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INT--NEUROLOGICAL DISEASE (PSYCHIATRIC) UNIT, BROOKINGS HOSPITAL, BALTIMORE, MD--NIGHT
DAY, who has just arrived at work, walks with her gear to a nurses' station where BONNIE PHILIPS, an older psychiatric nurse, sits doing paperwork. PHILIPS notices DAY.
PHILIPS
Hey kid. Ready for the Dysfunction Daily?
DAY
You shouldn't say that. These people are no more responsible--
PHILIPS
Uh-huh. But talk to me in 20 years.
(With affection.)
You really are the daughter I never wanted.
INT--PSYCHIATRIC UNIT, BROOKINGS HOSPITAL, BALTIMORE, MD--NIGHT
DAY and PHILIPS are walking down the hall of the unit.
PHILIPS
...but the big story is, Bill's back.
DAY
Bill.
PHILIPS
(Handing DAY a chart.)
William Clinton, 21-year-old white male, paranoid schizophrenic. Crashed
out of Yale after months of increasing psychotic symptoms. Especially
the delusion that he was...our beloved 42nd president, Bill Clinton.
DAY
No way. And he just happens to have the same name?
PHILIPS
Uh-huh.
DAY
Maybe he should change it.
PHILIPS
Well, obviously we've considered what role the name may have played in the pathology. But I'm not sure changing it now--
DAY
He'd just be Bill Clinton who changed his name.
PHILIPS
Right.
DAY
What's his middle name?
PHILIPS
Hamilton.
DAY
Well, that's a start.
PHILIPS
Yeah. Anyway, he left school early last year. But no diagnosis till early this year.
DAY
Why not, if the symptoms were that bad?
PHILIPS
Schizophrenics average 10 months of serious symptoms before they get treatment. And Bill's family--his socially prominent family--really struggled with it.
DAY
Least they can afford it.
PHILIPS
Problem is they can't deal with it. Really tough for anybody, sure.
(Adopting a refined accent.)
But how could it happen to us? William's brilliant--why can't he brush
his teeth?
DAY
(Looking at the chart.)
Olanzapine.
PHILIPS
Yeah, got him up to 15 mg. a day. But we haven't been able to keep him on it long enough to really assess it. Gets behavioral therapy too, but it's hard to keep him focused. And he can be oppositional, when he's not satisfied with our responses to his programs.
DAY
His programs?
PHILIPS
Yeah, his ideas for new programs, new funding, new treatment...
DAY
For his treatment.
PHILIPS
For everyone's treatment.
INT--PSYCHIATRIC UNIT, BROOKINGS HOSPITAL, BALTIMORE, MD--NIGHT
DAY and PHILIPS approach a large open space in which perhaps 15 INPATIENTS sit or stand. Some interact. Many are withdrawn. In one corner, three INPATIENTS listen to the attractive but somewhat disheveled WILLIAM CLINTON, as he speaks and gestures with his driver's license in his hand.
CLINTON
--so I challenge you to enact a comprehensive health plan founded on these principles: security, equality, and cost efficiency. That's what this card--the Health Security Card--is all about. Americans who work hard and play by the rules shouldn't have to worry about whether they can get the care they need. Nearly 40 million Americans are now uninsured, and--
CLINTON's eyes sweep his small crowd as he speaks, but when he spots PHILIPS and DAY, he stops immediately.
CLINTON
(To DAY, in a frantic whisper.)
What're you doing here?
The INPATIENTS turn and stare at DAY.
PHILIPS
Hello everyone. You know Anastasia Day. Bill, Anastasia's been with us for a few months, and she'll be your nurse tonight.
DAY
(Nodding to CLINTON's audience.)
Johnny, Mike, Donna. Mr. Clinton, I hope--
CLINTON
(To DAY.)
Do they know you're here? You know what they'll do if they find out.
DAY
Do they--who?
PHILIPS
(Leaning toward CLINTON.)
Bill, can we speak privately?
CLINTON
Well, as you can see I'm a little...
(Glancing at the INPATIENTS, then back at DAY.)
All right.
(Shaking INPATIENT hands as he leaves.)
Thanks for coming. Great to see you.
CLINTON, DAY and PHILIPS walk toward a vacant corner of the open area.
CLINTON
(To DAY, putting his arm around her.)
Hillary, don't you see how risky this is? Do Tom and Terry know?
DAY
(Easing away from CLINTON's arm.)
Mr. Clinton, I'm a registered--
CLINTON
I know your party affiliation, I'm talking about the R.N.C., Klayman, Limbaugh, Drudge, the Post, the Times, are you with me?
DAY
Well, I--
CLINTON
(To PHILIPS.)
If they find out, it's not going to look great for the hospital or the
university either. You depend on a hundred kinds of federal support.
PHILIPS
Bill, let's back up, OK? Can we just sit and talk for a minute?
CLINTON
You know how important security is. Hillary's taking a big risk, and I want to know who the hell let her--
DAY
Mr. Clinton.
CLINTON
Oh come on, use Bill, Bonnie knows who you are.
