Chapter One from "Borderline"
Brian Hanson held the phone six inches away from his ear as Tammy LaFleur screamed on the other end. He could predict what her barely intelligible words would be.
“I tried to come in, really. But they were outside my apartment again, those men. They're watching me. They're probably listening in on this call right now.” Her voice rose a notch in pitch and volume. “I don't care, you bastards, hear me?” Her voice lowered to a harsh whisper. “I know they're spreading rumors about me and I'm gonna get them. They think they got me, but they don't know who they're fucking with. I know about their tampering with my mail. Yeah, you bet I do. But anyway, that's why I couldn't come in.”
If Brian charted that she had missed another appointment, her PO would revoke the 25-year-old's parole. Coming in for every other week counseling sessions was part of Tammy's plan to clean up charges of possession with intent to distribute, prostitution, and resisting arrest.
Layers of makeup did little to conceal the damage done during her ten years of methamphetamine use. She had gone from fashionably lean to gaunt, with strangely protruding silicone breasts. Her bleached blond hair looked brittle. Her nose, broken by an abusive boyfriend, listed slightly to the left. Her teeth would cost as much as a Lexus to get back to presentable.
In early sessions with Hanson, she'd brought in five-year-old Glamour Shots. While carefully maintaining boundaries, he'd agreed how beautiful she had been. She had set goals of getting back that glow and recognized that she'd have to stay clean and sober, attend Narcotics Anonymous and an anger management group, and keep counseling appointments.
The first few months she had been treatment compliant. Hanson had gotten optimistic, not that she'd be a beauty queen, but that she could swim out of the hopeless whirlpool she was in. Stop dating exploitative boyfriends. Maybe get her son back from child protective services custody. Resume community college classes to become a veterinary assistant.
Brian knew he'd changed in measuring success from when he'd first started in the mental health field, nearly 25 years earlier. Using veteran's benefits to get a Masters in counseling after going through his own turmoil, he'd been convinced he could change the world. Don Quixote with a couch.
Her diatribe broke into his thoughts. “Why do I even bother calling in? You don't give a damn. No one cares. You're just part of the whole fucking money-making system. Telling me what to do, not really helping. Making things worse. I'm better off without all of you stuck up blood-sucking bastards.”
God, what a schmuck I've been, he thought as Tammy continued to spew her anger. It was a struggle most days to convey hope to his clients when he had little himself. For too many years he had seen people at their worst, vicariously absorbing jolts of their pain. On top of his own.
Tammy had missed two appointments already. With some clients, like those with ADHD or dissociative problems, Hasnon would allow them to exceed the clinic's three strikes rule. With those who had substance abuse or personality disorders, limits and consequences even-handedly enforced was vital to the therapeutic process.
His small office was near the waiting room and he could hear Mr. Edgars--an African-American man in his 60s who was most at peace when he was in the waiting room of the Rose Community Mental Health Agency--wailing and railing against the demons that haunted him. When on the streets his paranoia would cause him to waylay citizens, get picked up by police, and wind up in the psych ward. Mr. Edgars was harmless but only those who knew him could tell. The wailing was louder than usual.
Tammy was talking about the conspiracy. “They know I've got proof. I'm involved with big names. You'd know ‘em right off the bat. The newspapers would love it too. They don't know who they're messing around with. I'm gonna make those bastards pay and then go down to L.A. I got a cousin whose been an extra in a bunch of movies.”
Tammy's delusions didn't have the obvious break with reality that Mr. Edgars' did. There were no aliens or CIA satellites beaming messages. Her beliefs were not plausible, but they were possible. Her paranoia could be coming from meth relapse or be part of her personality disorder. Still Hanson wondered if she was experiencing a first major psychotic break and showing signs of schizophrenia. Usually it hit earlier, though the illness could have an insidious onset. Like most of the clients in the clinic, LaFleur already had several serious diagnoses.
“What do you want from me?” Hanson asked, trying to keep the weariness out of his voice. Phone crisis work was particularly difficult. There were no visual cues to assess, coupled with the need to find non-visual ways to show the client that he was attentive.
“I gotta come in and see you. I don't want my PO giving me a hard time.” Hanson was about to wonder out loud how the PO would feel about her leaving the area with money she had extorted from the conspiracy that was persecuting her.
“I know you don't believe me,” she said. “Maybe that's why I trust you. You're not trying to sweet talk me. I might tell you a little. Guarantee it will rock your world. The conspiracy is bigger than you think. I've seen people at your center I know are involved.”
