Page 7 of Love and Other Mental Health Concerns
“Keith, welcome! You haven’t missed a thing; Marcy and I were just getting to know each other a little bit. Do you like Bon Iver?” Apparently, the arrival of Keith has cured Nick’s embarrassment, as he relaxes back in his chair and is able to look at me again.
“Like the fish? Yes of course.”
Nick and I steal a confused glance at each other and without missing a beat, Nick continues. “Marcy, I hope you don’t mind but Keith has insisted on joining our meeting today.”
As if I have a choice, I respond, “Of course I don’t mind.” And at this point, I really don’t. Having Keith present is a huge help in refocusing me, as he dramatically decreases the temperature in the room and distracts me from my almost flirt session with Nick. “I am wondering what you are hoping to understand from meeting with me. I haven’t been called into any planning or development type meetings for the hospital since being hired here.”
“That’s where I wanted to start actually,” Nick speaks up. “What has your involvement been in terms of establishing the social services programming at North River? No judgment, just want to hear your perspective.”
People that say “no judgment” have already judged. In this case, I can say that it’s fair. There isn’t much in terms of programming at the hospital. The sparse support groups and my cache of pamphlets from various mental health or substance abuse treatment agencies is the extent of it. Patients meet withme of course, but I can’t offer long term therapy from this position. I decide to start from the beginning, as I practiced at home.
“I have been at the hospital for three years, since getting my LCSW.”
“What does that mean?” Keith briskly interrupts me, sending a quake through my anxiety, now alert and ready to assist in my fight or flight. Rings twirl.
“Um…it stands for licensed clinical social worker. It means I can practice without direct supervision, and I have clinical expertise in mental health diagnoses and treatment.” I turn to Nick to explain, “The Hospital requires this level of license since I am the only Social Worker on staff.”
“Yeah, I would assume. Did you go straight to graduate school after your undergrad?” He asks, somewhat shocking me that he understands my position, while Keith, technically my boss, clearly doesn’t have a full grasp of my role here.
“I did. I knew it would be necessary to complete if I ever wanted the position here, which was always my goal. I wanted to work at this hospital, and I jumped at the opportunity when the previous social worker announced her retirement.” I’m getting back on script, trying not to let my anxiety derail me, emphasizing my desire to be an employee here.
“That’s amazing Marcy, I don’t know many people that can say they have achieved their career goals at all, let alone at such a young age.” Although I just met the man, his reassurance does give me the reminder to take some deep breaths and forge through the interruptions.
“Thanks Nick, its’ been a dream come true for me.” And that is true. “To answer your question, when I started working at the hospital, the social services programming was non-existent. Discharge planning services only.”
“Well Marcy,” I’m yet again interrupted by Keith and his stupid necklace. “To say non-existent sounds a bit dramatic…” I start to flush at his condescending tone, thoughts scrambling from my nerves now and I can feel the embarrassment on my face. “What you could say…”
“What she could say, Keith, is whatever she wants.” This time Keith is interrupted by an agitated Nick Anderson. “I invited Marcy here to inform us, so if you can stop interrupting her and let her tell us her experience, that would be preferred. If that sounds too difficult, you are welcome to leave, and I can review her responses with you later.” Nick’s eyes are fixed on Keith in a direct stare, no signature smile in sight. An angry golden retriever. Keith’s mouth starts to flap like a fish out of water. The energy so tense that you could cut it with a knife. I am mutually mortified and turned on, which adds to my mortification. Nick has quickly filled the room with some serious authority, without having to rise from his chair.
Keith clearly doesn’t know how to handle this scenario and meets Nick’s gaze but stays quiet. Eventually, he gives a light nod towards him in acknowledgement of his options.
“Okay great, thanks Keith.” Nick’s jaw is tense, but he is trying to feign some resolve as he turns back to me, an apologetic expression on his face. He offers a tight and feigned smile, the corners of his mouth struggling to engage. “Marcy, so sorry about that. You were saying?” He warmly encourages me, ignoring Keith, and re-engaging with me as if the past sixty seconds hadn’t happened. Beneath his initial upset with Keith is a clear confidence, maybe even cockiness, in his control of the situation.
“Yes, I umm…” Ugh, I sound so pathetic, now stammering and lost in the messiness of whatever cock fight that was. “Sorry, what was I saying?”
“You were saying that the social service offerings at this hospital had been largely non-existent before you arrived. Then Keith interrupted you.” He keeps eye contact with me while Keith squirms a bit in his seat. I breathe deeply again, refocusing my thoughts. I’m feeling a bit disturbed by own enjoyment of Keith’s proverbial tail between his legs, and the bravado of the man that caused it.
“Yes, thanks.” I take another second to regain my composure and mentally revisit the points I wanted to make. “After my first few months here, I recognized that there are four designations within our population that are high utilizers of our services, especially in the emergency department. We have quite a large elderly and aging population, college students that need mental health support, young families struggling to access resources, and people struggling to get free of the cycle of substance abuse. I have tried to add some support groups to fit these needs and have assembled quite the collection of resources to refer people to. As far as I know, the only budget available to cover social service needs is the one for my salary. So, without monetary support for more staff, it’s difficult to add more resources or programming to benefit our patients.” I finish with a deep exhale and my shoulders finally relax for the first time since I walk in the room. I didn’t realize they had been camped at my ears.
“Marcy, thank you.” Nick’s genuine grin is now back, ear to ear, and I swear he must have chosen his lamp placement to best highlight his square jaw and cheek bones. “That was really helpful and echoes some of the data that I have been assessing from ED admissions records. How would you improve your department if you did have more resources?”
How do I want to improve my department? Does one person a department make?
I’m only realizing in this moment what a problem it is that I have never felt I had a place to voice my needs in this organization.
I am an entire Department.
“I don’t want to make excuses, but no one at this organization has asked me about improvements I could make for social services and mental health care at the hospital. I have been trying to meet needs as they arise, and am only now realizing I am an entire department as we sit here speaking.” Nick chuckles at that. “I am appreciating the challenge to take some responsibility for more planning though, if leadership is on board with that.” Look at me, stepping up to the plate.
“They will be.” Nick responds without looking at Keith, keeping his encouraging eyes on mine. The conversation has become entirely between Nick and I, forgetting Keith is even in the room. I have nausea swirling in my stomach from the anxiety of not having a readily available answer for improvements to patient care or programming, having assumed they would only ask about past or current issues. I’m feeling like I failed somehow, not that Nick or Keith is giving that indication.
“How about this, you take your time on making a list of ideas to move social services forward. I’ll brainstorm too, based on what I learn from running numbers and analyzing the health records. Then we meet again in a week or two to form a plan?”
“Sounds great,” I respond hearing something unfamiliar in my own voice…was that enthusiasm? “Do you reach out to me, or how does that work?” Sometimes knowing these details helps me feel more grounded, one less question to answer.
“How about you reach out to me when you are ready?” Nick responds, his presence still dominating the room, but I don’t find it intimidating in the way some men try to be. Instead, the encouragement he is offering me is causing an unsettling feeling of empowerment that is both refreshing and terrifying.
“I can tell you really care about the Hospital and your patients, Marcy. Improving and increasing the availability of your services can save the hospital money in the long run. We are talking fewer re-admissions, less waste of resources, and opportunities to make money if staff are properly educated on the ways to bill insurance companies more appropriately. There’s no reason increasing social services needs to be a sacrifice for the hospital.” Again, with that incessant smile on his face.
