Yet another perspective

So I'm watching some Law and Order:SVU rerun tonight, right? Because I've got a couple dozen of them DVR'd and waiting for me at this point. And in this one, which probably has an episode title but I don't know it, Mary Stuart Masterson guest stars as a cop-turned-psychiatrist. And Olivia is yelling at her because their victim, a very disorganized and psychotic schizophrenic, has just checked herself out of Bellevue after her 24 h hold expired.

First off, yeah, right. Like that patient wouldn't have been petitioned so fast she'd have had paper cuts. Second of all, maybe it is different in New York, but most states have a 48 or 72 hour hold.

But nonetheless. So Olivia says to her,

That's the problem with the mental health profession. You medicate them, just enough so you can cut 'em loose, and then nobody monitors them. They go off their meds and the next thing you know, they either become the victim of a crime or they commit one. Either way, we have to clean up your mess.

Some days, you know, I feel kind of the same way.

I got into a thing with our social worker today when I refused to discharge a patient because he lied to me about having a place to stay. It's possible his family lied to him. I think everyone was lying in this scenario, frankly. And so I made the decision that he was going to stay another day so we can make sure that the new place he's told us he can go is valid. And the social worker was like, why are we so concerned about where this guy is going? We toss people out on the street all the time. You know, homeless people, we just send them out to be homeless again.

And she's right. Last week I discharged a guy to the TTA bus. He was going to take it to Durham and "figure something out." I kept arguing with him that he needed to identify someplace safer that "figuring something out", but he said he was sick of stability. He gave me no reason I could commit him. He was voluntary, and he wanted to leave. My 72 hour hold expired. I had no choice but to discharge him to the streets.

At least with this guy, I had a choice.

Most of the time, if we send them to a shelter, is that really any better? Is it really any different? Some of them are only open at night. They're all overcrowded. There's just no good answer.

Which is part of why it sucks to be really crazy.

Sometimes this job is really hard (you know, like math, right PS?).

I spent the better part of an hour telling my one patient's parents they need to back the hell off and let him be a grown up. He's 18, wickedly neurotic, and very enmeshed with his family. And when I got in this morning and found that his mother had camped out in the waiting room all night and was planning to more or less be there until we discharged him so she could come in at every visiting period, I gained a much better understanding of why. So I went out, gave some really basic advice. A little bit of logic. A few reminders about how hard it is to establish your own individuality. He's a good kid. He has a lot of potential. They want to know every detail but at the same time they validate nothing (his four years of being chronically suicidal was "teenage moodiness"). His mother told him that because she never felt suicidal when she was depressed that he wasn't really depressed. Oy.

I have another woman who was supposed to be discharged today. She was doing fine, and then last night started seeing little brown monsters jumping on her bed. So, I kept her today, too. She, incidentally, was the patient of Dr. Ming's of yesterday's post. I think she legitimately has multiple personality disorder. Like my cousin. Like my good friend down south. Like my ex. And there is a lot of division in the profession about whether or not this diagnosis even exists, right? I think it does. I think it's the end of a spectrum of something that happens to all trauma victims, particularly those who are traumatized at an early stage of development. However...not everyone thinks the way I do. And now I'm starting to understand why my friend in Florida never wants to go into the hospital when she needs to. When she's unsafe, it feels safer for her to sit home in mortal peril than to go to a "safe place" where people can help her.

Some days, this job also makes my head hurt. Or it could be that I'm getting a cold.

Whatever. It's time for bed. And so with that thought, I leave you with another SVU line, from a subsequent episode. Everyone's favorite Cop Killa turned TV detective, Fin Tutuola (Ice-T), busts in and goes all undercover narco on this shifty lawyer, and the lawyer looks at Fin's partner , who's sitting in the back of the office, asks, "Who the hell is that guy?" Fin says,

Him? That's my Jew.

That one made me giggle.