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Don't Get Sick - Mental Health in the ED

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"I can't pee."

"How come?"

"They froze my urethra! They got mad that I didn't listen to them and they froze it and now I can't pee."

"Who did?"

"The voices."

I look at him closer. He's a good looking man, with his non-blinking blue eyes and silver buzz cut, in spite of the blue paper scrubs. That's the uniform our mental health patients wear. It makes them easy to distinguish from the other patients, those who can come and go as they please. The blue patients get no more than supervised bathroom privileges. It also prevents them from ripping the cloth to make a noose and hang themselves. It saves on laundry...

He smiles politely, clearly enjoying our chat. That's a welcome change from being sworn and spat at.

"How did they freeze it?"

"By remote control. They put in a chip."

How, I wonder? I wish I had that technology. It would do wonders for my incontinent patients. Beats adult diapers every time.

"Have you had any thoughts about hurting yourself or anybody else?"

"No. It's the wolf-pack."

"The wolf-pack?"

"Yes. They told me to kill myself but I didn't. That's why they froze my urethra."

I nod. I get it.

Some days it's the FBI. Some days it’s God. Some days it's the devil. Today it's the wolf-pack.

Today is my blue day. Besides my regular share of heart attacks, STDs, and diarrhea, I’m in charge of half a dozen (give or take) mental health patients. They're all waiting for something - medical clearance, mental health evaluation, or a psychiatric bed. There are only three mental health safe rooms, so half of them are in the hallway, watching the action, until they become the action.

Some are sick, like "wolf-pack."

Some are sleeping off yesterday's liquor. Since they were too drunk to walk or maybe they texted somebody that life’s too hard, police picked them up and dropped them in the ER. Where else?

There are kids who are out of control – some as young as 5. Their parents or teachers called police to bring them over, hoping for a magic pill to transform them into little angels.

There are demented old folks who bit their nurse or peed in the sink and the nursing home sent them here. They didn't know who she was. They don't know who they are. And the sink looks pretty much like a urinal.

Some tell me they'll kill themselves if I don't give them Dilaudid or Xanax. Both if possible.

Some need attention. They took 4 tablets of Motrin or scratched their wrist with a paperclip, aiming to die.

Some are lonely, despondent, and unable to cope - their wife of fifty years died; the cat, their only friend, got run over by a car; their kids never call. They no longer want to live this way.

They're all mine.

They wait for hours, days, sometimes weeks in the ED purgatory with no hope in sight. They get bored to death sitting in their windowless rooms watching the walls.

They are humiliated, on display in the hallway like animals at the zoo.
They are needy. They need nicotine patches, sandwiches, a third warm blanket, a fifth cup of coffee - not decaf - with four sugars and milk. They need so many things that the ED can't give them.

They swallow curtain rings and forks to buy themselves an endoscopy and the sedation that goes with it. They punch walls and eat the paint.

They get angry, threatening, and belligerent and try to elope or fight. For their safety and ours, we need to sedate and restrain them.

They start flirting with the blue patient next door or get inappropriately attached to the staff that changes every shift, reinforcing the rejection.
They wait. They wait some more. They wait for a long time.
The lucky ones go home.

Some will come back tomorrow, and the day after that, and the day after that.

Some get admitted. Some return the day after they get discharged.
Some have nowhere to go. They can't live on their own, they have nobody to care for them, and there isn't enough room in the very few long-term care facilities still left.

Some have no insurance.

This is mental health Emergency Care in today's America.

Don't get sick.

Rada Jones M.D. is an Emergency Physician practicing in Upstate New York . She lives with her husband, Steve, and a deaf black cat named Paxil. She is working on publishing her first novel, Overdose, an ER Thriller where a lot of people die in exciting ways and the good guys drink like fishes. Find out more at, instagram RadaJonesMD and twitter @JonesRada.

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