Tales from the Nuthouse: Lest You Think I have a Really Suck Job
 

One of the entertaining things about what I do is that I never know what each night will bring me ... Will I track someone else's feces into my house, or will I be touched in some way, save a life, or hear about one ending? Sometimes this is all in one night.

Tonight I worked with a fellow who just hasn't been doing well lately. He's been back in the hospital with a quick turnaround time ... a couple of weeks ago he'd gotten out of another hospital that day and didn't last out the ride home with his case manager ... this time he'd been out for not quite two weeks, but wasn't maintaining well. His apartment was a shambles, he was dishevelled and malodorous (this means he looked scruffy and was stinky), and he wasn't making sense much of the time. So, we get him in, the doctor sees him, and decides to admit him. I now have to call his insurance company and see what I can do about getting paid for admitting him. We eat about a half-million dollars each year in unfunded treatment ... I'm the first step in the chain that lead to operating capital, so I do my darndest to get people authorized for treatment (if you've ever been to any hospital, not just a nuthouse, a good portion of the time you spend waiting has to do with someone arguing with your insurance company to get your treatment paid for).

So, I'm talking to the care manager at the insurance company, and give the patient's name. Her response is totally off the cuff, as it's a somewhat unusual name ... "You mean like [first and last name of nationally known murderer]?" "Yeah," I reply. "This is his brother. And he insists that his brother is totally innocent of the crime." "You're kidding me, right?" "Nope. Totally serious. Really is his brother."

Just as I'm finishing up on this fellow's paperwork, I get my next joy of the evening. An older woman who was religiously preoccupied.

I mean really religiously preoccupied. I was reminded of one of several evolution threads here.

Satan is at large in the world, you know, and first will come Armageddon. Well, actually Armageddon will come after the Great Tribulation which will precede it.

Okay, ma'am. Could you tell me though, what's the Great Tribulation?

(I don't think she actually knew ... she just told me to read Revelations. Apparently the whole deal is revealed there or something. I tried to get some more details on the scheduled date for Armageddon, but apparently she hasn't been given this information yet. It would be helpful for me to know, as I need to make a point of buying extra ammunition.)

Do you believe in Satan?

No ma'am.

Do you believe in Christ, and in his power?

Ma'am, I'm not a Christian. (she never, incidentally, asked me what I was. I wouldn't have told her anyway, as I don't think it's therapeutically appropriate. I won't lie to a patient, but that doesn't mean that I'll give them information that I think will set them off. Bad. Extra bad in this case.)

Do you believe in the Bible?

I have seen one, so I think they exist, yeah (yes, I did actually say this. set her back for a few minutes).

Do you believe in EVOLUTION? Do you believe that you came from an ape?? (see, I told you this was like the evolution v. creationism threads!)

Yes ma'am, but I don't think that there is any conflict between the Biblical account of creation, evolution, and the creation myths of many cultures including the Ancient Egyptians, the Celts, Native Americans, the Germanic peoples ...

(she seemed satisfied with this as well. It worked with this very unfortunately psychotic woman in four-point restraints. Why doesn't it work with you guys as a line of reasoning?)

Do you read the Bible??

Not lately ma'am. I've been reading the Koran.

She spent a lot of time praying very loudly and begging and pleading with God to make me see the light and come to Jesus. She was a bit upset over my advising her that I wasn't terribly concerned over not being forgiven of my sins through the power of Christ, but settled back down a bit when I told her that I did accept the existance of the historical Jesus.

Aw, go ahead and lie to 'em. Be what they want you to be. What happened to the customer is always right? :lol:

Falls flat in the face of "don't ever become part of a patient's delusional system."

Are you saying that by strictly adhering to the truth, you're able to avoid this problem?

wouldn't they just believe what they're gonna believe anyway? I mean, isn't that part of the definition of delusional? How can your saying one thing or the other keep you on the right side of these tracks?

They believe what they are going to believe, yes, but working to keep the patient grounded in reality is part of beginning treatment. You also can't get into a pissing match with somebody over their delusions. It's kind of like walking a tightrope that occasionally moves unexpectedly. I guess what I'm really trying to get across is to say that you don't play into someone's delusions ... don't pretend to understand or agree with the conspiracy or whatever it is, because that WILL backfire.

It's really a lot easier sticking to the truth too ... you don't have to keep track of the lies. I also won't lie about little things like "The doctor will be right in to see you" when "right in" could be any period of time between 15 seconds and three hours. Most of the patients understand and respect that.