There was more noise from the waiting room. A thump. Unintelligible sounds.
Because of his history and his being bigger and stronger than the largely female staff, Hanson was the de facto security guard. There had been talk at one point of having a real guard but the majority of the staff felt that would “create an oppressive atmosphere.” Instead it was just added on to his responsibilities.
“Okay, Tammy, I've got an opening at 4 p.m.,” he said quickly. “If you don't make it in, I will notify your PO and close your chart for 90 days. Do you understand?”
“Thanks, Brian. Listen, I appreciate the slack you've cut me. I know you don't believe that I'm clean, but you know my UAs have been good.”
It was not the time to talk about the 50 creative ways clients could beat a urinalysis. “Yes. Just be here at 4.”
“I will. I been thinking, maybe, like as an insurance thing, I should tell you my proof. You have to keep it confidential, right?”
“Unless there is a threat of imminent danger to yourself, someone else, or abuse of a child, senior, or developmentally disabled person.” He had said it so many times during intakes, the exceptions spilled out like a bored waiter reciting a menu.
Another loud thump. The receptionist yelled, “Stop it! Stop it!”
“Tammy, I gotta go,” Hanson said, hanging up and hurrying to the nearby waiting room.
Several clients had backed away. A few stared, wide-eyed. One woman didn't look up from the 3-year-old Ladies Home Journal she was reading. Mr. Edgars
sang a hymn. Roxanne, a 300-pound Caucasian woman, was as silent as Mr. Edgars was noisy. She sat in her usual corner, glowering at anyone who came in, her four shopping bags spread out on the seats around her. A couple contained food clearly past the expiration date.
A man and a woman thrashed around on the floor. They slapped at each other, more concerned with getting attention than actually doing damage.
Ginger, the cranky, overly made-up, always emotional receptionist/file clerk had climbed on top of the front counter and was screaming, “Stop it! Stop it!”
It had taken Hanson a fraction of a second to take in the scene. The door behind him opened and his supervisor, Betty Pearlman, barreled through. She was a stout woman with close-cropped gray hair and a no-nonsense manner. They'd worked together for more than 10 years, had never had any contact outside of the office, but had a powerful camraderie on the job.
She nodded to him and they went into action. Hanson grabbed the man's belt and yanked, his other arm dislodging the woman. Pearlman hustled the woman into an interview room in the back. Hanson easily ducked under the man's theatrical punch and grabbed his wrist, tugging the man forward. With his left arm he pushed up under the elbow, folding the man over. His movements were smooth, conveying the complete confidence of someone who had several years inpatient experience as a psych tech.
“I'd like to talk with you,” Hanson said. “If I let you stand upright, can we walk into the back without any trouble?”
“Okay,” the balding 30-year-old said docilely.
Another clinician who wasn't in session came into the waiting room to calm the other clients. And the receptionist.
Sitting in the six-by-ten, cinderblock-walled treatment room, Hanson resisted the urge to give his sore shoulder a rub. He secured Fred's basic demographic information and was assured that the man wasn't suicidal or homicidal. “Okay, Fred, what's going on?”
The man wanted to complain about his wife. Hanson redirected him repeatedly, trying to get enough information to see if he was appropriate and eligible for treatment.
Fred finally explained that police had dumped the couple at the center after responding to a half dozen domestic disturbance calls at their apartment over the past week. The couple had been arguing about having a kid. He wanted to, she didn't. Hanson made a mental note that would be his entrée into working with Fred. Hanson continued his assessment, drawing out that Fred had no prior treatment, drank “a few beers” every weekend and reported no substance abuse, had an uncle who had bipolar disorder but no other mental illness in the family. “Other than my wife, who's fucking nuts!”
Even though structured by Hanson's directed questioning the conversation had helped the man de-escalate. It took a little more than 45 minutes to gather the basic information, a tribute to Hanson's skill and Fred's willingness to talk.
“Well, Fred, I think there are issues we could work on.”
“How nuts women are? Are you married?”
Hanson nodded, thought momentarily of his own marriage, then rapidly shifted his attention back to Fred. “I see you've got strong conflicts with your wife…”
“Wouldn't you? I mean, she's…”
“Fred, we only have a few minutes left. I want you to know what we can help with and what we can't help with.”
“Okay, you've got conflicts. In my experience, there's usually energy coming from both partners.” Fred started to speak and Hanson cut him off. “Not always 50-50. It may even be 90-10, but there's always some issues both partners can address.”
