I stood in the psych ER - a seven-bed locked unit, just across from the ER, trying to present my very second patient ever to a taciturn crisis clinician whose name was at distinct odds with his mahogany skin. It had gone well, thus far, despite my unreasonable fear of him - he seems such a competent man, this clinician, with such brief and simply eloquent responses to questions. I don't know that it is fear; perhaps it is more awe.
The presentation was going well - I had discussed it briefly with others prior to the whole mess going down, and was reasonably confident that the depressed and unconfident (is that a word?) gentleman who had been so forthcoming regarding his drinking (four beers a day before the gin and wine starts at 5 PM) and crack cocaine (up to $500 a day, when he was working, every day. Now just a couple times a week) habits, who admitted that he had a problem and who didn't want his four-year-old daughter (youngest of seven children) to see him drunken and depressed; that this gentleman had a probable substance-induced depression on top of a questionable organic depression, and that the best place for him was in D&A - drug and alcohol rehab. The presentation was going well until the police arrived.
They brought with them a gentleman - and I use the word loosely, O Best Beloved - who was in wrist restraints, the kind that keep your hands crossed behind your back so that you really can't move them much. I can't imagine that they'd be very comfortable. But he was insistent that the police had slammed him up against the wall in these restraints and broken his wrist "again" - and he was insistent in the most floridly obscene fashion. He demanded an X-ray, he demanded his rights, he demanded this, that, and the other. And I, bless her heart, I could almost see it in the clinician's eyes, I could not concentrate. I could not concentrate long enough to get two words out. The noise and the spectacle, son et lumiere, so to speak, they were enough to drive a normal person to distraction. Myself...the battle was over before it was begun.
"I'm sorry. I'm distracted." He's distractin', the clinician agreed, soft as ever. I have, sometimes, to strain to hear him. Let's go in here. So I finished my presentation behind the closed door of the medication room. And I presented my plan and he nodded. Sounds perfect. Let's see how fast we can get him in.
We came out of the medication room and the clinician made some phone calls. I leaned on the door and watched three security officers trying not to laugh overtly as their "prisoner", now freed of his wrist restraints (does anyone know what they're called? I did, earlier today) continued to spew forth bile from his room in the ER. I was reminded, briefly, of the woman with the battered face who was brought in on ID (an immediate detention, a 24-hour order that allows someone to be held for psychiatric evaluation if they are dangerous to themselves or others) insisting shrilly that she'd done nothing wrong, that her no-good husband had taken all the pills and was framing her.
"Her no-good husband definitely did that to her face," the officer said to me in an aside. "But she can't even walk straight." I hope her no-good husband is in jail now. I don't know what happened to her. This man, though, had personal insults to each of the police officers. I hope, if I am ever driven to rail in four-letter words, that I am half so creative. I could not hope to recount them, but one shared glance with Security and I was snickering too. How could I not? The patent absurdity of this man's venom was astounding.
We went to see our patient, the clinician and I, and got him set up to find a bed in an inpatient detox unit. If he calls, and I hope he calls, and I hope that four-year-old little girl gets her daddy back, he'll start detox tomorrow. We think he will go. He has a few good reasons.
I finished the leftover curry for lunch, then, and hung around on a call with the resident - the crisis was that the patient's doctor had decided that she was abusing her Xanax (which, more or less, she was) and refused to prescribe any more (which, in my opinion, was the wrong way to go about this) and now she was going to have a horrible anxiety attack at any second, according to her mother, who did all the talking. Somehow, clinician and resident convinced the woman to come back in the morning and bring her daughter to get into a medication detox program. We're betting there's a 50% chance she'll actually come back in the morning. She has insurance, of a sort; more likely she'll go find a doctor who will prescribe her the Xanax. She's only been taking it for 13 years, after all.
Megan and I are staring at each other across the table, both gauging our behaviour on the actions of the other. "Shall we just go after lectures?" I will if you will. "Should we take Psych ER patients?" They scare me. "Did you park by the VA hospital?" So did I. It's nice to have someone here who's just as lost as I am, and admits it. Plus, she's cute, in a girl-next-door sort of way, and fun to talk with.
I don't make friends easily; I still rank on the I side of the Kiersey scale. But I like to talk, and I love my audience (as well you know, O Best Beloved), and I like the company. The company is nice. If only this rotation didn't drive me crazy.