The Third Table

a: More Cooley

THE  COOLEY GANG

by: The  Cooleys

Patients differ in degree of psychopathy. Nurses also differ in temperament, courage, imagination, and nursing style. Everyone brings  certain baggage to relationships, viewing new relationships through the lens of experience with parents, sibs, employers, etc.  Patients varied enormously in their acceptance of nurses as parent figures, as nurturers, or as scolders — all of which we were. We found that as patients prepared for their discharge, the parental aspects and associations fell away and the relationship became friend-to-friend.

During our first months we became aware that the patient group had great talent, creativity, and potential for making substantial contributions to the arts and sciences. A few were critical, demanding prima-donnas who gave the nurses headaches — it seemed the rules were designed for other patients, not for them. Ed Howard had warned us all about this before experience bore him out. We agreed with him that it was worth it —   if “obnoxious behavior was part of the struggle of getting well.”

Shirley and I have always thought of ourselves as a team, “The Cooley Gang.” We backed each other’s play so that one of us might spend extra time with a patient while the other carried the “house.” If a patient had “night terrors,” one of us would stay with him or her until a sedative could take effect. Shirley had an intuitive sense of what to say and do if a patient had a “panic attack.” I was a good punching-bag: one patient would insult me to see if I kept my cool, and he learned that I didn’t melt like candle-wax as he feared. Several patients used us a sounding-boards, trying out good, bad or “crazy” ideas on us to get our reaction. Shirley spent half the night with a  crying patient who finally recovered a painful memory and then made rapid strides in therapy. One patient asked me to call his therapist late at night; he had never made such a request before, so I knew it must be important and put him through without a single question. A number of patients just liked to drop in and chat, without feeling they had to use symptoms like admission tickets.

One of the nurses once gave a patient a dressing-down about his behavior, and he was delighted she called his bluff. But he would take nothing off me; I reminded him too much of his fault-finding Father (as did every other adult male figure). I became a confidant to one woman in her thirties, while another reproached me for keeping my distance. Three women kissed me uninvited — one old enough to be my Mother,  one young enough to be my daughter, and the third one of the most disoriented patients I ever met.

“We come here  to be known,” said one patient, defending nurses’ reports and observations. There were daily reports and weekly summaries. Detailed reports were a part of every nurse’s job description,  although that didn’t make the “spying” any more palatable. Of course we had to check places like the kitchen, because of the potential fire hazard. Otherwise, we’d just keep our ears open for weeping or fights. And we had to check that windows were closed in stormy weather.

We needed to know where people were if we were supposed to give them medication. We had to dispense pills dose by dose, because we didn’t dare trust the patients not to hoard their medications, and take a big batch all at once.   So then it became medications given only by nurses and only when ordered. There were a variety of physical illnesses over the years that had to be taken care of, everything from diabetes to crab lice. The receptionist was important in this.

Charlotte would stay on the line to make sure there was a connection, but she didn’t listen in — she wouldn’t have time, anyway — the switchboard was a pretty busy place.

Once when a patient went through a disturbed episode, I showed him my notes. I got no support at that time, in fact it made people uncomfortable, so I didn’t continue the practice. I don’t know whether this was pioneering or just mischief-making.

In his great days Robert Knight was the best thing that ever happened to Riggs. He was a magnificent administrator,  a superb teacher, and a great therapist. When he died so early, the loss was just terrible for Riggs and for all of us who knew and loved him.  It was as if Riggs stopped being Riggs when he died. Things just fell to pieces. Fell apart.  Dr. Knight had always been able to hold the community, pulsating with ideas and dissents, together, so that the splits weren’t visible until his illness. It was a team, from the lowest to the highest, from Knight right on down.

It was horrendous, personally, having to  take care of Dr. Knight.  The nursing staff had to administer his medication and it was dramatic to see somebody that you, well,  loved, go downhill like that.  It always is and remember we’d known him for ten years.  With Rapaport it was very different.  His death was sudden and also most of the pateints knew him – had worked with him.   With Knight that wasn’t true. He was ill for three years and many of the patients did not know him personally.  That meant that a great deal of the community was not really involved with his death.

