Thursday, November 06, 2014

Margaret the agitated, hallucinating schizophrenic visits the emergency room

She was seen talking to herself, minding her own business. I'm sure she talks to herself all the time, she is mentally ill. This is her daily life.

The police were called because she was talking to herself and making people uncomfortable. Of course she was confused. Police called ambulance. Ambulance brought her to us of course.

She was confused and agitated when they took her in the ambulance. So they restrained her. She arrived in restraints and on a hold.

When she arrived, we debated whether to keep the restraints on.  Here's the thing: she weighed 300 pounds. If she got out of control, somebody could get hurt. Decided to keep two restraints on. She went to the bathroom soon after arrival.  Spent too much time in there until I had to make her get out. Went back to the room and started pacing the room. After 15 minutes of asking her to lay down, she finally did.

OK, whew, at least she is under control.  Security on watch. Let me start the restraint paperwork which means charting about 15 things every 15 minutes.

She continued to be agitated, trying to get up.Security and I spent lots of time trying to redirect her.  I could tell she was in her own little world, talking to at least three other people. Eventually, I gave
her meds, not sedatives, anti psychotics. Didn't work.  Finally talked the doctor into something to sedate her. She calmed down some. I took the restraints off.

She went to sleep. When she woke up, she would pace the room, try to walk out the door.

Of course, she would be admitted for about the 4th time in the last 6 months. Here's the thing: no beds available at our hospital.  Getting a psych bed at our hospital is impossible these days. Of course there were no other psych beds in the city either. They were looking at a bed two hours away.

When Iest 12 hours later, she was still there, up walking back and forth in the room. She'll probably be there in the morning, pacing and talking to herself. This is the lot of mental health patients in emergency departments these days, waiting hours and hours, sometimes days for nonexistent beds.


Mathi Bear said...

Sounds familiar. It is also the mismanagement of cases like this that means there are no psych beds available for the acute psych emergencies.

Anonymous said...

Well written, and oh so true!
It's same situation in every ER. Including ours. Boarding Form 1 and admitted patients in The ER for days on the new reality we face. Have any hospitals found creative solutions to this issue? Looking for inspiration!

By the way, great blog...keeps me sane knowing your out there posting! Keep up the fantastic posts!

Mark p.s.2 said...

More money for a system that doesn't work. Brilliant!

Firstly , society can not jail people before they have committed a crime. The hospital is a jail if they can not leave,

Second , society can not give drugs to people who are not physically sick.

The drugs (you call medications) cause the very problems you seek to cure.

"The antipsychotics block 70-90 percent of the dopamine receptors in the brain. In (response) return, the brain sprouts about 50 percent extra dopamine receptors. It tries to (compensate) become extra sensitive. So in essence you've created an imbalance in the dopamine system in the brain. You (now) have too many dopamine receptors. And what happens? People that go abruptly off of the (antipsychotic) drug, do tend to have severe relapses." author Robert Whitaker

Mark p.s.2 said...

Dr. Joanna Moncrieff psychiatrist & senior lecturer on withdrawal