed before they returned, this time with a woman in her early thirties they introduced as Betty Whitmore, a social worker.

"Ms. Whitmore called her office, and they confirmed the basic details you provided," Doctor Jepsen said. "And they confirmed what Violet said about why she 'freaked out' in her words. Ms. Whitmore?"

"Last night, someone, and I don't yet know who, called and left a message on Violet's answering machine that her mother's application for parole had been granted, and she's being released on Saturday."

"Oh, shit!" I groaned. "No wonder Violet lost it! I thought her mom was doing twenty years, minimum."

"I don't know the details, but there are any number of possibilities, including compassionate release due to health problems, some kind of special plea arrangement, good behavior, and so on. Violet's assigned case worker, Christine Manheim, will get the details and speak with Violet about it."

"OK. What about seeing Violet?"

"I'll approve that," Doctor Jepsen said.

"How is she?"

"Her vitals are stable; she's awake, alert, and oriented."

"OK. I'm going to call my attorney and ask him to send over the healthcare power of attorney forms for her to sign."

"I don't see a problem with that," Doctor Jepsen said. "But I should warn you that Doctor Lochner suggested strongly that she might try for a court order."

"Can she get one?"

"Maybe, maybe not," Doctor Jepsen said. "Ms. Whitmore?"

"I spoke with Violet, and I see no reason to support intervention by Doctor Lochner. I can't speak for my boss, but I would recommend opposing an order. Mr. Kane, if you can get the healthcare power of attorney signed before Doctor Lochner appears before a judge, you can basically foreclose her ability to get an order ex parte. Do you know what that means?"

"Yes, without Violet being there or having a representative there. But I think better yet — Doctor Jepsen, could you release her? If so, her friend Lily, who's in the waiting room, and I will stay with her today, and I'll get the paperwork done, as well."

"Sidney, what's your opinion?" Doctor Jepsen asked Doctor Baum.

"There is no medical reason to keep her, and as I said to Jonathan earlier, she's awake, alert, and oriented times three..."

"Times three?" I asked, interrupting.

"It's ER shorthand for being aware of their name, their location, and the time or date. Basically, it means she knows who she is, where she is, and what's going on, all of which are indications of good mental function."

"Thanks; sorry I interrupted."

"It's OK. I didn't use that phrase earlier exactly because it's medical shorthand. What I was going to add is that she's no danger to herself, and so long as she has someone with her for the day and someone she can call if she needs help, there's no reason she shouldn't go home. I'll sign the release forms if she wants to leave."

"I'm sure she does," Ms. Whitmore said. "And she did insist, several times, on seeing Jonathan once I told her he was here."

"Ben," Doctor Baum said, "take Mr. Kane to see his friend; I'll complete the release paperwork."

"And I'll go back upstairs and let Doctor Lochner know our decision," Doctor Jepsen said.

"Could you stall for however long it will take to get out of here?" I asked.

"As soon as I sign the discharge, she's no longer a patient," Doctor Jepsen said. "I'll sign the chart now, and then she's free to go, though you should wait for the discharge notes. I'm sure Doctor Baum will complete those quickly."

"I will," he confirmed.

"If you'll come with me, Mr. Kane," Ben said.

I got up and followed him out of the room, then asked if I could duck out and tell Lily what had happened. He agreed, and I gave her a thirty-second synopsis and asked her to wait for us, which she said she would. I then followed Ben to Violet's room where she was lying in bed with a hospital gown on and the covers pulled up to just below her shoulders.

"Jonathan!" she exclaimed.

"Hi," I said. "I arranged to take you home. Lily is here, too."

"You called her?"

"Shelly did. She knew what had happened because the phone woke her up, too, and I told her I was coming here. She called Lily around 6:00am. I promised Doctor Jepsen, Doctor Baum, and Ms. Whitmore, the social worker, I'd stay with you today."

"Did they tell you what happened?"

"They did. And they didn't have any more details but said that your social worker would get the details and get in touch with you."

"What do I do?" Violet asked, shaking.

"I promise I'll protect you," I said. "No matter what."

She visibly relaxed and smiled, "Thank you."

"Doctor Jepsen signed your discharge, so we can go whenever you're ready."

"I, uhm, need to get dressed."

"I'll get a nurse to help you," Ben said. "And your friend can wait outside."

"Thanks," Violet said.

Ben and I left, and he asked a nurse to help Violet. About ten minutes later, with discharge papers in hand, we walked out to the waiting room where Lily was sitting. She hopped up, came over to Violet, and hugged her, and we walked out of the ER. Both Lily and I had our cars, and after a brief discussion, we agreed to have breakfast at the diner where Violet and I usually met after class. Once we were seated, I explained what had happened.

"How can they do that?" Lily asked after the waitress poured coffee for each of us.

"No clue," I said. "I think we have to wait for the social worker to provide more details."

"What can we do?" Violet asked.

"I have no idea," I replied. "When we get to your house, you should call your social worker. She may have some ideas."

"What about an order of protection?" Lily asked.

"We'd need to ask an attorney or maybe the social worker. I'm sure there will be some restrictions for parole, but I have no clue what they might be. For now, let's just have breakfast and then go to Violet's house."

"What about work?" Violet asked me.

"I called in and let them know I wouldn't be in this morning. I need to call back around 10:00am to let them know if I'm missing the whole day."

"I don't want to be alone today," Violet said.

"I have class from 8:30am to 11:00am," Lily said. "If Jonathan stays with you this morning, and I stay with you this afternoon so he can go to work, then comes back for his usual dinner with you, would that be OK?"

"Yes," Violet agreed.

That would allow me to keep my lunch date with Marcia and to work a half day, which, all things being equal, was better than I'd expected earlier in the morning.

"Don't you need to call the daycare?" I asked.