Wolf, you bring back memories for me. When I lived in Tucson, my temp agency had me working as receptionist/secretary for Pima County agency which did job counseling for mental patients with substance abuse problems (The emphasis was on getting them away from the substance abuse so that the underlying mental problems would not prevent them from living independently). So all day long I took phone calls from these poor souls or their supervisors, directed them to counseling sessions, and tried to be reassuring and keep them calm in the lobby while waiting for various doctors or social workers to see them. After a month the program director offered me a permanent job, telling me that I seemed to have a way with these people and a good grip on the work at hand while still being empathetic and friendly with everybody. I needed the work desperately, but I declined and told her I would have to be leaving instead. I explained that I would have to work 9-10 hours there and go home to the exact same situation for the rest of the day and night and I just could not handle it. My husband had alcohol abuse problems, his brother had died of an overdose, his mother was under psychiatric care, my father-in-law was adicted to Codeine and in a wheelchair, living on welfare, and my husband couldn't hold a job. (Of course this whole crew liked to get all incensed about how unfairly they were being treated and call our house to take it out on me and the husband, that is when the husband was not also taking it out on me). She said she was disappointed but understood perfectly.

There is only so much any one person can handle, no matter how strong they try to be. You have my admiration, Wolf, you are amazing. Hang in there.

My sentiments exactly. I worked in psych for only three years and crashed and burned. xobruce tells me there is a complete spectrum of nursing and I have been working the wrong end (for my particular personality.) It's not that I mind doing social work, I just would rather do it among the rich! ;) Dealing with nuts all day caused a major melt down for me. I admire wolf's dedication and compassion. I just couldn't do it anymore.

My wife used to do what Wolf does. She noted several instances of involuntary commitment by zealous parents of teenagers whose only psychological malfunction was being non-Christian. On many occasions, her pre-admission interview revealed intelligent, well-grounded kids, making good grades and characterized as being socially adept by their own parents. Their only "malfunction" was having the audacity to explore alternative spiritual paths, most particularly anything having to do with witchcraft.

Just one more area of the profound Christian bias in this country...and yet, increasingly, we are being told that Christian freedom of speech is being suppressed by activist judges...go figure.

Or, you know, the presence of some extremists in this country. The government wasn't committing them, their own parents were. Lots of parents are shitty in lots of different ways.

Paganism is not grounds for involuntary commitment in Pennsylvania.

Not on my shift, anyway ... ;)

When we get parents of bad teens in, typically the kids are majorly bad. Circumventing Columbine bad.

The hospital has to accept them for the committing to occur...

Drive-by comment
 

Might have something to do with the restraints.

Drop me a line if you get that apocalypse warning; we can do a group purchase on the ammo. :-)

Me too, I have a little room left on the credit card.

We can form a mutual reciprocity pact. Each can tell the other when the little voices tell us that it is time.

Maggie!!!! Hugs, honey! Long time no post!

Good idea on the group ammo thing. When you can have a full pallet drop shipped you can get a really good deal.

WB Mags, dave's not here any longer.

Welcome back.

BTW, ordering a metric ton of ammo is a nice invitation to the ATF to try for a second Waco. :cop: :rattat: :flamer:

Is this where you are thinking you have had enough, or was this just a more 'entertaining' week?

Have you ever had a patient where you can really just not see why he is so screwed up. just someone who you think - nope. no help for you, your born bad and you should be locked in a dark cell for the rest of your life. someone who you think - there was never any hope for you. cant see a good bone in your body.

Or is everyone saveable?

Some people are just plain broke in my opinion. This one kid we had come to us one evening was this skinny little white 14 year old. He'd been picked up down in the 9th Ward of New Orleans by the sheriff's department before he'd been shot. I was working with Big Al Laurent, 6'6" and 350, hence the big part. When the kid arrived on the ward he took one look at Al and yelled at the top of his lungs "Fuck you, you fat nigger!" Al's creole by the way. Yeah, the kid really knew how to make an entrance.

One of the highlights of the evening was when he ran and hid under one kid's bunk and we had to wake that kid up. It's really disturbing to the milieu to have to tell the paranoid kid on the ward that we were waking him up to pull another crazy kid out from under his bed...

Anyhow, back to the broke part, the new kid's mother was a deaf, schizophrenic, alcoholic, chain-smoker who had been raped by another resident of the institution she was sporadically required to attend.

