Chapter 5: Moses and Mack

Meeting with the Moses psychiatrists, Sharon and Marilyn identified one upcoming, and one future, admission of teenagers they thought would fit in our program. They weren’t all hypersexual but included people that we thought would benefit from our sort of communication.

One such person, Mack Trade, met the Moses criteria for adolescent admission. He was now in the admissions process. The other, Margaret, still had administrative hurdles.

Happy to have gotten away from his mother, Mack, just admitted to the B-3 unit, found, to his initial dismay, was a locked unit for men. Nate Nightingale, a senior psychiatric nurse, did the initial admission. “Mack, I know this first part is likely to be annoying. I’m going to do a basic physical and history, with another one from our internal medicine doctor, and yet another from your psychiatric resident. This is only for a couple of days, with the main intent being finding out if you have any outstanding physical problems.

“Being admitted and even temporarily losing your freedom is stressful. As part of my training, I was taken to a hospital under a false identity and went through an admission workup just like yours. I knew I’d be out soon, but I still had my temperature and blood pressure go up, purely from stress. If I had had some underlying cardiac problem, or a lurking infection, or maybe had concealed drug use, those would have come out. This is for your safety and the safety of other people here. I’m managing the admission and will try to keep it as hassle-free as possible.”

He introduced a student nurse sitting on a couch with him. “This is Cheryl Spencer.” Mack sensed her reserve, wanted to be courteous, but could not help but notice that she was attractive. Nate continued, “Mutual respect is a big part of our approach. In many institutions, nurses are introduced as first name only. We think you have a right to know who is treating you. If, however, you ever used identity knowledge to harass someone outside the program--well, that’s not a place that you want to go.”

At that point, Mack raised a hand. “My mother is a psychotherapist, and I’ve spent a lot of time around mental health professionals. I understand the need for security, especially in outpatient care, lest a patient turn into a stalker. But this isn’t outpatient. I’m under control. My suggestion is that everyone stay reasonably formal at first -- no first names in any direction. I promise not to try undue familiarity until working relationships are established. Is that acceptable, Mr. Nightingale?”

“Mr. Trade, I apologize. Perhaps I made assumptions based on your age, but you are taking this in as mature a manner as I could ask. The hospital policy here is that younger patients have to be able to function at an adult level, which you just demonstrated.

“Let’s start over. My student nurse, under training, Is a senior in the bachelor’s program. Her name is Cheryl Spencer. I believe, Mr. Trade, you have just been introduced to Miss Spencer?

“Over here, we have a social worker with the LICSW certification, Janice Jones. She’s going to lead the history and initial psychotherapy, along with Calvin Rasolnikov, a psychiatric resident, and Sally O’Rourke, a specialist in neuropsychiatric methods such as Eye Motion Desensitization Reprocessing (EMDR). We aren’t trying to overwhelm you, but both be sure the expertise is available ad that we also carry out our training function. You have every right to know who is treating you. If the number of people seems overwhelming, say so, and we’ll seriously consider reducing it. For example, you might have a medical student rotating in at some point.”

“Thank you, Mr. Nightingale. Let me get something said to reduce tension. Miss Spencer is very attractive. If I was meeting her socially, I’d like to get to know her better. But this is not a social occasion and it has its own rules.”

“Excellent, Mr. Trade. Let’s begin with your basic history. I try to avoid making this an interrogation, so questions can go in both directions. First, though, could we get the internal medicine examination out of the way? This also needs some blood samples. Would you prefer to be alone with Dr. Corrigan, our house internal medicine doctor?”

“No reason for that. We can keep talking.”

“I understand that you chronologically are 15, but our evaluation team concluded you will operate at an adult level. As I meet you, certainly stressed, you seem to be physically fit, with neat clothes and good grooming. It looks like you have more physical growth coming.”

“Yes, Mr. Nightingale. For the record, I am 5’10”, and do wrestling and martial arts in an under-162-pound class. Obviously, I have blonde hair and blue eyes, and a good tan that is medically monitored. I’m pretty comfortable with my appearance, but I also have a lot of anxiety when trying to interact with peer or older women. I hope to progress on that.”

“Your psychiatric resident here is Dr. Calvin Rasolnikov. We made some effort to have his background match yours. His undergraduate training was as a medical engineer, but also had a strong interest in history that matched Mack’s. He had been an enlisted medical technician in the Army and was considering military medicine as a career.”

With a gentle smile, Dr. Rasolnikov continued, “Thanks, Mr. Nightingale. We’ll develop our relationship, but I should say, from the beginning, that I like some humor and not overwhelming formality.” He reached down and presented a stuffed tiger puppet. “This is Hobbes, appropriate enough because I’m named Calvin. I believe that therapy can be complemented with humor.

“I believe in the Moses treatment model of milieu therapy, in which every aspect of the environmental milieu, not just formal psychotherapy, was intended to benefit the patient.

“I was introduced to you formally, with title. We cultivate mutual respect around here. Think about what makes you comfortable, and we’ll do that: either formal address for everyone, or informal address for everyone.”

“Those are the introductions, Mr. Trade. I suggest you and I adjourn to an examination room for your admission physical and blood tests. I’ll have you check over the medical history, but I think that’s fairly complete. We also need to go over your medication, but it looks like that’s a baseline stimulant plus one as-needed, for excessive daytime sleepiness. My hope is that we can fix the underlying sleep problem.”

Janice and history

Janice Jones was an impressive woman, in her thirties. Her diction and presence reminded Mack of Winston Churchill. “Could we begin, Mr. Trade, with you telling us your general family history? Yes, we know the basic demographics, but to the extent that you can trust us with it, we’d like you to tell us about how you felt about the many changes you had. I’m personally sorry that you had to go through so much.”

“Thank you, Miss Jones. Empathy like that is pretty rare from mental health professionals, and I like it.

“I was born conventionally to a young married couple, who divorced when I was three. From talking to adults, my strong impression was that my maternal grandmother put immense pressure on the couple and essentially broke up the marriage. My birth mother and I went to live with her parents.

“I began reading very early, without any real teaching. My grandmother took me off for psychological evaluation, for the wrong reasons. The private psychologist gave her raw IQ test results, which she immediately turned into a status symbol with her peers. She told me I was a genius too good to play with my peers, and absurdly catered to me -- she didn’t let me dress myself, although I did so, not well, when I was around five. While I didn’t understand it other than it felt good, I started masturbating from about age four.

“I went to kindergarten at age five, and it was a disaster. By then, my birth mother had moved out and was dating a man in Texas. She became ill and died soon, with my grandparents getting custody. Her fiancé took no interest in me.

“Why do you call kindergarten a disaster?”

“Miss Jones, when I entered kindergarten, I had some basic achievement testing that showed I was reading on an eighth-grade level. In retrospect, I should have been in a gifted & talented program, but those did not exist at that time and in that place. I acted out until I eventually was expelled.”

“Yes, I’d call that a disaster. Did you get any customized education?”