Tales from the Nuthouse: Lest You Think I have a Really Suck Job
 

One of the entertaining things about what I do is that I never know what each night will bring me ... Will I track someone else's feces into my house, or will I be touched in some way, save a life, or hear about one ending? Sometimes this is all in one night.

Tonight I worked with a fellow who just hasn't been doing well lately. He's been back in the hospital with a quick turnaround time ... a couple of weeks ago he'd gotten out of another hospital that day and didn't last out the ride home with his case manager ... this time he'd been out for not quite two weeks, but wasn't maintaining well. His apartment was a shambles, he was dishevelled and malodorous (this means he looked scruffy and was stinky), and he wasn't making sense much of the time. So, we get him in, the doctor sees him, and decides to admit him. I now have to call his insurance company and see what I can do about getting paid for admitting him. We eat about a half-million dollars each year in unfunded treatment ... I'm the first step in the chain that lead to operating capital, so I do my darndest to get people authorized for treatment (if you've ever been to any hospital, not just a nuthouse, a good portion of the time you spend waiting has to do with someone arguing with your insurance company to get your treatment paid for).

So, I'm talking to the care manager at the insurance company, and give the patient's name. Her response is totally off the cuff, as it's a somewhat unusual name ... "You mean like [first and last name of nationally known murderer]?" "Yeah," I reply. "This is his brother. And he insists that his brother is totally innocent of the crime." "You're kidding me, right?" "Nope. Totally serious. Really is his brother."

Just as I'm finishing up on this fellow's paperwork, I get my next joy of the evening. An older woman who was religiously preoccupied.

I mean really religiously preoccupied. I was reminded of one of several evolution threads here.

Satan is at large in the world, you know, and first will come Armageddon. Well, actually Armageddon will come after the Great Tribulation which will precede it.

Okay, ma'am. Could you tell me though, what's the Great Tribulation?

(I don't think she actually knew ... she just told me to read Revelations. Apparently the whole deal is revealed there or something. I tried to get some more details on the scheduled date for Armageddon, but apparently she hasn't been given this information yet. It would be helpful for me to know, as I need to make a point of buying extra ammunition.)

Do you believe in Satan?

No ma'am.

Do you believe in Christ, and in his power?

Ma'am, I'm not a Christian. (she never, incidentally, asked me what I was. I wouldn't have told her anyway, as I don't think it's therapeutically appropriate. I won't lie to a patient, but that doesn't mean that I'll give them information that I think will set them off. Bad. Extra bad in this case.)

Do you believe in the Bible?

I have seen one, so I think they exist, yeah (yes, I did actually say this. set her back for a few minutes).

Do you believe in EVOLUTION? Do you believe that you came from an ape?? (see, I told you this was like the evolution v. creationism threads!)

Yes ma'am, but I don't think that there is any conflict between the Biblical account of creation, evolution, and the creation myths of many cultures including the Ancient Egyptians, the Celts, Native Americans, the Germanic peoples ...

(she seemed satisfied with this as well. It worked with this very unfortunately psychotic woman in four-point restraints. Why doesn't it work with you guys as a line of reasoning?)

Do you read the Bible??

Not lately ma'am. I've been reading the Koran.

She spent a lot of time praying very loudly and begging and pleading with God to make me see the light and come to Jesus. She was a bit upset over my advising her that I wasn't terribly concerned over not being forgiven of my sins through the power of Christ, but settled back down a bit when I told her that I did accept the existance of the historical Jesus.

Aw, go ahead and lie to 'em. Be what they want you to be. What happened to the customer is always right? :lol:

Falls flat in the face of "don't ever become part of a patient's delusional system."

Are you saying that by strictly adhering to the truth, you're able to avoid this problem?

wouldn't they just believe what they're gonna believe anyway? I mean, isn't that part of the definition of delusional? How can your saying one thing or the other keep you on the right side of these tracks?

They believe what they are going to believe, yes, but working to keep the patient grounded in reality is part of beginning treatment. You also can't get into a pissing match with somebody over their delusions. It's kind of like walking a tightrope that occasionally moves unexpectedly. I guess what I'm really trying to get across is to say that you don't play into someone's delusions ... don't pretend to understand or agree with the conspiracy or whatever it is, because that WILL backfire.

It's really a lot easier sticking to the truth too ... you don't have to keep track of the lies. I also won't lie about little things like "The doctor will be right in to see you" when "right in" could be any period of time between 15 seconds and three hours. Most of the patients understand and respect that.

Wolf, you bring back memories for me. When I lived in Tucson, my temp agency had me working as receptionist/secretary for Pima County agency which did job counseling for mental patients with substance abuse problems (The emphasis was on getting them away from the substance abuse so that the underlying mental problems would not prevent them from living independently). So all day long I took phone calls from these poor souls or their supervisors, directed them to counseling sessions, and tried to be reassuring and keep them calm in the lobby while waiting for various doctors or social workers to see them. After a month the program director offered me a permanent job, telling me that I seemed to have a way with these people and a good grip on the work at hand while still being empathetic and friendly with everybody. I needed the work desperately, but I declined and told her I would have to be leaving instead. I explained that I would have to work 9-10 hours there and go home to the exact same situation for the rest of the day and night and I just could not handle it. My husband had alcohol abuse problems, his brother had died of an overdose, his mother was under psychiatric care, my father-in-law was adicted to Codeine and in a wheelchair, living on welfare, and my husband couldn't hold a job. (Of course this whole crew liked to get all incensed about how unfairly they were being treated and call our house to take it out on me and the husband, that is when the husband was not also taking it out on me). She said she was disappointed but understood perfectly.

There is only so much any one person can handle, no matter how strong they try to be. You have my admiration, Wolf, you are amazing. Hang in there.

My sentiments exactly. I worked in psych for only three years and crashed and burned. xobruce tells me there is a complete spectrum of nursing and I have been working the wrong end (for my particular personality.) It's not that I mind doing social work, I just would rather do it among the rich! ;) Dealing with nuts all day caused a major melt down for me. I admire wolf's dedication and compassion. I just couldn't do it anymore.

My wife used to do what Wolf does. She noted several instances of involuntary commitment by zealous parents of teenagers whose only psychological malfunction was being non-Christian. On many occasions, her pre-admission interview revealed intelligent, well-grounded kids, making good grades and characterized as being socially adept by their own parents. Their only "malfunction" was having the audacity to explore alternative spiritual paths, most particularly anything having to do with witchcraft.

Just one more area of the profound Christian bias in this country...and yet, increasingly, we are being told that Christian freedom of speech is being suppressed by activist judges...go figure.

Or, you know, the presence of some extremists in this country. The government wasn't committing them, their own parents were. Lots of parents are shitty in lots of different ways.

Paganism is not grounds for involuntary commitment in Pennsylvania.

Not on my shift, anyway ... ;)

When we get parents of bad teens in, typically the kids are majorly bad. Circumventing Columbine bad.

The hospital has to accept them for the committing to occur...

Drive-by comment
 

Might have something to do with the restraints.

Drop me a line if you get that apocalypse warning; we can do a group purchase on the ammo. :-)

Me too, I have a little room left on the credit card.

We can form a mutual reciprocity pact. Each can tell the other when the little voices tell us that it is time.

Maggie!!!! Hugs, honey! Long time no post!

Good idea on the group ammo thing. When you can have a full pallet drop shipped you can get a really good deal.

WB Mags, dave's not here any longer.