Dr. Howard was made the administrator after Dr. Knight became ill.  He never was the administrator that either Knight, or later, Otto Will were.  You didn’t have the feeling that there was a firm hand on the wheel.  Of course, Dr. Howard had always said he was not an administrator, he didn’t want to be one even before Dr. Knight came – after Dr. Riggs died. He knew his own limitations and was perfectly frank about them.

That ended when Marshall Edelson took over the Community Program.. The staff became fractured, it became us and them. It made for resentment, it made for hurt, and it just tore the place down.

This fragmentation was the effect of Dr. Knight’s loosening direction of Riggs. His loss of energy stemmed from his worsening illness. He wasn’t at Community Meetings and neither were senior staff; their absence denied the meetings the leavening that representation by all members of the community might have afforded. Senior staff were not allowed to attend even after they requested admission. The consensus philosophy seemed to deteriorate into a license to brow beat anyone who disagreed; the goal of debate and diversity of opinion was forced to yield to intimidation and conformity. We were vehemently opposed to this neo-facism. The nursing staff felt “set up” in CM, a target for community disaffection. There was throughout a sense of no firm hand at the tiller. Nursing resignations poured in and we knew our days were ending, too as we were not being given the respect and the cooperation we deserved.  We worked many seventy-two hour weeks, and day after day were stretched so thin that only one nurse was on duty most of the time.  We felt that there was a real danger of harm to the patients or staff. And events proved us right.

Debbie C,  a young patient with a serious drinking problem, became abusive and self-destructive whenever she drank.  We had asked the community to deal more strictly with her because we were alarmed.  Nothing happened.  Finally Edith Breed tried to restrain her from harming herself one night when she was drunk and Debbie broke the old woman’s arm.  We brought the matter up in Community meeting, and we also asked the staff  and the Community Committee to put a drinking ban publicly on her, so that we would have the whole community helping us. And Dr. Howard, who was then running the hospital,  told Shirley point blank, “You’re not going to get that ban. I don’t want it.” He said he felt it could be handled better in therapy. This was the first time I could remember the nurses asking for community assistance and being told flatly they couldn’t have it.

Then there was Gail B’s conference. Our hands were full with her.  We told the conference we couldn’t cope with her. We recommended she not be kept on at Riggs for treatment. At which point Ian Storey said that it was “much too interesting” an opportunity to let her go. The patient should be kept so that he would be able to “study the nurses”.    After all  they (the nurses) claimed they couldn’t handle her. Saying this in the staff conference was a personal insult to Shirley.  It would never have happened if Robert Knight were still running the hospital.

We had similar apprehension about other patients. We urged the administration to prevent Ivan and Molly, both outpatients, from coming over to the Inn where they encouraged Bea in misbehavior. Bea was only twenty and we felt there should be stronger governance of her, and  the influence of the others should be curbed. Nothing was done.

There was a sword of Damocles hanging over us. We felt there was a tragedy waiting to happen. We just didn’t know the form it would take or when it would happen, but we could sense that something was building.

We were pretty burned out by the time that Otto Will came.  After Dr. Knight died it was almost a year before a new director was found.  We were working seventy two hours a week, never getting any days off.  When we left I (Shirley) was owed over a thousand dollars in back pay!  We only had three nurses from seven A.M. until eleven P.M. – which meant we were often working alone.  And, we weren’t just sitting in the nurses sitting room all day twiddling our thumbs.  There were daily summeries to write and monthly schedules to prepare.  We were burned out and thought,  “Why not get a decent job – for a decent wage?  Why not work five days a week eight to four?”  On top of that my mother had cataracts and couldn’t care for herself, so it made sense to work near Pittsfield where we could care for her.

Of course there must have been something there since lots of patients came back after discharge to tell us what a difference Riggs had made.  I still get Christmas cards from patients from 1955 and later and we always felt we had enough leeway to make a difference.  We had feedback from the staff that ran the gamut from , “I never read the nurses reports.  I don’t like them.”  to a written note from Dr. Robert Knight that said, “Excellent report — Thank you.”

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