posted
I only know the procedure in the UK and even then I work in the drug dependency field and only touch on acute psychiatry very occasionally--although I have to discharge drug patients from one each week.
You can section someone under the Mental Health Act if you believe they pose a risk to themselves or others. The specific section you may use is dependent on the situation and each section may only be legally enforceable for a specific period of time varying from hours to days to weeks to months. Different professionals (nurse, doctor, social worker, approved doctor, policeman) have powers to section in certain circumstances for varying period.
To section someone because you think they are suicidal requires a high degree of certainty as you are restricting their freedom. Sectioning happens against someone's will--if they are willing to remain voluntarily in hospital then that is what happens. If they choose then to leave and you still have very strong concerns then you may section them anyway.
Assessment of suicidality requires a person with sound clinical experience. There are scales etc, that you can use but usually a psychiatrist will interview the patient looking for admissions of intent and planning: yes I want to kill myself because...and I have a stockpile of pills at home that I plan to take. The person also may have a history of previous serious attempts; plenty of people have taken overdoses or slashed their arms but have no intention of dying when all is said and done--although sometimes they do accidentally.
A recent incident (death of close member of the family; traumatic incident (war) of some sort) could predispose someone to make an impulsive attempt to kill themselves.
In the UK people often end up at the ER following suicide attempts; many are just sent home after seeing the on call psychiatrist. The attempt itself gave them a clearer viewpoint and they know they don't really want to die. More serious people may be sent to a psychiatric ward for observation...really seriously suicidal people may be put on observations which may be constant; quarter hourly etc. for a few days...
They are unlikely to be allowed leave until the psychiatrist is certain they are safe. They would be allowed contact with family. They would have their belongings checked on entry to the ward--politely--for things that may cause them or others harm.
Some people take paracetemol overdoses and then report it a day or two later, not realising that you ideally need the antidote within 12 hours. Fatal liver damage ensues and the only solution is a transplant. So despite changing their minds the still die.
posted
I also work in this field, and I have had to send people with suicidal ideations to psychiatric holding facilities (usually a psychiatric ward within a regular medical hospital).
The laws are different in each state. In Virginia, where I live, there are two paths you can go by. With one, a TDO (Temporary Detention Order, the person goes semi-voluntarily. This involves the person going to either a medical or psychiatric facility (the voluntary part) and being evaluated by a licensed counselor or psychiatric personnel. The second, an ECO (Emergency Custody Order), involves going to the local magistrate and presenting a written and oral case that the individual is a danger to self and/or others. A policeman or deputy will basically arrest the person (without an actual charge) and take them to a facility to be evaluated for suicidal/homicidal thoughts.
An interesting dilemma is that if a person is under the influence of an intoxicating substance (drug or alcohol) they can only be held for a fairly short amount of time (can't remember - it's been a while). If the person doesn't become sober within this period, the psychiatrist will refuse to evaluate them and they will be released. Because of this, our law enforcement prefers to perform an ECO when the person is sober.
If they are evaluated and committed, it is typically for only a few days. It basically only takes the person to say, "I realize that I wasn't thinking clearly," for him or her to be released. They really have to be determined to kill themselves and be 100% honest about it in order to stay for any length of time. Most of these places are never reimbursed (unless by Medicaid) and they have people lining up at the doors. Get them in, get them stabilized, and get them out.
They are then let out the front door with whatever items they brought in. They have to arrange their own transportation or start walking.
Most of the people with whom I work are suicidal. Just about all of them have schizophrenia, bipolar disorder, or severe depressive disorder.
posted
When you say "county hospital," I think smaller area out in an underserved area. Don't forget that such hospitals are less likely to encounter psych patients often (less population, less inner city drug abuse, etc...), and probably don't have a psych specialist on staff (maybe pageable?) Thus, they would be more prone to making errors from the deviation.
What role does this play in your story? Is it central to plot or merely detail you want to make sure is accurate?
posted
Actually, I live in a rural area, and the psych wards of our local hospitals (two primaries in a 50 mile radius) stay full. I actually live not too far from Virginia Tech, which also sits in a somewhat rural area. This was the problem with Cho - he was court ordered for evaluation, but only stayed a few days and was released.
The problem with most of these people is that they display manic behavior (severe swings in mood) and they are not very dilligent in taking medication. While in the hospital, their meds are strictly regulated (same with jail), but when they get out, they often forget or do not get them due to financial reasons.
