Just another ordinary day on psychiatry...

A few days ago our psychiatry team was asked to see a gentleman with a history of schizophrenia who was scheduled to have a surgery that would help him fully recover from cancer. At the last minute, the man changed his mind and threatened to leave the hospital AMA. We went to visit him in his hospital room and found him fully clothed, packed, and ready to leave. As our fearless leader begins to talk to him, something about the man becomes obvious. That day he was truly not capable of making decisions for himself. He was delusional, stating he had a necrotic scrotum (which, unknown to me, is an imaginary complaint that schizophrenic patients commonly report). He also started talking about people all around him being his children because they look like him and that 3 year olds look like adults because of their high metabolic rate. It went on and on. Our attending made the decision that the gentleman needed to be EOD'ed to our psych ward for a few days to get him stabilized on his medications so that then he could make a proper decision about his health. He went on to see the next patient and left us to break the news. I should have anticipated this plan would not go over well with our new patient. He became angry, shoving our resident aside and heading toward the elevator. Our resident, not knowing quite what to do, went after him. I caught up with them just in time to see my resident come flying out of the elevator. Apparently, the guy shoved her pretty hard. I went by the nurses station and told them to call security because we just had a patient assault one of the residents. The nurses just stared at me in shock and said, "what?". I repeated myself and all of a sudden, 20 people were headed to the elevator to help out. Apparently, this much excitement on 2-East is rare. At the elevator there wasn't much to see, really. Our resident was standing in the way of the sensor so the doors wouldn't shut and our patient was inside yelling at her to move and trying to push her out of the way. Pretty soon, the police came and the man calmed down. He wasn't too thrilled about going to the psych ward but he cooperated since he had no choice. During all this, our head psychiatrist walked up, paused, and stated, "I think we made the right decision".

Lately I've been thinking about this man. He didn't mean any harm to anyone, he was just afraid. Maybe he was afraid he would be forced to have the surgery, I don't know. What I do know is that there are thousands of people in this country like him. He is lucky because he lives with this parents. What will happen when his parents are no longer able to care for him? If he is lucky, arrangements will be made for him to go to a group home. If he's like a lot of the mentally ill, he will live on the streets. 1% of the population has or will develop schizophrenia. They don't ask for it, and they certainly don't want it. Some of them can function at a pretty high level, but a lot of them detach from society and begin a lonely downward drift to homelessness.

As much as I complain about things in life that aren't fair, I am thankful that I have a clear mind- one that doesn't hear voices or think people are out to get me. I wasn't ever abducted by aliens and I don't get special messages from the people inside the TV. Instead, I go through my hardest days and feel pretty secure that I will sleep in a warm bed, eat a good dinner, wake up in the morning, and start a new day.