My Trip to the ER: Attention Must Be Paid
I’m a psych patient. My primary diagnosis is bipolar II, but there’s a little anxiety, PTSD and other stuff mixed in. I’ve been dealing with it for decades. Sometimes I’m really stable and sometimes less so. The last several weeks fall into the “less so” category.
I spent several hours recently in one of our local ERs. It ranks as the all-time worst experience with medical personnel of all stripes that I have ever had — and that, I assure you, is saying something.
My therapist has been increasingly concerned about my physical condition, to the point that he called a nurse friend of his to come up and look at me in the middle of our most recent session. She was sufficiently worried that they agreed a trip across the street would be in order. My therapist, G., called ahead, filled them in on my symptoms, and said we were on our way, then walked me over.
I don’t know if being accompanied by a mental health professional had anything to do with it – my guess would be a resounding yes — but I was triaged nearly before I got my butt in a seat in the waiting room and put in an “acute care” room.
Different hospitals call them different things, but the name doesn’t really matter. It’s what they’re missing that matters. Among those missing things: Cords, sharp objects, sharp edges, pictures on the wall, your clothes, keys and belongings, which disappear immediately in favor of paper scrubs or a gown where everything is visible. Generally there is a cop or three standing across the hall, peering in at you every so often.
This one also had a closed-circuit TV and no fewer than three giant red “panic buttons” for staff who might find themselves with particularly agitated patients.
After that description, I bet this won’t surprise you: It turns out that nobody paid attention to anything G.’s nurse friend or he himself said.
The first physician who saw me said, “So you came in for a fever?”
Umm, no. The fever was minor, and just the beginning. It happened to be at the top of the symptom list G. and the nurse wrote down, or it probably would have been overlooked.
The doctor continued on to ask if I had a runny nose and sore throat. Again, no – not something I would have taken up ER resources for.
So, even though what had concerned G. and the nurse had been typed into my electronic record and read over the phone to the admitting clerk before I got there, I had to try to remember it all. I have severe brain fog these days, and when I’m not feeling well anyway, I’m not exactly reliable.
I did manage to mention the meds I’m on. G. thinks perhaps there is some toxicity going on. I have no idea if there is a way to measure Abilify, which just got added to my regimen. But I know for sure Depakote and lithium can be tested for. One of the two made it onto the lab panel. One didn’t.
I was asked if I wanted to see a psychiatrist. I said yes, as the reason I’ve been seeing a therapist three times a week recently is so he can make sure I’m still breathing.
The psychiatrist told me she didn’t understand why I wanted to see her:
“I read your history and you have chronic suicidal ideation [which is untrue] and you’re bipolar and you seem fine to me.
“I mean, not that I’m trying to be dismissive or anything.”
She didn’t have to try at all. She just was.
I don’t know what part of “I spend basically 24/7 thinking about wanting to die” she didn’t comprehend. I told her that I’ve been maxing out the PHQ-9 (a quick quiz that measures the presence of depression and its severity) for weeks, and she said, “Yeah, you’ve probably got those questions memorized by now.”
Which is unfair, because while there are a couple of those forms I can fill out in my sleep (and I do), that one I take seriously. I really try to determine how I’ve been feeling — and how I’ve been feeling has led me to max it out for weeks.
But it got better. She came back a bit later and asked if I lived in an adult foster care home.
“Yes, I’m the caretaker,” I said.
“OMG, I’m so sorry,” she laughed. And then left.
Yep. You just told me five minutes ago I seemed fine to you and couldn’t benefit from some intensive therapy and a med assessment, but I seem somehow screwed up enough to be a resident of a traumatic brain injury home instead of a worker there?
The (male) nurse who was on duty had his moment in the sun too, but I’m still too frosted to talk about it. (Also, it might not quite be fit for public consumption.)
And do you know what? Nobody ever really addressed the medical issues I went there for. They sent the nurse in, four hours or so after it all started, to tell me my lithium level was low and I could go home. I didn’t even get a suggestion to follow up with my primary care doc.
My very first psychiatrist asked me if I thought it was an accident I was a communications major, because he had never met anyone so desperate to be heard.
I have struggled for a long time with my mental health. It has mightily affected my life. But it doesn’t define who I am.
Can you hear me now?
Czernicki, C. (2013). My Trip to the ER: Attention Must Be Paid. Psych Central. Retrieved on October 6, 2015, from http://psychcentral.com/lib/my-trip-to-the-er-attention-must-be-paid/