FYI, while in the the hospital, people are not usually confined to a room unless they are delusional. They typically have free reign of that ward - kind of like One Flew Over the Cuckoo's Nest without the shock treatment. They attend group sessions, watch TV, and occasionally meet with the psychiatrist. They all where hospital gowns and wrist bands until they are released. No reflection on skadder, but I have found many of the staff with similar dispositions to Nurse Ratched.
posted
It's transitional, It moves a dynamic character from belief she can handle the events currently happening to herself, to excepting an unsure referral to seek the counsel of the main character. She is a victim to begin with, but by the end will become the main characters confidante, and partner in future investigations.
The important details are: a phone. Does she have easy access to one, does it require permission, are there restrictions at what time you can use them. She has none of her possessions at this time, so no cell phone, no money for a pay phone, but she would want privacy to talk to the main character.
Second: If she seems like a normal person, but seems unwilling to talk about events that lead her by witnesses to appear to try and jump off a cliff. How long can they hold her if she appears to be trying to act normal, refuses to talk about it, but states clearly she does not want to kill herself. I'm looking for the period of time the doctor could hold her to try and get the answer, but if they didn't what would happen?
If they held her for evaluation would she be moved to the psychiatric ward or just a regular room?
I can guess the details but I would like it to be as accurate as possible. So there are no future grumblings over specifics in the intros and clues.
County Hospital: I'm referring to the usual city hospital that take people without insurance. I've always known them by that name, but if there is a better term for them that I'm missing please let me know. The local is a medium ocean side city: population around 250,000.
Thank you all for the info it is very helpful. Any insight is appreciated.
posted
Sorry Philo, I didn't mean to demean little hospitals at all. Its not that they aren't up to professional standards, just that sometimes budget constraints tie up what is available. For instance, I worked at a fancy schmancy academic hospital, and there was an entire psychiatric ED for the residents in training. Now, I work at a Detroit ED (where we have much more demand) but there is often no psych specialist available until normal business hours.
Anyways, the basic rule for forcefully (or chemically) restraining someone is if they present an imminent threat to themselves or others (homocidal, suicidal, delusional, etc.) OR if a screening practicioner (but not expert) thinks they need an expert evaluation to verify if they are a harm to themselves or others.
Paracetemol = British for Tylenol...
For your story, what gets her in the facility in the first place? The patients would usually have access to phones, and as long as the patient is merely "troubled" and not acting out or threating herself or anyone else, you could basically leave it up to the practicioner to determine if they are stable. This could be as simple as a basic assertion she doesn't want to hurt herself, so the doc lets her go, to a more in depth character trying to get to the bottom of things and realizing that he trusts her (at least enough to release her...)
If you need it merely for a transitional chapter, the basic scene would go like this for a suicide eval:
she enters the hospital ER and is stripped of all belongings (yes, including underwears to avoid secluding weapons or whatever) and put in a hospital bed with two limbs in leather or canvas restraints (think handcuffs) to the bed. One arm and one leg, on opposite sides of the body to prevent her from falling out.
The doctor sees her, and must screen for anything that would be a medical rather than psychological reason for suicide (is she drunk? On drugs? Old and suffering dementia? Have a stroke?) These tests usually take about an hour or two. Then, the doctor decides if she is threat to herself or others or if she is medically clear. Most ER practicioners don't want the liability of making this judgement for themselves, so a psychiatrist or social worker usually does a preliminary screen. If they decide she is safe, she now can no longer be legally restrained and must be discharged. If they decide she is not safe, she is kept restrained until an admission to a psychiatric facility can be made.
Also --> have you considered the possibility that she escapes instead? That could add drama and action if you need pacing and excitements... She may convince the nurse to let her up to the bathroom and then sneak out (maybe she sees where they stashed her belongings, or steals someone elses and uses their phone.) Restraints must be rotated periodically to prevent skin injury, maybe she could pull a houdini and flex her muscles at an odd angle so the restraint is looser, then pull free when noone is looking. Or, she may just find they weren't that tight to begin with (they usually aren't if the patient isn't struggling...) Or, she nabs a key from a passing nurse by pickpocketing her when they lean over the stretcher to fix an IV or something (remember: one hand is free if the person cooperates...)
And yes, I've seen all those happen.
If she escapes, there is another obstacle exiting the hospital. If they have security, they would be alerted the instant a nurse noticed she was missing. So she'd have to get out quick, or find a way out through the basement. If she stole someone else's clothes, she should be able to walk right out the main or side exit...
