When the Planets are Aligned and the Stars are in Order...No Telling What Will Happen.....Yes, There can be a Random Cosmic Event......

Unfortunately, cosmic events can be good or bad. This one didn't work out that well. Let's see where it all started. A lady called concerned about her brother who has a mental illness. It seems that she had been caring for him, so to speak, for the past twenty years. And, during that time he had exhibited no psychiatric symptoms of any kind. In fact, he didn't even have a case manager. He had a psychiatrist who he saw once a month. Yep, this gentleman had been stable for many years. No hospitalizations for over 20 years.
Anyway, his sister reported that a couple of weeks ago he had fallen down the stairs in their townhouse. He had a severe leg fracture that required surgery and pins.
His sister reported that since he’d been discharged from the hospital (for the problem for his leg), he had stopped eating with noticeable weight loss, was drinking beer daily, refused to take his medication and was ongoingly exhibiting symptoms of mental illness.
She said that he told her he was working for the CIA and that they were after him. Yes, the Mafia was after him. He had also refused to wear the leg air-cast-device that he had been discharged with. Additionally, she reported that he kept talking about winning the lottery. Because of this 180 degree change in his behavior, she asked that we evaluate him.
When I got to their home, he basically confirmed what the sister had stated. In fact, he said he needed to get to the hospital so that "a" doctor could give him $200,000,000. He wasn't clear as to why a doctor would give him that much money and he wasn’t able to give me the name of the doctor. It was obvious that this gentleman was grossly psychotic. And, as you may remember, a person can be detained for being substantially unable to care for self, which this gentleman was. Mr. Smith was completely unaware of his situation and circumstances, was unable to make needed decisions about his welfare and well being, and was unaware of his need for emergency psychiatric care.I called one of our local hospitals, one that had GeroPsych unit, a unit for older folks. Generally, age 55 or older. Yes, there was an available bed. Soooo, now I had to get the gentleman to the emergency room (ER). His family was exhausted, having dealt with him for over a week. For several reasons, I thought that it best to get the paramedics to take him to the hospital emergency room (ER). Sooooooooo, I called the paramedics. When they arrived I introduced myself to The Captain (can’t remember his last name)....a young fellow...most likely not much older than 30. I briefed him: psychiatrically stable for over 20 years, now thinking he was a CIA agent and so on. Also, mentioned that he wanted to go to the hospital to see a doctor so that he could get his $200,000,000. Anyway, I introduced The Captain to Mr. Smith. Mr. Smith, this is the fellow who is going to take you to the hospital to get your $200,000,000. Mr. Smith smiled broadly and seemed pleased. The first words out of The Captain’s mouth; Mr. Smith, what day is it?
Hmmm. Mr. Smith is grossly psychotic and The Captain asks, What day is it? Oh, well….not sure what he’d do with that information.I knew I had to get out of there. Captain, would you please take Mr. Smith to County General ER? They know he is coming. They have a psychiatric bed for him. Just need to get him to the ER to get him medically cleared.
I'm not sure I'm going to transport him......
Hmmmm... I thought I do need to get out of here. I explained that we were overwhelmed with business and I'd be in my car catching up with some paperwork.
A while later, The Captain, three other paramedics, and two police officers came to my car. The Captain said, He's medically stable and there is no reason for us to transport him. Hmmmm. I explained that I was going to get a TDO. Has he been evaluated, he asked? Yes, I evaluated him. He will be TDO'd and there is a bed waiting for him. One of the cops piped up, Do you have papers (meaning, do I have TDO papers)? No, I can't get those until Mr. Smith gets to the ER and gets medically cleared. There is a bed waiting for him.
The Captain, then said, Well, the family has agreed to transport him to the ER.
At this point, I knew I was whistling Dixie. He and the cops acted as though they never transported folks to the ER because of mental problems.... which of course is not true. Routinely paramedics take folks to the ER for a variety of nonmedical reasons; they take drunks, crack heads, older folks who are demented, and the mentally ill. These are the times that you feel like whippin’ out the old AK47 and blasting away. Hmmm. Thankfully, I didn’t have an AK47......
Sooooooo, off goes the family...frazzled as they are, to the ER. I followed up with the psychiatric nurse. Trying to stay abreast of what is happening to Mr. Smith.
