Quantcast
4S Ranch Allied Gardens Alpine Baja Balboa Park Bankers Hill Barrio Logan Bay Ho Bay Park Black Mountain Ranch Blossom Valley Bonita Bonsall Borrego Springs Boulevard Campo Cardiff-by-the-Sea Carlsbad Carmel Mountain Carmel Valley Chollas View Chula Vista City College City Heights Clairemont College Area Coronado CSU San Marcos Cuyamaca College Del Cerro Del Mar Descanso Downtown San Diego Eastlake East Village El Cajon Emerald Hills Encanto Encinitas Escondido Fallbrook Fletcher Hills Golden Hill Grant Hill Grantville Grossmont College Guatay Harbor Island Hillcrest Imperial Beach Imperial Valley Jacumba Jamacha-Lomita Jamul Julian Kearny Mesa Kensington La Jolla Lakeside La Mesa Lemon Grove Leucadia Liberty Station Lincoln Acres Lincoln Park Linda Vista Little Italy Logan Heights Mesa College Midway District MiraCosta College Miramar Miramar College Mira Mesa Mission Beach Mission Hills Mission Valley Mountain View Mount Hope Mount Laguna National City Nestor Normal Heights North Park Oak Park Ocean Beach Oceanside Old Town Otay Mesa Pacific Beach Pala Palomar College Palomar Mountain Paradise Hills Pauma Valley Pine Valley Point Loma Point Loma Nazarene Potrero Poway Rainbow Ramona Rancho Bernardo Rancho Penasquitos Rancho San Diego Rancho Santa Fe Rolando San Carlos San Marcos San Onofre Santa Ysabel Santee San Ysidro Scripps Ranch SDSU Serra Mesa Shelltown Shelter Island Sherman Heights Skyline Solana Beach Sorrento Valley Southcrest South Park Southwestern College Spring Valley Stockton Talmadge Temecula Tierrasanta Tijuana UCSD University City University Heights USD Valencia Park Valley Center Vista Warner Springs

Who answers San Diego's crisis lines

With a shotgun in one hand and the phone in the other

 “That's our work. Our invisible work."  - Image by Paul Stachelek
“That's our work. Our invisible work."

The telephone is hidden in a black box fixed to the north wall of a small building, island-side of the tollbooths. It’s easy to miss; the signs, posted at even intervals along the Coronado bridge, are not. White letters on a reflective blue background. “We care about you. CHM CRISIS Team. 24 hours.” Two phone numbers. The telephone in the black box is connected directly to the CRISIS Team office in a large county government building. Twice I get lost trying to find the office, which is through one of the many unmarked doors lining a long, anonymous corridor.

“Most bridge calls are from people who had a flat tire."

The office is a large, high-ceilinged, win-dowless box glowing with incandescent light. Two rows of desks face each other behind waist-high partitions upholstered in a nubby beige fabric. In the six-foot channel between the rows of desks sit two big reclining chairs and a couple of metal tables. Papers, binders, books, stacks of papers, loose papers, pamphlets cover every surface in the room.

“The mental health clinics, almost all your 9-to-5 clinics and outpatient programs are closed now."

It's 3:30 pm and the four evening shift staffers settle in for duty. Day shift workers toss eight hours' worth of empty soda cans into a recycling bin in the kitchenette, pick up sweaters, mime goodbyes as they leave. Only one person, Tina, an evening shift staff member, talks into a phone. The room is quiet except for her voice, which is milky and low. Only her side of the conversation can be heard.

Coronado bridge. The average call to CRISIS Team is from a woman and lasts 20 minutes.

Tina’s face barely moves when she smiles. A telephone headset, the kind receptionists wear, holds her long auburn hair in place. Her shoulders and bust, draped in a purple-blue peasant blouse, do not move either. Her right arm rests near the phone, a pencil wedged for the evening between right thumb and index finger, poised near the phone’s bank of buttons. The rest of her is obscured by a frizzy pastel plaid blanket, by the desk where she sits, by her wheelchair. On the wall a few feet behind her head is a sign that reads, “Bang Head Here," on one line, with a big X beneath it, then a third line, ‘To Relieve Stress.”

Of the 28,023 crisis calls received last year, 2108 were from acutely suicidal people.

When she hangs up, she says the call was from a woman whose best friend is suicidal. The friend called her for help: she didn't know w hat to do. The friend had attempted suicide before by jumping off an eight-story building.

“It was a Marine with a Southern accent. Suicidal because his wife, whom he beat, has finally left him. At the beginning of the call he was in tears. You don't hear a man cry that often."

“If you took pills," Tina explains, "I wouldn't be as concerned as if you jumped off a building. People often take pills in an attempt, and most of the time, it turns out to be an attempt that doesn’t work. I don't mean to give the impression that if you take pills it won't work, because you can die. People do die from pills all the time. But it isn’t as high-risk as a jump. Often, through time, the way that a person attempts suicide increases in lethality."

Marion is counseling her caller to be less dependent on others, Victor is suggesting to a woman that she lean less on her husband. and Pam is persuading a man to think less about his wife.

As Tina talks, a red-bearded man in black and grey sweats settles into one of the two big recliners in the channel between the desks: we'll call him Victor. He puts a 7-Eleven Big Gulp on the metal table next to his phone and leans back enough in the chair to activate the footrest. He opens Naomi West’s Beauty Myth and inverts it against his expansive belly. His ID tag is clipped to one shoelace. When the phone next rings, he picks it up, simultaneously taking a pen from beside it and beginning to enter data on a phone log sheet. Soon all four staffers are busy on the phones. The voices, luring anonymous callers away from suicide, form a seductive rhythm, a mother's heartbeat.

Marion sets down her telephone receiver. She occupies the brightest spot in the room: big color photographs of the Grand Canyon line the partition at her left shoulder. On the wall behind her head is a pencil drawing of a black woman in a yellow flowered shift, hands serene on swollen stomach. (“Campaign for alcohol and drug-free pregnancy," the poster says.) Marion wears a red turtleneck and tunic woven with red Guatemalan birds. Barrettes hold her silver-shot brown hair back from her temples, revealing glass bead earrings. The desk light bounces off her eyeglass lenses.

“The unusual thing was that my last caller was referred by the Coronado bridge. She said the phone is out. The only other phone it can reach is this one." She points to a beige rotary-dial phone on a comer table beneath a framed photograph of a tropical beach. “Most bridge calls are from people who had a flat tire."

“She asked for a support group referral. The thing is, there's a zillion kind of different support groups on a zillion different kind of themes. She wasn't specific what she wanted. Basically, she’s not happy with the way she deals with anger and wanted help finding ways to channel it better.

“She said her hands and arms were injured, like she was punching things. She realized now that she has not only her anger to contend with but injured arms and hands. So she wanted to figure out a better way to cope." Marion reaches for her now-ringing phone before the words have died in the air.

The County Department of Health formed CRISIS Team in 1970 as DEFY, a drug-abuse crisis hotline. The service was renamed CRISIS, an acronym for Counseling, Referral, Information. Suicide Intervention Services, in 1981. Pam, the CRISIS Team program manager, explains, “Funding changed. When you’re in a political system like a county, funding is always changing. Even though we called it a drug line, it wasn’t exclusively drug people who called. People called with all kinds of stuff. We broadened our mission statement to reflect that."

Two more calls come in while Pam explains that CRISIS Team is virtually the only hope for a person in crisis on a Friday night. “The mental health clinics, almost all your 9-to-5 clinics and outpatient programs are closed now," Pam says. “No one can reach anybody there. Doctors and therapists are off for the weekend. People panic and start to call. And we take calls for agencies that are closed on Friday afternoons. Some of their recordings list our number as a backup. We get public health calls, for example, that we have no expertise in. Sewers backed up, rats running around in the attic. Because those services are cutting back, we get a few more calls here, a few more there. It can be rather quiet. Or it could be like this." The room is now buzzing with gentle conversation.

This is how it works, this fielding of calls from people on the bridge, or on downtown pay phones, or in apartments across the county. Workers sit dow n w here they like. Calls are answered by whoever happens to pick up the phone first. Contact established, the counselor sets about determining risk.

“We have a set of criteria for assessing risk," explains one of the day-shift staffers. “It’s a formal process, but we also know informally, with experience, w hat a life-threatening situation is. One woman here had a high-risk situation earlier today. The person was calling from a pay phone near a highway. She was contemplating walking onto the roadway. The police brought her in to the hospital. She w anted help but she didn't w ant help. That happens fairly often."

Pam retrieves a black three-ring binder from atop a file cabinet. “This is our high-risk book. We try to keep track of high-risk cases we have identification on. We get other callers who we consider high-risk but don’t document, because they remained anonymous. There’s no use in documenting those. But we do write up folks who we have identification on or end up having to call the police on."

The police, Pam explains, act as CRISIS Team’s “only arm to go out to do what we call a 5150 assessment. That’s the Welfare and Institutions Code for assessment and involuntary hospitalization. If someone’s acutely suicidal, or acutely homicidal, or so disturbed they’re hurting themselves, you can involuntarily take them to the hospital and have them assessed. The only folks in the county who can do that now are the police.”

A high-risk caller earlier in the day spoke with a staffer named Lauren. According to Lauren's write-up in the high-risk book, the caller, a young woman, “started out kind of hysterical." She had recently been kicked out of her apartment. She had run out of Prozac. She spoke of rejection by her family, anxiety attacks. She sounded desperate. Lauren's concern was that “she was impulsive, [the woman] said she was at a pay phone and (Lauren] could hear traffic going by... It sounded like one of those situations where you need the police out there. We don’t know. Lauren stayed with her on the phone, tried to calm her down and apparently did. By the time the police arrived, she was calmer and almost kind of felt bad. like the police had been called unnecessarily. But the police ended up coming in." Pam doesn’t know if the woman was admitted to a psychiatric hospital or not. Once a phone call ends, so does CRISIS Team's responsibility.

But while the responsibility exists, it may require several important decisions, judgment calls, by a couaselor. The most grueling is whether or not to involve the police. ‘It may be clear you need to get the police out there right away. You know it's going to take time for them to respond, and you don’t want to delay the decision too long because the person might hang up."

Pam says, "Keep in mind this is quite a tenuous relationship. The caller's anonymity is important. You want people to call in when they re hurting, and you don't want them to have roadblocks to that. If people think you're going to try to find out who they are, then they're not going to phone us."

Pam flips over the high-risk caller form. Printed on its back is a Suicide Lethality Checklist, consisting of three columns of phrases describing low-, moderate-, and high-risk traits in perhaps two dozen categories. The suicide plan of a high-risk caller, for example, will probably include a well-thought-out method. The caller will probably be ready to execute the plan immediately, at his present location, and probably has the means to do so in hand.

High-risk callers to CRISIS Team are usually men. The means will be lethal, probably. He may have given away all his possessions. written a note, made a will. He may have attempted suicide previously, perhaps several times, in potentially lethal ways. He may be a habitual drug or alcohol user. He might have “tunnel vision," be able to see death as the only possible scenario. He may be “markedly hostile." He may be "markedly disoriented." If he has received psychiatric help in the past, he will probably have “a negative view" of it. He probably has few “significant others." He may have recently lost a job. divorced a wife, lost a family member to death. He will probably feel hopeless, helpless. withdrawn. He may be panicked and severely depressed, or he may be calm and happy because he has made the decision to die.

According to statistics compiled from CRISIS Team reports, he will probably be white, under 35 or over 65. with access to firearms. And he may well be in the military.

Pam retrieves a copy of CRISIS Team's 1991 annual report to the county. According to its statistics, the average call to CRISIS Team is from a woman and lasts 20 minutes. About 12 percent of the calls are related to substance abuse, continuing a five-year decline. Calls from people who say they have been diagnosed as mentally ill. however, continue to increase and now make up 30 percent of all contacts. The signs on the Coronado bridge bring in perhaps 2 percent of the team’s calls. The telephone at the toll booths is rarely used. The last call from the bridge was in May, from a Navy pilot grounded because of anxiety attacks.

Most calls to CRISIS Team, however, are requests for information and referrals. The most frequent referrals in the month of June, according to one desk's lists, were made to the Info Line, drug self-help groups, support groups, detox centers, Ask-A-Nurse. and County Psychiatric Services.

Within the last six months. San Diego County’s mental health budget has been cut by $5 million, one third of its total budget, according to Pam. We now have only 33 psychiatric beds for the 2.5 million people in the county. Contracts with private hospitals make a few more available. So far, CRISIS Team has been left intact, but they are nervous about the next round of financial cuts. A flyer calling for a protest outside the County Administration Building the next Monday had been placed on the desk where Pam seated me.

“By the way," Pam says, “I’m on my way out as program director." She is transferring to a position elsewhere in the county health system. A replacement at CRISIS Team might not be hired. There is a county-wide hiring freeze in effect. “Each year for the last 20 I’ve seen services get cut more and more. So far this program hasn't been cut. But this year may be our year."

Pam walks away again, returns to lean in next to me with a black three-ring binder entitled “Hotline Directory ." It shows lists of crisis counseling hotlines across the country, by state and city. “Someone will call, say they’ve gotten off the phone with their aunt in New York and she's depressed, can we give them a phone number for a hotline in her area which might be able to help her."

Asterisks next to a few of the numbers indicate certification by the American Association of Suicidology, which Pam hopes is an assurance of competency on the part of its operators. She hopes it means these are not church-basement, volunteer-staffed hotlines. "This field is not regulated. Anybody, you, can start a hotline in your basement. If you've got the money to advertise, you can do it. No one can prevent it. In fact, we’ve discovered several flaky operations. In fact, there’s one in town now that’s a sort of proselytizing Christian-based teen runaway line.

“It does mean a lot to as that we re certified. That certification book is this thick" — she indicates its massiveness by holding her hands wide apart and shaking them — “of the criteria you have to meet. You have to be 24-hour. You have to have ways to handle high-risk cases. If a hotline's certified, it means they've been around for a long time, they won't fold up tomorrow, they 'll answer the phone.

“There’s a hotline that advertises in all the Yellow Pages, Call it up and it’s a tape. A tape! It's located up in Long Beach. They have an 800 number. You call it up and they say, You can leave your number, we ll call you back. Basically they re there to get people into a hospital. It's a marketing tool."

