Mouth Wired Shut

My colleague told me of a consult that she got from one of the floors when she had the consult pager this weekend during our 24 hour call.  The medical team wanted her to assess depression in a young woman who was shot in the head by her boyfriend, now had her mouth wired shut and was refusing PO.  First of all, wouldn’t you be depressed if your SO shot you in the head?  Second of all, how in the world was she supposed to talk to this patient?  (The resident told my colleague to “just try it”)  Did they think we had a magic wand which would automatically open her mouth and enable us to talk to her?  Or did she think we (weekend EMERGENCY psychiatric service) were going to sit there for 2 hours communicating via hand written notes?  Third of all, how in the world do you give PO to someone who’s MOUTH IS WIRED SHUT????  Shouldn’t she be on IV fluids?

I don’t know how many times I’ve been consulted by medical teams for reasons that make absolutely NO sense.  I don’t know how many more times I will have to deal with their quickness to label a patient “crazy” and attempt to abdicate all responsibility for the medical management of that patient if

1) s/he has a mental health illness (or even a whiff)
2) s/he is bucking their autocratic and condescending manner of communication (if you can call bullying and commandments communication)
3) s/he is refusing treatment b/c s/he is angry/crying/frustrated/upset
3) s/he is crying/angry/upset for any reason

I surely don’t know why residents have gotten crunk with me after I ask them for basic consult information.  When you consult a service it is b/c you have attempted to deal with the situation, followed proper protocols and are now at the end of your expertise–in short you need their expert advice and you expect them to ask you a series of questions in order to better triage the case.  That’s how it is when you are working on medicine.  You have to present the pt in a way that is germane to that particular service and you have to be willing to answer their questions.   I couldn’t call the cardiology fellow and tell him that my patient’s heart rate was “funny” and I needed him to come and see the patient!!!  Oh my gosh, the tongue lashing that I would receive would be so severe that my head would explode!  But how often have I been greeted with animosity when I ask questions of residents–as if they don’t have time to talk to me!  Well honey, you’re the one who consulted me.

I don’t know how many times teams will ask for psychiatric consults at the last minute (right before they want to d/c the pt so they try to pressure us for our recommendations just in case something adverse happens to the pt and they can blame psych) or how many times they will not follow our recommendations the first time and then have the audacity to re-consult us when the pt remains as is or how many times medical teams won’t spend the extra 5 minutes with the pt to get to know them and understand how confusing, frightening and overwhelming a hospital admission is for these people.  Isn’t this common sense? 

I don’t know how many times they will consult us b/c the patient is having personality conflicts w/ medical staff or how many times they will consult us on how to use the most basic of medications–medications that they should have learned about in medical school and which–if the shoe were on the other foot and I consulted them about oh let’s say, HTN–they would more often than not blatantly ignore my requests or act as if their time were too precious to answer my question.  I don’t know how many times they will complain that we are taking too long to see their patients when after we have asked for the medical teams to help us out with our patients they have not seen the pt but still give us recommendations or worse yet, not EVEN show up to see the pt and not respond to our calls.

I don’t know how many times our administration will allow the medical services to dictate to us how we can be treated (we have to respond to their consults ASAP even though they treat us like crap).  I don’t understand why our administration doesn’t push back and demand from them the same kind of treatment that they so often demand from us!  I’m a little tired of being treated like the ugly red-headed stepchild of medicine!

In other news I’m also a little tired of myself. I find that more often than I would like, I am lacking in the milk of human kindness that I once thought was personally inexhaustible.   I  have allowed myself to become jaded by all the malingerers, anti-social personalities, substance abusers, able-bodied individuals on disability who refuse any psychiatric treatment but want to get easy money from the government etc etc etc. 

I can never do that. 

It is hard to explain–truly.  It is not that I am completely lacking in compassion/sympathy/hope for my patients.  As much as I groan about seeing so many patients; when I am with them, actively engaging in a therapeutic alliance, I am ALL there and I want to help the patient as much as possible.  It is just that I am much quicker to allow my frustration with the nature of their illness to manifest in a cynicism that is short on faith in the patient.

I don’t know how many times I’ve got to keep reminding myself that as many millions of times as Christ has forgiven ME–who am I to stand in the way of another human being’s millionth chance?