Shit

Oh, in so many ways.

So....last night, was bad. I admitted four people. I did full evaluations and admissions on three more. I totally worked one kid up and sent him to Other State Hospital, which is an involved process to begin with, but he was mentally retarded, which then adds this whole long process of requesting an exemption from some Senate Bill or House Bill or dollar bill or something like that. I did four consults we didn't admit.

The last admission was this very sad woman who had been tossed out of another local hospital after a bizarre altercation with the staff psychiatrist, who was just highly inappropriate. But she'd originally been headed to the medicine service overnight, but you know, then she sort of woke up, and so it's 2am, and I finally get a minute to breathe, and I'm literally closing down my computer to go to bed, and my senior (who, in her defense, had also gotten slammed all day with inpatient consults) says, can you just go evaluate this woman in the ER? You don't need to admit her yet, but, you know, just go see her.

That was 2am. I finally called my attending at 6.

Now, admittedly, I had everything except the orders pretty much wrapped up by the time I called him. I mean, why wake him up in the middle of the night if I don't need to? And I had some calls to field in there, too. So shortly after 7am I wandered up to bed. I got a couple more pages, and then finally dozed off for about twenty minutes until the pager woke me up again. It was an outside call, and at least half of those are other institutions trying to transfer a patient. Which, on a weekend like this when we're full to the gills, is an easy denial.

Instead, I got the call we all dread.

There was a woman on the other line, obviously having consumed some substance, who told me that she had overdosed on her sleeping meds. She kept telling me that she didn't want to wake up, how nobody liked her, how she wanted to die. I tried to talk her into coming in, into letting me call some help for her. She was a little gamey with me, but I finally managed to get her to give me an address. She kept going on and on, and I'm stuck in this call room, by myself, trying to figure out what the hell to do with her. So I finally went through the little bathroom that connects my call room to the second year's, woke up my senior, and tried to ask her to call the local police. Which is hard to do in the dark when you wake somebody up, so asked the girl to hang on, and wasn't off the phone for more than fifteen seconds. When I got back, she'd hung up. I tried to call her back, but the number she'd given me was disconnected. So we called the hospital police, who sent us to the town police, who told us to call 911. So I finally end up talking to the county police, who called me back and said that they went to the address, which was a vacant house.

Shit. All I could say to the officer was, shit.

We get about three or four calls from the ledge per year, from what I understand. Sometimes we can help. Sometimes we can't. I don't know. I don't know if she was fucking with me, if she was high/drunk/stoned and decided this would be fun, if she was setting up the person who was listed at that vacant address and had a similar name and happened to be listed in our medical records system so they got a visit from the county PD. I don't know if she actually had overdosed and really wanted to die. Maybe she slept it off and felt better. Maybe she's just personality disordered and wasn't in trouble to begin with. Maybe she needs help and will come in, to us or some other institution, to get it.

Maybe she's dead.

All I know is, that sucked. And I ten minutes to signout after I got off the phone (again) with the police. The last thing I needed was caffeine, but I went down to the coffee shop anyway for my morning cup of English Breakfast tea with cream. And a scone, because they don't have bagels on the weekend. I wasn't especially hungry, and I was already shaky (you know that feeling where you feel like you're trembling uncontrollably but you aren't actually shaking? Is is just me?), but I needed the routine of it. And I was $.50 short. And they were so nice to me, and just let it go, and she got me started on a club card, because "well, you get a free drink for every 15 you buy, and you're here every morning (and about half the time I buy my med students coffee, too), so it's silly that you don't have one." I felt a little better. And then I felt a little better when the intern who relieved me was all like, "oh my God!" But the senior coming on, who, by the way, is my completely useless "big sibling," was like, "yeah. Oh well, what are you going to do? So what do I need to do today? How come there's all these consults left?"

I'm new at this, alright? And I'm not sure this kind of thing is ever going to get easy. It really shouldn't.

The clincher? The senior I was on call with comes in to report and says, "So...someone, during the course of last night, went into the bathroom by our offices and left a large pile of feces on the back of the toilet. Who does that?"