Relentless heat and pervasive humidity permeate the McKeldin building, home to 65 patients at Springfield Hospital Center. Everyone swelters, patients and staff alike.
A nurse returns to her work station drenched in sweat after a 15-minute walk through the halls. Patients lapse into lethargy, saying they prefer sleep to physical activity in the stifling atmosphere.
McKeldin is the only building at the state-owned hospital for the mentally ill in Sykesville without central air conditioning.
The aging, one-story brick structure houses three wards, each with at least 20 long-term patients, who range in age from 20 to 70.
Staff members maintain an optimistic attitude, smiling through the perspiration permanently beaded on their brows. Few pass up the opportunity to stand a minute in front of a window fan to try to shake the stickiness from their clothing.
"We pull together," said Bill L. Ebeling, acting assistant director of nursing. "We know it's unpleasant, but we deal with it the best we can."
Many employees find relief in air-conditioned cars and homes at the end of their shifts. They are keenly aware of those who don't have the same opportunity.
"We have our eight hours and then we go home," said Precious Morrison, a registered nurse. "We all realize this is where our patients have to stay."
Another nurse said she doesn't turn the air conditioning on at home.
"It would be too hard to adjust to the temperature change between home and here," said Beverly Boyer.
Barbara Kelly said everyone on the staff takes a turn at treating patients to Popsicles and ice cream.
"We do a lot of things for our patients; they are like a part of our family," said Ms. Kelly, a registered nurse. "We try anything we can to make them cooler."
Room-darkening shades filter the glaring sunlight from every room. Large, loud fans churn constantly, circulating hot air through halls, dimmed to cut down on heat. In the steamy shower rooms, exhaust fans pull the heat outside.
"Fans help, especially if you close the building and dim the lights," said Ms. Morrison.
But only air conditioning can provide real relief.
The state fiscal 1995 budget includes money to design a system. Installation, estimated at $487,000, is at least two years away and dependent on approval from the state legislature.
So, the patients, with help from their care givers, cope as best they can. Many avoid the unshaded courtyards -- favorite spots in milder temperatures.
Instead, they gravitate to the air-conditioned day rooms, the only cool places in the 40-year-old building.
Heat curtails most physical activity, an integral part of therapy, said Paul Insinga, an activity therapist. When summer saps any cool air from the building, he cancels or shortens time in the gym.
He substitutes cards, art work or board games in the day room for exercise.
As the temperature rises, the hospital relaxes its dress code and allows employees to wear sandals, shorts and sleeveless shirts. Nearly everyone dresses down.
"Shorts really help with both comfort and mobility," said Al Carbonell, a registered nurse. "I put them on as soon as we got the OK."
Twice on each shift, an employee records the temperature from thermometers placed throughout the wards, some in patient rooms. Often, the charts list degrees in the 90s.
"We monitor the temperature and humidity to see how it is affecting our patients," said Mr. Ebeling. "We don't have a specific cut-off, but it helps us maintain good judgment."
The staff encourages patients to pass time in the spacious day rooms, where 23,500-BTU window units hum endlessly and temperatures dip to 80 degrees.
They willingly moves beds to accommodate patients who want to sleep in the day rooms, which are normally recreation areas.
"Unless it's unbearably hot, most patients prefer to sleep in their own rooms," said Melanie Berry, a licensed practical nurse.
Patients like to maintain their privacy with closed doors, but that prevents cross-ventilation, she said.
Only two patients regularly choose to sleep in the day room in A Ward -- usually the hottest ward, because of its location above the basement filled with machinery -- said Kim Heline, ward nurse.
Dr. Godofred Lim, staff physician, said high temperatures can affect patient temperaments. He is especially concerned about the effect of heat on several residents with chronic lung disease.
Few elderly patients live at McKeldin.
"The three wards at McKeldin house, by and large, the hospital's most aggressive patients," said Mr. Ebeling. "The treatment teams do an excellent job. Their dedication supersedes the difficulties."
LuAnn Gamber, a clinical nurse specialist, has worked at Springfield 23 years and has seen the patient census drop from 3,000 to 429.
"It is hot, but it's better than it used to be," said Ms. Gamber. "We have a lot more fans and a lot quieter patients."
Ward C, where she now supervises 22 patients, used to house more than 40, "and that really added to the heat congestion," she said.
"Many other people work without air conditioning," she said. "The heat is just a fact of life that we deal with."