The San Diego Yellow Pages lists 13 hotlines, including CRISIS Team. Two aid rape victims and battered women, one is for crime victims, one is for police victims. Two more offer service specifically to teens. Three are run by psychiatric treatment facilities.

Pam tells Marion an ad in The California Therapist is soliciting applications from social workers, MFCCs, psychologists, psychiatrists to work on a 900 number. “People in crisis call in, you counsel them a little, suggest they come in to your office to talk more. You’ve gotta see this." A woman they know has gotten five referrals from such a service. Pam retrieves the magazine from her office. “Opportunity to broaden your income base," the ad suggests.

“Working on a phone line is a specialty. The caliber of what is offered on phone lines differs, however. Because CRISIS Team members are mental health professionals, they get to the point faster, they give out more information. Most volunteer lines spend more time with people, because they're floundering. That might be helpful, because if you spend time, people can talk themselves out of things. On the other hand, we focus discussion quicker. We give more technical information. How to make your way through the system, for example. Many volunteer lines aren't able to do that because they spend time reflecting back feelings, you know. Gosh, that must be frustrating to lose a friend like that."

Tina started with CRISIS Team in 1982. “If you're new here, you classify more calls as high risk for suicide than you do after you’ve been here ten years. So our statistics don't accurately reflect the number of suicide calls." (Of the 28,023 crisis calls received last year, 2108 were from acutely suicidal people. And 182 of those were classified high risk.)

Marion has been on staff even longer than Tina. Marion leans over. "We have an on-cali worker who has been here even longer! In 1980, my first year, I only lasted 11 months full time. It is my belief one ought not to do this type of work full time. It is too draining.

"The primary complaint among people for whom the job hasn t worked," she goes on, “is the lack of visuals. But it can work as an advantage. The person in crisis has to articulate his problem, and that articulation helps move him along in the process of dealing with it."

“There are those who perceive this job as not being legitimate," Tina says. ‘Even people who work on the line will say, We re only a telephone line.' They think they can't perform a meaningful intervention."

Waiting for calls. Victor luxuriates in his recliner reading the Union-Tribune. He fills out his log sheet, the record each suffer keeps of his calls. The sheet is printed with columns for recording the duration of the call (in tenths of an hour), codes for different types of calls. A “2.1," for example, denotes a chronically mentally ill person. “That way. at the end of the year Pam can shoot out the statistics and let people know exactly who we re helping and hope for more funding." Tina adds.

A phone rings. “CRISIS Team," Victor says into the receiver. His face remains blank as he listens. “Well," he ventures to the caller, “it depends what you mean by that."

For a long time, he listens. Then he says, “As long as she’s on drugs they re going to... Sounds like, at this point, going for a conservatorship would be a good idea..."

Pam has hung up the phone. “A teenager," she says of her call, smiling sadly, drooping her words in sympathy or nostalgia. “By herself. Complained her mom doesn’t let her go out anymore." She describes the caller as sounding a little depressed and imitates the girl's pouting voice. “Sounds like she's an only child, and she can't talk to her stepdad, says he's moody. Sounded like her friends were all going to be graduating, from ninth grade, and she w anted to go out and see them. I asked her, What would you do, if your mom didn't let you go out?' She said, Well, I 'll probably sneak out anyway, without telling her.’" Teenagers rarely call because, Pam says, “It's hard for them to reach out." Last year, teens made only two percent of the calls to CRISIS Team.

Most callers are women. Most people who succeed in killing themselves are men. In the past, Tina goes on, women tended to choose less violent means. “Probably because of the way we re socialized. Now women are more frequently choosing guns. But women are socialized to ask for help more than are men, so they reach out sooner. Women also tend to try via passive means, because we're trained to be passive. It takes tremendous energy to attempt suicide."

Another quiet period follows. .Although it’s just nearing 6 p.m., conversation lags and revives here as it does in the late hours of a drunken dinner party. No tension sparks them to fill the silence. Marion sits with one hand wrapped around a caffeine-free Pepsi, staring at the desk. She's already on her second sheet of callers.

The trilling of the phone doesn't startle anyone. Tina picks it up. “CRISIS Team. .. Yes. Just one second..." She puts the call on hold. “It's for you," she sighs at Marion.

Marion spoke with this caller earlier, offered her the number of a county agency that runs support groups. She is calling back to report her failure to make contact with them. Marion explains the Friday dilemma and helps the person plan a way to “get through the weekend."

On a wall beside a massive map of the county hangs a bulletin board frilled by a profusion of stapled-together papers pushpinned to it in rows. A sign in one comer of the board identifies them as “Repeat Callers." Next to these words, a clipping from a magazine advertisement reads, "Life is limited only by how many 800 numbers you know."

Pam walks over to the board and shoots an index finger toward the sign. “The repeat caller syndrome is fairly unique to hotlines, our satisfied customers who keep coming back for more." The papers pinned to the board are this week’s Repeat Caller forms, perhaps two dozen stacks of them. Pam speaks in pianissimo. “Certain callers become dependent on us. More often than not, they’re chronically mentally ill and simply need constant support. We’ve learned the best strategy is to keep track of them, strive for consistency in what we tell them. If not, they may call 50 times a week and get 50 different pieces of advice. Some of these folks may call 50 times a day. Their mental illness gets bad or they get anxious. It's difficult for us because we then can't handle all the other calls."

She thumbs through the pages of one stack of forms. Since some repeat callers use aliases, the forms note what could be referred to as the caller’s M.O. “This one refers to herself as we.’ Says she doesn't want to return to Canada..." The forms detail conversations, help offered, referrals made. “Here, this is a woman who we would call borderline personality disorder,' who becomes quite dependent, difficult, manipulative, but also has a variety of personal problems and needs ongoing rapport." The worker who last dealt with her noted the woman had been raped and that her therapist had moved out of town at the time of the assault.

“Actually," says Pam, ‘you’ll find similar histories on several of these folks." Raised in orphanage, raped by staff member, a few marriages, last one to a Navy man who she refers to as ‘the psychopath."

Battered and threatened. “We would be guessing that this woman could be classified as borderline, because we're only dealing with her over the phone, but she has that presentation. Individuals with sexual trauma in their backgrounds may come across that way: needy, dependent yet rejecting, with abandonment issues' — when left, they’re completely thrown off balance. The Fatal Attraction woman..."

She points at another report. “This woman comes across as extremely depressed. Chronically depressed. You pick up the phone, and your mood is immediately brought dow n a couple of decibels." Next to the most recent date of contact listed, the worker has written “UGH!" in block letters. “It gets to you. We referred her to one counselor, and he’s gotten to where he has a pretty good relationship with her and can tolerate it.

“We also get sexual callers. Guys who want to call you up and tell you a fantasy as a way of getting off. We don’t usually write them up because we don’t spend much time with them. We tell them. The call is inappropriate, if you want help w ith a sexual problem we can give you a referral, see you later.'

“But they still call back, because they know you’re always going to answer," Pam says. “It's often women who answer, and they want to talk to a woman." (Of CRISIS Team's 28 staff members, 19 are female.) “One technique that works well, by the way, is you say, ‘Oh, listen. Let me get a male counselor to talk with you.’ The guys are tricky." She grimaces.

“You may talk to the guy for half an hour before you find out." Pam's voice lowers to a whlsper. “Then they’ll call right back and do exactly the same thing. It’s compulsive behavior. They won’t even change their line. If you work here long enough, you begin to recognize them immediately." Counselors deal with several such calls each day.

The Repeat Caller binders are emptied out once a year. The stapled-together sheets can run 15, 20 pages for one caller. “Look at this." Pam says, grabbing a thick one. "Look at this one fellow. He s pretty funny. Chronically mentally ill. He has a major mental illness. He goes on and off medication, so he needs frequent contact.

“It's usually 200 or so high-risk, documented cases. Each page of these is a separate caller." Pam figures the binder represents half the hotline s high-risk calls. “You're talking high-risk at the beginning of the call and high-risk toward the end. If you spend 20 minutes with someone, they may end up in a dramatically different place. Suicide works that way. It’s acute, often transitory. The danger period Is short. One of our goals here is to get them past that."

Marion is on a call. The tip of her right index finger presses against her temple. “But it sounds like you can't completely prevent that either, because it sounds like he’s already going through it.. Mmm-hmm... Was there any alcohol in your home when you were growing up?"

The phone rings and Victor fields it as Pam walks behind her desk to answer the next ring, from the telephone repair people, asking her to have the Coronado bridge phone tested. They think it’s fixed.

Tina concludes a call. “That w as a Navy wife with a problem with alcohol. She didn't want to use her husband's insurance to get help, because she didn't want him to find out she was an alcoholic, and she didn't want the Navy to find out, because if they reported it back to him he would get mad at her. She thought I was trying to get information from her to turn her in. She was paranoid.

“She probably wasn't gonna get the help she needed." Tina sighs. “I’m usually good at establishing rapport with people. That's one of my strengths. But there was no way to get to her. So I was going over the call in my mind... I think I did what I could do. She wouldn't give me any information. She wanted an answer to a question without giving out any information." She huffs, a half-laugh meant to indicate that people do this all the time.

When she’s not on a call. Tina fills out her phone log sheets. Maybe she'll chat with the other counselors. They don’t often play games. “You can’t do anything that involving... 'This job reminds me of that part in the movie The Big Chill. Jeff Goldblum writes articles for People magazine that can't take any longer to read than it does to take a shit?" Across the room, Pam guffaws, surprised by the vulgarity. Tina ignores this. “You can’t do anything that takes longer than that."

Pam removes another binder, seats herself on the edge of a desk. "This is our Classic Calls book." She opens at random. ‘This person said, ‘I drinked and I drinked and I drinked. I have pancreas of the stomach from drinking so much!'

"And this person was asked if she had ever tried to kill herself. 'Oh yes. I’ve killed myself several times. With poison, a knife, and a gun.' Do you remember this one? The police dispatcher said to Mary, who had spent over an hour with an extremely unstable, homicidal, suicidal, delusional, paranoid, heavily armed male, who was unaware the police had been dispatched. Do you think you could ask him to step outside with his hands up?'

‘Shelly took this call from a little old lady, she says, I feel like dying.' Shelly says, Well, do you have a plan? And she says, ‘Yes, I've tried it all day long and it hasn't worked.' Shelly asks, Well, what is that? She says, 'I've driven all around Southeast San Diego with the window rolled down.'’"

Another ring stops the laughter short. Tina presses her pencil tip to a button on her telephone. “CRISIS Team."

‘Okay... Right...," Tina’s voice is thick, as if she is ready to cry. "Where is he working?... Okay... Is that because they re cutting back or because he can't work anymore in that?... Okay ... Are you still seeing one?... And what does he or she say? Uh-huh... Maybe from living with him. huh?

“Is your husband willing to get help? Has he ever been in ongoing therapy?... Yeah... But that was it... When you say that he's bitter and resentful and hateful. did you say...? And he takes it out on you?" This confirmed. Tina's voice deflates. ‘Well, it’s hard to imagine a loved one treating you like that."

Marion balances phone receiver between shoulder and ear, taking a new call. “Did something happen today?" She inquires. "Have you seen a therapist before?"

"Do you think he’ll change?" Tina asks her caller. “Because if he's dealing with childhood Issues, he's not going to change immediately. It's gonna take at least six months to see prominent change in his behavior. He's gonna slip back.

“I don't know if he calls you names or degrades you... That's what he is programmed to do. It takes a while to be reprogrammed. Unless he's been diagnosed as having a mental illness, I don't think he needs a doctor. He needs to see a marriage and family therapist or a licensed clinical social worker that can work on the family issues that he needs to look at. Those are available on a sliding-fee scale, but I'm not sure whether you can find one for less than ten dollars an hour.”

Marion sounds concerned. "What are your plans for the rest of this evening?... Do you think you could rest?...Mmm-hmmm. Do you have your room where you can close the door?... What would you like to do?... Okay, what do you think your choices are?... That was yesterday? Okay... But you didn't today... Okay... So you’re still angry over that. too. huh?... What can you do to take care of yourself?... Yes... Coffee'll keep you awake, though... You mean, the situation with your parents?... For the moment, though, there s not much that you can do. huh, for the weekend?... I'd say. put it aside until you can get help from the counselor. Treat yourself good this weekend... Sometimes crying is a good thing... Yeah, it's sad. when you look to them for help and you don’t feel like they came through. Sounds like.that would hurt. That would hurt your feelings..."

A janitor shoulders open the hallway door, briefly admitting the glare of the outside world. He pulls in a cart of green 50-gallon trash cans, bends for a waste-basket in the comer, dumps its contents into the trash can. He moves on silently through Pam’s office, the kitchenette, the main room. No eye contact is exchanged. Tina stares at her log sheet. Marion slowly flips through the pages of The Final Call, the Nation of Islam newspaper. “What the Muslims Want” reads an editorial topping one page.

While Marion does this, she is talking into the phone. “How do you support yourself, Tina?... Unh-huh. And what's your disability?... What is the disability that qualifies you? What’s your disability? Unh-huh... And do you have a psychiatrist that you see?... When do you see that person next... So that's not till... You're not happy with your psychiatrist?... Well, let your psychiatrist know that."

Tina is asking her caller, “Has he been evaluated by a doctor?... I would tell him. though, that it's not okay anymore, to take it out on you... Instead of taking it out on you. can you give him this phone number?... You need to w alk out of the room and say, ‘You need to call the crisis center. "

‘Okay. Tina, good luck.” Marion hangs up the receiver heavily and sighs. She looks up. “I'm trying to think what she originally said was wrong. It often doesn't come out right away. If I think chronic mental illness is a factor. I'll ask. How do you support yourself? If the answer Is they re on SSI or disability. I'll ask. W hat is your disability?' Then you can ask if they re on medication. If they are, you can gauge the severity of illness from what kind. She is on Haldol. That's a heavy-duty medication. She's having problems with her parents, who visited her yesterday. She's still upset..."

Marion squints. “After I hang up, the call goes straight into the memory banks. When I try to recall it, I think. Wait a minute, was that the other call? They all start sounding alike." She grins toothily. "It pulled on my heartstrings, because, you know, people want to be heard. The person w ho prescribes her the Haldol has her in there ten minutes —" Marion snaps her fingers rapidly three times — “asks her enough questions to determine whether that's the medication she should continue. That's how they operate.

