Eight hours in an emergency psychiatric wardreveal the fragility of the human psyche--and the horror that can lurk within
Psychosis is never pretty, especially in the morning. Depression, anxiety and addiction fare a little better, but not much. Like it or not, these are the types of things routinely encountered here, morning, noon and night. And as I glance around at the patients before me, today is likely to be no different.
Emergency Psychiatric Center (EPC) is a mental health crisis facility at a major metropolitan hospital. The center was established in 1972 to help serve the emergency mental health needs of this major U.S. city, which has a population of approximately one and a half million. It's basically a psychiatric emergency room, open 24 hours a day, and it sees everything in the book, from medication refills to lethal suicide attempts.
It is 8 a.m., and nine patients are waiting to be assessed. And so begins another day at EPC.
8:00 a.m.
Time for shift change at the command center, the hub where all clinicians except nurses are based. It's been a long night for the social worker, two psychiatric nurses and on-call psychiatrist. The incoming day shift is larger, comprising an intake worker, two psych nurses, a therapeutic patient worker (TPW), two social work therapists (including me) and an attending psychiatrist. Report sheets listing the patients are passed out. The primary day shift therapist, Pete, calls out the first name for review.
"Nathalie L." (All names in this article have been changed.) One of the psych nurses from the night shift starts. "Natalie is a 16-year-old white female brought to EPC at 2 a.m. today by police after she told a friend she was going to kill herself. Patient's boyfriend recently dumped her. For a cheerleader, I think."
"Figures," snorts the TPW.
Pete continues. "Next case, Chad S." A groan goes up from the crowd of clinicians. Chad is what we call a "frequent 'flyer," someone who is repeatedly in crisis. These people are often manipulative, and usually "personality disordered"; they are a major physical, emotional and financial drain on the mental health community.
"Chad S.," says the other night nurse, "is a 24-year-old single white male brought in by police after he reportedly threatened It) stab a neighbor's dog. Story is, a neighbor heard something in his backyard and found Mr. S. there with a knife, yelling at his dog. Chad was pretty cooperative when he first came in, but as soon as the police took the cuffs off, he began to get agitated. We locked him in Seclusion Room One and that's when he destroyed the bed in there, tore one of the rails off. We put him in four-point restraints and gave him a cocktail of Ativan [a sedative] and Haldol [an antipsychotic] IM [an injection given intramuscularly]. He calmed down and has pretty much been asleep ever since." She pauses, and adds, "Good luck."
"Sandra P.," Pete barks out.
"Sandra P. is a 39-year-old married African-American female brought in by squad for overdose. Husband came home from work, found her lying on the couch, groggy but coherent. There was an empty bottle of Trazadone [antidepressant with a sedative effect] near her; he called 911. Patient claims she took about 15 of them. Also had been drinking--undetermined amount. She was sent to ACS [Acute Care Side--the medical emergency room of the hospital], medically cleared, and transferred over here for psych eval. She's in bed three."
"How about Helen R.?"
The night social worker takes this one. "Helen a cutter"--that is, someone who chronically cuts him/herself. "She's a 42-year-old white female who came here via ambulance after she called 911 saying she had cut herself with a steak knife. Claims voices told her to do it. She acts like she's responding to internal stimuli. Multi cuts on left arm--no sutures. She's been here before. Patient has been medically cleared and is in SR 4."
"Michelle F."
"Michelle F. is a 44-year-old single black female with complaints of depression."
"Arnold K."
"Mr. K. is a 54-year old divorced white male self-referred to EPC seeking detox from alcohol. Mr. K.'s BAC [blood alcohol count] was .277 upon arrival--it's now. 154. His pulse, temp and BP were up, so we gave him one milligram of Ativan in case he's withdrawing. He's been calm and cooperative. He's in bed two."
"Okay," says Pete. "Stephanie A."
"Stephanie A. is a 25-year-old married black female here for a med refill. Needs two weeks of psych meds until she can meet with her new doctor. History of bipolar. No psychosis detected. A little manic, maybe, but that's all. She's in the lobby."
"Okay, last but not least, Cathy W.."
