Chapter 9

KIM SMILED HER thanks at Darlene, Philip's receptionist, when she waved her toward the inner office. She had asked to meet with Philip to discuss the situation with the ER. After two weeks in the ER, Kim knew right where the majority of the blame for the problems between psych and the ER lay. Philip is not going to be happy.

Philip smiled warmly as she approached his desk. "Hey, Kim. Have a seat. How was the ER? Did the staff treat you well?"

Kim made herself comfortable in one of the chairs in front of his desk. "ER was fine. The staff down there was very friendly and helpful."

Surprise showed on Philip's face. "Well then, you must be the exception. I've heard nothing but complaints from the rest of the psychiatric staff."

I bet Chris Roberts is the chief complainer. Kim decided to keep that opinion to herself. "The complaints are justified."

"Ah. Well, that puts a different light on things," Philip said, clearly relieved. "I knew it couldn't be just our people causing the problems."

Kim shook her head. "You didn't let me finish. The complaints against psych are totally justified. The ones against the ER aren't."

"It can't all be on us," Philip said, his tone turning defensive. "I know for a fact that the residents call for consults for the most inane things. That should be better monitored by the ER staff."

"You're right. It probably should be," Kim said. Tread carefully here. While Philip had asked her to find out what the problems where between psych and the ER, he was the head of the department she was criticizing. "When was the last time you covered the ER?" Kim knew as chairman, Philip didn't cover the ER, but he would have as a staff psychiatrist.

Philip appeared confused by the non sequitur. "I haven't. I've always been the chairman of the department here."

"Well, unless you experienced it, you wouldn't believe the volume of patients that go in and out of that ER in a single shift." Even having worked in other ERs, Kim had been amazed at the number of patients seen every day. "So I'm not surprised some of the residents' requests for consults aren't cleared by one of the ER Attending. But the truth is the inappropriate consults are partly psych's fault as well."

"How do you figure that?" Philip asked, sounding shocked.

"Because psych isn't providing the residents with any lectures to teach them to evaluate patients correctly so they are able to judge when psychiatry needs to step in."

"No," Philip said, shaking his head sharply. "You can't put that off on psych. Those are ER residents. It's not our job."

Kim leaned forward, closer to Philip's desk. "Yes, it is. This is a teaching hospital. Just because there isn't a psychiatry residency doesn't mean the staff doesn't need to teach residents from other departments that interact with ours." Kim gripped the front of Philip's desk. "You hired me as a liaison between psych and the ER because of the staff conflicts. I thought you wanted me to find out where the problems were and try to correct them. So now I'm informing you... this is one of the problems."

Philip's shoulders sagged a bit. "I can't make people give lectures." He cut her off when she started to interrupt. "Oh, I know. I could order the staff to give lectures, but I can't make them teach residents. And you know as well as I do that one without the other is useless. Just reciting a lecture verbatim from a syllabus doesn't teach anyone anything."

"All right." Kim sighed in frustration. "I don't like it but I understand." She relaxed back slightly in her chair. "Just so you know. I've agreed to provide an extended lecture series to the residents. The first series is for new incoming residents. I've also arranged to give an advanced set of lectures to the more senior residents. I'll need time away from psych floor duties when I'm not assigned to the ER."

"That's fine. I'm sure it will help improve things between the two departments," Philip said. "I'll see if I can find time to fit a couple of lectures in as well." A small smile touched Philip's face. "Maybe if it helps cut down on unnecessary consults, it will motivate the rest of the staff to participate more."

Kim smiled. "It's sure worth a try."

"You're right, you know," Philip said looking somewhat sheepish. "This is a teaching hospital, and it's time I remember that. The program director of the Family Practice residency approached me a while back. He wanted psych to provide lectures to his first-year residents. I said no, but I think it's time to reconsider that decision."

Philip leaned back and crossed his arms over his chest. He smiled slightly lessening the defensive nature of his posture. "Okay. What other problems did you find?"

"The teaching issue is a big one. The lectures are only a small part of it. I was more than a bit surprised to see how shocked the residents were when I invited them to work-up the patients with me."

"Come on, Kim. You can't blame the staff for that. They'll end up being in the ER all day if they have to hand hold the residents too. You know it's much easier and quicker to handle the case yourself."

