“Fill us in on what’s going on,” Reardon asked Lundeen.
“Yeah,” echoed Molinari. “I was in the rack snoozing. This better be good.”
Hoffmeister, Hanson and Frankie sat waiting for Lundeen to begin. He wasted little time in getting to the point.
“Fredericks caught me breaking into his office. I had planned to copy his computer hard drive to get evidence against him and his plans.”
“Holy crap,” said Molinari.
Lundeen continued. “You all know that he intends to fire Sonya, permanently transfer McGinnis and kick us old vets out of the group. He told me to expect to be sent to an Old Soldiers Home with a one way ticket, and if I resist, he’ll press charges.”
Hoffmeister’s eyes grew wide as he sputtered. “He can’t do that. Due process must be followed. His actions are unethical if not illegal.”
“Sure he can do it,” said Reardon. “He’s got the power, the seniority, and the suck. Who’s going to believe some broken-down vets instead of a VA mucky muck?”
“That don’t make it right,” said Hanson.
“We don’t have to sit in the stands and let it happen,” piped up Frankie. “If we put our heads together, we can stop him.”
“How?” pleaded Hoffmeister. “He’s got all the cards.”
“Not all of them,” said Lundeen. “Even though he’s doctored his personnel records, Fredericks has a history of abusing people that’s a mile long. And that’s coming from a guy who served with him in Nam. What’s more, Nathan Proctor and I are working on getting testimony from people he’s harmed.”
“Like who?” asked Molinari.
“We’re working on that. For now, I wanted to find out who among you will help Mopsy and me clean house.” The nods of agreement around the table made it unanimous.
“Good,” said Lundeen. “Let’s keep all this under our hats, for right now, and sit tight and wait for Shellenberger to show up and call our group to order.”
“Sounds good,” Buck Hanson drawled, “But I’m wonderin’ which side of the fence Bubbles is on. Even with his pollution problem and parroting thing, he seems pretty straight up.”
“Straight up ’cuz he’s got a pole up his butt,” growled Molinari.
“Hey,” said Frankie, “He loosened up a bunch during our last meeting. I think he’s got the makings of an alright guy.”
“Too early to tell,” said Lundeen. “Let’s wait and see. Until then, I’ve got some visiting to do. Seems like an old army buddy is on this VA Review Team. Mopsy and I might buy her a cup of coffee for old times’ sake. It’s been awhile since we’ve had a chance to chat with a nurse with combat stripes from Nam.”
Before the group could respond to Lundeen’s comments, a somber-faced Bertrand Shellenberger entered the room. His cheeks and jaw looked like they were supporting the weight of the world and losing. With stooped shoulders, he stared at the group, looking for a vacant chair, and held his hand up in a half-hearted greeting. “Let’s begin,” he mumbled. “Does anybody have something easy to begin with?”
“Easy?” asked Lundeen. “I guess that would exclude McGinnis being replaced, sexual harassment of staff, shutting down the group, and our being sent to domiciliaries.”
Shellenberger turned white. Nobody said a word, as they waited for him to react.
“You feel that an ‘easy’ beginning might ignore what is most pressing.”
“Yep,” said Buck. The rest of the group waited in awkward and uneasy silence. Finally, Frankie broke the tension.
“I’d like to talk about quitting smoking,” said Frankie.
“Are you kidding me?” said Molinari. “All hell is breaking loose and you want to talk about smoking?”
“Easy there, Sergeant,” said Hoffmeister. “No need to jump on her that way.”
Molinari swung around and glared at him. “Yeah, well maybe we ought to take a look at the skeletons in your closet.”
Reardon stepped between the two. “We don’t need this argument right now. Let’s listen to what Frankie has to say.”
“I agree,” said Hoffmeister, who appeared relieved that the conversation was taking him off the hot seat. “She raises an interesting topic. Our group contains smokers who might profit from such discussion.”