You tell me, what is the likelihood of this kid turning out right?

No, not everyone is saveable. And not everyone I see is actually mentally ill. When a person is irreclaimable because of their own stupidity (drug users and criminals, for instance) I don't feel much for them. They did this, and they have to face the consequences of their actions, which are sometimes quite dire.

On the other hand, there are folks who are very, very crazy. They just are. Multiple attempts to stabilize these folks on medications have failed ... and often these are fairly bright people, folks that when they can grasp reality are pretty cool ... those are the ones who hurt.

These groups are usually separate from each other, but every now and then someone from group II will be an alcoholic or something.

There was a guy, Ross. Ross was someone that I saw if not every month, every other month. He was pretty mild mannered, drank like a fish, and became very suicidal every time he missed getting his testosterone shot (he had a condition called Klinefelter's Syndrome). It took us a while to figure out the suicidal/lack of testosterone link, but one we got it, it was one of those smack yourself in the forehead moments.

So anyway, poor Ross was not terribly functional. He was on welfare and SSD, hadn't worked productively in 30 or more years, and divided his time between the bar, his apartment, and the nuthouse. He had a few friends in the community, but was essentially a loner.

We knew Ross wasn't worth a whole lot to the world in the general scheme of things, but it's important to understand that we never treated him that way. And he let us know that he appreciated that care, and especially that respect that we gave him.

On one of his last admissions I was working with him and had let him out of seclusion to use the restroom. He emerged and I asked him to go back to the exam room, where I was going to lock him back up to wait for nursing to escort him to the unit.

He drew himself up to his full height (he was about 6'2") and said "no."

"Ross, whaddaya mean "no." You can't say no. You have to go back to the room."

"No, I'm not going in the room."

"Ross, if you go back to the room, I'll give you a cigarette." (bribery is an effective therapeutic tool."

"No, I'm not going!" (Ross, who was very soft spoken, actually shouted.)

"Ross, you're going to make me put on the gloves. You know I don't want to put on the gloves ..." (repeat patients know that prior to entering ass-kicking mode I put on a pair of black leather gloves)

He looked at me as I very deliberately and seriously reached into my back pocket for the takedown gloves. His shoulders drooped, his posture relaxed, and he truly looked defeated as he walked back to the exam room.

I went with him and sat with him a while, as he cried, telling me that he knew that he was a worthless piece of shit. I told him I didn't agree with him, and tried to help him regain what shreds of his dignity remained. And I gave him the cigarette. He cried at the thought that somebody gave a damn. Which I truly did. (I don't incidentally, get this way with all of my patients. some of them are one and done, some of the frequent flyers much less compelling. I couldn't survive if I did. You need to step away to keep doing this.

It was a month or two after that discharge that he was found dead, of an overdose that was believed to be accidental. He didn't leave much behind him in the way of a legacy ... few friends, no children, hadn't had contact with his parents in 30 or so year.

But I will always remember Ross.

Aw, Wolf. It must be so hard to detach yourself sometimes.

Not usually, which is why I can still do this.

Or If I care, I care for about 15 minutes and then I get over it.

You know, John Titor says that we should all know someone within 100 miles away and be ready to get there when the civil war breaks out this year.

If I promise not to proselytize, will you let me hang out witchyall? I'm voting slang, NBN and Wolf "the people I most wanna be friends with when all hell breaks loose".

Even I know someone about whom I can say ... "The world is going to end tomororw. X is ready for it."

Sure you can hang out. Proselytize away, I can use the practice.

So, what celebrity did you lock up tonight?

Oh, for the love of...

YAY! New Year's Eve Party at Wolfie's place everyone! Will that thing buy us all tickets out of the country, afterwards?
:celebrat: :guinness: :band: :bolt:

Finish it. ;)

pete.

Minor hijack: what's a John Titor? -- and why should we know him?

Purported time traveler. Google him, kind of an interesting bunch of info.

Pete? Griff has a Centurion card? :lol:

How do you think he got the goats?

Many Cellarites are experienced goat-getters.

Shush. You're gonna tip off The Man.

Too late, Griff! The goat is already out of the barn. I believe it was last seen headed in the direction of Sunsparkz's place. ;)

Too late...I'm already here.

Oh...sorry, bro. You meant THE Man.

No. A man, you're excused. :p

This was originally posted to the What I Learned Today thread, but someday I will go looking for it again, and I won't find it unless it's posted here.