"I find myself in a bind. A lot of the community agencies are scared of chronically mentally ill people and particularly scared of people that mention suicide. From my point of view, after 11 years of this stuff, dealing with suicide seems fairly basic to treatment. Seems to me everyone reaches a turning point in life and contemplates suicide.”

“We have private practitioners call," Tina says, "who ask us what to do with a suicidal client.”

"Yeah," Marion confirms. “Psychiatrists, psychologists."

"Social workers —"

“What are they doing calling you when it’s their job?"

‘That’s what we ask ourselves when we hang up and they're making $80 an hour and we re making $15!"

‘Psychiatrists get the least training, in terms of therapy,"

Victor adds, "They get trained as medical doctors. They may take some courses in counseling, but they’re not trained specifically for that. The higher up you go on the totem pole, the less training mental health professionals have in counseling."

The Coronado phone rings, a festive sound. “I guess it’s working," Victor says. He answers it, thanks the caller, hangs up. Then the Coronado phone rings again. He lurches hack over and picks up the receiver. “Yeah. Okay. Thanks." He hangs up and returns to his chair. ‘They're depressed over talking to me before and now they want to jump!"

“CRISIS Team," Victor answers a call. Pam leans, arms folded, against a shelf-and-file drawer unit while she talks. Above her head, an oak-framed clock reads 8:45 p.m., to her left the photograph of the tropical beach beckons. Rolodexes, file boxes, binders, books with titles like Behavior Control garland her head. "Fundamentally," she concludes, “12-step programs are marketing strategies."

“That was Kim Il Sung," Victor interjects. “He wants us to vote for him for president." Victor returns to Naomi West.

“Oh. that's what’s-his-name. Pete. He always calls up with political things," says Pam.

Pete, Victor explains, looking up with raised brows, “is probably psychotic. Has delusions. He probably has little contact with the rest of the world. We're it."

The sentence terminates in a quiet room. The phones are mute and nobody's talking. The massive building around us breathes. Almost inaudible, a tense electric hum underlies the carpet, vibrates behind the walls. Muffled by the kitchenette door, the refrigerator clicks off.

"You guys w ant pizza tonight?" Pam asks. She walks across the room. For no particular reason. “No, thanks,” Victor says.

“What? Are you on a diet?"

Victor slaps his substantial stomach. ‘You think I need one?"

“No."

“No, honestly, I don't feel like pizza."

They don’t generally eat together. Because Pam and I are around, “We're not acting like we usually do," Pam says.

"I'll go out for pizza, and you guys can act the way you usually do," Pam suggests.

“How’s that?"

‘We usually have balloons. Lithuanian midgets...” Victor says. ‘ We re on our best behavior!"

“And we re actually talking to the people who call!" Tina says. All laugh at this.

“I get these theme calls," Marion says. “On the weekends, people with disabilities have been left alone. When the police find them a day later, the bedclothes are soiled and the person hasn't eaten. So the police will call me and ask if we can find someone to help. Well, are they in medical danger?' No. Well, visiting nurses can't come out because it’s not a medical situation. I try to weasel something. The police call Adult Protective Services, because adult abuse is going on. Well, Adult Protective Services aren't there on the weekends, so we get the call. But we're directed, in emergencies, when Adult Protective Services are not there, to call the police. But it’s the police calling us."

“As a woman on staff here says, everybody’s a capitalist until they need help," Pam says. ‘Then they're a socialist, calling and expecting the services to be here."

“People assume the government will provide services," Marion continues. ‘They’re shocked to find out after they voted for Prop. 13 and Libertarian candidates that, surprise, surprise. My 37-year-old son is addicted to drugs, can you come and get him? No. My 15-year-old! I’ve had it! Send somebody to pick him up! Uh, who did you have in mind? The limo's out right now.

“There are many angry people out there. Drunks call up wanting to be abusive. The way they get through their day is to make you feel bad." Marion pretends to pick up the phone. ‘Okay. ‘CRISIS Team.’ Hello?’ Yes.’ ‘WELL, YOU'RE A COUNSELOR, YOU SHOULD KNOW WHAT’S WRONG!’ ’

Pam says, “They think you’re clairvoyant."

“Administration," Pam puts in, “dictates that we treat the persistently mentally ill. So it’s all well and good that you're dealing with these other people, but we don’t have the money. That’s not what the state’s paying us to do. That’s not mandated. Crazy."

They’ve never “lost anyone.” They've heard a few times of chronically suicidal people who once phoned in and who later killed themselves. Although they receive a monthly report from the County Coroner’s office, the connection between those statistics and their own experience remains, perhaps by choice, vague. “I’m not sure I’d want to know,” Marion says. “I mean, if I were to find out later somebody killed themselves after contact. I might wonder why I am doing this."

The coroner’s list consists of three pages attached to a cover letter in which the phrase Deaths of Interest is prominent. The list Pam detaches from the bulletin board details January and February of 1992. “For me, it’s a way to tabulate suicide trends," Pam says. ‘Sometimes you’ll see certain drugs become pronounced, that people are overdosing on. Sometimes you see little flurries of different kinds of suicides."

The report records name, sex, age, race, codes for type of death, method, location, address.

ACC. What does ACC stand for?

“Accidental."

OD dash UND slash TD COMPOSITION.

“Undetermined. In other words, the body had decomposed and they couldn’t determine."

Overdose. Lithium.

“Lithium's usually for bipolar disorder."

A woman overdosed on lithium in a motel. “Chances are she had a major mental illness," Pam says. “Lithium is fairly lethal."

“The therapeutic dose is not far from the toxic dose," Victor explains.

‘You don’t see it that often," Pam comments.

“People usually don't take enough of it to kill them," Victor says.

A plus sign next to combinations of substances indicates more than those listed were found in the body. “Somebody ingests whatever they find in their kitchen cabinet, for example," Pam says.

In January and February this year, people killed themselves in mobile homes, motels, hotels, at home, in apartments. In or at the bay. Sometimes the location listed is “hospital." ‘Hospital usually means they were certified dead at a hospital," says Pam.

A 70-year-old woman. Asphyxiated. Plastic bag. Motor home. “I wonder where they got that idea, huh?" Pam snorts. She is thinking of Derek Humphrey’s Final Exit. I love where Humphrey says, If you have to kill yourself in a hotel room, leave a generous tip.’"

The dead people, the ones listed as suicides, are all Caucasian. Which is typical. They are mostly men. Men “succeed in killing themselves four to one over women." “Complete" is the preferred word.

Amitriptyline?

“That’s an antidepressant." The drug is commonly known by the brand name Elavil.

Hanged... Gunshot to the head... A woman... incised wounds in arms?

“Wrist slasher. That's unusual."

A 74-year-old man. Gunshot to the head.

75-year-old man. Gunshot to the head.

35-year-old man. Gunshot to the head.

“As you can see. that's the most common way." "If only we had more guns on the street." Victor adds

An 84-year old man hangs himself in his garage. Another gunshot to the head. man. 33. open area, in his car on Lake Jennings Road. A 71-year-old man, gunshot to the head, 34-year-old man. gunshot to the head and mouth. Lithium, fluoxetine — commonly known by the brand name Prozac — overdose. Gunshot to the head. Overdose. Overdose. Gunshot to the head, a woman. A jumper. Ingested lye.

“Eww..." Earn wrinJdes up her mouth.

A 33-year-old man.

“What does that say psychologically." Pam asks, turning her head to address Victor, “that you ingested lye to kill yourself? That you feel corroded? It would corrode and bum all the way down." She ruas a hand down her body, tracing the path of her esophagus. “Might be psychotic at the time?"

Why would you purposefully make it as painful as possible?

“It’s the symbolism behind the method," Pam says.

“Or a person can be psychotic," Victor says. “I've seen psychotic people who feel parts of their bodies are taken over by Satan and have to be gotten rid of. Saw a man in a hospital once poked his eyes out. Had another woman, she was in restraints, they didn't do it properly. She bit her finger off. Thought her hands had been taken over by Satan."

Gunshot to the head. Gunshot to the head. A woman, hanged herself. Man, gunshot to the head. Hanging. 18-year-old man. Gunshot to the head. Gunshot to the head.

Things are getting busy again. Pam. Tina, Victor, and Marion are all on calls.

Gunshot to the head, 40-year-old male. Gunshot to the head, 21-year-old male. Gunshot to the head, 24-year-old male. Gunshot to the head, 57-year-old male. Jumped from a bridge, 28-year-old male. Gunshot to the head. 17-year-old male. Gunshot to the head, 72-year-old male. Gunshot to the head. 78-year-old male. Gunshot to the head. 48-year-old male. Gunshot to the head, 19-year-old male. Gunshot to the head, 79-year-old female.

Victor replaces the receiver of his phone on its cradle and resumes reading.

Also in January and February this year, a 53-year-old man overdosed on auto exhaust in a parking lot in Fallbrook. A 22-year-old male shot himself in the head; a 53-year-old male did the same in a hotel on 13th Street.

"Losing your license," Pam is explaining into the phone, “usually involves broad or sexual misconduct or a crime. Whereas the ethical standards that the association might have could involve how you advertise..."

Tina is saying to her caller, “Don’t do it now because this is a temporary problem. After this crisis has let up. maybe you can make a more, uh. knowing decision about taking your own life. Now is not a good time to make that decision. Wait until your housing crisis is over."

Marion refers a caller to Oz, a teen shelter. When she hangs up the phone, she comments, “A parent not getting along with her teenaged daughter. Wanted to know where she could drop her off."

Trna shoots a knowing glance her way, says, “There used to be a counselor here who said there should be a Bad Kid Wagon that they could call out. There should be a Bad Parent Wagon!"

Marion leans back in her chair. ‘Sometimes I get a call from a person who assumes we have the technology to find out who and where they are," she says. “I worry that people will give us a hard time thinking we can show up and save them? I try to clarify with them. If you want to get help, you have to tell us where you are. If you won't cooperate, there’s no point in telling me. You ought to tell 911 you're going to kill yourself and want help. If they're playing cat-and-mouse, then there’s a question as to what they’ll tell me. People are often ambivalent about suicide."

This rests on silence for a minute. “Sometimes," Marion says then, “they call you up to dare the counselor. I dare you to save me."

“Or they’ll say, I’m calling for you to give me a reason to live,’" Tina says. “SOR-ry! Doesn’t work that way."

After most calls, the counselors mentally evaluate their performance, wondering what they could have done differently. There Isn't always a good answer.

Victor, who has been monitoring our conversation over the West book, lowers it, marking his page with a thumb. “I'll be talking to a woman." Victor says, “and no matter what I say she'll be hostile. It will occur to me, ten minutes later, that her issue is she's mad at men. If it occurs to me on the phone, I can ask her if she'd like to talk to a woman, pass her over, and then she can have a conversation."

‘If you make a suggestion that doesn't hit home, they'll tell you," Tina adds. ‘They’ll say, ‘No, that s not what I mean!' ’

“Or if you make a true or on-target statement to a person that they don’t want to hear, they’ll get pissed off and go away," Victor says. “I’ve had people call who have talked to, say, 80 different people who told them what they need to do is kick the 37-year-old, drug-addicted brother out of the house. You say the same thing, because that's what they need to do, and they get pissed off."

This sparks a discussion about how long to remain on a call. Each counselor has a different definition of risk, of crisis, a different idea about how to help. A former staff member was in the habit of spending an hour and a half on calls, which the others considered excessive — and resented, because it increased their own work loads. People at CRISIS Team work “in a fishbowl." Everyone hears and judges everyone's technique. The upside: if a counselor uses a certain tone of voice, says certain key phrases, the others listening can initiate a call trace.

The smell of oregano and hot cheese precedes Pam into the room. She balances a grease-spotted cardboard pizza box on one hand as she slings her shoulder big off onto a metal tabletop. The pizza box she lays on Tina's desk. She disappears into the kitchenette. returns with cake-sized paper plates. She separates the slices of pizza with her fingers, loads a piece onto a plate, slides it to me. She places another next to Tina. A third she carries back across the room to her desk. This is all done silently.

Tina is saying, “You're getting people right where they are. They’ll tell us things they won't tell their therapists. Because they’re too embarrassed. I'll ask them, if they're seeing a therapist, if they’ve told the therapist something, and they’ll say, Oh no, because he would put me in the hospital, or I’m ashamed of it.’ They have more of a chance to be who they are." Already tonight there have been five such calls.

“Women with sexual abuse histories call us up. They always say they haven't told their therapists," Pam says.

“Many women start having memories in their 30s," says Tina. “They’ll be in therapy for it but they ve had a flashback and their therapist isn’t available. I think it’s important to be available for that."

In the ensuing pall, comments are lazily traded on the subject of bittersweet chocolate. Dove Bars, coupons, an ex-employee who has started her own private practice. I sit in a chair facing the desk where Pam sits. Her wristwatch reads 9:30 p.m. She doodles on an 8 1/2"x11" pad of lined paper.

The phone rings. Marion dives for it. “Mental Health Crisis Team."

“What’s your situation?” Marion says, narrowing eyes and plugging her free ear against the chat. “What’s your name? ...Pardon? Frank? What's your situation today, Frank? I can't understand you, Frank. Can you speak more slowly, maybe?... Okay, what were you looking for? And what’s that?... Frank, have you been drinking?"

Tina fields the next incoming after two rings. “Can you call back... Frank?" A peevish edge enters Marion's voice. “Pardon? Are you in your home?... I can't understand what you’re saying... Are you in your home?... And where Is that?... Pardon me?..." Exasperation has erupted in Marion's tone. “Frank. I'm going to have to hang up now, I can’t understand what you re saying. Call back when you haven’t been drinking." Marion clumps the receiver down.

"I did get a no out of him for suicide. That was the magic word. I was thinking, God, please, don’t say yes!’ Those are awful!" To Marion’s mind, the toughest calls are from suicidal drunks. The terminally ill also are difficult but rarely call.

In the case of drunks, it ’s nearly impossible to determine to what degree the suicidal state is precipitated by mental illness and to what degree by the alcohol. One night they dealt with a man despondent over the loss of wife, job. youth. He planned to shoot himself. At one point during the call, he shot the gun off in the air. The counselor, alarmed, sent out the police. They determined the man, who did indeed have a gun and w as still threatening suicide, should be hospitalized. At the psychiatric hospital, he was medicated, then given a bed in which to sleep off his drunk. He stayed perhaps eight hours, then was released. Pam pauses for dramatic effect. “Well. About two months later he got a bill. From the hospital. About $400. He was furious! I looked at the medical record. Turned out when they brought him in he had a blood alcohol level of .26. Legally drunk is now .08. Probably most people would be dead before they hit .26.” Marion sighs and puts her head in her hands.