[This message has been edited by Teraen (edited July 13, 2010).]
[This message has been edited by Teraen (edited July 13, 2010).]
posted
Oh yeah, and in the US, there is no such thing as county hospitals for dedicated non-insured patients. Due to EMTALA, all hospitals see any patient who walks in the door and must treat them, despite what you may have read in the papers about refusing treatment to illegal immigrants or uninsured patients or whatever.
The ambulance usually goes to whatever facility is closest.
posted
No problem, Teraen. We have a "hospital" in the town I live in, but I would never go there for a serious problem - medical or mental. And they don't have a psychiatric ward. In this situation people are taken to one of the two hospitals that do have one about 40 miles away.
All right, I suppose I can accurately answer these questions. Roanoke, Virginia is my home town and has a population of around 250,000 people. The hospital, Lewis Gale Medical Center, has a decent psychiatric center that admits individuals with suicidal behavior on a short term basis.
Let’s say your character is picked up by police after allegedly “attempting to jump off a cliff.” The police themselves then will issue a TDO (or whatever term is used in that particular state) through the magistrates office. The person is then taken to the psychiatric ward of the hospital for immediate and relatively short evaluation or they could also use another source like a psychiatrist from a CSP (community service provider). Either way, let’s say your person refuses to talk, but denies suicidality. The psychiatrist might suggest holding them for 24 hours for observation.
They get an average size hospital room with a roommate. They get hospital scrubs (sorry, not a gown) with paper/cloth-like slippers. The door is unlocked and they have access to hallway. The hallway leads to a nurse’s station, which has a larger hallway that leads to a medium size activity room (not nearly as large as the ones in movies and television) with a mounted TV and some board games, including cards (cards and checkers are really popular). This often doubles as a dining facility.
They can usually receive calls during a wide range of time, but often are limited to specific times to make calls. They have a decent amount of privacy, but the phone is usually right outside the nurse’s station. The nurses stay busy. There will be someone who comes by and checks on them, even at night, every half hour to every hour, depending on policy.
They will participate in group sessions that often include both sexes (unless there are physical abuse concerns). The psychiatrist will get their medical history when they first get there and will make medication suggestions based on their behavior and responses. They can’t force them to take it. After 24 hours, if the person seems stable, denies suicidal thoughts, and appears reasonable, the psychiatrist will read about how they have done – the nurses and therapist, who conducts the groups, report on them throughout – and decide whether the person can be released. If they appear stable and coherent, then they will probably be released. They are asked to arrange transportation and given back their clothes and other possessions they came in with (unless illegal paraphernalia). The paperwork to actually get released takes forever (at least an hour) – several have to sign off.
posted
In my experience, my clients have not been strapped to beds. One did enter in handcuffs, but was taken out of them when he demonstrated he had self-control. He sat in a kind of waiting room/office with the cop until the psychiatrist was able to come in, read the report and do his own evaluation. Not sure, but I think it took about a half hour.
My others went voluntarily. The next step was changing out of clothes into hospital garb - I don't think they were watched (not sure), but they might have been given an examination. The rest is as I've described.
The generic term (which the trademark owners would prefer writers use if they are not going to include a trademark notification such as TM or R) is acetaminophen, at least in the US.
I don't know whether Paracetemol is the trademark in the UK or the generic, but the trademark symbol would help.
posted
Thanks a lot, you guys really helped me flush out the detail here.
The phone was a real sticking point that I was worried wouldn't be believable if there was no way for her to get access to one.
The hard part was I didn't want to much focus going into the task of getting to a phone taking away the focus on why she needed to make the call.
The pace moves from her realizing in the hospital she's still alive, and sort of happy about that.
Then realizes what events actually happened to bring her there.
Then to feeling confused, trapped, and alone in a strange city.
To lastly taking a desperate chance on contacting a referral from a previous trusted source for help.
The character knows if she holds out and just acts normal that they will release her tomorrow, but the building anxiety of the trauma threatens to overwhelm her sense of surety in herself. She in a mental struggle about leaving the security of being watched over. She knows if she doesn't reach out to someone on the outside now, she might break and end up there for a much longer stay. Thus the need to find a phone that no one can over hear becomes imperative, which triggers the call to a stranger(Protagonist) that will intertwine their two fates.