“You want to have a child with her, I presume that means you want to stay together?”
Fred murmured, “Yes.”
“You want your kid to grow up in a house where his parents are acting like they're part of the World Wrestling Federation?”
Fred almost smiled. “No.”
“Fine. We can work on that.” Hanson's words were gruff but his eye contact and warm facial expression were welcoming, a professional balance. “I'm going to talk with my supervisor, who's with your wife now, and see if we can develop a treatment plan for you two.”
“That woman is your boss? You see, they're running everything.”
“Fred, do you want to try treatment with us or not?”
“I'll give it a shot.”
“Go to the receptionist, complete the paperwork she gives you, and set an appointment for a week from today.” They shook hands and Fred ambled out. His wife was coming out at the same time. They hugged, then locked in a passionate embrace in the waiting room. Only when Roxanne and Mr. Edgars began applauding did they break their open-mouthed kiss and head out.
In the chart room, Hanson made a few brief notes while his memory was fresh. Pearlman came in and began writing as well. The steel shelf-lined chart room, walls packed with binders filled with tales of sorrow, was like Rick's American Café in Cascablanca . Somehow, everyone ended up there.
“Think they'll be back?” Pearlman asked.
“Probably not until the next time they need an audience for their drama.”
Pearlman raised an eyebrow. “My, my, you're sounding more cynical than usual. That's pretty hard to do.”
“Think I'm burning out?”
“What do you think?” she asked.
“Spoken like a good therapist.”
She stared at him patiently, attentively.
“Therapeutic silence,” he said. Their supervision sessions could be like two veteran chess masters who knew each other's moves, yet could only improve by playing against each other. Hanson and Pearlman had about the same number of years of experience. At one point, before she had been hired, he'd been offered the clinical director position. He had declined, saying he preferred direct service work, even though it would have meant a $5000 a year pay hike. Pearlman now was the chief clinical officer for the agency that had 75 case managers and counselors.
“Yeah, I think I'm burning out,” Hanson admitted. “I mean, I can take joy in handling Fred smoothly, but I've got little hope in seeing him change.”
“Maybe,” she said. The word was one of their ways of mutual acknowledgement. They both enjoyed the old Chinese story of the farmer marries a beautiful girl, getting congratulations from everyone When villagers say how great it is, he goes, “Maybe.” Then she dies giving birth to their son. Everyone says how terrible that is, and he says, “Maybe.” Then he inherits her family's large farm, and the villagers say how great that is, “Maybe.” But the locusts come and, etc. etc.
“Maybe,” he repeated.
During the course of the day the police brought in a man prone to suicidal gestures, who they had once again talked down off the bridge. The first few times officers had taken him to the hospital. Now they just dropped him at the center.
Then Hanson met with a middle aged Native American man with schizophrenia who had first been brought in by the police a year earlier, babbling an incoherent string of letters. When everyone else was confused by the babbling, Hanson had recognized the “word salad,” and its ingredients. Prick 25, Rough and Puffs, Bloop Gun, Oodles, Law, White Mice, REMF, Victor Charles.
Vietnam . The Salish Indian's first psychotic break had occurred while in combat, and hadn't been noticed for three months. Hanson had worked with him for two years, gotten him to be aware to his symptoms, take his medications, connect with his family and tribe, and maintain his own apartment. Major achievements and they had begun to talk about cutting back service to a quarterly check-in by phone.
His 3 o'clock appointment was a girl who had been sexually abused starting at age eight. She was now 16, and probably going to be in the system for life. She had made a suicide attempt after her 35-year-old boyfriend forced her to get an abortion. He was now in jail for statutory rape. The girl was beginning to show glimmers of realizing that the rape was not her fault.
This is my city, Hanson thought, ironically amused that it had been named by Money magazine as one of the five best places to live in the United States . Property values were solid and reasonably priced compared to similarly sized cities. Employment rates had been steadily growing the past few years, while the crime rate had dropped precipitously. Portland had a temperate climate, minimal air pollution, a slew of great restaurants, the best bookstore in the U.S. , and an award-winning mass transit system. The Cascade mountains, Central Oregon desert, numerous rivers, and the Pacific Ocean were within easy driving distance.
By 4:15 p.m., he knew Tammy wouldn't show. Which was fine, since it allowed him to clean up the inescapable pile of paperwork. Including closing her chart.
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