“Even that one, I don’t know. He could have... I don’t know. He might have been a repeat caller. He did say that. ‘You guys don’t like me to call there.”

She hoists out of her chair, treads heavily over to the shelves, and consults the Repeat Caller book. “When I open this thing, I keep expecting it to be alphabetized." The reports are simply stuck in the binder where they seem to fit.

“What we need is a computer system," Pam says, wiping hands with a paper towel. “So that you could look him up under Frank or incoherent drunk.’" “Cross-referenced by the hours they call. Some people call at certain times."

A computer system in place, briefly, last year, wasn't used. The counselors found it too distracting. “A lot of people don’t understand the concentration required," Pam says. “They see us sitting at a desk talking on the phone. That's it.”

Marion reflects. “Our work is invisible. What we do is invisible. So it looks like we re not doing anything. People walk in here and all they see is, we re talking on the phone. Or we re sitting without speaking, hearing these anonymous voices."

“Or they walk in and we're not on the phone!"

Tina pipes up. “We re sitting at desks talking. We have to go through this debriefing process after the calls."

“You don’t always get the chance to debrief," Marion says. “You go from suicide to domestic violence to child molest."

“I debrief by talking with other counselors," says Tina. “But now I’ve been here a long time and I can debrief fast — like, I hang up the phone and say, Oh, that was gross!’"

“It depends on the call," Marion quickly adds. “You do that searching-your-mind thing, wondering what you could have done. But even saying ‘That was gross’ can be important. Here you are, straining to be nonjudgmental and cut this person slack, give them permission to articulate w hat they ’re trying to. You’re putting all this energy into accommodating their needs. When you hang up the phone —*

“—Part of me has to come back, "Tina finishes. “My values have to resurface. In general you have to put your values aside, but you need them. If they're getting abused, you need your values for education purposes. But most of the time you’re putting them aside."

“It's the frustration of, She’s gonna go back to him. I know she’s gonna go back to him. I’m gonna hang up the phone and she's gonna go back to him.” Marion pounds a fist against the desktop to punctuate her sentences. “I can’t dump that on her on the phone, but as soon as it’s over I feel the frustration."

“A homeless man called the other night," Tina says. “Many homeless people call us, because our 800 number makes the call free. This guy had a history of mental illness but wasn’t chronic. He could have a conversation. The picture he painted for me of being homeless was so intense. I still have it. Here’s this guy who lives in a box, and he only wanted to talk to another human being who wasn’t drunk, who wasn't homeless too, before he got into his cardboard box for the night."

Tina answers the next call, “CRISIS Team." The soft encouragement and pauses continue for a long time. When Tina finishes her call, it turns out that she was talking to a young man on the streets, scared, who left home five months ago because he “kept getting angry." He described a childhood of neglect and a disappointing experience with therapy.

‘People like that only want the bad feelings to go away. I try to get them used to the fact that they have to deal with the feelings," Tina says, intercepting another call. “...The only place I know of is the YMCA," she offers the caller. “They have beds for 20 bucks." She lists some motels, gives locations and prices, then hangs up.

Pam addresses Tina and Marion. “Don’t you feel now and then that you should be able to charge a caller 75 bucks for the help you give them?"

"I do," Tina says. “I’m doing loads of work here—"

“— For loads of other therapists," Marion concludes.

“Is there a type of call that makes you feel that way more than others?"

“Yeah," Marion says. “When somebody already has a therapist, and we re doing backup for the therapist."

“What I hate is when a woman will call up and start complaining about her boyfriend, and he’s in the room the whole time. She's calling up complaining that he doesn’t listen to her, so he'll hear. She’s going on and on. and in the background I hear. You lyin' bitch! "

"My personal favorite," Pam says, “is call waiting. They'll call up. weeping. Oh. I'm in crisis! Help me! Oh. can you hold on? I’ve got another call.’"

“I don’t do call waiting. I say no." Tina says. “Unless I've made a strong connection with the person and they say they'll get rid of the other call. Then I'll wait."

“Or they'll call us while they're waiting for their therapist to call. That may be my psychologist, but hold on in case it isn't!’ My God. How needy."

So where are these people's families? Why are they calling strangers?

Tina is quick on it. “Because, I'm sorry, but the family doesn’t work."

“Oh. the nuclear threat ?" Marion jokes.

Tina adds. ‘The family is often why they’re calling. The family's dysfunctional or worn out. You get that with drug addicts and with chronically mentally ill people. The family gets worn out. The person feels ashamed or has been ridiculed by the family for the problem."

The building whirr and shrieking phones irritate the ears now. The lights that seemed so soft seven hours ago glare. Four women in a vast, nearly empty building. Victor is on a break. Marion notes plenty of security people around as Pam moves over to shut a doorway onto a back corridor. She and Marion reminisce over their old office, on Island Avenue. One worker would be on at night, handling two phone lines.

“This lady called." Pam tells us. “It was one o'clock in the morning. She was crying. Heaving." Pam gives a few illustrative sobs. “Felt terrible. I finally get her to start talking. She had been depressed. Lonely. So she's starting to stop sobbing, we're pulling her together —" Here, Pam puts on a voice — “and she says, ‘I...wrote...a poem tonight. Can I read it to you?’"

A low chuckle gains momentum in Marion’s chest. “I'm sitting there rolling my eyes — you know, people say these things to you and you don t know what to do. So I said sure. I'm there all by myself, nothing else to do. She says, It’s called, No One Cares. Just then the other line started ringing."

Marion recalls ‘an old gentleman" who used to call hotlines in town, request help in piteous tones, and burst spontaneously into poetry recitations. She worked on two phone lines at the time, which is how she came to find out he was “an operator." Cab drivers and police used to call in about him, saying they'd given him spare change and cups of coffee and wasn't there something CRISIS Team could do?

This prompts Tina to remember calls when she was sure she knew the caller's identity, recognized friends, neighbors. This leads Pam to mention callers who you think are one age from the voice but whose problem is typical of a different age category. Someone, for example, whose voice is 40 years old, devastated over a romantic breakup like a teenager. This causes Marion to remark. ‘Those 16- or 17-year-old breakups, those are difficult calls."

“They're terrible, "Tina agrees.

“Because they ve bought into the whole romantic myth of the one and only —"

“— And they think their life Is over."

“Those are real scary calls."

“It's intense. The boys, especially, can be hard..."

Marion firms her face. “It goes along with another thing, that I suspect is a uniquely American thing. We, as Americans, expect to live a life without pain in it. We're incredulous that pain should have to happen in our lives. People never bargained for this much hurt."

‘In this culture." Tina adds, “we don’t teach people to deal with loss. It's like, we re supposed to keep getting stuff till we die."

The phone again. Marion picks it up. says. “Mental health crisis team."

Everyone falls silent as Marion says, in a tight little voice, “What's your first name?... Well, I'd prefer to hear it... Okay."

Tina looks over. “Want me to listen?" Marion nods, once, slow. Tina touches her pencil tip to a sequence of buttons on her phone. (This matter of listening in is a delicate business. Later. Tina explains that one asks if the counselor handling the call would like one to listen in. as a matter of politeness. Pam and Marion add that “it’s a matter of performance anxiety ")

“And how were you hoping we could help you? ...Okay... And how were you hoping we could help you?"

Tina says calmly over to Pam, “I think that's him again. Pam. If you want to hear him."

Pam rounds the comer of her desk, dives for receiver.

“Think so?...Have you told your psychiatrist? Can you do that? ...Uh-huh...Uh-huh... Have you spoken with your psychiatrist? ...I think it's important to let your psychiatrist know this the next time you see him or her...Yeah, I’ll bet I'll bet it’s hard to listen to those."

Another call comes in. and after Tina has picked it up. another which Pam answers.

Marion is saying. “When do they come back?... Oh... So if you can endure until Thursday, you'll be okay then, right?... Mmmm. .. So can you ignore it tonight, do you think? I think if your mother were here tonight, she d say ignore it tonight, wouldn't she? ...Yeah... Well, ignore the regret too."

Tina is saying. “If he continues to be violent?... Well, can you tell me where he saw the psychiatrist?"

Marion concludes her call, and even as she is saying goodbye the phone is ringing again. “Mental health crisis team... Wltat s going on? You sound like you're upset."

On the other side of the room Pam clacks down her phone, cat-stretches, leans back in her chair.

“I can give you the number where he might be able to talk to a psychiatrist...”

“What's been happening the last couple of days?"

The phone rings again. Pam picks it up.

“You feel like you're going crazy? ...Uh-huh... What are you afraid might happen?... Yeah.”

Tina concludes her call. Victor, back from his break, plows silently up the channel between the desks. He hasn't yet sunk into his chair w hen the phone rings again. He answers after the first ring.

Marion transfers her caller — a frightened young man, in from another town. stuck on the streets — to another number and hangs up. “The caller before that was hearing voices." she looks up and announces. “It mast be awful hearing voices and stuff. He said it was like a broadcast, like having a microphone in your ear. Sounds like he lives with his mother, and his mother usually tells him to ignore it. then he ignores it. So I tried to tell him to ignore it."

Pam is saying, intently. “Well, you can change, in small little ways that will make a huge difference. You have to start from today... Sounds like you've already started, you went to Family Services?... Well, start there, and when your wife comes back to the marriage..."

The familiar trill again, halted by Tina. When all the phone lines are lit up, the room fills with a low litany of sympathetic phrases. The atmosphere is churchlike, with the gentle absolutions, the team members’ heads bent to desk pads, to forms cradled on crossed legs, intent on the voices entering their heads through the instrument. Even their eyes listen.

Tina: “You don't have any money at all?"

Pam: “Well, what do you feel now? Alone? Rejected? That's frustrating, and painful...”

Tina: “I can call shelters for you. After nine o’clock they might have a bed that hasn't been filled..."

Pam: “So what do you think she’s doing? So maybe she's, like, playing around, or flirting, or flaunting the fact that you're not around?..."

The phone rings; Marion picks it up. The phone rings immediately again. After the second ring. Marion gets that one too.

Tina: “Have you ever been evaluated for a stress disorder?"

Pam: “She’s giving you mixed messages? She’s leading you on?"

Tina: “Have you ever had that checked out?"

Marion: “You’re feeling hurt by her and when..."

Pam: ‘Maybe she's doing it becaase you’re asking her that. Most people wouldn’t even ask... Well, I... I mean, if my hasband were away. I wouldn t ask him. What time are you coming home?' I wouldn't... So he wouldn't ever do that to me."

Marion: ‘When you think of killing yourself, how do you think you'll do it?... Have you ever tried by other means?"

Pam: ‘Maybe she’s doing that because you ask and because you want to know. Cuz she knows it will bother you... 'Cuz you're afraid that she would leave you?"

Tina: “If you’re going to get well, you need to go through that process. All your feelings are stirred up inside you."

Marion: “What would have to change for you to feel better?"

Tma: “That will make other people angry, because of what happened to you when you were a kid?"

Marion: “What would the change he?"

Tina: ‘Were you abused?"

Pam: “It's tough." She sighs. Her voice takes on a quivering timidity. “What did you do before you were married?"

Marion: “You want to be happy."

Pam: “And when she came along, it helped you change."

Tina: “There are crisis residential centers in town."

Victor’s voice, too low to distinguish clearly, provides a bass line. The other voices form a higher-pitched trio, a Mozart creation. While Marion is counseling her caller to be less dependent on others for his own well-being, Victor is suggesting to a woman that she lean less on her husband. and Pam is persuading a man to think less about his wife. ‘Maybe if you were focusing on another aspect of life, she would begin to miss you and then she would call you more..." Pam suggests. “No. not to hurt her... I'm not saying hurt her. she'd wonder, she'd live through it... I'm not saying play games. I'm saying you get something else. .."

It is a little before midnight. Victor gently returns receiver to cradle. His longest session tonight lasted 22 minutes. Pam’s call ends 2 minutes later. “It was a Marine." she says, “with a Southern accent. Suicidal because his wife, whom he beat, has finally left him. It's too bad you couldn't listen in. You miss the emotional impart hy hearing only one side of the conversation. At the beginning of the call he was in tears. You don't hear a man cry that often." She shakes it out of herself, exhales.

I wonder if she Is still trying to get away from that feeling when she walks around to the outside of her desk cubicle, distancing herself from the phone. She tells me she has a friend w ho jokes that she and the rest of the team should be wearing jumpsuits and helmets with flashing lights on top of them. Victor puts down his book, sets his phone log sheets on the metal table next to his phone.

‘The job can be absolutely basic.” Pam says. “It may be a matter of telling a person how to breathe. Or reminding a person of the reasons why it ’s not a good idea to kill someone."

By the end of the shift, Pam doesn't remember how many calls she has fielded. Tina has handled 17 calls. Victor has taken 18, Marion. 20. “That's our work," Marion says. “Our invisible work."

Here's something you might be interested in.
Submit a free classified
or view all

Previous article

Nicholas Wiseman: a great influence on John Henry Newman

Also known as author of Fabiola, a novel
 “That's our work. Our invisible work."  - Image by Paul Stachelek
“That's our work. Our invisible work."

The telephone is hidden in a black box fixed to the north wall of a small building, island-side of the tollbooths. It’s easy to miss; the signs, posted at even intervals along the Coronado bridge, are not. White letters on a reflective blue background. “We care about you. CHM CRISIS Team. 24 hours.” Two phone numbers. The telephone in the black box is connected directly to the CRISIS Team office in a large county government building. Twice I get lost trying to find the office, which is through one of the many unmarked doors lining a long, anonymous corridor.

“Most bridge calls are from people who had a flat tire."

The office is a large, high-ceilinged, win-dowless box glowing with incandescent light. Two rows of desks face each other behind waist-high partitions upholstered in a nubby beige fabric. In the six-foot channel between the rows of desks sit two big reclining chairs and a couple of metal tables. Papers, binders, books, stacks of papers, loose papers, pamphlets cover every surface in the room.