"Fine." Kim shrugged. "Then they shouldn't complain when the residents request all sorts of unnecessary consults. How are they supposed to know what's necessary and what's not if the psych staff isn't willing to teach them?"

With a shake of his head, Philip chuckled. "You're relentless."

"That's why you hired me," Kim shot back.

Philip laughed. "Okay. I give," he said with a placating gesture. "I'll talk to everyone at the next staff meeting." Philip gave Kim a speculative look. "Is that it?"

Don't push your luck. You've made good progress. Kim smiled. "For now."

A dramatic sigh from Philip was his response, making Kim laugh.

"Hey, stranger. Welcome back." Kim heard as she opened her office door. She had just finished her meeting with Philip. Smiling warmly, she turned to greet Brenda. Just who I need to see. Brenda was the nurse-practitioner she would be proctoring for this week.

"Haven't seen hide nor hair of you in two weeks. I was beginning to think you'd been kidnapped by the ER."

With a laugh, Kim motioned Brenda into her office. "Come on in."

"Seriously, how did it go covering the ER?" Brenda asked as she settled herself on the leather couch in Kim's office.

"Really well," Kim said. She joined Brenda on the couch. "The staff was friendly and helpful. I especially liked working with residents."

Dark eyes wide, Brenda leaned over and felt Kim's forehead. "Nope, no fever. So that's not what's making you delusional." Her disbelief was apparent. "Are we talking the same ER staff that every other psychiatrist complains about incessantly?"

"I can't speak for the rest of the staff. But I found the ER to be an interesting and challenging place to work. I enjoyed my time there. And I look forward to going back."

"You'd be the first, then. Dr. McKenna has a reputation of running roughshod over our staff." Clearly Brenda was skeptical. "She didn't give you a hard time?"

"No. Jess and I worked very well together." Kim smiled as she remembered the night she worked with Jess taking care of the little girl, Tara.

Her eyebrows shot up. "Jess," Brenda mouthed incredulously.

Shit! Kim immediately realized she had made a mistake. No one calls Jess by her first name. "Anyway, enough about the ER. Bring me up to speed on your group. I'm working group sessions this week," Kim said.

"Hold on a sec," Brenda said, unwilling to let the subject go. "There're some things you need to know first."

"About what?" Kim didn't like where she thought this conversation was heading.

"I should've warned you about Dr. McKenna." Brenda sighed. "Don't get me wrong. She is gorgeous. But she's one of the most emotionally controlled women I've ever met. And from all I've heard that —"

"Stop right there," Kim said, allowing her displeasure to leak into her voice. "Unless you have something to tell me about Dr. McKenna professionally, I don't want to hear another word."

Brenda's expression turned stubborn. "You need to hear this."

"If it's about Dr. McKenna's personal life, then no, I don't." It was hard enough working in, as Jess herself described it, a fishbowl. Sure, gossip was inevitable. And sometimes Kim used it to her advantage, like telling Chris she was a lesbian, knowing full well he would spread it around. But Kim felt strongly about talking about a co-worker's personal life behind his or her back. "You know how I feel about this kind of talk."

"I know and normally I'd agree with you, but this is different. It's important you know —"

"No," Kim said firmly, cutting her off. "You don't know any of it for a fact, do you?"

Brenda started to protest. The look on Kim's face dissuaded her. "No," she finally admitted.

"Right. It's just gossip. I'm not interested."

"I don't want to see you get hurt," Brenda said. Her eyes glistened with suppressed emotion. "I care about you."

You know she's not being malicious. She acts like a mother hen with all the staff. Kim had told Brenda early on that she was a lesbian, and Brenda had kept it to herself. She was not normally a gossip. Allowing her expression to soften, Kim offered a slight smile. She gave Brenda's forearm a quick squeeze. "I appreciate your concern. But there's nothing to worry about. Dr. McKenna and I are colleagues, nothing more." And even if we were more than that I still wouldn't want to hear it. Jess will eventually tell me anything I need to know. "I enjoyed working with her just like the rest of the ER staff."

Brenda eyed Kim, looking for any signs that she was being less than truthful.

Kim met Brenda's stare and carefully kept her expression neutral. It's the truth. No matter how much you wish it wasn't.

With a resigned sigh, Brenda gave in. "Okay. My group this month is all young adults dealing with situational depression," Brenda said.

Kim forced her thoughts away from Jess and to the business at hand as Brenda continued to fill her in on the individual patients in her group.