Tuesday, February 17, 2009

Say What?

[Homeless patient receiving disability payments from the government, angry with me for not admitting him to the hospital to protect him from homelessness]: "I pay your salary, did you know that?"

[Sleepy, cranky me on call]: "...?"

[Well-rested co-intern the next day, upon hearing the story]: "Actually, my tax dollars pay for your health care AND my salary."


More Truisms from Psych Call:

1. The "urgency" of the patient in the emergency room is indirectly correlated with how late it is.

2. If you get angry and yell at me for being "racist" because I won't admit you to the hospital, it isn't going to make me relent--it's going to make me call security to escort you from the ER.

3. The potential dangerousness of the patient is indirectly correlated to the likelihood that the nurses will actually have changed him/her out of their street clothes, put them in a gown, and removed their belongings from the room. We've seen bottles of alcohol and sometimes weapons.

4. If you come to the ER with a wussy overdose attempt, like, taking a couple extra antipsychotic or antidepressant pills (barely over the therapeutic limit, and not a drug like lithium or a tricyclic), it is entirely possible that the ER doc will have the nurse place an NG tube and do a gastric lavage. No, I will not pull it out of your nose for you. Actions --> consequences.

5. The "urgency" of the patient in the emergency room is indirectly correlated to the likelihood they caught an ambulance to come to the ER. This holds true in most areas of medicine, not just psych.

6. The corollary to #5: the urgency of the patient is entirely unrelated to whether the police brought them in. Sometimes the police bring in the really outraged, psychotic, agitated patients who were swinging an axe at traffic; sometimes the police bring in the chronically suicidal "I called 911 and said I wanted to kill myself and no it has nothing to do with how much wine I drank tonight".

7. The lateness of the ER consult is directly correlated to my level of crankiness and indirectly correlated to my level of "give-a-shit"ness.

Sorry for the rant, but psych call is mentally stressful and involves dealing with a lot of manipulative people trying to angle their way into the hospital. I hope that venting like this will help me not burn out and be able to keep showing up for call. /crankiness


The Gonzfather said...

My favorite was a patient that tried OD'ing on 10 tabs of Seroquel....25 mg each. Congratulations sir (or ma'am), you just tried overdosing on a subtherapeutic dose.

Anonymous said...

I pray to God I don't have any sort of mental health crisis late at night when you are on call.

1. Hmmm..go figure. People acting mental and manipulative at all hours of the night demanding crazy things. Now who would have ever guessed you'd see THIS during a PSYC rotation?!

2. Maybe these are people who are out to get you, and make YOU crazy?

Hope you don't already have or plan to have kids. Your post pretty much sums up life with teenagers..which is why I'M CRANKY and could very well wind up in your ER begging for some time away!!

The Shrink said...

But . . . I like it!

Anonymous said...

Anon...amen! How about an OD of 23 60mg Cymbalta...and cutting...? Geee, hate to disturb you, but...