Thursday, March 15, 2018

Preliminary Stuff (Psych)

It's not Friday but it feels like Friday because my psych rotation days are Wednesday/Thursday and not Thursday/Friday as they have been for every other rotation I've done so far.

So psych.

On the first day, Wednesday, we did a required orientation and then we went off to our respective posts. I worked with the case managers. I got to see how they handle their case loads. Their day starts out sitting in on patient assessments with the psychiatrists and then in the afternoons they call families, chase down insurance companies, and begin planning for discharge (making follow-up appointments, arranging for prescriptions to be filled, making transportation arrangements).

Of course I can't talk about patients in any real detail that could identify them, but I can say that the unit houses some very, very mentally ill patients, some of whom can be treated and some of whom should probably be locked up and the key very definitively thrown away. For example, there was one patient who on first sight gave me the creeps--a legit apprehensive, sick-to-my-stomach feeling--and later, speaking to someone on the unit, I found out that the patient's diagnosis was antisocial personality disorder, which a lot of laypeople just shorthand as psychopathy (though psychopathy is not an actual mental-health-related diagnosis).

In fact in the last two days, I've met other people with that same diagnosis. At least one was not remotely creepy but enormously charming. These same asocial personality types were housed with patients with substance abuse issues, with depression, with bipolar disorder, with schizophrenia...a hodge-podge of potential victims, all vulnerable in one way or another. Not good.

Most of the patients have expressed either suicidal or homicidal intent. (In the case of homicidal intent, there is a duty to warn the intended victim. One of the case managers told me of once having to reach out to a popular entertainer's agent. One case manager doggedly tried to reach another patient's estranged spouse.) Some are incapable of expressing anything at all. Some can't achieve coherency. Some express themselves beautifully. Many have substance abuse issues. Some want to quit using but most don't. The patients range in age from 18 to 60-something. Men and women are housed together on the unit. There are no locks on the doors to the patients' rooms, but every other door is locked. They walk around in their street clothes and their own shoes with their shoelaces replaced by white medical tape or they shuffle around in hospital gowns and socks.

I am warned not to block the doors when in a patient's room. I am told never to go alone into a patient's room. I am told to keep my hands in view as much as possible. I am told never to give a patient a pen. There are many, many more rules. I am my usual friendly self despite the rules.We'll see how that plays out.

It was a long day, ten hours from start to finish, in a very strange and unfamiliar environment.

Today, Thursday, I started out on the children and adolescent unit. For the hour I was on the unit, I did a physical assessment of a child and I praised a young patient who showed me a legitimately impressive magic trick and I spoke with another friendly, happy, very young child who was sweet and funny and eager to chat and play and who had physically attacked and seriously injured a schoolmate and harmed several animals and sexually molested a sibling.

After that hour, I was pulled away to spend the rest of the day working with someone who assesses patients who come into the emergency room needing possible admittance for in-patient treatment. Some are brought in by the police. Some come in on their own. Some are brought in by family. They range in age: Today about half were children. Many had tried to commit suicide.

When they arrive in the emergency room, their clothes and belongings are taken away and they are put in paper pajamas and placed in a room with nothing in it and then they wait, sometimes for days. They are waiting to be assessed. They are waiting for a bed to open up. Many of them sleep the hours away.

Between the patients who are seen in person, there are patients in other hospitals that need to be assessed via a kind of video conferencing. There is charting to be done. There are phone referrals to be made. There are patient charts to be faxed. There are patient histories to be reviewed. There are patients who need to be checked on every 15 minutes. The day flies by.

One patient though...there's often one patient who stands out in any situation on any unit I've been on. Today it was a suicidal pre-teen who the parents dragged in and then wanted to drag out again. We spoke with the child and it was clear that something was very, very wrong. The parents tried to change their minds about the whole thing, about hospitalization and treatment, but the person I was working with put his foot down and told the parents that their child was being admitted for treatment and would not be leaving the hospital with them for any reason. It was the right decision. Sometimes I wonder, with psych patients especially, if, when they walk in the doors of the emergency room, they're not jumping out of the frying pan and into the fire. But for this patient, even the fire was a better option than going home.

Awful.

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