Monday, August 15, 2011

Manipulative Manics

All was well this morning. The rain was pouring outside where I couldn't see it anyway :-), the patient load was still low :-), I was saved from being in the drunk tank yet again :-) :-)... Then, around noon, I heard a commotion coming from our waiting room. Never one to miss the action, I stuck my head around the corner to see a normally chill nurse flip out at somebody.

Mr. M&M was young- around my age- with a baby face.
Mr. M&M: "All I want is my wallet. That's why I'm here. I want my wallet."
Nurse: "Ok, we'll call the psychiatric unit you were in, just stay right there."
He took steps forward, "but I want my wallet. I have everything in there- my whole life is in that wallet."
Nurse: "I already told you, I'm calling- look I have the phone."
Mr. M&M: "It might be in the bathroom, it might be in the room, it might be anywhere. Maybe you locked it in those security lockers."
Nurse: "They don't have those kind of lockers in that unit, but they said they'll take a look for you."
Mr. M&M: "Ok, thank you, can I go back in?"
Nurse: "No, sir, you were discharged this morning."
Mr. M&M: "But there is something wrong with me."
Nurse: "There is nothing wrong with you. That's why you were discharged."
Mr. M&M: "Well, how could you just say that there's nothing wrong with me? What if there was? I am going to sit here," He sat defiantly in the triage chair, "and wait."
Nurse: "You can't sit there. There are patients that need to sit there."
Mr. M&M: "Well I'm a patient."
Nurse: "No, you're not, you were discharged this morning."
Mr. M&M: "My legs and back hurt real bad. I can't walk. Can you admit me as a patient?"
Nurse: "No!"
Mr. M&M: "Then I want to hurt myself. I want to kill myself."
Nurse: "Don't say that..."
Mr. M&M: "I mean, I don't actually want to, but that will get me in as a patient, right?"
Nurse, eyeing all the people lined up: "Uh, no, please get out of the chair. There were other people who signed in before you."
Mr. M&M: "I'm not moving out of this chair."
Psychiatric Nurse: "You definitely did not leave your wallet back there with us. Please leave- we're not going to see you again today... you just left a few hours ago."
Mr. M&M: "Wait, you're kicking me out?"
Nurse: "Get security."
S: "Hey, sir, since your back and legs hurt and all, do you want to sit in this wheelchair?"
Mr. M&M: "Sure. Thanks a lot."
Nurse: "Wheel him faaaar back over there."
S: "Ok."
Mr. M&M: "You don't have to, I was going to go outside for a cigarette anyway."
S: "... Oh... Ok, whatever you like."
Mr. M&M: "What's your name?"
S: "S."
Mr. M&M: "Thanks, S."

I turned around and suddenly heard a scuffle. Mr. M&M was trying to wheel himself outside to smoke a cigarette. Security caught up to him and made him get up and get out. We thought it was the last we'd see of him....

Around 1400, I heard the ambulance bay doors open and then a nurse say "you've got to be KIDDING me."
"Nope," I heard an EMT reply. I rushed, out, and there was Mr. M&M sitting on an EMS stretcher, staring at us.
Mr. M&M: "So since I came in by ambulance, I can get admitted, right?"
Nurse: "No, no, no. Get out. Seriously. The exit is over there."
Mr. M&M: "I can't believe you're refusing me. What if there was something wrong with me?"
Nurse: "Get off the stretcher. We're not dealing with you again. You were discharged this morning, you came back a few hours later, and now you called an ambulance to come here again. Please leave."
Mr. M&M: "I'm not getting off this stretcher!"
EMT: "Come on, man, we need this stretcher."
Mr. M&M opened his mouth and started wailing. The ER came to a standstill as everybody heard and wondered what was going on in the ambulance bay.
Mr. M&M: "I want to kill myself! End it all! I mean, I don't really want to, but I tried before, see this?" He pointed to a small scar on his arm. "I did this to myself when my grandmother died! I could hurt myself out there!"
Nurse: "You gotta get off that stretcher right now."
Mr. M&M: "I want to hurt other people. I want to kill them."
Nurse: "Why are you saying that now? Do you really want to hurt other people?"
Mr. M&M: "Saying that will get me back in the psych unit, right?"
Nurse: "Uh, that will get you arrested, actually."
Mr. M&M: "So arrest me! Do it now!"
Nurse: "Ok, I'm getting a headache. Just go sit on that stretcher over there. We'll ask the mental health team to come talk to you one last time."
Mr. M&M cheerfully hopped onto the stretcher. "Why aren't you guys doing your jobs? Aren't you supposed to register me? Don't I need a new name-band?" He took one out of his pocket. "This was from when I was admitted yesterday. Hey, aren't you going to take my vital signs? Oh, God I don't want to live a life of crime! Don't let me back out on the streets! I need to live! Please admit me!!!!!!!" He was roundly ignored.

Meanwhile, patients had been coming in and I was completely ignoring him. "Hey, S." Mr. M&M called- "Yessir?" Despite it all, he still looked wide-eyed and a bit naive/slow to me, so I humored him and answered him.
Mr. M&M: "Why are those security officers and all those nurses talking to me like I'm garbage?"
S: "Well... when you say you want to kill yourself and you don't- is that right? You don't want to kill yourself?"
Mr. M&M: "Well, no, I don't, but nobody takes me seriously unless I say that."
S: "Well, when you say things like that and you don't mean it, don't you think that comes off a little... manipulative?"
Mr. M&M: "Well I don't mean to be manipulative or anything..."
S: "I'm only pointing out that that's how you come across."
Mr. M&M: "I appreciate that. You're the only one here that talks sense."
S: "Mmm..."
I was a little disturbed to be the only one that made sense to him. Soon, he was carted off, once again, to the sidewalk. He might have tried to come back a few more times, but I was off on another shift area by then.

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