Being a psych patient in the emergency department

So you’re in the emergency department, probably in a small, windowless room, dressed in paper (or, if you’re lucky, crazy green cotton cloth) scrubs. You’re lying in a bed with a plastic mattress and scratchy sheets staring across the room at the door that has a small chicken-wire reinforced tempered glass windowlette in it and is ajar just enough to let you see the shiny black shoe of the security guard who keeps watch over you.

The room is either hotter than blazes or cold as ice, in which case you reach down for the thin blanket. They’ve taken your blood, leaving a little round bruised area in the bend of your left arm (“I write with my right hand-can you stick me in the left arm, please?”). You’re lucky, because the tech that was on early this morning is good and got a purple top, two red tops and a speckled all filled after just one stick. She was the first person you’ve seen since about five AM. A conversation partner who sticks you with a needle is better than no one at all, you suppose.

Now, you think that the morning will have to be better than the dead of night, when you answered questions until your eyes crossed and your voice croaked, you were banded and poked and prodded and had blood pressures taken and sticks stuck down your throat and a doctor briefly listened to your chest and said “hmm” to himself. You’ll get to see your family this morning and everybody will understand that this was all just a huge mistake and you’ll get to go home.

Except that’s not how it goes.

Many hospital EDs have rules that say you can’t have any contact with anybody, including family members, for the first twenty four hours of your stay, maybe as much as seventy two. Safety, security, blah, blah, blah. Now, I’ll grant you that sometimes seeing the family member who took out the probate court order of detention that got you picked up and hauled in here in the first place might be a little dicey. You are, after all, confused and not a little perturbed that Aunt Millicent would do this to you. Seeing her might cause you to rise up and try to commandeer the medication cart and go wheeling down the hall toward the door, wreaking havoc through the corridors. Best that she stay away. Unbeknownst to you, she feels horribly guilty for what she did, even though it was the right thing and you need this evaluation.

I have heard tell of family who come bringing gifts of drugs and other contraband to ease the suffering of their hostage kin. I have seen parents who get their teenaged daughters brought to the ED for help, then sit in the room with them and browbeat them to the point that they are asked to leave. I have seen mothers who sit by the bed of their child in the ED day and night and absolutely refuse to leave until some disposition is made. I have seen other mothers who drop the problem child off with these white-coated strangers, sign a paper, turn on a dime and hightail it out the door, never to return.

So hey, in the ED, family visits are sometimes good, sometimes bad. Sometimes helpful, sometimes not so helpful.

Oh, you’ll see other people this morning. Techs, cleaning people, maintenance people, support staff, admin (sign here and here and here, please), consultants, psych liaisons, staff nurses, charge nurses and maybe even a doctor. It takes a lot of people to run a hospital and an ED, and they pass through in a steady stream all day long, doing their thing, getting their jobs done, all in the service of the organism.

Oh, the doctor and nurse thing? Let me tell you a little something about that. Well. maybe just the doctor part since I am a doctor and can speak directly from my own experience.

If you’re a psych patient in an ED, doctors will treat you kindly and efficiently and do what they have to do to assess you, but that’s all. They are basically uncomfortable around you. Sometimes, they are afraid of you. Sometimes they are bothered by the fact that you are even there, especially if the mental health assessment gig is new for their hospital and ED.

Now, to be clear, I am not doctor bashing. I am a doctor. It’s as though I, a psychiatrist and, I think, a good one, walked into a modern-day cardiac ICU and was assigned a sixty-year-old man who had just had his third myocardial infarction and was being kept alive on a ventilator. I’d be able to handle most of the rudimentary procedures necessary to keep him alive. I can still do a competent physical examination, review and interpret lab results, and see evidence of congestive failure or pneumonia on a chest x-ray. However, I am not comfortable taking care of someone suffering the effects of a massive heart attack. It’s not what I’ve been doing the past twenty six years. Give me antipsychotics and hallucinations and depression and panic attacks. I’m at home in that landscape. You get my drift?

Even when it feels like you’re being avoided by the doctors and nurses in the ED, I just can’t imagine that this is ever done out of spite or neglect or malice. Healthcare providers are not wired that way. We want to help people. But, like the plumber who knows his pipes and the electrician who knows junction boxes and wire, each of us has a body of knowledge, learned and honed and fine tuned over years of clinical experience after that initial rudimentary medical education we all get. We know what we know, and we avoid what we don’t know how to do. It’s training, but it’s also human nature.

When you have an encounter with an emergency department after a serious suicide attempt, you don’t ft the established mold. You can’t be sutured. You can’t be set and casted. You can’t be TPA’d.