Tuesday, September 06, 2005

Out of the Frying Pan

Today I was involved in a scene at a patient's home that was straight out of a movie. My patient, a middle-aged man not born in this country, has a history of polysubstance abuse, Hepatitis C, violence, a personality disorder, and a former life of foreign miltary service with a history of committing and witnessing violent acts of warfare. I will not disclose his city of residence, age, or his country of origin.

People involved in this gentleman's care are often afraid of him. He can cut an imposing figure until you look into his eyes and see the wounded child crouching in his heart. This man lives in fear and psychic pain, and his family member with whom he lives also lives in fear and pain. I was called to the home because it was apparent that my client had possibly taken way too many antipsychotics and benzodiazepines over the weekend, prescribed medications that he will frequently supplement with crack cocaine. The fact that he has recently been under threat from a local gang does not inspire confidence in his coping and interpersonal skills.

Based on an urgent request from the primary physician, my unannounced arrival to the home with a third-year medical student in tow did not meet with a warm welcome, although his family member was relieved that we had come. When the situation became somewhat threatening, I was sure to always keep myself between the patient and the medical student in my charge, and constantly de-escalated the conversation and redirected the patient to why I felt he should go to the hospital.

At one point, my patient was on his hands and knees in the kitchen, babbling incoherently in his native tongue mixed with English, crying like a baby. Shortly after, only semi-coherent and walking very unevenly with eyes at half-mast, he exited the home to smoke outside and I knew that there was no stopping him. From previous experience, I understood that physical touch of the most minimal kind could send him over the edge, so I simply followed him outside, leaving the medical student to chat calmly with the family member, who, when asked, reassured me that there were no weapons in the home. (Later, I would glean a great deal of information from the medical student, who truly got an "ear-ful" while I was outside.)

Once outside, speaking with the primary doctor on my cellphone, I asked her to call 911 and request a police cruiser and an ambulance. After fifteen minutes of following my patient up and down the hot street, the ambulance arrived and we coaxed him onto the stretcher as he whimpered and pleaded for mercy. The police arrived ten minutes later when we were getting ready to leave the scene and return to the clinic. Better late than never, I guess. They must have been at Dunkin Donuts.

This was simply a 60-minute scene at the end of a day filled with telephone calls of desperation, illness, another unfolding crisis, two lovely and uneventful home visits, and the odd prescription refill. A day in the life.

So here I sit on the porch, the frogs and cicadas beginning their evening chorus, and I prepare to officially document all that I did at work today before I forget the gory details. It was a rude awakening from a perfect weekend, and I'm pretty sure I missed the frying pan.
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