DAY
Bill. I am a registered nurse--
CLINTON
Ich bin ein Berliner, eh, honey? Well, I'm a nurse too. I feel their pain.
I remember what my mother used to say...
(Turning to PHILIPS.)
I'm sure we don't need to tell you what a threat the nursing shortage
poses to the future health of all Americans. Nurses are overworked and
underpaid in a shortsighted cost-cutting environment, struggling with
a public image that they're unskilled handmaidens--an image that takes
no account of the job's real demands, or its place on the front lines
of 21st century health care. Nurses are leaving for easier, better paying
jobs, and new ones aren't being trained. The average age of a nurse today
is 47...seven...severe...
(CLINTON seems lost, then recovers.)
...projected 20% national shortfall. Who'll care for the aging boomer
population, with the growth of life-extending technology driving demand
even harder? What if there's a serious bioterror event? That's why Hillary's
co-sponsored legislation that offers tax and educational incentives to--
DAY
Bill, I appreciate all that. But my job--despite being overworked and underpaid in a shortsighted cost-cutting environment--is to help you. With your thoughts.
CLINTON
My...thoughts.
DAY
Do you know where you are?
CLINTON
Well, a hospital, of course.
DAY
Right. And we're nurses. We're trying to help you with your thinking--
CLINTON
All this talk about thinking, Hillary, I know some of your grades were better, but I'm not sure--
DAY
That's not what I'm talking about, Bill--you've clearly got some serious game. I mean helping you think better about basic things, so you can get back to where you were, making a contribution outside of the hospital. Is that something you'd like?
CLINTON
But I'm here...you know why I'm here.
DAY
Why are you here?
CLINTON looks down.
PHILIPS
(Leaving.)
I have to go. See you tomorrow.
DAY
Thanks, Bonnie.
(Pausing.)
Bill, are you familiar with schizophrenia?
CLINTON
Of course. As one of the most common psychiatric conditions, it affects about 2.8 million Americans. It's been estimated to cost us $65 billion annually--and that figure's over 10 years old. You know, despite de-institutionalization, schizophrenia still accounts for roughly 40% of all long-term hospitalization days. Most schizophrenics have a history of substance abuse, and the suicide rate's been estimated at 15%.
DAY
It is very serious, and that's why we're working to find--
CLINTON
Clearly it's a brain disease associated with genetic and environmental
factors. I understand they're looking at abnormalities in brain structure
and activity in the prefrontal cortex and other areas, especially the
amygdala, the emotional center that's often much smaller in schizophrenics...
(Camera shows image of a BRAIN with shrinking AMYGDALA highlighted.)
...brain circuitry problems that can cause an overload of unfiltered information,
leading to positive symptoms like hallucinations, then negative symptoms
like flat affect as the mind withdraws from the barrage...
(Camera shows brain circuits getting OVERLOADED.)
...and brain chemicals, especially imbalances in neurotransmitters like
dopamine.
(Camera shows DOPAMINE activity.)
DAY
I'm familiar with that research.
CLINTON
The real question is, what can be done about it?
DAY
I was just wondering that.
CLINTON
Are you aware of the newer "atypical" medications that can work on even the negative symptoms, like Olanzapine?
DAY
I believe I've heard of Olanzapine.
CLINTON
And the re-emergence of electroconvulsive therapy? And the growing focus on cognitive-behavioral therapy, to help build capacity for normal thinking and living skills?
DAY
Let's talk about that.
CLINTON
But despite the advances, medication side effects remain a serious issue.
The condition still carries a major stigma, and most sufferers don't get
adequate care, especially African-Americans. That's why I worked with
Tipper on mental health initiatives--
(CLINTON pauses.)
--and that's all we did, nothing else--to ensure parity for mental health
insurance coverage, provide a better continuum of services for homeless
sufferers, organize the first White House conference...continence...
DAY
Bill. Bill?
CLINTON
Yes?
DAY
I'm glad you know so much about this. And I really appreciate your ideas. I think we can build on them. Okay?
CLINTON is silent.
DAY
I noticed you didn't say much about the symptoms of schizophrenia. Are you familiar with those?
CLINTON remains silent.
DAY
Like delusions, hallucinations, disorganized speech and behavior?
CLINTON
Well...yes.
DAY
And I understand you've had some trouble with your thoughts. Organizing them, distinguishing what's real, helping others understand you.
CLINTON
It all depends on what the meaning of the word "trouble" is.
DAY
I mean whether you can function and relate to people the way you'd like.
CLINTON
I...but...you're so busy, I don't want to drag you into this. On top of everything else I've done...
DAY
Bill, that's what I'm about. I'm here to help you. We're gonna work hard and play by the rules, all right?
INT--THE BURNING EMBER, BALTIMORE, MD--DAY
The NURSES are sipping their drinks.
SMITH
What about--
A glass BREAKS at the bar, and drunken LAUGHTER drowns out the rest of SMITH's words.
MENDEZ
Maybe I should just report here for my ED shifts.
SMITH
What about you, Trent?
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