Sunday, April 3, 2011

Crisis-shift, suicidal client

Some writing I did towards the end of my stint at an outpatient psychiatric clinic at a large hospital:
Client wears blue track suit pants and brown v-neck sweater vest with no undershirt. He also wears a black newsboy cap. Except for the pants and the white sneakers, nothing matches. He is a little stocky, pale skin, dark hair, a little stubble, latino. He looks tired. I see him waiting in line when I am in the hall. He hangs around the desk until the secretary tells him to have a seat. He is looking at me as I talk to the secretary. I wonder why he is looking at me. I guess he is gay.

The secretary tells me he is a walk-in. I roll my eyes. On crisis, no walk-in means no work. A walk-in means work. Looking over his chart, I see he’s been in and out of the hospital twice this month. Suicidal. Borderline. He comes in and he is polite. He tells me he got out of the hospital Tuesday. He was good till Wedensday when the voices told him to kill himself. With a knife. He shows me the scar across his wrist with fresh sutures. He has made many suicide attempts since he was 12 and several this month: the wrist, 30 ecstasy, 40 anti-depressants, he tried to hang himself but started to cry and changed his mind. Just yesterday he got out a knife and touched it to his wrist. Then he took the tv cord and thought about hanging himself. 

“I am worried about my life. I am not ready to die,” he says. He has an accent. There is something sweet about him. Lost, sweet, innocent. “I was good for a long time. Then I have a breakup 3 months ago.”

“I think you need to go to the hospital.” 
He nods. “I am worried about my life.” 

I let him use my phone to call his sister. He speaks in Spanish. I tell the secretary to call security, standard procedure. I put him in another room and sit with him awkwardly until security shows up. 

“Do you want a magazine to read?” 
“No I am allright”. He sits in a leather therapist chair staring vacantly.

In the staff room, I tell a therapist who knows him that he is the most obvious case for hospitalization I have ever seen. 
"Wrist cutting!" "Command hallucinations!" "Hanging!" "Pills!" These words roll off my tongue like punch lines. 
“Awww” my co-worker says, in a there-there voice. Something about my story has aroused compassion even though I didn’t say much about this client. 
“Stop,” I say, “you will remind me he is a person.”

After 4 hours the ambulance shows up. Per protocol, they haul him off on a stretcher even though he is fine to walk. His brother is there. He looks like a slimmer version of the patient. His track pants match his track jacket. He either has gold teeth or extensive dental work, I can’t tell which.

“My brother,” he says but he pronounces it like, “browther”. “My brother,” last time he went to Hospital X. “Today he is going to a Hospital Y where he went the time before.” “He makes a grimace. “Hospital Y is better.” 
“I am sorry," I say. "I don’t control this. I don’t make this decision. They put him in the hospital with the first bed available.”

I start to walk away. 

“I want to ask you another question. What happened to my brother?” 

Federal law prevents me from talking to a family member without consent, but it seems cruel to not say anything. We are in the hall and I lead him to my office. 

“Your brother was going too hurt himself.” 

He asks me for the number for the hospital. I have to turn the computer back on to get this information. I write it down for the brother. 

He says, “last time, they let him out of the hospital. My brother, he is… last time they let him out after a little time.” “
They let him out too soon,” I say. “
"Who let him out?” 

I point to the name of the doctor I wrote next to the phone number although this is the doctor who released him two trips ago. And this is a problem that goes way above this doctor’s pay grade. Still, it is helpful to have a scapegoat. 

“In this country, they let people out too soon. They push them out." I make a pushing motion with my arms and hands. “I am sorry.” 

The brother looks sad and troubled. “Thank you doctor,” he says and he shakes my hand. I am happy he is not unhappy with me. I am sad for this brother. I am sad for this patient. I leave the clinic. It is night. I see the ambulance pull out of the driveway and onto the street. I see the client on the stretcher. A female EMT is talking to him. I salute the client, but I am not sure he sees me.