“Dr. McGinnis talked about starting a behavior modification program on the ward for smokers,” said Frankie. “It’s too bad he isn’t here.”
“Isn’t that a fact,” grumbled Molinari. “Maybe we should talk about why he isn’t here instead of ‘cancer sticks’.”
“Hmm, upset more about Dr. McGinnis than your smoking,” said Shellenberger.
“Yeah, we’ve been wondering about what really is going on behind these walls,” said Buck. “Doc McGinnis is a good man and we miss him.”
“If we could stray from politics to treatment,” droned Hoffmeister, “I’d like to talk more about his approach toward changing our behavior. Dr. McGinnis had some behavior modification strategies that helped me out considerably, strategies that could apply to ceasing smoking and other aberrant behaviors.”
“Like what?” asked Molinari. “Thinking positive, whistling in the dark and changing the subject?”
“I agree we’ve got heavier stuff to deal with than smoking,” said Buck, “but I’ve got to admit I have a terrible time dumping tobacco. ‘One pinch between the gums’ keeps me wired with chew, and I don’t like it.”
“You feel that tobacco is a problem, but not important enough to talk about today,” reflected Shellenberger.
“Here we go again,” mumbled Molinari.
“Just give me some hints about how to stop,” said Frankie.
Hoffmeister cleared his throat. “Well, it’s clear some of us want to kick the cigarette habit and find a practical way to do so, without spending years in psychoanalysis–”
“Or on an organ transplant ward, getting our lungs replaced,” said Reardon.
“Quite,” said Hoffmeister, “so I asked Mr. Metzger to offer a thumbnail outline for modifying behavior, be it smoking or whatever behavior may be a problem.”
“Oh, my God,” said Molinari. “You want to hear a psychology lecture while our house is falling down.”
“Actually,” sniffed Hoffmeister, “the proper phrase is ‘while Rome is burning’. But whatever the case, it might be helpful to learn how to manage our own stress responses, like smoking, before we try to deal with issues on the ward and beyond.”
“You mean you can’t think if you’re smoking?” asked Molinari sarcastically. “Gawd, Hoffmeister, you are a piece of work that– ”
“Let’s give Brad a chance,” interrupted Hoffmeister. “What do the rest of you think?”
Rich Reardon began hacking and coughing. Reaching for his cup of coffee to help clear his throat, he took a sip.
“You sound awful, Rich,” said Buck. “Have you seen the doc yet about that cough of yours?”
Reardon glanced at Hanson and then looked around the room. “Before we talk about me, let’s give Brad a shot.” The group looked at Brad. “Go ahead,” said Reardon, “Give us some hints on how to kick this rotten habit.”
Brad hesitated, seeming uncertain about how to proceed. As the group continued to wait for his comments, he jumped in. “Like Loren said, maybe our talking about the behavior modification of smoking might help us with other issues.” Several nods of approval in the group greeted his remark, so he began.
“A behavioral analysis of smoking, or any behavior, includes three components.” Pushing his chair away from the table, he walked toward the white board, picked up a black marker, and wrote, “(1) Target behavior.” Turning to the group he said, “First, you’ve got to target or identify the behavior you want to change. You need to be specific. ‘Stopping smoking’ is too vague a description. ‘Lighting a cigarette’ is more precise.”
“Shouldn’t McGinnis be giving the instructions here?” asked Molinari.
“You mean Dr. Shellenberger?” asked Sonya.
“No, McGinnis.”
“Well, he’s not here,” answered Hoffmeister, “So permit Brad to continue.”
Molinari shot Hoffmeister a dirty look but remained silent. Brad gave Shellenberger a quick glance and looked uncomfortable. Hearing no further comments, he continued.
“Second,” he said, you need to record the number of times the target behavior occurs.” Brad wrote “(2) Record” on the board. “For example, you might make a check mark, each time you light a cigarette, on a piece of paper tucked inside the cellophane of the cigarette pack.”
