By the time the psychologist arrived at Loudon Memorial Hospital's emergency room, it was 2 a.m. and a man, dressed in the shredded remains of his gray, three-piece suit, was bound with leather straps to a stretcher. Spitting at the seven deputies surrounding him, his screams echoed against the block walls: "Let me die, let me die."
A high-powered Washington consultant who lives in Northern Virginia, he had gone on a rampage in a local bar, throwing glasses against walls and attacking customers. Five hours later, his bonds untied, he cried.
"He said he felt like no matter how hard he tried, he couldn't get ahead," said Cathy Miller, an emergency psychologist with Loudoun's Department of Mental Health. "He said he was tired of being so strong, that nobody understood."
In Loudoun County, the proud rural heritage of thoroughbred horses and blank-fenced farms is giving way slowly to sprawling suburbia. Over the last 10 years, the population has grown almost 6 percent annually. As new residents have come, escaping more crowded cities for the rolling countryside, they have brought with them their urban problems: unemployment, inflation, the stress of making ends meet.
But because Loudoun is still considered a country community by the lawmakers in Richmond, says Loudoun director of planning John Dugan, "the funding for the services our new residents demand is not there. We have to think up creative solutions to people's problems."
What emerged 15 months ago is the Loudoun department of mental health's Emergency Services Program, a rural area's attempt to deal with citified headaches.
Using $74,000 in state and county funds, Miller and one other psychologist are on call at Loudoun Memorial's emergency room on nights and weekends, 66 hours a week to deal with people who "get to the point that they can't cope with life anymore," Miller, 29, said.
Unlike District of Columbia agencies, which have been criticized for their inability to coordinate services and goals, the Emergency Services Program seems to be a model of old-time cooperation among the hospital, mental health workers, law enforcement officers and the Department of Social Services.
"The program is really working out well," said a spokesman for Loudoun Sheriff Donald Lacy. "It relieves our deputies of the responsibility of having to act both as psychologist and a police officer. In the past, if someone went off, we would make an arrest and then obtain a mental petition and have the person committed to a mental hospital. Now, a lot of times, the charges are left pending and the finding deferred to see how the counseling goes."
If Emergency Services is an example of how a community can learn to make do with what it has, it also offers a glimpse into the underside of a county that usually has been looked upon by multitudes of high-rise and row house dwellers that inhabit Washington and its immediate suburbs as a pastoral haven in the wilderness, a place devoid of pressure and hardship.
Says Miller, who with her partner has treated 150 people in the last six months: "People out here are the same as everywhere else. They are all kinds and have the same problems as anyone anywhere."
The call comes at 8 p.m. from the northern end of the county, the wife of an unemployed carpenter. She's crying, hysterical. "It's my husband," the woman says. "He's got a machete and he says he's going to kill the kids and me and himself." Click. The line goes dead.
Miller, on call that night, calls back twice. The man answers with obscenities, hangs up. The third time, the woman answers: "He took the car and went barreling down Route 7. He's been drinking."
Miller calls the sheriff's department and asks them to pull the man over. The man heads back for home, several squad cars following. He barricades himself into his two-story rambler. A SWAT team sets up and rifles are trained on the windows and doors. Deputies cordon off the area.
An hour later, the man runs from the house and locks himself in his car; Miller and a deputy approach cautiously. The man raises the machete, two feet long, pulsing with the red lights of the squad cars. "I'm going to do something if you don't leave me alone," the man screams through the window.
Miller and the officer try to reassure him, calm him down. Another hour passes. The deputy knocks and the man rolls down the window, the knife held high in his right hand. "Listen," the officer says. "I just wanted to tell you I can't do anything else for you. I'm going home. I just wanted to make sure you weren't mad at me."
The deputy offers a handshake. The man puts down the knife, reaches to shake his hand. The deputy pulls the man halfway through the window. It is over.
It turned out, Miller said, that "the man had some pretty major problems. He was unemployed and had a longstanding alcohol problem. But the thing that set him off was a family problem. He told me that his first wife had that day told he he couldn't come visit his children anymore. It was the last straw for him, I guess."
The man is undergoing treatment at a mental health center in Fairfax. He is doing well, Miller said, and will be released soon.
Miller stresses that she is not always called on to handle the dramatic. Last May, it was a mother who lost her 15-month-old daughter to sudden infant death syndrome. After several months of outpatient therapy, the mother, Tricia Stuart, a Vepco switchboard operator from Leesburg, is now able to tell her story herself:
I was at work, and I called home to ask my husband how the baby was doing. She had been sick the day before with an ear infection. He went to check on her I could hear a commotion going on in the background. He yelled, "Call the rescue squad!' and hung up. I did and then called him back. He said she wasn't breathing. I came home and she was laying on the floor. She was blue. I was screaming and then the rescue squad came and took her to the hospital.
an hour later the doctor came out and told us there was no chance. They had gotten her heart beating again, but said if she had survived, she would be a vegetable.
For two months afterward, I couldn't accept her death. I had nightmares, I could feel myself cracking. I wasn't getting along with my husband. My arms would go numb. Then, one day, I went to work and I felt like I couldn't keep my head up. My whole left side went numb and they called the rescue squad. I was ready to die.
Miller said that Stuart's treatment was mostly a matter of teaching her to live with what happened, learning to break the mental block she had developed."I got her to concentrate on the good memories she had of her daughter," Miller said.
"I feel so good when I think about [my work]," Miller said. "I guess it's because we've found a way to help people."