“The mental health clinics, almost all your 9-to-5 clinics and outpatient programs are closed now."

It's 3:30 pm and the four evening shift staffers settle in for duty. Day shift workers toss eight hours' worth of empty soda cans into a recycling bin in the kitchenette, pick up sweaters, mime goodbyes as they leave. Only one person, Tina, an evening shift staff member, talks into a phone. The room is quiet except for her voice, which is milky and low. Only her side of the conversation can be heard.

Coronado bridge. The average call to CRISIS Team is from a woman and lasts 20 minutes.

Tina’s face barely moves when she smiles. A telephone headset, the kind receptionists wear, holds her long auburn hair in place. Her shoulders and bust, draped in a purple-blue peasant blouse, do not move either. Her right arm rests near the phone, a pencil wedged for the evening between right thumb and index finger, poised near the phone’s bank of buttons. The rest of her is obscured by a frizzy pastel plaid blanket, by the desk where she sits, by her wheelchair. On the wall a few feet behind her head is a sign that reads, “Bang Head Here," on one line, with a big X beneath it, then a third line, ‘To Relieve Stress.”

Of the 28,023 crisis calls received last year, 2108 were from acutely suicidal people.

When she hangs up, she says the call was from a woman whose best friend is suicidal. The friend called her for help: she didn't know w hat to do. The friend had attempted suicide before by jumping off an eight-story building.

“It was a Marine with a Southern accent. Suicidal because his wife, whom he beat, has finally left him. At the beginning of the call he was in tears. You don't hear a man cry that often."

“If you took pills," Tina explains, "I wouldn't be as concerned as if you jumped off a building. People often take pills in an attempt, and most of the time, it turns out to be an attempt that doesn’t work. I don't mean to give the impression that if you take pills it won't work, because you can die. People do die from pills all the time. But it isn’t as high-risk as a jump. Often, through time, the way that a person attempts suicide increases in lethality."

Marion is counseling her caller to be less dependent on others, Victor is suggesting to a woman that she lean less on her husband. and Pam is persuading a man to think less about his wife.

As Tina talks, a red-bearded man in black and grey sweats settles into one of the two big recliners in the channel between the desks: we'll call him Victor. He puts a 7-Eleven Big Gulp on the metal table next to his phone and leans back enough in the chair to activate the footrest. He opens Naomi West’s Beauty Myth and inverts it against his expansive belly. His ID tag is clipped to one shoelace. When the phone next rings, he picks it up, simultaneously taking a pen from beside it and beginning to enter data on a phone log sheet. Soon all four staffers are busy on the phones. The voices, luring anonymous callers away from suicide, form a seductive rhythm, a mother's heartbeat.

Marion sets down her telephone receiver. She occupies the brightest spot in the room: big color photographs of the Grand Canyon line the partition at her left shoulder. On the wall behind her head is a pencil drawing of a black woman in a yellow flowered shift, hands serene on swollen stomach. (“Campaign for alcohol and drug-free pregnancy," the poster says.) Marion wears a red turtleneck and tunic woven with red Guatemalan birds. Barrettes hold her silver-shot brown hair back from her temples, revealing glass bead earrings. The desk light bounces off her eyeglass lenses.

“The unusual thing was that my last caller was referred by the Coronado bridge. She said the phone is out. The only other phone it can reach is this one." She points to a beige rotary-dial phone on a comer table beneath a framed photograph of a tropical beach. “Most bridge calls are from people who had a flat tire."

“She asked for a support group referral. The thing is, there's a zillion kind of different support groups on a zillion different kind of themes. She wasn't specific what she wanted. Basically, she’s not happy with the way she deals with anger and wanted help finding ways to channel it better.

“She said her hands and arms were injured, like she was punching things. She realized now that she has not only her anger to contend with but injured arms and hands. So she wanted to figure out a better way to cope." Marion reaches for her now-ringing phone before the words have died in the air.

The County Department of Health formed CRISIS Team in 1970 as DEFY, a drug-abuse crisis hotline. The service was renamed CRISIS, an acronym for Counseling, Referral, Information. Suicide Intervention Services, in 1981. Pam, the CRISIS Team program manager, explains, “Funding changed. When you’re in a political system like a county, funding is always changing. Even though we called it a drug line, it wasn’t exclusively drug people who called. People called with all kinds of stuff. We broadened our mission statement to reflect that."

Two more calls come in while Pam explains that CRISIS Team is virtually the only hope for a person in crisis on a Friday night. “The mental health clinics, almost all your 9-to-5 clinics and outpatient programs are closed now," Pam says. “No one can reach anybody there. Doctors and therapists are off for the weekend. People panic and start to call. And we take calls for agencies that are closed on Friday afternoons. Some of their recordings list our number as a backup. We get public health calls, for example, that we have no expertise in. Sewers backed up, rats running around in the attic. Because those services are cutting back, we get a few more calls here, a few more there. It can be rather quiet. Or it could be like this." The room is now buzzing with gentle conversation.

This is how it works, this fielding of calls from people on the bridge, or on downtown pay phones, or in apartments across the county. Workers sit dow n w here they like. Calls are answered by whoever happens to pick up the phone first. Contact established, the counselor sets about determining risk.

“We have a set of criteria for assessing risk," explains one of the day-shift staffers. “It’s a formal process, but we also know informally, with experience, w hat a life-threatening situation is. One woman here had a high-risk situation earlier today. The person was calling from a pay phone near a highway. She was contemplating walking onto the roadway. The police brought her in to the hospital. She w anted help but she didn't w ant help. That happens fairly often."

Pam retrieves a black three-ring binder from atop a file cabinet. “This is our high-risk book. We try to keep track of high-risk cases we have identification on. We get other callers who we consider high-risk but don’t document, because they remained anonymous. There’s no use in documenting those. But we do write up folks who we have identification on or end up having to call the police on."

The police, Pam explains, act as CRISIS Team’s “only arm to go out to do what we call a 5150 assessment. That’s the Welfare and Institutions Code for assessment and involuntary hospitalization. If someone’s acutely suicidal, or acutely homicidal, or so disturbed they’re hurting themselves, you can involuntarily take them to the hospital and have them assessed. The only folks in the county who can do that now are the police.”

A high-risk caller earlier in the day spoke with a staffer named Lauren. According to Lauren's write-up in the high-risk book, the caller, a young woman, “started out kind of hysterical." She had recently been kicked out of her apartment. She had run out of Prozac. She spoke of rejection by her family, anxiety attacks. She sounded desperate. Lauren's concern was that “she was impulsive, [the woman] said she was at a pay phone and (Lauren] could hear traffic going by... It sounded like one of those situations where you need the police out there. We don’t know. Lauren stayed with her on the phone, tried to calm her down and apparently did. By the time the police arrived, she was calmer and almost kind of felt bad. like the police had been called unnecessarily. But the police ended up coming in." Pam doesn’t know if the woman was admitted to a psychiatric hospital or not. Once a phone call ends, so does CRISIS Team's responsibility.

But while the responsibility exists, it may require several important decisions, judgment calls, by a couaselor. The most grueling is whether or not to involve the police. ‘It may be clear you need to get the police out there right away. You know it's going to take time for them to respond, and you don’t want to delay the decision too long because the person might hang up."

Pam says, "Keep in mind this is quite a tenuous relationship. The caller's anonymity is important. You want people to call in when they re hurting, and you don't want them to have roadblocks to that. If people think you're going to try to find out who they are, then they're not going to phone us."

Pam flips over the high-risk caller form. Printed on its back is a Suicide Lethality Checklist, consisting of three columns of phrases describing low-, moderate-, and high-risk traits in perhaps two dozen categories. The suicide plan of a high-risk caller, for example, will probably include a well-thought-out method. The caller will probably be ready to execute the plan immediately, at his present location, and probably has the means to do so in hand.

High-risk callers to CRISIS Team are usually men. The means will be lethal, probably. He may have given away all his possessions. written a note, made a will. He may have attempted suicide previously, perhaps several times, in potentially lethal ways. He may be a habitual drug or alcohol user. He might have “tunnel vision," be able to see death as the only possible scenario. He may be “markedly hostile." He may be "markedly disoriented." If he has received psychiatric help in the past, he will probably have “a negative view" of it. He probably has few “significant others." He may have recently lost a job. divorced a wife, lost a family member to death. He will probably feel hopeless, helpless. withdrawn. He may be panicked and severely depressed, or he may be calm and happy because he has made the decision to die.

According to statistics compiled from CRISIS Team reports, he will probably be white, under 35 or over 65. with access to firearms. And he may well be in the military.

Pam retrieves a copy of CRISIS Team's 1991 annual report to the county. According to its statistics, the average call to CRISIS Team is from a woman and lasts 20 minutes. About 12 percent of the calls are related to substance abuse, continuing a five-year decline. Calls from people who say they have been diagnosed as mentally ill. however, continue to increase and now make up 30 percent of all contacts. The signs on the Coronado bridge bring in perhaps 2 percent of the team’s calls. The telephone at the toll booths is rarely used. The last call from the bridge was in May, from a Navy pilot grounded because of anxiety attacks.

Most calls to CRISIS Team, however, are requests for information and referrals. The most frequent referrals in the month of June, according to one desk's lists, were made to the Info Line, drug self-help groups, support groups, detox centers, Ask-A-Nurse. and County Psychiatric Services.

Within the last six months. San Diego County’s mental health budget has been cut by $5 million, one third of its total budget, according to Pam. We now have only 33 psychiatric beds for the 2.5 million people in the county. Contracts with private hospitals make a few more available. So far, CRISIS Team has been left intact, but they are nervous about the next round of financial cuts. A flyer calling for a protest outside the County Administration Building the next Monday had been placed on the desk where Pam seated me.

“By the way," Pam says, “I’m on my way out as program director." She is transferring to a position elsewhere in the county health system. A replacement at CRISIS Team might not be hired. There is a county-wide hiring freeze in effect. “Each year for the last 20 I’ve seen services get cut more and more. So far this program hasn't been cut. But this year may be our year."

Pam walks away again, returns to lean in next to me with a black three-ring binder entitled “Hotline Directory ." It shows lists of crisis counseling hotlines across the country, by state and city. “Someone will call, say they’ve gotten off the phone with their aunt in New York and she's depressed, can we give them a phone number for a hotline in her area which might be able to help her."

Asterisks next to a few of the numbers indicate certification by the American Association of Suicidology, which Pam hopes is an assurance of competency on the part of its operators. She hopes it means these are not church-basement, volunteer-staffed hotlines. "This field is not regulated. Anybody, you, can start a hotline in your basement. If you've got the money to advertise, you can do it. No one can prevent it. In fact, we’ve discovered several flaky operations. In fact, there’s one in town now that’s a sort of proselytizing Christian-based teen runaway line.

“It does mean a lot to as that we re certified. That certification book is this thick" — she indicates its massiveness by holding her hands wide apart and shaking them — “of the criteria you have to meet. You have to be 24-hour. You have to have ways to handle high-risk cases. If a hotline's certified, it means they've been around for a long time, they won't fold up tomorrow, they 'll answer the phone.

“There’s a hotline that advertises in all the Yellow Pages, Call it up and it’s a tape. A tape! It's located up in Long Beach. They have an 800 number. You call it up and they say, You can leave your number, we ll call you back. Basically they re there to get people into a hospital. It's a marketing tool."

The San Diego Yellow Pages lists 13 hotlines, including CRISIS Team. Two aid rape victims and battered women, one is for crime victims, one is for police victims. Two more offer service specifically to teens. Three are run by psychiatric treatment facilities.

Pam tells Marion an ad in The California Therapist is soliciting applications from social workers, MFCCs, psychologists, psychiatrists to work on a 900 number. “People in crisis call in, you counsel them a little, suggest they come in to your office to talk more. You’ve gotta see this." A woman they know has gotten five referrals from such a service. Pam retrieves the magazine from her office. “Opportunity to broaden your income base," the ad suggests.

“Working on a phone line is a specialty. The caliber of what is offered on phone lines differs, however. Because CRISIS Team members are mental health professionals, they get to the point faster, they give out more information. Most volunteer lines spend more time with people, because they're floundering. That might be helpful, because if you spend time, people can talk themselves out of things. On the other hand, we focus discussion quicker. We give more technical information. How to make your way through the system, for example. Many volunteer lines aren't able to do that because they spend time reflecting back feelings, you know. Gosh, that must be frustrating to lose a friend like that."

Tina started with CRISIS Team in 1982. “If you're new here, you classify more calls as high risk for suicide than you do after you’ve been here ten years. So our statistics don't accurately reflect the number of suicide calls." (Of the 28,023 crisis calls received last year, 2108 were from acutely suicidal people. And 182 of those were classified high risk.)

Marion has been on staff even longer than Tina. Marion leans over. "We have an on-cali worker who has been here even longer! In 1980, my first year, I only lasted 11 months full time. It is my belief one ought not to do this type of work full time. It is too draining.

"The primary complaint among people for whom the job hasn t worked," she goes on, “is the lack of visuals. But it can work as an advantage. The person in crisis has to articulate his problem, and that articulation helps move him along in the process of dealing with it."

“There are those who perceive this job as not being legitimate," Tina says. ‘Even people who work on the line will say, We re only a telephone line.' They think they can't perform a meaningful intervention."

Waiting for calls. Victor luxuriates in his recliner reading the Union-Tribune. He fills out his log sheet, the record each suffer keeps of his calls. The sheet is printed with columns for recording the duration of the call (in tenths of an hour), codes for different types of calls. A “2.1," for example, denotes a chronically mentally ill person. “That way. at the end of the year Pam can shoot out the statistics and let people know exactly who we re helping and hope for more funding." Tina adds.

A phone rings. “CRISIS Team," Victor says into the receiver. His face remains blank as he listens. “Well," he ventures to the caller, “it depends what you mean by that."

For a long time, he listens. Then he says, “As long as she’s on drugs they re going to... Sounds like, at this point, going for a conservatorship would be a good idea..."

Pam has hung up the phone. “A teenager," she says of her call, smiling sadly, drooping her words in sympathy or nostalgia. “By herself. Complained her mom doesn’t let her go out anymore." She describes the caller as sounding a little depressed and imitates the girl's pouting voice. “Sounds like she's an only child, and she can't talk to her stepdad, says he's moody. Sounded like her friends were all going to be graduating, from ninth grade, and she w anted to go out and see them. I asked her, What would you do, if your mom didn't let you go out?' She said, Well, I 'll probably sneak out anyway, without telling her.’" Teenagers rarely call because, Pam says, “It's hard for them to reach out." Last year, teens made only two percent of the calls to CRISIS Team.