While Metzger’s back was still turned to the group, Molinari muttered, “This is the kind of psychological crap that turns me off. Our leader gets canned, his boss threatens to kick us out of the hospital, and we’re counting cigarette butts.”
“Please, Geno, let him finish his speech,” said Frankie. Brad didn’t appear to hear Molinari’s remark as he continued. “After recording the target behavior, you need to decide on a reinforcement program.” He wrote, “(3) Reinforce” on the white board. “Whatever follows your target behavior, in this case, lighting a cigarette, will determine if that behavior continues. If it’s a reward, then the target behavior will increase. If it’s punishment, the behavior will decrease.”
“Well, duh,” mumbled Geno to himself.
“So, if you smoke the cigarette, you will be rewarded by the effects of tobacco: its taste, the effects of nicotine, feeling relaxed and so on. All of these are powerful reinforcers for continuing to light up cigarettes,” said Metzger. “If you punish yourself after lighting up, such as snapping your wrist with a rubber band, paying a fine, losing a privilege for a day etc., chances are your smoking will decrease.”
Molinari pulled out a pack of Marlboros tucked in his shirt pocket and put them on the table. “I think getting rid of these takes more than snapping rubber bands.”
Hoffmeister shot Molinari another disapproving glare.. “It’s the behavioral principles Mr. Metzger is trying to illustrate. Give him a chance to finish.”
Molinari fired back, “Brad’s a good guy but we’re wasting time. We’ve got bigger problems riding on our backs. This is too much like a health class. I don’t know about you, but health classes for me were boring, boring, boring. Let’s get to the important stuff.”
“Maybe this is part of the ‘important stuff,’” said Sonya. “Brad is trying to make some helpful suggestions. What if smoking, like a lot of our problems, is learned behavior that can be changed through learning strategies? Not just through nicotine patches and drugs, but by using learning principles”
“Learning principles like—?” asked Reardon.
“Rather than bore you with a list, you can read about them in this text I picked up in grad school— Behavioral Medicine Made Ridiculously Simple. It’s got a section on learning that is brief and to the point.”
“Are you kidding me?” scoffed Geno, in his best rendition of Butte blustering. “Us read a medical book? Come on, Doc, I need something with pictures.”
“You sell yourself short,” argued Sonya, “As do you all. I’m sure you all can read three or four pages of this book without growing another head. Try it. If it’s not helpful, I bring donuts to our next meeting.”
“You are on,” grinned Molinari.
“Please,” said Shellenberger. “I feel this conversation is getting off the point and out of hand.”
“I concur,” said Hoffmeister, “From the absurd to the profane.” Exhaling with a groan, he looked around the group. “I tire so easily from hearing all this arguing and bickering.”
“Well la-de-dah,” said Molinari. “You’re the one who pushed for a lecture about smoking.”
Rich Reardon began to shake his head in disagreement. “Maybe this lecture hasn’t been such a bad idea. Smoking can put some of us in the grave.”
“True enough, but we still need to talk about getting kicked out of the hospital,” said Lundeen. “Dr. Shellenberger, what did Fredericks have to say when you talked with him about our situation?”
“I was afraid that question was coming. To be honest, some major problems surfaced before I had a chance to bring your issue up.”
Faces around the table exchanged glances of disappointment as well as suspicion.
“How might we interpret this as far as your support of our position?” Lundeen asked. Shellenberger remained silent.
“We need to know where you stand,” said Reardon.
Shellenberger shook his head in frustration. “These issues have become more complex.”
Molinari’s face began to show streaks of red. “You know, Doc, we’re not issues. We’re people.” His voice began to escalate in volume and intensity. “Fredericks is poised to throw us out on our butts and you talk about ‘issues becoming more complex.’ Are you with us or not?”
Shellenberger closed his eyes and set his jaw. “I’m not picking sides.”
Shrugging his shoulders, Lundeen responded, “Sounds like you already have.”