Thursday, September 29, 2005

Emergency Room

So I made it through the month of August, doing pediatrics ward work--or, as I like to call it, "sticking needles into babies." It was fun and interesting and I will talk about it sometime soon. I have been spending this month on emergency psychiatry. We have our own part of the emergency room, to keep those bad crazy people away from the "legitimately sick" people. Actually, it is nice to have our own space. Believe it or not, sometimes the people who we have come in are upset or agitated. (Can you believe it?) And so, it's a nice thing to be able to have a place where they can be that has locked entrance and exit doors, and no monitors or oxygen nozzles on the walls for them to break or injure themselves with.

Aside from the near-constant threat of physical violence (just kidding mom!) it's been fun. It's so interesting to see how people get to the point that they need to come to the emergency room, and the stories they tell when they are here. Some of the biggest shockers have been people telling me about all the drugs they do ("I do as much cocaine as I can." "How do you get the money for that?" "Food stamps.") and the fact that people lie. To doctors! They lie! I'm shocked and horrified. ("I don't drink that much." "But your alcohol level was .460 when you came in last night. I'd be dead!" "Well, I just had a few drinks.") Meanwhile, I've been working with very talented social workers and nurses who have been helping me a LOT. The nice thing about having the social workers there, ASIDE from the fact that THEY can evaluate patients, write up the eval and SEND THEM SOMEWHERE (i.e. to a hospital) is that they know a lot of the "frequent fliers." They have specific plans for when Ms. BR comes in saying she is suicidal but realls just wants a sandwich. They know when the patients are looking for attention and when they are really sick. So that helps a lot.

But it's kind of scary. I'm seeing people here at their lowest. They want to die. Alcohol or drugs have taken control of their lives. The voices in their head just won't go away. The voices are telling them to kill themselves. The television is telling them they've already killed someone. The radio and X-box are talking to them, but the X-box speaks a different language so no one knows what it's saying. Their partner just died. Their cat just died. Their television just died. Their dad brought them into the emergency room to hospitalize them to "teach them a lesson." They want to die. They want to die. They want to die.

And you sit across the room and look at them. You listen to them. You try to help. You try to give hope. Things can get better, you say. There are a lot of treatment programs. I can see that you're a smart person, you're a survivor. You have a lot of skills. We want to help you. We want you to get better. We want to send you to the hospital where they can help you. The frequent fliers scoff at that. They don't help me there, and sometimes you believe them. Sometimes you wonder what we can do. Then you send them to the hospital anyway, and they spend a few days there, or a week, or a month, and then they get sent home with follow-up appointments they don't keep, therapists they don't see, and psychiatrists they don't call.

And then a few nights later, they come and see us again.

Anyhow, tomorrow is my last day in the ED. I start the consult service on Monday, where we help out medical and surgical services with the psych issues of their patients. We have an interesting attending so I know I will have some fun stories!

I have some knitting content to put up too. Will happen soon, I promise.