Most callers are women. Most people who succeed in killing themselves are men. In the past, Tina goes on, women tended to choose less violent means. “Probably because of the way we re socialized. Now women are more frequently choosing guns. But women are socialized to ask for help more than are men, so they reach out sooner. Women also tend to try via passive means, because we're trained to be passive. It takes tremendous energy to attempt suicide."

Another quiet period follows. .Although it’s just nearing 6 p.m., conversation lags and revives here as it does in the late hours of a drunken dinner party. No tension sparks them to fill the silence. Marion sits with one hand wrapped around a caffeine-free Pepsi, staring at the desk. She's already on her second sheet of callers.

The trilling of the phone doesn't startle anyone. Tina picks it up. “CRISIS Team. .. Yes. Just one second..." She puts the call on hold. “It's for you," she sighs at Marion.

Marion spoke with this caller earlier, offered her the number of a county agency that runs support groups. She is calling back to report her failure to make contact with them. Marion explains the Friday dilemma and helps the person plan a way to “get through the weekend."

On a wall beside a massive map of the county hangs a bulletin board frilled by a profusion of stapled-together papers pushpinned to it in rows. A sign in one comer of the board identifies them as “Repeat Callers." Next to these words, a clipping from a magazine advertisement reads, "Life is limited only by how many 800 numbers you know."

Pam walks over to the board and shoots an index finger toward the sign. “The repeat caller syndrome is fairly unique to hotlines, our satisfied customers who keep coming back for more." The papers pinned to the board are this week’s Repeat Caller forms, perhaps two dozen stacks of them. Pam speaks in pianissimo. “Certain callers become dependent on us. More often than not, they’re chronically mentally ill and simply need constant support. We’ve learned the best strategy is to keep track of them, strive for consistency in what we tell them. If not, they may call 50 times a week and get 50 different pieces of advice. Some of these folks may call 50 times a day. Their mental illness gets bad or they get anxious. It's difficult for us because we then can't handle all the other calls."

She thumbs through the pages of one stack of forms. Since some repeat callers use aliases, the forms note what could be referred to as the caller’s M.O. “This one refers to herself as we.’ Says she doesn't want to return to Canada..." The forms detail conversations, help offered, referrals made. “Here, this is a woman who we would call borderline personality disorder,' who becomes quite dependent, difficult, manipulative, but also has a variety of personal problems and needs ongoing rapport." The worker who last dealt with her noted the woman had been raped and that her therapist had moved out of town at the time of the assault.

“Actually," says Pam, ‘you’ll find similar histories on several of these folks." Raised in orphanage, raped by staff member, a few marriages, last one to a Navy man who she refers to as ‘the psychopath."

Battered and threatened. “We would be guessing that this woman could be classified as borderline, because we're only dealing with her over the phone, but she has that presentation. Individuals with sexual trauma in their backgrounds may come across that way: needy, dependent yet rejecting, with abandonment issues' — when left, they’re completely thrown off balance. The Fatal Attraction woman..."

She points at another report. “This woman comes across as extremely depressed. Chronically depressed. You pick up the phone, and your mood is immediately brought dow n a couple of decibels." Next to the most recent date of contact listed, the worker has written “UGH!" in block letters. “It gets to you. We referred her to one counselor, and he’s gotten to where he has a pretty good relationship with her and can tolerate it.

“We also get sexual callers. Guys who want to call you up and tell you a fantasy as a way of getting off. We don’t usually write them up because we don’t spend much time with them. We tell them. The call is inappropriate, if you want help w ith a sexual problem we can give you a referral, see you later.'

“But they still call back, because they know you’re always going to answer," Pam says. “It's often women who answer, and they want to talk to a woman." (Of CRISIS Team's 28 staff members, 19 are female.) “One technique that works well, by the way, is you say, ‘Oh, listen. Let me get a male counselor to talk with you.’ The guys are tricky." She grimaces.

“You may talk to the guy for half an hour before you find out." Pam's voice lowers to a whlsper. “Then they’ll call right back and do exactly the same thing. It’s compulsive behavior. They won’t even change their line. If you work here long enough, you begin to recognize them immediately." Counselors deal with several such calls each day.

The Repeat Caller binders are emptied out once a year. The stapled-together sheets can run 15, 20 pages for one caller. “Look at this." Pam says, grabbing a thick one. "Look at this one fellow. He s pretty funny. Chronically mentally ill. He has a major mental illness. He goes on and off medication, so he needs frequent contact.

“It's usually 200 or so high-risk, documented cases. Each page of these is a separate caller." Pam figures the binder represents half the hotline s high-risk calls. “You're talking high-risk at the beginning of the call and high-risk toward the end. If you spend 20 minutes with someone, they may end up in a dramatically different place. Suicide works that way. It’s acute, often transitory. The danger period Is short. One of our goals here is to get them past that."

Marion is on a call. The tip of her right index finger presses against her temple. “But it sounds like you can't completely prevent that either, because it sounds like he’s already going through it.. Mmm-hmm... Was there any alcohol in your home when you were growing up?"

The phone rings and Victor fields it as Pam walks behind her desk to answer the next ring, from the telephone repair people, asking her to have the Coronado bridge phone tested. They think it’s fixed.

Tina concludes a call. “That w as a Navy wife with a problem with alcohol. She didn't want to use her husband's insurance to get help, because she didn't want him to find out she was an alcoholic, and she didn't want the Navy to find out, because if they reported it back to him he would get mad at her. She thought I was trying to get information from her to turn her in. She was paranoid.

“She probably wasn't gonna get the help she needed." Tina sighs. “I’m usually good at establishing rapport with people. That's one of my strengths. But there was no way to get to her. So I was going over the call in my mind... I think I did what I could do. She wouldn't give me any information. She wanted an answer to a question without giving out any information." She huffs, a half-laugh meant to indicate that people do this all the time.

When she’s not on a call. Tina fills out her phone log sheets. Maybe she'll chat with the other counselors. They don’t often play games. “You can’t do anything that involving... 'This job reminds me of that part in the movie The Big Chill. Jeff Goldblum writes articles for People magazine that can't take any longer to read than it does to take a shit?" Across the room, Pam guffaws, surprised by the vulgarity. Tina ignores this. “You can’t do anything that takes longer than that."

Pam removes another binder, seats herself on the edge of a desk. "This is our Classic Calls book." She opens at random. ‘This person said, ‘I drinked and I drinked and I drinked. I have pancreas of the stomach from drinking so much!'

"And this person was asked if she had ever tried to kill herself. 'Oh yes. I’ve killed myself several times. With poison, a knife, and a gun.' Do you remember this one? The police dispatcher said to Mary, who had spent over an hour with an extremely unstable, homicidal, suicidal, delusional, paranoid, heavily armed male, who was unaware the police had been dispatched. Do you think you could ask him to step outside with his hands up?'

‘Shelly took this call from a little old lady, she says, I feel like dying.' Shelly says, Well, do you have a plan? And she says, ‘Yes, I've tried it all day long and it hasn't worked.' Shelly asks, Well, what is that? She says, 'I've driven all around Southeast San Diego with the window rolled down.'’"

Another ring stops the laughter short. Tina presses her pencil tip to a button on her telephone. “CRISIS Team."

‘Okay... Right...," Tina’s voice is thick, as if she is ready to cry. "Where is he working?... Okay... Is that because they re cutting back or because he can't work anymore in that?... Okay ... Are you still seeing one?... And what does he or she say? Uh-huh... Maybe from living with him. huh?

“Is your husband willing to get help? Has he ever been in ongoing therapy?... Yeah... But that was it... When you say that he's bitter and resentful and hateful. did you say...? And he takes it out on you?" This confirmed. Tina's voice deflates. ‘Well, it’s hard to imagine a loved one treating you like that."

Marion balances phone receiver between shoulder and ear, taking a new call. “Did something happen today?" She inquires. "Have you seen a therapist before?"

"Do you think he’ll change?" Tina asks her caller. “Because if he's dealing with childhood Issues, he's not going to change immediately. It's gonna take at least six months to see prominent change in his behavior. He's gonna slip back.

“I don't know if he calls you names or degrades you... That's what he is programmed to do. It takes a while to be reprogrammed. Unless he's been diagnosed as having a mental illness, I don't think he needs a doctor. He needs to see a marriage and family therapist or a licensed clinical social worker that can work on the family issues that he needs to look at. Those are available on a sliding-fee scale, but I'm not sure whether you can find one for less than ten dollars an hour.”

Marion sounds concerned. "What are your plans for the rest of this evening?... Do you think you could rest?...Mmm-hmmm. Do you have your room where you can close the door?... What would you like to do?... Okay, what do you think your choices are?... That was yesterday? Okay... But you didn't today... Okay... So you’re still angry over that. too. huh?... What can you do to take care of yourself?... Yes... Coffee'll keep you awake, though... You mean, the situation with your parents?... For the moment, though, there s not much that you can do. huh, for the weekend?... I'd say. put it aside until you can get help from the counselor. Treat yourself good this weekend... Sometimes crying is a good thing... Yeah, it's sad. when you look to them for help and you don’t feel like they came through. Sounds like.that would hurt. That would hurt your feelings..."

A janitor shoulders open the hallway door, briefly admitting the glare of the outside world. He pulls in a cart of green 50-gallon trash cans, bends for a waste-basket in the comer, dumps its contents into the trash can. He moves on silently through Pam’s office, the kitchenette, the main room. No eye contact is exchanged. Tina stares at her log sheet. Marion slowly flips through the pages of The Final Call, the Nation of Islam newspaper. “What the Muslims Want” reads an editorial topping one page.

While Marion does this, she is talking into the phone. “How do you support yourself, Tina?... Unh-huh. And what's your disability?... What is the disability that qualifies you? What’s your disability? Unh-huh... And do you have a psychiatrist that you see?... When do you see that person next... So that's not till... You're not happy with your psychiatrist?... Well, let your psychiatrist know that."

Tina is asking her caller, “Has he been evaluated by a doctor?... I would tell him. though, that it's not okay anymore, to take it out on you... Instead of taking it out on you. can you give him this phone number?... You need to w alk out of the room and say, ‘You need to call the crisis center. "

‘Okay. Tina, good luck.” Marion hangs up the receiver heavily and sighs. She looks up. “I'm trying to think what she originally said was wrong. It often doesn't come out right away. If I think chronic mental illness is a factor. I'll ask. How do you support yourself? If the answer Is they re on SSI or disability. I'll ask. W hat is your disability?' Then you can ask if they re on medication. If they are, you can gauge the severity of illness from what kind. She is on Haldol. That's a heavy-duty medication. She's having problems with her parents, who visited her yesterday. She's still upset..."

Marion squints. “After I hang up, the call goes straight into the memory banks. When I try to recall it, I think. Wait a minute, was that the other call? They all start sounding alike." She grins toothily. "It pulled on my heartstrings, because, you know, people want to be heard. The person w ho prescribes her the Haldol has her in there ten minutes —" Marion snaps her fingers rapidly three times — “asks her enough questions to determine whether that's the medication she should continue. That's how they operate.

"I find myself in a bind. A lot of the community agencies are scared of chronically mentally ill people and particularly scared of people that mention suicide. From my point of view, after 11 years of this stuff, dealing with suicide seems fairly basic to treatment. Seems to me everyone reaches a turning point in life and contemplates suicide.”

“We have private practitioners call," Tina says, "who ask us what to do with a suicidal client.”

"Yeah," Marion confirms. “Psychiatrists, psychologists."

"Social workers —"

“What are they doing calling you when it’s their job?"

‘That’s what we ask ourselves when we hang up and they're making $80 an hour and we re making $15!"

‘Psychiatrists get the least training, in terms of therapy,"

Victor adds, "They get trained as medical doctors. They may take some courses in counseling, but they’re not trained specifically for that. The higher up you go on the totem pole, the less training mental health professionals have in counseling."

The Coronado phone rings, a festive sound. “I guess it’s working," Victor says. He answers it, thanks the caller, hangs up. Then the Coronado phone rings again. He lurches hack over and picks up the receiver. “Yeah. Okay. Thanks." He hangs up and returns to his chair. ‘They're depressed over talking to me before and now they want to jump!"

“CRISIS Team," Victor answers a call. Pam leans, arms folded, against a shelf-and-file drawer unit while she talks. Above her head, an oak-framed clock reads 8:45 p.m., to her left the photograph of the tropical beach beckons. Rolodexes, file boxes, binders, books with titles like Behavior Control garland her head. "Fundamentally," she concludes, “12-step programs are marketing strategies."

“That was Kim Il Sung," Victor interjects. “He wants us to vote for him for president." Victor returns to Naomi West.

“Oh. that's what’s-his-name. Pete. He always calls up with political things," says Pam.

Pete, Victor explains, looking up with raised brows, “is probably psychotic. Has delusions. He probably has little contact with the rest of the world. We're it."

The sentence terminates in a quiet room. The phones are mute and nobody's talking. The massive building around us breathes. Almost inaudible, a tense electric hum underlies the carpet, vibrates behind the walls. Muffled by the kitchenette door, the refrigerator clicks off.

"You guys w ant pizza tonight?" Pam asks. She walks across the room. For no particular reason. “No, thanks,” Victor says.

“What? Are you on a diet?"

Victor slaps his substantial stomach. ‘You think I need one?"

“No."

“No, honestly, I don't feel like pizza."

They don’t generally eat together. Because Pam and I are around, “We're not acting like we usually do," Pam says.

"I'll go out for pizza, and you guys can act the way you usually do," Pam suggests.

“How’s that?"

‘We usually have balloons. Lithuanian midgets...” Victor says. ‘ We re on our best behavior!"

“And we re actually talking to the people who call!" Tina says. All laugh at this.

“I get these theme calls," Marion says. “On the weekends, people with disabilities have been left alone. When the police find them a day later, the bedclothes are soiled and the person hasn't eaten. So the police will call me and ask if we can find someone to help. Well, are they in medical danger?' No. Well, visiting nurses can't come out because it’s not a medical situation. I try to weasel something. The police call Adult Protective Services, because adult abuse is going on. Well, Adult Protective Services aren't there on the weekends, so we get the call. But we're directed, in emergencies, when Adult Protective Services are not there, to call the police. But it’s the police calling us."

