My current rotation of the month is psychiatry, and specifically I spend my days in the Psychiatric Emergency Room. Technically, the Psych ER is where patients with emergent psychiatric issues -- such as suicidal or homicidal ideations or an inability to take care of themselves -- are brought in, where, just like a "regular" medical ER, they are stabilized and either sent home or shipped out to an inpatient facility; they are typically brought in by police or paramedics after a call to 911 is made. In short, it's where the crazy people are brought as they calm down from their craziness.
It is not uncommon to see people brought in, for example, because they were discovered slicing their wrists; or because they were found wandering the freeways naked trying to climb onto passing cars; or even because they were observed to be defecating, picking up their poop, and then rubbing that same poop all over themselves. Yeah, it's that kind of place. And it is also quite common for all our patients to be on involuntary holds, where they are held against their will for either 3 days or 14 days.
It's a jail of sorts, but for crazy patients. I don't particularly like that word, because the psychiatry field is already fraught with and stigmatized by such descriptions, but if you want a quick-and-dirty description of the Psych ER, that's what it is: locked-up crazy patients. Thus, given our patients, it's a very unpredictable place. A bizarre and exciting place with rarely a dull moment. There's no telling when the peace will be disrupted by an event such as a formerly quiet patient yelling at the top of his lungs demanding that demons leave his body. Or ... the exciting, yet slightly frightful, event that happened today.
The day began with me re-evaluating a young patient who was admitted the night before for suicidal behavior. When I first approached him, he was sound asleep on a couch. As I tried waking him up, he repeatedly refused, and the best response I got was an occasional eye-opening that lasted no longer than several seconds. I attempted my usual round of questions that seek that determine whether the patient has shown enough improvement since the previous day to warrant his/her release ... basic orientation questions such as "do you know where you are?" and "what is today's date?" to questions about their current mental health, such as "do you still want to hurt yourself?" and "are you still hearing the voices that told you to strangle your neighbor?".
However, this guy was in no mood to answer questions. Not only would he not answer, he would neither open his eyes nor open his mouth. The extent that he held up his end of the conversation involved him pulling out a piece of paper and pointing to some words he had written down earlier. The most productive part of our conversation went like this:
Axis: "Where are you?"
Patient: [points to the word "hospital"]
Axis: "How are you feeling?"
Patient: [points to "I want 2 trays of food"] (technically, a non-sequitor, but never mind that).
With the conversation going nowhere fast, I walked away, reported back to my attending, and he was left alone, fast asleep on a couch, with his response-papers, still wanting 2 trays of food.
End of story? Not quite. One hour passed while I followed up some errands, and returned to the Psych ER only to see a few cops running inside as fast as the little doorway would allow them. Once they had funneled in, they were surrounding something at the opposite end of the room. I struggled and stood on tiptoes to see what they had so swiftly surrounded, only to see my mute patient from earlier! How a sleeping guy with slow hand movements piqued the interest of 5 trigger-happy police officers was beyond me, but the scene was enough to keep my attention.
Allegedly Mr. Mute has snapped out of his silence and began demanding -- aloud -- to receive those 2 trays of food. Talk about perseverance. Anyway, he had earned himself the privilege of a gurney with 4-point restraints. All but one of the cops stood around Mr. Mute, waiting, I assume, for him to bust a move, while that last cop then unholstered the weapon strapped to his left: a Taser gun.
Damn, a Taser! I don't know much about Tasers, except that once that little rectangular gun is fired, it causes the victim to collapse in a fit of painful spasms and howling. For now it was pointing down, away from the patient, with its malicious little red laser aim dot swirling around the floor like a jittery disco light. The police urged the patient to comply peacefully to avoid using force and the Taser; the patient responded with rude grunts, while his eyes were fixated on the red laser light floating on the floor. After several rounds of verbally going back and forth, Mr. Mute begrudgingly agreed to walk over to the gurney.
Finally arriving at the gurney, the patient sat down and announced, "this is as far as I'm going". But then this confidence was quickly turned to compliance, and mild fear, when the officer with the Taser firmly stated to "lay down now" and pointed his Taser at the patient's chest. With the red menace dancing around his heart, Mr. Mute quickly lay back with looks of death in his eyes aimed at everyone.
He was then restrained without incident -- except for the mouthful of swear words he let loose -- and the curious crowd in the ER slowly dissipated. Once all the cops left and the patient was restrained and curtained off, everyone resumed their tasks from before this tense stand-off. So goes the Psych ER.
That patient, however, did get in the last word. In protest to the preceding event, spotting a slit in the curtains and clearing his throat loudly, he spit out one well-aimed snotball through the slit ... launching it over 10 feet away, nearly tagging a nurse. Nice.