Credit: Richard Manning

On Call

by Cynthia Siadat

Koreatown, Los Angeles, CA,  2019 at 3AM

Oh. My God. I’m jolted awake and sit upright in bed. My neck muscles tense immediately.

It’s just my phone with it’s blaring ring. Why did I choose such an obnoxious ring tone? I don’t know. It matches the situation, I suppose. My alarm clock says it’s 3am. It’s the kind of clock that is supposed to mimic the sunrise by gradually increasing in brightness with the accompanying sound of chirping birds. Great for when someone needs to get up before the sun does. Like now.But it’s 3am and no sunlight, real or artificial, should be up right now. Especially not after an over 12-hour work day.

I snatch up my phone and slip out of bed, trying not to shake it so much that I wake my husband. I tip-toe out of the door and successfully escape to the home office next to our bedroom when I press the green answering button and hear the female dispatcher say,

“Is this Cynthia — on-call back up?”


Wait. What? That’s right, I’m on-call back up. The supervisor for the front-line clinician. I’m starting to wake up now and as I do, I’m becoming more and more aware that the usual order of operations hasn’t been adhered to. I’m not supposed to be the person getting this call. It’s supposed to go to the front line clinician. There is a preset order to this chaos after all. The call only goes to me if they can’t figure out what to do with the caller on their own. I hear the female dispatcher’s voice,

“We have a male client calling in. He’s reporting suicidality and I already tried to call the front-line clinician and kept getting their voicemail.”

I begrudgingly gather the clients information from the dispatcher and, trying not to let my annoyance with the front line clinician bleed into our conversation, make a plan with the dispatcher to follow up with and enforce the protocol with the frontline clinician.

I put the front-line clinician in the hot seat in my head, reprimanding them. There’s a reason for it. The protocol is designed to maintain the highest levels of objective clinical judgement and I’m not very objective right now. I’m fuming. This is what the protocol is there to prevent, so I start calling the front-line person to see why they couldn’t be bothered with this call. Answer your damn phone.

My eyes go dead and flat. It’s in this moment realize that I am actually trying to pass the responsibility of this call onto the frontline clinician. But they don’t answer. I can’t believe I’m trying to get out of doing this work as someone in distress is waiting on the line.

I hold my breath and I call the dispatcher back to tell her to patch me into the caller. I should be preparing for the call in this silence, but instead I hope I don’t have to go out to the field and think about how it’s so late, who knows who’s on the road at this time? But if he’s in imminent danger, I don’t have a choice. The call connects.

“Hello, my name is Cynthia — who am I speaking with? How can I help you?”

Silence, except I can hear breathing. I wait a moment for his response.

“Hello? Can you hear me?”

I speak in as sweetly a tone as I can muster at 3am and settle into my large green armchair’s deep cushion right into an awkward slouch that both strains my neck and gives me a double chin. The angst of being awake when my body wants to be asleep kicks in as I look across from me at the closed door to my bedroom, imagining my husband asleep on the other side. How come this client still isn’t speaking? He just told the dispatcher he was in crisis. I can hear you breathing, sir. I stop in that moment and scold myself saying that I shouldn’t be so harsh, that it took a lot for him to call. Speak gentler and kinder.

“I understand you’re calling because you’re experiencing some difficulty with suicidal thoughts tonight, is that correct?”

Maybe a yes-no question will be more his speed, sometimes in crisis I understand it can be difficult to find words. I pull a section of my hair, twirl it, and aim it towards my mouth. Then I chew on the ends. A habit I do when I’m nervous or overly stressed.

Silence, click.

I feel the hairs on my back come alert. He hung up!… Wait, did he mean to? What if this is the last phone number he calls and it’s to a total stranger who dreaded being on-call? I don’t know how I’ll deal with this if I hear later that he died tonight. I don’t recall doing it but I’m stiffly sitting on the edge of my chair now and feel the frame of the seat under me, my feet straddling the edge of our circular shaggy carpet and the office’s faux wood flooring. I’ll wait. Maybe he’ll call back.

My phone rings again. My shoulders fall. There he goes. I tell the dispatcher to connect me right away and say hello again.

“Hello? Can you hear me? I’m glad you called back, seems we got disconnected there.”

The truth is, I am glad. I am relieved he’s reaching out, there’s so much strength in that. Silence. More breathing. I adjust my pajama to keep the spaghetti strap from slipping off my shoulder.

“Hello, I’m here for you. Are you still with me?”

I’m not sure how I can be helpful if he doesn’t speak. I recall sitting with an old supervisor who told me about the importance of setting boundaries with clients to help contain the chaos they are experiencing. The chaos I am also experiencing. I quickly decide to put a timeline on the call.

“I can wait for up to 20 minutes for you to speak with me, but I will need for you to speak with me so I can try and help.”

It feels so awkward to put a time limit on something like this. If this evening has shown me anything, it’s that protocols, as well intended as they are, don’t always work nor do they truly keep in mind the humanity of a difficult situation. My muscles relax as I begin to wonder, would I be alright staying on the line with him all night and he doesn’t talk? I’d be ok with that.

There’s conflict within me. I’m fairly certain I’ve never been told what should happen here, I don’t recall in my 10 years of training being told how to handle a crisis call when the other person doesn’t speak. Closest bit of advice: no one call is like the next. I notice my dog has come into the room, he does that sometimes. I gesture him to come onto the chair with me and he lays across my lap; it seems he’s forgiven me for not walking with him earlier. I pet his soft cream-colored fur hoping for comfort.

I start to rationalize with myself. Really. I’d prefer he stays on the line with me rather than hangs up. I shake my head to rid myself of my savior complex. If I were in his shoes, I wouldn’t want to be alone at a time like this — I think I’d be comforted by someone just being there with me. I yawn. Don’t yawn — he needs you focused.

“Hi, I think you’re there, and I haven’t heard anything from you yet. Could you tell me about why you’re calling tonight?”

This feels disingenuous because I know what the dispatcher told me, but in order to conduct a crisis assessment I need to hear it for myself. That way I can determine if I need to get him to the hospital. Placing a hold on someone is something to be taken very seriously, and I have been given that authority, and terrifying responsibility, to make such a decision on another person’s behalf. I first came into this field to be there for someone when they needed it most; to be the person I want when I’m having a hard time. I never imagined the intense pressure I would feel being on a call with someone who was not talking. But, here I am.

His 20 minutes is running out and I begin to consider staying on the line and sitting here in my armchair longer without him speaking.

“I don’t want to, but I’m going to have to hang up in a few minutes — If you need to call back again, I’ll be happy to listen to you.”

In my mind, I beg the caller to talk while my eyes are welling up from the late hour and feeling powerless to help. Please, I want to hear your voice so we can talk this through.

I don’t say this aloud because I’ve learned that no matter how nicely, or compellingly I ask, I can’t make anyone do anything. I can only give the tools to help them and hope they pick it up. Then it’s up to them to do something with it.

But what am I supposed to do here, just leave him? I haven’t heard a word from him yet, just his breathing. I go back and forth in my mind about staying or leaving. I could stay on the line for a while, I’ll just adjust my seat and get comfortable. A crisis doesn’t have a time limit.

The line goes out. He’s hung up again. I try to call him a couple of times but he doesn’t answer. A little defeated, I resign myself to sitting here for a little while longer to see if he calls back. He may not, but I want to be here just in case he does. I want him to know that in this dark moment, he’s not alone. I want him to know I’m here, that someone, somewhere in this giant city is awake with him. I put my legs up, and settle in. I could be here a while.

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