“As a woman on staff here says, everybody’s a capitalist until they need help," Pam says. ‘Then they're a socialist, calling and expecting the services to be here."

“People assume the government will provide services," Marion continues. ‘They’re shocked to find out after they voted for Prop. 13 and Libertarian candidates that, surprise, surprise. My 37-year-old son is addicted to drugs, can you come and get him? No. My 15-year-old! I’ve had it! Send somebody to pick him up! Uh, who did you have in mind? The limo's out right now.

“There are many angry people out there. Drunks call up wanting to be abusive. The way they get through their day is to make you feel bad." Marion pretends to pick up the phone. ‘Okay. ‘CRISIS Team.’ Hello?’ Yes.’ ‘WELL, YOU'RE A COUNSELOR, YOU SHOULD KNOW WHAT’S WRONG!’ ’

Pam says, “They think you’re clairvoyant."

“Administration," Pam puts in, “dictates that we treat the persistently mentally ill. So it’s all well and good that you're dealing with these other people, but we don’t have the money. That’s not what the state’s paying us to do. That’s not mandated. Crazy."

They’ve never “lost anyone.” They've heard a few times of chronically suicidal people who once phoned in and who later killed themselves. Although they receive a monthly report from the County Coroner’s office, the connection between those statistics and their own experience remains, perhaps by choice, vague. “I’m not sure I’d want to know,” Marion says. “I mean, if I were to find out later somebody killed themselves after contact. I might wonder why I am doing this."

The coroner’s list consists of three pages attached to a cover letter in which the phrase Deaths of Interest is prominent. The list Pam detaches from the bulletin board details January and February of 1992. “For me, it’s a way to tabulate suicide trends," Pam says. ‘Sometimes you’ll see certain drugs become pronounced, that people are overdosing on. Sometimes you see little flurries of different kinds of suicides."

The report records name, sex, age, race, codes for type of death, method, location, address.

ACC. What does ACC stand for?

“Accidental."

OD dash UND slash TD COMPOSITION.

“Undetermined. In other words, the body had decomposed and they couldn’t determine."

Overdose. Lithium.

“Lithium's usually for bipolar disorder."

A woman overdosed on lithium in a motel. “Chances are she had a major mental illness," Pam says. “Lithium is fairly lethal."

“The therapeutic dose is not far from the toxic dose," Victor explains.

‘You don’t see it that often," Pam comments.

“People usually don't take enough of it to kill them," Victor says.

A plus sign next to combinations of substances indicates more than those listed were found in the body. “Somebody ingests whatever they find in their kitchen cabinet, for example," Pam says.

In January and February this year, people killed themselves in mobile homes, motels, hotels, at home, in apartments. In or at the bay. Sometimes the location listed is “hospital." ‘Hospital usually means they were certified dead at a hospital," says Pam.

A 70-year-old woman. Asphyxiated. Plastic bag. Motor home. “I wonder where they got that idea, huh?" Pam snorts. She is thinking of Derek Humphrey’s Final Exit. I love where Humphrey says, If you have to kill yourself in a hotel room, leave a generous tip.’"

The dead people, the ones listed as suicides, are all Caucasian. Which is typical. They are mostly men. Men “succeed in killing themselves four to one over women." “Complete" is the preferred word.

Amitriptyline?

“That’s an antidepressant." The drug is commonly known by the brand name Elavil.

Hanged... Gunshot to the head... A woman... incised wounds in arms?

“Wrist slasher. That's unusual."

A 74-year-old man. Gunshot to the head.

75-year-old man. Gunshot to the head.

35-year-old man. Gunshot to the head.

“As you can see. that's the most common way." "If only we had more guns on the street." Victor adds

An 84-year old man hangs himself in his garage. Another gunshot to the head. man. 33. open area, in his car on Lake Jennings Road. A 71-year-old man, gunshot to the head, 34-year-old man. gunshot to the head and mouth. Lithium, fluoxetine — commonly known by the brand name Prozac — overdose. Gunshot to the head. Overdose. Overdose. Gunshot to the head, a woman. A jumper. Ingested lye.

“Eww..." Earn wrinJdes up her mouth.

A 33-year-old man.

“What does that say psychologically." Pam asks, turning her head to address Victor, “that you ingested lye to kill yourself? That you feel corroded? It would corrode and bum all the way down." She ruas a hand down her body, tracing the path of her esophagus. “Might be psychotic at the time?"

Why would you purposefully make it as painful as possible?

“It’s the symbolism behind the method," Pam says.

“Or a person can be psychotic," Victor says. “I've seen psychotic people who feel parts of their bodies are taken over by Satan and have to be gotten rid of. Saw a man in a hospital once poked his eyes out. Had another woman, she was in restraints, they didn't do it properly. She bit her finger off. Thought her hands had been taken over by Satan."

Gunshot to the head. Gunshot to the head. A woman, hanged herself. Man, gunshot to the head. Hanging. 18-year-old man. Gunshot to the head. Gunshot to the head.

Things are getting busy again. Pam. Tina, Victor, and Marion are all on calls.

Gunshot to the head, 40-year-old male. Gunshot to the head, 21-year-old male. Gunshot to the head, 24-year-old male. Gunshot to the head, 57-year-old male. Jumped from a bridge, 28-year-old male. Gunshot to the head. 17-year-old male. Gunshot to the head, 72-year-old male. Gunshot to the head. 78-year-old male. Gunshot to the head. 48-year-old male. Gunshot to the head, 19-year-old male. Gunshot to the head, 79-year-old female.

Victor replaces the receiver of his phone on its cradle and resumes reading.

Also in January and February this year, a 53-year-old man overdosed on auto exhaust in a parking lot in Fallbrook. A 22-year-old male shot himself in the head; a 53-year-old male did the same in a hotel on 13th Street.

"Losing your license," Pam is explaining into the phone, “usually involves broad or sexual misconduct or a crime. Whereas the ethical standards that the association might have could involve how you advertise..."

Tina is saying to her caller, “Don’t do it now because this is a temporary problem. After this crisis has let up. maybe you can make a more, uh. knowing decision about taking your own life. Now is not a good time to make that decision. Wait until your housing crisis is over."

Marion refers a caller to Oz, a teen shelter. When she hangs up the phone, she comments, “A parent not getting along with her teenaged daughter. Wanted to know where she could drop her off."

Trna shoots a knowing glance her way, says, “There used to be a counselor here who said there should be a Bad Kid Wagon that they could call out. There should be a Bad Parent Wagon!"

Marion leans back in her chair. ‘Sometimes I get a call from a person who assumes we have the technology to find out who and where they are," she says. “I worry that people will give us a hard time thinking we can show up and save them? I try to clarify with them. If you want to get help, you have to tell us where you are. If you won't cooperate, there’s no point in telling me. You ought to tell 911 you're going to kill yourself and want help. If they're playing cat-and-mouse, then there’s a question as to what they’ll tell me. People are often ambivalent about suicide."

This rests on silence for a minute. “Sometimes," Marion says then, “they call you up to dare the counselor. I dare you to save me."

“Or they’ll say, I’m calling for you to give me a reason to live,’" Tina says. “SOR-ry! Doesn’t work that way."

After most calls, the counselors mentally evaluate their performance, wondering what they could have done differently. There Isn't always a good answer.

Victor, who has been monitoring our conversation over the West book, lowers it, marking his page with a thumb. “I'll be talking to a woman." Victor says, “and no matter what I say she'll be hostile. It will occur to me, ten minutes later, that her issue is she's mad at men. If it occurs to me on the phone, I can ask her if she'd like to talk to a woman, pass her over, and then she can have a conversation."

‘If you make a suggestion that doesn't hit home, they'll tell you," Tina adds. ‘They’ll say, ‘No, that s not what I mean!' ’

“Or if you make a true or on-target statement to a person that they don’t want to hear, they’ll get pissed off and go away," Victor says. “I’ve had people call who have talked to, say, 80 different people who told them what they need to do is kick the 37-year-old, drug-addicted brother out of the house. You say the same thing, because that's what they need to do, and they get pissed off."

This sparks a discussion about how long to remain on a call. Each counselor has a different definition of risk, of crisis, a different idea about how to help. A former staff member was in the habit of spending an hour and a half on calls, which the others considered excessive — and resented, because it increased their own work loads. People at CRISIS Team work “in a fishbowl." Everyone hears and judges everyone's technique. The upside: if a counselor uses a certain tone of voice, says certain key phrases, the others listening can initiate a call trace.

The smell of oregano and hot cheese precedes Pam into the room. She balances a grease-spotted cardboard pizza box on one hand as she slings her shoulder big off onto a metal tabletop. The pizza box she lays on Tina's desk. She disappears into the kitchenette. returns with cake-sized paper plates. She separates the slices of pizza with her fingers, loads a piece onto a plate, slides it to me. She places another next to Tina. A third she carries back across the room to her desk. This is all done silently.

Tina is saying, “You're getting people right where they are. They’ll tell us things they won't tell their therapists. Because they’re too embarrassed. I'll ask them, if they're seeing a therapist, if they’ve told the therapist something, and they’ll say, Oh no, because he would put me in the hospital, or I’m ashamed of it.’ They have more of a chance to be who they are." Already tonight there have been five such calls.

“Women with sexual abuse histories call us up. They always say they haven't told their therapists," Pam says.

“Many women start having memories in their 30s," says Tina. “They’ll be in therapy for it but they ve had a flashback and their therapist isn’t available. I think it’s important to be available for that."

In the ensuing pall, comments are lazily traded on the subject of bittersweet chocolate. Dove Bars, coupons, an ex-employee who has started her own private practice. I sit in a chair facing the desk where Pam sits. Her wristwatch reads 9:30 p.m. She doodles on an 8 1/2"x11" pad of lined paper.

The phone rings. Marion dives for it. “Mental Health Crisis Team."

“What’s your situation?” Marion says, narrowing eyes and plugging her free ear against the chat. “What’s your name? ...Pardon? Frank? What's your situation today, Frank? I can't understand you, Frank. Can you speak more slowly, maybe?... Okay, what were you looking for? And what’s that?... Frank, have you been drinking?"

Tina fields the next incoming after two rings. “Can you call back... Frank?" A peevish edge enters Marion's voice. “Pardon? Are you in your home?... I can't understand what you’re saying... Are you in your home?... And where Is that?... Pardon me?..." Exasperation has erupted in Marion's tone. “Frank. I'm going to have to hang up now, I can’t understand what you re saying. Call back when you haven’t been drinking." Marion clumps the receiver down.

"I did get a no out of him for suicide. That was the magic word. I was thinking, God, please, don’t say yes!’ Those are awful!" To Marion’s mind, the toughest calls are from suicidal drunks. The terminally ill also are difficult but rarely call.

In the case of drunks, it ’s nearly impossible to determine to what degree the suicidal state is precipitated by mental illness and to what degree by the alcohol. One night they dealt with a man despondent over the loss of wife, job. youth. He planned to shoot himself. At one point during the call, he shot the gun off in the air. The counselor, alarmed, sent out the police. They determined the man, who did indeed have a gun and w as still threatening suicide, should be hospitalized. At the psychiatric hospital, he was medicated, then given a bed in which to sleep off his drunk. He stayed perhaps eight hours, then was released. Pam pauses for dramatic effect. “Well. About two months later he got a bill. From the hospital. About $400. He was furious! I looked at the medical record. Turned out when they brought him in he had a blood alcohol level of .26. Legally drunk is now .08. Probably most people would be dead before they hit .26.” Marion sighs and puts her head in her hands.

“Even that one, I don’t know. He could have... I don’t know. He might have been a repeat caller. He did say that. ‘You guys don’t like me to call there.”

She hoists out of her chair, treads heavily over to the shelves, and consults the Repeat Caller book. “When I open this thing, I keep expecting it to be alphabetized." The reports are simply stuck in the binder where they seem to fit.

“What we need is a computer system," Pam says, wiping hands with a paper towel. “So that you could look him up under Frank or incoherent drunk.’" “Cross-referenced by the hours they call. Some people call at certain times."

A computer system in place, briefly, last year, wasn't used. The counselors found it too distracting. “A lot of people don’t understand the concentration required," Pam says. “They see us sitting at a desk talking on the phone. That's it.”

Marion reflects. “Our work is invisible. What we do is invisible. So it looks like we re not doing anything. People walk in here and all they see is, we re talking on the phone. Or we re sitting without speaking, hearing these anonymous voices."

“Or they walk in and we're not on the phone!"

Tina pipes up. “We re sitting at desks talking. We have to go through this debriefing process after the calls."

“You don’t always get the chance to debrief," Marion says. “You go from suicide to domestic violence to child molest."

“I debrief by talking with other counselors," says Tina. “But now I’ve been here a long time and I can debrief fast — like, I hang up the phone and say, Oh, that was gross!’"

“It depends on the call," Marion quickly adds. “You do that searching-your-mind thing, wondering what you could have done. But even saying ‘That was gross’ can be important. Here you are, straining to be nonjudgmental and cut this person slack, give them permission to articulate w hat they ’re trying to. You’re putting all this energy into accommodating their needs. When you hang up the phone —*

“—Part of me has to come back, "Tina finishes. “My values have to resurface. In general you have to put your values aside, but you need them. If they're getting abused, you need your values for education purposes. But most of the time you’re putting them aside."

“It's the frustration of, She’s gonna go back to him. I know she’s gonna go back to him. I’m gonna hang up the phone and she's gonna go back to him.” Marion pounds a fist against the desktop to punctuate her sentences. “I can’t dump that on her on the phone, but as soon as it’s over I feel the frustration."

“A homeless man called the other night," Tina says. “Many homeless people call us, because our 800 number makes the call free. This guy had a history of mental illness but wasn’t chronic. He could have a conversation. The picture he painted for me of being homeless was so intense. I still have it. Here’s this guy who lives in a box, and he only wanted to talk to another human being who wasn’t drunk, who wasn't homeless too, before he got into his cardboard box for the night."