Hmmmmm. When he gets to the ER his pulse is 157.....and his labs are not within normal limits (WNL). Nice. Anyway, he is admitted to medicine. Yes, he is so medically unstable that he is admitted to the regular part of the hospital. He was not medically stable enough to go to the psychiatric unit. Nice. But, of course, the old Captain had stated there was nothing wrong with him and that he was medically stable.
An interesting aside, if you will. Here is a fellow that I stated meets TDO criteria. I stated that because of mental illness he is no longer able to function outside of a hospital psychiatric hospital. It would be interesting to see how The Captain would explain things if on the way to the ER, being driven by his family, Mr. Smith had jumped out of the car, or had gotten out of control and had caused an accident. Hmmmm. Nice.
Folks, it's going to get better......
Now, keep in mind that this gentleman was taken to the ER because of a complete mental status change. Yes, for 20 years or so this gentleman had no psychiatric symptoms. When he was admitted to the hospital, he was talking about a doctor, whose name he didn’t know, who was going to give him $200,000,000......and he was a CIA agent and people were after him and were going to kill him.
It gets better or worse depending on your viewpoint.....
Mr. Smith was admitted on a Monday, let's say. Wednesday evening I get a call from his sister who is frantic. She said that the hospital called her son (without talking to her), and said he needed to pickup his uncle. Yes, remember, this is the fellow who is grossly psychotic. Yes, this is the fellow that I had alerted the charge nurse that he was coming in...and also alerted the psychiatric nurse...yes, the nurse was the one who said they had a bed they were holding.
His sister said when she got home from work, Mr. Smith was naked, had taken off his leg brace, had cut it up and put it around his neck…and there were some other things he was doing. Additionally, his sister told me he was refusing to go back to the hospital.
Now, here is the dilemma. There isn’t a legal way of forcing him to go to the ER.
My only hope at this point is to get the psychiatrist on call, to accept Mr. Smith under a TDO. OK.
Listen closely, we’re coming to the best part of the story. I called the psychiatric nurse who is on duty. Yes, C$%6&8% %#@9N, RN, is working. Hi, I tell her what had happened with Mr. Smith and ask that she call Dr. Jones and get him to accept Mr. Smith under a TDO.
Oh, I can’t do that, you have to have him MEDICALLY CLEARED!
Hmmm.
Let’s see if I understand this. Mr. Smith comes to your hospital. The hospital was alerted that as soon as Mr. Smith was medically stable, he would be detained to the psychiatric unit. For whatever reason, your hospital discharged this man who was still grossly psychotic…discharged this man who you had been told was going to be detained….you did this. Now you’re telling me he has to be medically cleared after you wrongly discharged him from your hospital a few hours ago. Medically cleared?
Yes, folks, hell is the absence of logic…and I could feel the heat. Writing this, I feel the urge to say some really naughty things…however, I will restrain myself….though I’m not going to cancel the order for the AK47.
Yes, that’s what I’m telling you……he must be medically cleared.
OK. Now what? If I hadn’t evaluated Mr. Smith within the past 72 hours I could seek an Emergency Custody Order (ECO). This orders police to pick up a person and take them to the designated site so they can be evaluated. I could have had Mr. Smith taken to the ER using this order. But, this wasn’t an option.
Can you imagine what Mr. Smith’s sister is thinking about this time? Every screw-up that could have been made was made….and now what, who is going to help her???? I was running out of options……..
Oh, well.
In desperation, I called police dispatch and tried to act as casual as possible as if what I was going to ask…I did every day.
Hi, this Robert Martin at Community Mental Health. I need your help. Would you be so kind as to send a unit by 128 Elm Street, pick up Mr. Smith and take him to the County General ER? I’m working on a TDO but need to get him to the ER for medical clearance. Have the officers call me if there is a problem.
Gosh, I usually love the cops, and this was another one of those times. Yep, they took Mr. Smith to the ER.
The next day when I got to work I found out that Dr. Jones, the psychiatrist, refused to admit Mr. Smith to the psychiatric unit. The doctor claimed he had too much energy.
Nice, because of this, we had to find another hospital that would accept him, and the police had to take Mr. Smith to the other hospital. Yes, the planets were definitely aligned for Mr. Smith and his sister…..