It would be a late night time attempt at the phone, so that still presents some challenges. Originally I had it in her room, and made her just wrestling with whether to call or not. If she has to make it unobserved to by the nursing station and call this presents problems. I need to make it fluid so it doesn't bog down the pace. No more than a paragraph from room to phone.
Here's a question you might be able to answer. Do the nurses ever leave there cell phone unattended at the nurses station? Or are there rules about them?
Thanks for all the help,
After I sort out what happen here and do a rewrite I'd be happy for some Critique.
Feel free if you do to be brutal and honest, I have a pretty good mental filtering system being an artist also. There's nothing quite like having something hanging in a gallery, or a wall mural, and not being known and overhearing straight honest Critique from hundreds of people. It at times can feel just like your being booed off a stage. Over time you get a pretty thick skin as I'm sure most here know and have experience before. I tend to follow the rule of being encouraging, but for my own work I like to hear just straight talk, it helps me move forward, and not waste years, on repeating the same mistakes over and over again. I've wasted to much time already doing that, so I'd like to put out some quality work before leaving this rock.
posted
"Which raises the question as to why another nonproprietary name is needed, when "acetaminophen" already exists (or vice-versa)."
Because the English people from England-land are weird like that. They tried to spread their culture and language around the world, and were so surprised when people started actually using their language that they had to invent new words so as to maintain a sense of superiority. For instance:
Anyways, Philo, as far as strapping to the bed goes, that is an Emergency Room thing as far as I am aware. Patients actually must be out of the restraints by the time they are admitted to the psych ward. That is because the ED doesn't have locking rooms or units - whereas most psych wards I am aware of at least have padded rooms in cases of patients who are an iminent threat to themselves or others.
Do nurses ever leave the phone? All the time. In fact, most places have phones in the rooms or hallway that are open for use. The only situation I can imagine (and I can't imagine a whole lot, mind you...) where a phone would be denied a patient is if it interfering with their treatment, ie, a patient loudly demanding to use one and refusing all attempts to engage in conversation and otherwise calm them down or get them to cooperate. Loud and boisterous patients who cannot be reasoned with are by definition unpredictable, and since an exam and evaluation cannot be done if they are uncooperative, they may be restrained until a medical clearance can be done.
quote:Because the English people from England-land are weird like that. They tried to spread their culture and language around the world, and were so surprised when people started actually using their language that they had to invent new words so as to maintain a sense of superiority. For instance:
Is this humour? Just because you feel inate sense of inferiority to English people doesn't mean they would feel superior to you. I am certain if you met one they would immediately take pity on your plight and feed you some nuts through the bars of your cage.
[This message has been edited by skadder (edited July 14, 2010).]
posted
We wouldn't restrain someone to a bed in the UK--we would be far more likely to use observation (i.e. someone staying with them) or if they were disturbed we would offer medication.
[This message has been edited by skadder (edited July 14, 2010).]
posted
Yup, you caught me. I wish I was a Brit, but I'm not, so I resort to transference...Yes, it was supposed to be humor. As you can tell, I'm not very funny. (Although Brits are - for evidence see: any type of British Comedy. Much better than over here.)
Anyways, what do you do with combative patients across the pond over there? A sitter doesn't help much when the patient is delusional and taking swings, spitting and biting.
Or does "offer them medication" mean "We'd sneak up behind them and jab a few milligrams of haloperidol into their backside" in real English?
posted
Yes...it's the polite version of the verb to wrestle to the ground and inject them whilst they try and spit in your eyes.Posts: 2995 | Registered: Oct 2007
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posted
Another question: When a patient is changed out of there clothes and others are provided is there a record made of what items are taken, or do they just place them in a bag next to the person? I mainly want to know for clue sake if there is a record of items in the patients description. Example: Patient Items: 1 torn white shirt, blue jeans, shoes, etc.
Or would this be more of something logged in a police record? Do police have to keep a record of a possible suicide, even if they don't act on it? For example someone else reports a possible event, but when it is check out everything appears normal. Do they keep a record of that report, or is it just dismissed?
posted
Teraen, I really don't know what the point of your post was, but it certainly did read as oddly snarky and also irrelevant, given that "paracetamol" is the INTERNATIONAL name (as approved by the WHO, not an English organisation), whereas "acetaminophen" is the US name (though used in a number of other countries). one could as cogently argue that it was the Americans who "had to invent new words".
