You never know what to expect working psychiatric emergency on Christmas Day. I was on call for 12 hours starting at 4 a.m., and my first page came at 1:45 this afternoon.
I’d been paged by the emergency department (ED) where I do the vast majority of my work. The initial information indicated I’d be working with a 29-year-old male who, depressed over not being able to provide Christmas gifts for his children, cut his wrists. Of course, I’ve grown accustomed to taking the information offered in the initial call with a grain of salt. At any rate, my patient was medically cleared, so off I went to see what I would see.
As soon as I arrived at the ED the attending physician assigned to “Marty’s” case dialed me in on what had happened…and, thank God, what had not happened. Typically, I check the medical record for previous psych assessments or admissions, but I was told he had no psych treatment history; so I flipped through his chart and headed for one of two palatial E.D. psych patient rooms. You know, the ones with absolutely nothing in them but a gurney.
As I approached Marty’s room, I came by a woman sitting just outside. I was pretty sure she was in some manner connected with him, and confirmed she was his wife. Interestingly, when I asked Marty if she could join us he shook his head no. So I politely asked “Michele” to grab a seat in the family waiting area and said I’d be down in just a bit to speak with her. It’s very important to get as much information as you can about the presenting circumstances and history.
So my time with Marty began. And here was this strapping young man, stretched-out on a gurney dressed in a hospital gown. He was alert, fully oriented, and well kempt; but he appeared as though he had no concept of self, and had absolutely no clue as to what was happening to him. Marty was lost.
I introduced myself and Marty received my hand in greeting. That’s always a good sign. Upon asking Marty to share exactly what had happened, and the events leading up to it, he very readily let it all go in a soft southern accent. And as is so often the case with male patients, he made sure I knew he was no “pussy.”
Marty went on to tell me his anxiety and panic attacks had finally gotten the best of him. Now, it’s my belief Marty came into this world with a neuroticistic temperament, and exacerbating this predisposition was the fact that his business was tanking, leaving the family in dire financial straits. And before long, Marty confirmed the last straw was his in-laws buying “his” sons Christmas gifts because he and his wife were broke.
But there’s much more to the story. What would stop you from coming back for the ending?