One Week After Working in an ED Psych Ward
At orientation, I overheard another consultant mentioning she didn’t want to work in the emergency department “because of the blood”. As a huge fan of chaos, mayhem and gore, I asked her if she’d like to switch. She eagerly agreed. She tactfully failed to mention, however, that the assignment was in the psych ward of the emergency department, behind closed doors and glass windows with behavioral health patients experiencing crisis. Needless to say, I had a nightmare the night before my first shift.
I began working night shifts. Patients from all walks of life were admitted (willingly and unwillingly) on a wide spectrum of mental health disease.
No night was the same.
No patient was the same.
No story was the same.
Initially, I was frightened by the thought of being around “crazy people”. I had seen Silence of the Lambs and Split. I had taken abnormal psych courses in undergrad. The fear of the unpredictability and unknown brought out my worst fears: I had visions of someone stabbing me in the throat in a fit of homicidal rage. I was worried about conversing with someone with multiple personalities or telling me they see things that aren’t there. It became evident, as I discussed my new placement with family and friends that, as a society, we’ve been conditioned to fear those with mental health disease.
Some of those fears, I found, were justified. On my first night, for example, a patient came in and asked, “what is the fastest way to get the death penalty?”. I waited for the punch line. Evidently, it was to shoot everyone in this entire emergency department. The following day, the same patient warned me, “you think you’re safe, but you’re not. Just wait”. It got under my skin. I wasn’t ready to die. I had just paid off my student loans.
As the night went on, behavior from some patients would escalate: like toys twisted to perform, they would get upset at specific times, be verbally abusive, apologize quickly after and then do it all over it again — it was like groundhogs’ twelve hour shift.
It was never ending.
It was unnerving.
It was exhausting.
After the first two nights, the yelling and threats began to wear off. Instead of cringing behind the glass window to make myself disappear, I began to look up. There was one person I’ll never forget. He had this routine of pacing back and forth around three in the morning. After being in the psych ward for several days, he was becoming visibly restless and agitated. With his pacing, he began to wake up other patients who now wanted to walk as well. Imagine social hour at three am with all of the psych patients mingling over cranberry juice and turkey sandwiches asking each other, “so what are you committed here for?”.
The situation was getting out of hand. The nurse urged him to take his medication. After the administration, he was more calm.
We talked about rap (do you prefer Tupac or Biggie?), pharmaceuticals, politics and food. His knowledge was limitless. He knew about specific precursors in chemical reactions, details from political campaigns in the 90s, exact names of foreign cuisines across the world, lyrics from mainstream rap to lesser known music, how to crack a joke successfully and how to be polite even when it was difficult.
Incredibly enough, he even advocated for himself (and other patients) to not be overly medicated at the first sign of agitation. He pleaded for empathy. In an eloquent, timely and emotional argument, he called for better practices, asking those designated to take care of him to be more patient and empathetic. As he stood in front of me and engaged in conversation, with medication rushing through his blood stream, he showed me that he was more than just a patient with schizophrenia.
He was a person who chose Tupac over Biggie.
He was an athlete that loved martial arts and yoga.
He loved tuna sandwiches but politely declined taking mine if there weren’t anymore.
He was one of the most intelligent human beings I’ve ever met. With schizophrenia and non compliance with his psychotic medications, however, he was considered broken in our society. I couldn’t shake the feeling that the way we treat psych patients, medically and socially, was also broken.
Who was he? How did he get here? What was his childhood like? In an alternate reality, where would he have been in life? What if he had more robust services that provided mental health promotion services as he was growing up? What if our facilities were more holistic, more empathetic and more skilled to address his problems? What if we saw him as a person rather than as a concoction of chemicals? What if we provided him with a treadmill instead of an injection after being enclosed in a room for days?
We do not discriminate against patients with other diseases but with mental health disease, we begin to see the patient less of a human. Although both patients are affiliated with a disease, we treat a patient with schizophrenia very differently than a patient with heart disease. Why? Are we not appropriately trained with psych patients? Are we burnt out? Are we scared? Although all of my interactions with him were polite, professional and courteous, I couldn’t shake the shame and guilt with how he was being treated.
It felt like we were failing to help him in the ways it truly mattered.
Mental health was an abstract concept a week ago.
It was a Trump headline or an evening news segment.
Mental health disease, nowadays, is something I look in the face every night. It is the high school student who wants to hurt himself. It is the grandfather with dementia. It is the father with extreme paranoia. It is the young mom who began cutting herself again. It is the genius with schizophrenia and a lopsided smile.
Mental health disease is real. Mental health disease is pervasive, hidden and insidious. It is in our loved ones, our colleagues at work, our neighbors, our friends, in our own brains.
We cannot hide behind glass, creating more boundaries, distance and mistrust. We need to create more empathetic and compassionate communities that do not fear and alienate those with mental health disease. We need to practice medicine in ways that still sees the person with the mental disorder, rather than a disease with a body, incapable of logic, understanding and conversation.
For everyone’s sake, we must become better with mental health disease in our communities and hospitals. We can be better. We can do better.
I would love to hear your thoughts on this! Please comment below.