Quite what cockney rhyming slang, or a weird and facile article on "how to fake a British accent", have to do with anything previously in this thread is utterly beyond me.
posted
Walex - if the police bring someone in (rather than an ambulance) or if an ambulance brings someone in police custody (because they are under arrest, but still need medical attention) then the police may keep all or some of the belongings for evidence. If not, usually the nurses or nurses and security will take the belongings and make a record, exactly as you stated "one brown shirt, torn, etc... (side note: jewelry is not called by its metal. ie, they won't write "gold ring" because that means it is gold and the person could take whatever they are later given and say someone foisted an inferior product on them. They will write "yellow metal ring"...) A copy of the property list is then given to the patient to claim everything when they get it back.
Tchern - the acetaminophen comment was a little off track, but I mentioned it because skadder mentioned the other name, which I assumed was not as familiar in America here. Then the conversation sort of derailed into comments about British vs. American English when Jshuler asked about it. However, I do not think that entirely qualifies as hijacking the thread because I kept on topic after the side comments as well. Sorry if the comments sounded snarky, it was meant to be a sarcastic attempt at humor. It seems I failed at that attempt... although skadder seemed to get it, and as our resident Brit, I suppose its good I didn't offend him
[This message has been edited by Teraen (edited July 14, 2010).]
posted
Thank for good info everyone. Don't worry about the thread I got most of what I needed for the story. Tylenol debate was interesting none the less, and if nothing else will make for an interesting comedy sketch down the road. For now it's good to know the different names one pill can go by just from geography
quote:I actually used the taboo name because I couldn't remember how to spell the generic off the top of my head.
If you reread my Trademark Police comment, you may see that I tried to indicate it's okay to use the trademarked name (so that it's not taboo), if you put a trademark symbol next to it.
You would have been fine to write "Tylenol(TM)" where the name without the (TM) is what might be considered "taboo."
posted
Teraen - FYI, skadder is not the only "Brit" (in and of itself a term some people find mildly offensive - I've only ever come across it in the US and in my experience usually as a negative term) on this site.
It behooves everyone to remember that on the internet, no one can see your expression, or hear your tone of voice. Dry and sarcastic wit are very often "lost in translation".
And I didn't say anything about hijacking the thread, it was merelythe relevance of those links that completely puzzled me.
[This message has been edited by tchernabyelo (edited July 15, 2010).]
posted
FYI--I was a tiny bit offended--hence my response was a little pointed. However I assumed there was a little 'lost in translation' going on and so tried to limit myself to politely pointing out that the humour was lost on me.
The thing that offended me most was:
...They tried to spread their culture and language around the world...
Tried? Wasn't it the biggest empire EVER? We did!
[Puts away the flag]
[This message has been edited by skadder (edited July 15, 2010).]
posted
If there are phones in the room I would imagine that you have to get the nurse at the duty station to put the call through for you. Or something like that.
Posts: 41 | Registered: Jun 2010
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posted
No, I actually have seen the patients go up and just make a call. I'm sure they are restricted from making long distance or 900 calls, but otherwise it is pretty much an open line.
In between working various jobs in the mental health field, I sold cars for several years. The following is absolutely true - I was right there when the following situation occurred. A guy once called in a credit application (back when that could be done) in an attempt to purchase a vehicle. His credit was a little rough, but the salesman was able to get an approval after a day or two of working with various lenders. He called the guy back and (I'm sure you've guessed it by now)...the guy was a patient in the psych ward of the local Veteran's Hospital.
posted
"Brit" is offensive? I truly didn't know that - I thought it was common slang. I apologize retroactively for using it.
"The thing that offended me most was: ...They tried to spread their culture and language around the world... Tried? Wasn't it the biggest empire EVER? We did!"
Exactly. See? You understood my sarcasm prefectly
But back to the main thread:
Another thing to remember is that the patient can often get belongings back if they have been removed. For instance, a patient who is acting calm and cooperative may request that we get their cell phone from their belongings. It is a specific item (not a weapon) and the staff is getting it (not the patient, so they won't take other stuff) and often using priviledges in a reward system is a good way to help a patient cooperate...
Phones wouldn't be in the room: they have wires and could be used for self harm. The phones would be in a public area - either on a wall near the nursing desk or they may have a wireless one that they let people use to make calls.
