Night Call at EPS

Last night, I had one of our three mandatory call nights at the local emergency psych service. We were pretty much slammed the whole night, and it was certainly an interesting experience, if nothing else. Some of the patients were funny, some were touching and kind and knew they needed some help, some were sad, some were strange and a little frightening. Here's a glimpse of what we dealt with.

First up was a teenager* with depression. We think he was just lonely, because when he was brought in, he kept telling us that he wanted to commit a crime so he could go to jail and join a gang, but no one would let him. We called his mom to let her know where he was, and sent him home.

Next on the roster was a man who told us about the 6 spirits that live in his house, one of whom inhabits his body, and makes him do things like stick his tongue out at people without meaning too. He wanted to get admitted to a local hospital, but his insurance was too good so we tried to find alternatives.

I also spoke with a lady who spent almost half an hour just explaining her medical and surgical history to me, who was hearing voices and very tearful about the idea that people would think she was crazy. According to the doctors I work with, she was extremely delusional, seen there many times, and most of her health problems probably weren't real either.

Among other highlights were a teenager who got in a fight with his parents over moving out and going to college, a patient whose mother brought her in because she found her walking down the street in the middle of the night backwards because she needed to find god and ward off the devil, and a lady who, when I asked why she was there, spent 15 minutes telling me about her dental work she wanted done (apparently, she was threatening people in her apartment building, and someone called the police).

All in all, psych can be fascinating, but I think what I could never do is deal with patients who you just can't help. I mean, as a general practitioner you see lots of patients with chronic problems who come in for the same thing over and over, but usually you can offer them symptomatic relief if nothing else. In psych, no matter what drug you use, there's a decent chance it won't work and the voices will still be there, preventing the patient from having any semblance of a normal life. And that, I think, is just too sad and frustrating for me to do day after day.

*All names, identifying details, etc. have been removed and/or changed from this post.