Danger to Self: On the Front Line With an ER Psychiatrist by Paul Linde

Author:Paul Linde [Linde, Paul]
Language: eng
Format: epub
Tags: Medical, Health Care Delivery
ISBN: 9780520944558
Google: 3tAcbmsN7e8C
Amazon: 0520269837
Publisher: University of California Press
Published: 2009-12-08T05:00:00+00:00

SEVEN

THE CLAIRVOYANT

Whose Life Is It Anyway?

“That was a profoundly decent thing to do,” said my psychiatrist. I had just finished telling him about my meeting with the father of a young man, a one-vI sit patient now deceased, whom I had discharged from psych emergency only to have him commit suicide three days later by hanging.

I thought I detected soft tears in his eyes as he said this, but I couldn't be sure. Sometimes decency is all anyone has to offer to a grieving person. Yes, I could give myself credit for that. But one cannot undo what's been done—a man, a father like me, had not only lost his son; he'd lost his son to suicide, a supposedly preventable death.

I met with the young man's father for about half an hour outside the hospital, on a bench, under a warm spring sun. I did not hold back. I only vaguely considered the medico legal consequences. I was guided by my conscience and my wish to provide comfort. “In retrospect, I wish I had made a different decision,” I told him. “I wish I would have put him in the hospital, but I can't go back in time. I used my best judgment at the time. I'm sorry.”

On the day in question, I read through the patient's paperwork—the medical clearance, the paramedics' notes, the psychiatric hold written by the police—before seeing him. It says that the young man's father had called 911 at about two in the morning. He had reported that his son had taken an overdose of ibuprofen while intoxicated. Most of the one hundred pills—in a bottle previously full of two-hundred- milligram ibuprofen tablets—were gone.

When police and paramedics had arrived on the scene, Will O'Brien was difficult to rouse. The police officers placed him on a seventy-two-hour involuntary psychiatric hold, and the paramedics transported him to SFGH's Emergency Department. He was medically evaluated, given charcoal via a nasogastric tube, and then observed and monitored for several hours before being transferred to the Psychiatric Emergency Service on the basis of the “danger to self' criteria of the 5150 law.

Will O'Brien arrives in psych emergency on a Saturday morning, and I evaluate him early that afternoon. My contact with him begins when I go find him in the dayroom. He looks even younger than his stated age of twenty. He sports a peach-fuzz beard; probably he needs to shave no more than once a week. Activated charcoal still ringing his lips, Will appears downcast and says nothing.

This afternoon in the dayroom, a young woman picks at scabs on her forearms, moaning, gently banging her head against the wall, probably in response to traumatic memories or hallucinations. A very thin, wound-up little old lady paces back and forth, singing old Broadway tunes repetitively, loudly, and off-key. Two young men, clearly county jail graduates, yell at each other, threatening to punch each other's lights out: “Who you callin' dog, dog?” A middle-aged man puts his hand down his pajama bottoms and rolls his eyes.

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