Also, if you scene takes place in an emergency room rather than a hospital ward, the setting will be totally different. In fact, you could probably call up your local hospital and tell them you are a writer researching this, and ask to take a quick mini tour.
posted
two more technical question. If I had her cross and ask the nurse to use the phone, but was declined because of the late hour. If I had the nurse distracted for a moment and as she turns to go back to the room see's a cell phone within reach, my question is - security camera's? Do they just record or is there a guard actively watching from a monitor somewhere. If they saw her take the phone would they come down, or just call the desk?
and the large guys in white usually around to help restrain people are those orderly's?
posted
Ok, back to derailing the the thread (KDW started it!):
quote:given that "paracetamol" is the INTERNATIONAL name (as approved by the WHO, not an English organisation), whereas "acetaminophen" is the US name (though used in a number of other countries). one could as cogently argue that it was the Americans who "had to invent new words".
Well of course the Americans had to invent a new word, as the drug was first synthesized by an American chemist, and I don't think "that stuff I made in that beaker that one time" cuts it as a name. The question was, though, why the WHO had to come along over sixty years later and invent another word when a perfectly good one already existed.
Posts: 388 | Registered: Jan 2010
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posted
Your assumption is that the American who invented it called it 'acetaminophen' immediately--perhaps he didn't, perhaps he called it 'paracetemol' or something entirely different.
I was unable to find a chronology of the naming sequence, but would interested to know what it was named first. You mention WHO named it sixty years later--I assume you have a source to prove acetaminophen was coined first. It is flawed to believe that just because Americans call it acetaminophen now, and, since it was first invented by an American, it must have been called 'acetaminophen' first.
Besides, I guess it's tough...if WHO support the use of PARACETEMOL as the official name and in 100 years no-one (except some pharmaceutical geek) knows the other names...who cares? If it was the other way round I wouldn't care.
[This message has been edited by skadder (edited July 16, 2010).]
posted
Occam's razor would seem to cut the other way. But meh, the WHO is part of the UN, so isn't it customary to ignore what it says?
And the earliest reference I can find to the drug is in a German medical journal, published one year after its synthesis, where the drug is referred to as "Acetylamidophenole"
posted
Trademark police comments don't count as derailing threads. It's when people start discussing trademark police comments that a thread is derailed.
quote:The words acetaminophen (used in the United States, Canada, Hong Kong, Iran,[9] Colombia and other Latin American countries) and paracetamol (used elsewhere) both come from chemical names for the compound: para-acetylaminophenol and para-acetylaminophenol. In some contexts, it is simply abbreviated as APAP, for N-acetyl-para-aminophenol.
posted
"If I had her cross and ask the nurse to use the phone, but was declined because of the late hour. If I had the nurse distracted for a moment and as she turns to go back to the room see's a cell phone within reach, my question is - security camera's? Do they just record or is there a guard actively watching from a monitor somewhere. If they saw her take the phone would they come down, or just call the desk?"
That assumes two things: 1) there are security cameras. In an emergency room, there are usually only cameras near entrances. It is a violation of patient privacy to have cameras in the care areas. So any distraction would enable her to use a phone... especially if it was a quick call. (and its an emergency room, so any trauma or anything that came in could distract the nurse would provide a time to use the phone.) 2) Even if it was being recorded (like maybe on a psych floor) that the security guard watching would know that she wasn't supposed to use the phone. That wouldn't necessarily be the case, so it wouldn't look wrong.
Also, hospitals are 24/7, so late night rules usually don't apply. She could use the phone whenever. Again, this is mostly the case in the ED. A psych floor probably has rules for a structured environment that mental health patients need.
"and the large guys in white usually around to help restrain people are those orderly's?" - They usually don't wear white, just hospital scrubs.
Honestly, if you don't want to do an escape scene, I think your most realistic bet is to have the patient ask to use a phone after their medical evaluation and have someone on the staff get them one.
[This message has been edited by Teraen (edited July 17, 2010).]
quote:Honestly, if you don't want to do an escape scene, I think your most realistic bet is to have the patient ask to use a phone after their medical evaluation and have someone on the staff get them one.
I think your right. I'm over thinking this now, and for the continuity of the story I should keep it direct and simple at least for this part...
Hey! Whats great! and I just thought of It! I can have her think about some fancy idea to get to a phone and try, only to be caught, and the nurse tell her she can use the phone anytime she wishes, and gives her privacy to talk.
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Just because you feel inate sense of inferiority to English people doesn't mean they would feel superior to you. I am certain if you met one they would immediately take pity on your plight and feed you some nuts through the bars of your cage. 
(The glasses are so you can't see my expression)
