After hanging upside down and sideways for an hour, we went to Mother's Cafe and Garden (http://www.motherscafeaustin.com/) a few blocks away to eat a really good vegetarian lunch. And after that, we visited the Austin Faces AIDS photo exhibit. I've mentioned this already in my blog, one of my fellow volunteers is pictured in it, and surprise, surprise - I discovered someone else I know is also in the exhibit. It's beautifully done and it's free; you should check it out. Here's a link to the video work of the exhibit. http://vimeo.com/channels/austinfacesaids. It was a warm, sunny gorgeous December day.
So on to work the next day. (Again, I'm changing a few details to maintain confidentiality.) Not a bad shift, working with two of my favorite people, Curtis in charge and Gilbert. The PICU wasn't too riled up, we weren't in the med room sharpening our needles too often. I discharged four patients and part of the process is that we hand back their valuables that were locked in the safe. The patient goes over everything, verifies it's all there and signs for it. One of my discharges is thumbing through his wallet and I see a big "Registered Sex Offender" card. Interesting, because I didn't get any information about this in report and I realize that I was alone with him in the room at various times during the day -- and yes, I probably would've done that even if I'd known his history, but still....it's nice to know and plan how close your back needs to be to the door. Of course, the most likely explanation is that he didn't disclose any of that when he was admitted. That's a very big issue in mental health -- figuring out what is true from patient stories and surmising what gets left out. It's quite an important skill and one I know that I really don't have yet.
Amusing moments were provided by use of the phone on PICU. We have a phone for patients to use on each unit - but the PICU's (that's psych intensive care unit) wasn't working. So we pulled a phone across the nurse's desk and placed it at the dutch door for patients to use at various times. Normally we don't hear their phone conversations, but this day we heard them all. Several times I felt sorry for the government worker on the other end of the line as patients attempted to sort out some problem with SSI, their parole officer, or some kind of assistance. I wonder if they received special training on dealing with the mentally ill caller. Calls to family and friends sometimes offered insight. One caller was offering a long, rambling explanation of how she ended up with us. It involved her driving around the whole Austin metro area, trying to pay off all her parking tickets. Somehow that whole experience was too stressful for her, she ended up losing her cool with the friend taking her on this errand, and he deposited her at PES (Psych Emergency Services). As she recounted her frustration with this, her voice got louder and louder (apparently, the boyfriend didn't offer a sympathetic ear), "I said...I had to pay these parking tickets!" Then quickly, in the blink of an eye, she's calm, chuckles a little and says, oh it's snack time....I'll call you later. And it's over. I have new empathy for the patient, for I can only imagine the stress of driving through Austin traffic all day, and on such a depressing errand. Those of you not from here may not understand - Austin traffic is particularly bad, on many lists it's in the top 10 worst cities of the nation. The city council thought in the 1970's and 1980's that if they just didn't build a good highway infrastructure, people wouldn't move here. Austin has always had a thing about wanting to keep itself small & funky - which I totally appreciate - but look how that plan turned out.
I've been looking at the charts a little closer, especially at the forms and documents that I'll be responsible to fill out after I graduate. I noticed that a new term seems to be emerging, and I don't like it. Some of our patients are admitted after a confrontation with police where they make gestures that they hope will incite the police to shoot them and end their misery. In the past, we called this "suicide by cop". I noticed that the newer term (I guess more politically correct) is "police-assisted suicide". I really think that creates a false impression -- like, are they Dr. Kevorkian, standing there with a syringe? I think not. I'm going to stick with the old term.
In the rush of the morning, something absolutely funny happened. Mornings are busy because the majority of medication is given then, discharges are being prepared, and all the office personnel are at their desks. So at our nurse's station, we had two social workers, two doctors, three nurses, a unit coordinator, a rec therapist, and a mental health tech. Oh, and a pharmacist. Gilbert drops his pen while he's standing at the dutch door having a patient sign their discharge papers. After he picks it up, the patient says loudly "Hey, I saw your joker tattoo.". Gilbert looks startled, says, "What joker tattoo? I don't have any tattoos." "It's on your ass. I saw it when you bent over." Now everyone at the desk (me included) snaps around their head and is looking at Gilbert. He's blushing, starts to argue again with the patient....then realizes what he's doing and just shuts up. (note to self: don't argue with patients on PICU) Things move on and we get back to work. Later, Gilbert tells me he definitely does not have a joker tattoo on his ass, and I believe him. I remark that the only way he could've convinced all of us at the time, however, was to show us his ass. So where did the patient come up with that? If he was angry with Gilbert, that certainly was an effective way to get back at him. I bet half the people that witnessed that exchange now think Gilbert's a huge fan of Batman villains. That's the thing about mental illness....someone can be so intensely incapacitated yet still be one sharp cookie, capable of something so sneaky.
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