Today's lesson: There are psychiatrists in the world who are too stupid to be allowed to continue to practice.


wolf: Hello, suicide hotline, how may I help you?*

Dr Stupid: Yes, I need you to send someone out to see this patient of mine

wolf: We don't typically just go "see" someone. Why should we?

Dr. Stupid: Well, she left me a message early this morning telling me she was going to kill herself, and she hasn't responded to any of my phone calls.

wolf: It's 7:00

Dr. Stupid: Yes?

wolf: At Night.

Dr Stupid: So?

wolf: You didn't do anything other than try to call your patient?

Dr Stupid: No, what do you mean?

wolf: Did you call the police?

Dr Stupid: Why would I do that?

wolf: To check and see if your patient is not answering her phone because she is dead.

Dr Stupid: Oh.

wolf: Do you need the number for 911?



* This is the only line not an actual quote from the call. What I really say is "Emergency Service." None of the "how may I help you" crap on the initial answer of a call.

heh

heh

heh


oh my god


and I'm still laughing at "Do you need the number for 911?"

This sounds to me like a classic example of being unable to see the forest for the trees on the part of Dr.

was she dead?

I will probably never know.

That part of the job would suck for me. Never knowing.

Tonight was one of those truly interesting nights ... not the regular nut business, though. That was pretty run of the mill.

One of my cop buddies showed up just to show off some pictures. Completed suicide, residence awash in blood ... wouldn't be really remarkable, except that the guy had been dead for a month.

No, I didn't get copies. Sorry.

grrrrooooooossssss!!!!!

Did he bottle the smell, too? :greenface

At one point I took a class in crime scene photography at a well known forensic school. For a while I thought it would be a good alternate career. Then I thought about all the images and smells I'd rather not have rattling around in my memory. I bet a little goes a long way.

Glad it was just pics, and not "scratch-n-snif".

Say, wolf...I hope you weren't along for this ride. But you're not involved with the in-patents there, as I recall...

Funny how the Times Herald got though the entire article without actually mentioning NSH by name.

Not one of my patients, that's the actual state hospital.

Reporter could have been confused about which sub program on the grounds the patient came from. I did find it interesting that they didn't name the patient. That's rare.

When I worked as an ocean lifeguard in southern CA, we had a "dead" book of all the corpses that had rolled up on the beach. It was my favorite.

Welcome to the Cellar, BabbleOn5. :D
I guess that book didn't have many autographed pictures.

A family brought a lady in last night. She was not really wanting to see the doctor, but agreed, just to please her family. My assistant came back from his interview, barely able to stutter out, "Oh man, she's crazy." Seems that Jehovah chose her for a mission, and she let my asst. know that he was among the Annointed.

Oh boy.

Probably not the best patient for me to deal with ... she likely had some Old Testament thoughts about witches.

So, I go out. She turns out to be the nicest person I've ever dealt with that was that far out there. She kept making reference to a variety of Bible stories that I don't remember, but luckily she believed that I was part of the tests from Jehovah, because although I knew the stories, of course, I wanted to make sure she understood them properly.

Oh, and I'm one of the Annointed too. Because of this her Angels told her to tell me everything, so I was able to complete my interview.

The Mission from Jehovah, is that this lovely young lady has been sent from Heaven to bring about the End of the World.

Everybody better get your affairs in order, because it's happening sooner than we thought.

Thanks for the heads up. Will we still have time for the last night of the local high school performance of West Side Story tomorrow?

???

When you're a Celt,
You're a Celt all the way
From your first dish of Haggis
To your last dyin' day.

When you're a Celt,
If the spit hits the fan,
You got Clansmen around,
You're a family man!

You're never alone,
You're never disaffected!
You're home with your own:
When company's expected,
You're well protected!

Then you are set
With a capital C,
Which you'll never forget
Till they cart you away.
When you're a Celt,
You stay a Celt!

That should be fine. Don't expect them to have an exceptionally long run, though. Jehovah is working on a short schedule right now. Many pressing deadlines.

Great job, Wolf. That is "active listening" at it's best. Seriously, good job.

But, I don't understand, if it's the end of the world, why do I need to get my affairs in order? It's only if the world continues do I have to have things straight when my time is over.

I have some other balls in play, so to speak, to try to fend off the end of the world.

Be just and fear not.

On the other hand, you might want to get your affiars in order, damn the torpedoes, praise God and pass the ammunition!