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SALT LAKE CITY — Angela Keeton, by all appearances, is scared to tears.
“Don’t answer the phone, don’t answer the phone ‘cuz they’re gonna call me, and they’ll know I’m here,” she sobs.
"Who?" a woman asks.
“The mafia, the mafia!”
Keeton is breaking with reality. This morning, that’s her job.
She’s what’s called a standardized patient, an actor hired to pretend to be sick so students, here from the University of Utah College of Nursing, get hands on practice.
Keeton, an actress and opera singer, who’s had roles in musical productions from "Madame Butterfly" to "Kiss Me, Kate," is cast as Sarah Light, a 26-year-old veteran with chronic paranoid schizophrenia.
In past performances at the college, Keeton’s had polycystic ovary syndrome, a hormonal disorder and an infection from a leg she broke while skiing.
This, though, says Keeton, is her "Lucia di Lammermoor," her clinical version of the famous “mad scene” from Gaetano Donizetti’s opera.
According to a written description of the character, Light had paranoid delusions and threatened a library patron. Light thought he was a member of the mafia. Police took her to the hospital.
“She is very, very uncomfortable in the beginning and she‘s hallucinating, having auditory hallucinations and visual hallucinations,” Keeton says.
At the college’s Simulation Learning Center, a virtual medical center with functional hospital rooms, Keeton improvises four scenes with students from a mental and behavioral health nursing class. After each, which is videotaped, students review their performance.
Instructor Joan Hadley, an advanced practice registered nurse, says there was no medical play when she went to school in the 70s. She simply took classes, got a degree and went to work.
“It was very hard,” Hadley says. “They call it baptism by fire.”
She says standardized patients have become part of nursing education over the past five years.
“Sims,” as they’re called, she says, help students prepare for these urgent and unpredictable situations.
“It’s the red thing! It’s the red thing! It’s the red thing!,” says a distraught Sarah Light. She picks up a red sharps container. “It has to go because this is how they’re listening to me.”
Instructor Allison Pawlus has been watching the scene from a nearby video monitor-equipped control room. Keeton wears a radio receiver and earphones, and Pawlus whispers directions in her ear. Pawlus tells her to bolt.
Keeton dashes down the hall, the students in pursuit. “Where am I? Where is the exit?” she cries.
“It's so they (the students) can manage emergent-type situation in their future nursing practice,” Hadley says. “…and not run away due to fear that they may have, and you can see it in ‘em.”
“They do get that gut feeling that they just want to leave and run away, but they can’t,” she says.
In a later scene, Keeton lets out a gut-wrenching scream. Her neck twists to one side. Her fingers are bent.
“What’s happening, what’s happening, what’s wrong with me?” she sobs. “I can’t move. I can’t move. Oh, why are they doing this to me?”
Her character is having a reaction to antipsychotic medication.
“She was crying and really agitated, and it's hard,” says student Andrea Evans. “And you do kind of forget for a second (that Keeton’s not a real patient), but it's kind of good in a way that you forget because you take it seriously.”
Evans says recently she participated in a scenario with a “dying” patient and, emotionally, it was difficult. Some students, she says, were crying.
Keeton says it may be make-believe, but there are moments of human connection.
A few times this morning, when her character was in distress, student nurses reached out and held her hand. She says she felt comforted.
“There's moments where they connect with you as a human, and there's moments where you feel so disconnected, and there’s so much fear and discomfort and uncertainty,” she says.
At the end of a scene, while the class debriefs, Keeton lies back in her hospital bed and rests for a few seconds. Her face is red. Beads of sweat dot her forehead. She’s spent a lot of energy this morning and knows she has to perform again for a class this afternoon.
“I'm exhausted, yeah. Really I'm exhausted, and I’m gonna do it again in about an hour,” she laughs.