Tina answers the next call, “CRISIS Team." The soft encouragement and pauses continue for a long time. When Tina finishes her call, it turns out that she was talking to a young man on the streets, scared, who left home five months ago because he “kept getting angry." He described a childhood of neglect and a disappointing experience with therapy.

‘People like that only want the bad feelings to go away. I try to get them used to the fact that they have to deal with the feelings," Tina says, intercepting another call. “...The only place I know of is the YMCA," she offers the caller. “They have beds for 20 bucks." She lists some motels, gives locations and prices, then hangs up.

Pam addresses Tina and Marion. “Don’t you feel now and then that you should be able to charge a caller 75 bucks for the help you give them?"

"I do," Tina says. “I’m doing loads of work here—"

“— For loads of other therapists," Marion concludes.

“Is there a type of call that makes you feel that way more than others?"

“Yeah," Marion says. “When somebody already has a therapist, and we re doing backup for the therapist."

“What I hate is when a woman will call up and start complaining about her boyfriend, and he’s in the room the whole time. She's calling up complaining that he doesn’t listen to her, so he'll hear. She’s going on and on. and in the background I hear. You lyin' bitch! "

"My personal favorite," Pam says, “is call waiting. They'll call up. weeping. Oh. I'm in crisis! Help me! Oh. can you hold on? I’ve got another call.’"

“I don’t do call waiting. I say no." Tina says. “Unless I've made a strong connection with the person and they say they'll get rid of the other call. Then I'll wait."

“Or they'll call us while they're waiting for their therapist to call. That may be my psychologist, but hold on in case it isn't!’ My God. How needy."

So where are these people's families? Why are they calling strangers?

Tina is quick on it. “Because, I'm sorry, but the family doesn’t work."

“Oh. the nuclear threat ?" Marion jokes.

Tina adds. ‘The family is often why they’re calling. The family's dysfunctional or worn out. You get that with drug addicts and with chronically mentally ill people. The family gets worn out. The person feels ashamed or has been ridiculed by the family for the problem."

The building whirr and shrieking phones irritate the ears now. The lights that seemed so soft seven hours ago glare. Four women in a vast, nearly empty building. Victor is on a break. Marion notes plenty of security people around as Pam moves over to shut a doorway onto a back corridor. She and Marion reminisce over their old office, on Island Avenue. One worker would be on at night, handling two phone lines.

“This lady called." Pam tells us. “It was one o'clock in the morning. She was crying. Heaving." Pam gives a few illustrative sobs. “Felt terrible. I finally get her to start talking. She had been depressed. Lonely. So she's starting to stop sobbing, we're pulling her together —" Here, Pam puts on a voice — “and she says, ‘I...wrote...a poem tonight. Can I read it to you?’"

A low chuckle gains momentum in Marion’s chest. “I'm sitting there rolling my eyes — you know, people say these things to you and you don t know what to do. So I said sure. I'm there all by myself, nothing else to do. She says, It’s called, No One Cares. Just then the other line started ringing."

Marion recalls ‘an old gentleman" who used to call hotlines in town, request help in piteous tones, and burst spontaneously into poetry recitations. She worked on two phone lines at the time, which is how she came to find out he was “an operator." Cab drivers and police used to call in about him, saying they'd given him spare change and cups of coffee and wasn't there something CRISIS Team could do?

This prompts Tina to remember calls when she was sure she knew the caller's identity, recognized friends, neighbors. This leads Pam to mention callers who you think are one age from the voice but whose problem is typical of a different age category. Someone, for example, whose voice is 40 years old, devastated over a romantic breakup like a teenager. This causes Marion to remark. ‘Those 16- or 17-year-old breakups, those are difficult calls."

“They're terrible, "Tina agrees.

“Because they ve bought into the whole romantic myth of the one and only —"

“— And they think their life Is over."

“Those are real scary calls."

“It's intense. The boys, especially, can be hard..."

Marion firms her face. “It goes along with another thing, that I suspect is a uniquely American thing. We, as Americans, expect to live a life without pain in it. We're incredulous that pain should have to happen in our lives. People never bargained for this much hurt."

‘In this culture." Tina adds, “we don’t teach people to deal with loss. It's like, we re supposed to keep getting stuff till we die."

The phone again. Marion picks it up. says. “Mental health crisis team."

Everyone falls silent as Marion says, in a tight little voice, “What's your first name?... Well, I'd prefer to hear it... Okay."

Tina looks over. “Want me to listen?" Marion nods, once, slow. Tina touches her pencil tip to a sequence of buttons on her phone. (This matter of listening in is a delicate business. Later. Tina explains that one asks if the counselor handling the call would like one to listen in. as a matter of politeness. Pam and Marion add that “it’s a matter of performance anxiety ")

“And how were you hoping we could help you? ...Okay... And how were you hoping we could help you?"

Tina says calmly over to Pam, “I think that's him again. Pam. If you want to hear him."

Pam rounds the comer of her desk, dives for receiver.

“Think so?...Have you told your psychiatrist? Can you do that? ...Uh-huh...Uh-huh... Have you spoken with your psychiatrist? ...I think it's important to let your psychiatrist know this the next time you see him or her...Yeah, I’ll bet I'll bet it’s hard to listen to those."

Another call comes in. and after Tina has picked it up. another which Pam answers.

Marion is saying. “When do they come back?... Oh... So if you can endure until Thursday, you'll be okay then, right?... Mmmm. .. So can you ignore it tonight, do you think? I think if your mother were here tonight, she d say ignore it tonight, wouldn't she? ...Yeah... Well, ignore the regret too."

Tina is saying. “If he continues to be violent?... Well, can you tell me where he saw the psychiatrist?"

Marion concludes her call, and even as she is saying goodbye the phone is ringing again. “Mental health crisis team... Wltat s going on? You sound like you're upset."

On the other side of the room Pam clacks down her phone, cat-stretches, leans back in her chair.

“I can give you the number where he might be able to talk to a psychiatrist...”

“What's been happening the last couple of days?"

The phone rings again. Pam picks it up.

“You feel like you're going crazy? ...Uh-huh... What are you afraid might happen?... Yeah.”

Tina concludes her call. Victor, back from his break, plows silently up the channel between the desks. He hasn't yet sunk into his chair w hen the phone rings again. He answers after the first ring.

Marion transfers her caller — a frightened young man, in from another town. stuck on the streets — to another number and hangs up. “The caller before that was hearing voices." she looks up and announces. “It mast be awful hearing voices and stuff. He said it was like a broadcast, like having a microphone in your ear. Sounds like he lives with his mother, and his mother usually tells him to ignore it. then he ignores it. So I tried to tell him to ignore it."

Pam is saying, intently. “Well, you can change, in small little ways that will make a huge difference. You have to start from today... Sounds like you've already started, you went to Family Services?... Well, start there, and when your wife comes back to the marriage..."

The familiar trill again, halted by Tina. When all the phone lines are lit up, the room fills with a low litany of sympathetic phrases. The atmosphere is churchlike, with the gentle absolutions, the team members’ heads bent to desk pads, to forms cradled on crossed legs, intent on the voices entering their heads through the instrument. Even their eyes listen.

Tina: “You don't have any money at all?"

Pam: “Well, what do you feel now? Alone? Rejected? That's frustrating, and painful...”

Tina: “I can call shelters for you. After nine o’clock they might have a bed that hasn't been filled..."

Pam: “So what do you think she’s doing? So maybe she's, like, playing around, or flirting, or flaunting the fact that you're not around?..."

The phone rings; Marion picks it up. The phone rings immediately again. After the second ring. Marion gets that one too.

Tina: “Have you ever been evaluated for a stress disorder?"

Pam: “She’s giving you mixed messages? She’s leading you on?"

Tina: “Have you ever had that checked out?"

Marion: “You’re feeling hurt by her and when..."

Pam: ‘Maybe she's doing it becaase you’re asking her that. Most people wouldn’t even ask... Well, I... I mean, if my hasband were away. I wouldn t ask him. What time are you coming home?' I wouldn't... So he wouldn't ever do that to me."

Marion: ‘When you think of killing yourself, how do you think you'll do it?... Have you ever tried by other means?"

Pam: ‘Maybe she’s doing that because you ask and because you want to know. Cuz she knows it will bother you... 'Cuz you're afraid that she would leave you?"

Tina: “If you’re going to get well, you need to go through that process. All your feelings are stirred up inside you."

Marion: “What would have to change for you to feel better?"

Tma: “That will make other people angry, because of what happened to you when you were a kid?"

Marion: “What would the change he?"

Tina: ‘Were you abused?"

Pam: “It's tough." She sighs. Her voice takes on a quivering timidity. “What did you do before you were married?"

Marion: “You want to be happy."

Pam: “And when she came along, it helped you change."

Tina: “There are crisis residential centers in town."

Victor’s voice, too low to distinguish clearly, provides a bass line. The other voices form a higher-pitched trio, a Mozart creation. While Marion is counseling her caller to be less dependent on others for his own well-being, Victor is suggesting to a woman that she lean less on her husband. and Pam is persuading a man to think less about his wife. ‘Maybe if you were focusing on another aspect of life, she would begin to miss you and then she would call you more..." Pam suggests. “No. not to hurt her... I'm not saying hurt her. she'd wonder, she'd live through it... I'm not saying play games. I'm saying you get something else. .."

It is a little before midnight. Victor gently returns receiver to cradle. His longest session tonight lasted 22 minutes. Pam’s call ends 2 minutes later. “It was a Marine." she says, “with a Southern accent. Suicidal because his wife, whom he beat, has finally left him. It's too bad you couldn't listen in. You miss the emotional impart hy hearing only one side of the conversation. At the beginning of the call he was in tears. You don't hear a man cry that often." She shakes it out of herself, exhales.

I wonder if she Is still trying to get away from that feeling when she walks around to the outside of her desk cubicle, distancing herself from the phone. She tells me she has a friend w ho jokes that she and the rest of the team should be wearing jumpsuits and helmets with flashing lights on top of them. Victor puts down his book, sets his phone log sheets on the metal table next to his phone.

‘The job can be absolutely basic.” Pam says. “It may be a matter of telling a person how to breathe. Or reminding a person of the reasons why it ’s not a good idea to kill someone."

By the end of the shift, Pam doesn't remember how many calls she has fielded. Tina has handled 17 calls. Victor has taken 18, Marion. 20. “That's our work," Marion says. “Our invisible work."

Sponsored
Here's something you might be interested in.
Submit a free classified
or view all
Previous article

Pandemic dating smalltalk

Stop talking about current events to the extent they concern public health in any way shape or form whatsoever
Next Article

More on Orange County vs. Del Mar fair money

What Ed Bedford thinks of Governor Newsom
Comments
0

Be the first to leave a comment.

Sign in to comment

Sign in

Art Reviews — W.S. Di Piero's eye on exhibits Ask a Hipster — Advice you didn't know you needed Best Buys — San Diego shopping Big Screen — Movie commentary Blurt — Music's inside track Booze News — San Diego spirits City Lights — News and politics Classical Music — Immortal beauty Classifieds — Free and easy Cover Stories — Front-page features Excerpts — Literary and spiritual excerpts Famous Former Neighbors — Next-door celebs Feast! — Food & drink reviews Feature Stories — Local news & stories From the Archives — Spotlight on the past Golden Dreams — Talk of the town Here's the Deal — Chad Deal's watering holes Just Announced — The scoop on shows Letters — Our inbox [email protected] — Local movie buffs share favorites Movie Reviews — Our critics' picks and pans Musician Interviews — Up close with local artists Neighborhood News from Stringers — Hyperlocal news News Ticker — News & politics Obermeyer — San Diego politics illustrated Of Note — Concert picks Out & About — What's Happening Overheard in San Diego — Eavesdropping illustrated Poetry — The old and the new Pour Over — Grab a cup Reader Travel — Travel section built by travelers Reading — The hunt for intellectuals Roam-O-Rama — SoCal's best hiking/biking trails San Diego Beer News — Inside San Diego suds SD on the QT — Almost factual news Set 'em Up Joe — Bartenders' drink recipes Sheep and Goats — Places of worship Special Issues — The best of Sports — Athletics without gush Street Style — San Diego streets have style Suit Up — Fashion tips for dudes Theater Reviews — Local productions Theater antireviews — Narrow your search Tin Fork — Silver spoon alternative Under the Radar — Matt Potter's undercover work Unforgettable — Long-ago San Diego Unreal Estate — San Diego's priciest pads Waterfront — All things ocean Your Week — Daily event picks
4S Ranch Allied Gardens Alpine Baja Balboa Park Bankers Hill Barrio Logan Bay Ho Bay Park Black Mountain Ranch Blossom Valley Bonita Bonsall Borrego Springs Boulevard Campo Cardiff-by-the-Sea Carlsbad Carmel Mountain Carmel Valley Chollas View Chula Vista City College City Heights Clairemont College Area Coronado CSU San Marcos Cuyamaca College Del Cerro Del Mar Descanso Downtown San Diego Eastlake East Village El Cajon Emerald Hills Encanto Encinitas Escondido Fallbrook Fletcher Hills Golden Hill Grant Hill Grantville Grossmont College Guatay Harbor Island Hillcrest Imperial Beach Imperial Valley Jacumba Jamacha-Lomita Jamul Julian Kearny Mesa Kensington La Jolla Lakeside La Mesa Lemon Grove Leucadia Liberty Station Lincoln Acres Lincoln Park Linda Vista Little Italy Logan Heights Mesa College Midway District MiraCosta College Miramar Miramar College Mira Mesa Mission Beach Mission Hills Mission Valley Mountain View Mount Hope Mount Laguna National City Nestor Normal Heights North Park Oak Park Ocean Beach Oceanside Old Town Otay Mesa Pacific Beach Pala Palomar College Palomar Mountain Paradise Hills Pauma Valley Pine Valley Point Loma Point Loma Nazarene Potrero Poway Rainbow Ramona Rancho Bernardo Rancho Penasquitos Rancho San Diego Rancho Santa Fe Rolando San Carlos San Marcos San Onofre Santa Ysabel Santee San Ysidro Scripps Ranch SDSU Serra Mesa Shelltown Shelter Island Sherman Heights Skyline Solana Beach Sorrento Valley Southcrest South Park Southwestern College Spring Valley Stockton Talmadge Temecula Tierrasanta Tijuana UCSD University City University Heights USD Valencia Park Valley Center Vista Warner Springs
Close