A long pause. "Yeah."
"What are they saying?" Another pause.
"They're telling me to cut myself."
"Why?"
"I don't know." Cutters usually don't know why they hurt themselves. They only know they have to keep doing it. Cutters are very difficult to treat. I know, however, that I can't let her leave depressed, psychotic and inflicting harm on herself. After the mental checkup, I arrange for her to be hospitalized.
2:30p.m.
My last case of the day is Arena K., the 54-year-old seeking alcohol treatment. Arena has been drinking since he was 13 years old and has been in treatment more than 15 times. He looks terrible. I ask him if he is suicidal. Not today, he replies. Arena says he's tried Alcoholics Anonymous in the past but doesn't put much stock in it. I tell him maybe he wasn't ready then, but might be now. He shrugs but agrees to go to First Steps, a local drug and alcohol inpatient drug treatment center. After a brief talk with Arena, Dr. Arness agrees to the plan.
I watch Arena leave in a cab. Whether his cab will actually make it to First Steps, I can't say for certain.
3:50 p.m.
It is now almost time for shift change and report. In the eight hours our team has been on, we have evaluated and disposition eight cases. During that same time, seven new cases have come in. Emergency Psychiatric Center evaluates approximately 10,000 cases a year. It is estimated that one out of four people will suffer a major mental illness in their lifetime. One out of four.
Have I accomplished anything today? Eight out, seven in. Ten thousand a year. Sometimes the faces start to blur a bit, and the details overlap. But for every face there's a person and a life--I have to keep remembering that. The reality is, some days it's hard to remember that. They just keep coming. Either way, I'll be back tomorrow. And so will they.
PHOTO (COLOR): The Crazy Shift
PHOTO (COLOR): Some patients are chronically in crisis. They are usually personality disordered, often manipulative, and always a drain on the mental health system.
PHOTO (COLOR): The emergency psychiatric ward sees everything in the book, from mild anxiety to lethal suicide attempts and severe dementia.
Adapted by MSW, LSW
Daniel Watson, MSW, LSW, is an emergency psychiatric therapist. He currently resides in northern Kentucky.
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