I get lucky; it's the CM. I fill her in on Chad's latest presentation. She tells me that he's had many psychiatric hospitalizations (not exactly news to me) and that, when last asked, he wouldn't talk about his medication compliance (not good). She says he has been worsening over the last month (uh-oh). Apparently, he recently destroyed his room, and has a history of trashing places (I hadn't known that). The only violence toward a person she knows of was an episode a while back when he attacked his grandfather. She thinks Chad needs psychiatric hospitalization.
There isn't anyone else to call for more information. Chad and his mother are estranged; the grandfather is deceased. He has no other family in town, no roommate, no spouse, no girlfriend that I know of. I'm not sure if he has any friends, much less how to contact them, or how reliable they would be. I look around to see if the officer of the day (OD)--the psychiatrist on shift--is in sight so I can present the case. No such luck. I continue to write up the report.
9:40 a.m.
Soon, I notice the police bringing in a handcuffed, shirtless, barefoot man. He has a shock of black hair and streaks of dirt running down his arms and chest. He is quiet, head hanging down, as the two police officers lead him to the nursing desk. The larger of the two police officers removes the handcuffs and the nurse reaches to seat the patient for the admittance procedures. As soon as the nurse touches the man's arm, he goes berserk. He jumps two feet in the air, screeching at the top of his lungs, arms flailing. He begins running around the nursing island in circles, yelling strings of nonsense. The surprised nurse makes an attempt to capture the now out-of-control patient but can't hang on. At the next pass both police officers and the nurse grab him and attempt to carry him to a hospital cot. The man, however, is like a fish out of water, squirming and writhing. By now, someone has called security and five hospital guards burst in, pulling on latex gloves. It takes all eight of them to wrestle the patient onto the cot, strap him down and inject him with a sedative. The man screams, fights, cusses and spits the entire time. They wheel him into an empty seclusion room and shut the door. After a while the screams soften and then dissipate. I approach the nursing desk as the "takedown" team is washing up.
"What's the deal?" I ask an officer.
"We found this guy standing in the middle of traffic snarling at cars and waving a brick. Think he's been crackin'. We've picked him up before for drugs. I think he had one hit too many." I grunt, spying Dr. Arness, the OD. I make a beeline for him.
Dr. Arness looks up from his report, smiles, and sticks a finger in the air. I nod and return to my spot, putting some finishing touches on Chad's writeup.
9:55 a.m.
Dr. Arness walks over. I tell him about Chad's history, his behavior at the hospital, and what Chad's CM has told me.
"John," I say, "I've known Chad for a while, and at best his baseline is not good, but I've never seen him like this. Usually he's suicidal, with a little paranoia and delusional beliefs. Now he's delusional to the max, paranoid and threatening, with a knife to boot." I recommend hospitalization. "Let me talk to him--you're probably right," says Dr. Arness. "Go on and check bed status."
10:05 a.m.
Dr. Arness returns. "Yep, let's get him in."
10:35 a.m.
My next case is Michelle E, the 44-year-old African-American female who's been feeling depressed. She's not sleeping well, has lost 14 pounds, doesn't feel like doing anything and can't concentrate. There don't seem to be any major causes. She just loathes her body, her life, her job and her apartment, and she's tired of feeling like this. From across the table, waves of sadness are palpable. No, she's not suicidal. No, she's not hearing or seeing things. She just wants some pills. Ms. E gets a diagnosis of major depression and a referral to a local mental health agency for psychotherapy and possible medication. I try to emphasize how important it is for her to take an active role in her own recovery--how no magic pill will cure her. Medication can help, but it is only one of many tools a person uses to fight depression. We talk about some of those tools.
12:30p.m.
Somehow, between cases, I escape to the hospital cafeteria for food and cram it into my mouth as fast as I can. We call this lunch.
12:55p.m.
Time for Helen R. The middle-aged cutter listlessly shuffles into the interview room. Her arms are scarred so badly she looks like a burn victim. Arms are a main target for cutters, although some use the abdomen. The cuts are almost always superficial.
"Helen, when you cut yourself, did you want to die?" She shrugs, staring with dull eyes through greasy hair at the floor. Cutters are characterized by lifelessness; they truly resemble the walking dead. This is not without reason. Many were horribly abused physically, verbally, sexually, emotionally and in just about any way you can imagine.
"I don't know what I want," she mutters in a low monotone, her head hanging as if in eternal shame. Not once does she make eye contact with me. The self-esteem of a cutter is subzero. Cutters hate themselves. This is one reason they wound themselves. Some say the cutting is a way for sufferers to release pain; others believe their feelings are so deadened that they cut to feel something, anything. Cutters often carry a diagnosis of borderline personality disorder and are the most isolated people I know.
"Are you still hearing voices?"
Tags:
day shift,
depression,
eight hours,
emergency mental health,
fragility,
hospitalization,
human psyche,
medication refills,
mental health crisis,
metropolitan hospital,
morning noon and night,
night shift,
open 24 hours,
paranoia,
psychiatric center,
psychiatric emergency room,
psychiatric hospital,
psychiatric nurses,
report sheets,
shift change,
substance abuse,
suicide attempts,
tpw
