Distorted Perspective: Head's Up for Emergency Department Personnel

In a busy emergency department, in spite of the training personnel may have received for dealing with mentally ill patients, it’s easy to get caught up in the rush and pressure, and forget the sensitivities of these patients, and how to help them.

Not all visits to the emergency room are for psychiatric reasons, even for mentally ill patients.

But a mentally ill patient still has to navigate the experience through his perceptions that may or may not be distorted by his illness.

If ED personnel aren’t in tune with this need, the results can be unfortunate for the staff, and even dangerous for the patient.

Jeremy was 30 years old, had a 20-year history of Bipolar Disorder 1 rapid cycling with mixed states, and had also been diagnosed with Schizoaffective Disorder. ( I realize these combined diagnoses in the same patient are controversial, but these are the facts.)

Through 20 years of treatment, he’d had a few short periods of feeling sort of ok. Not at peace, but not volatile either.

He’d had multiple trips to the emergency room, and to the psychiatric crisis center for triage.

This just wasn’t his first rodeo.

Fact is, most of the time he was trying to manage himself in whatever way he could, often breaking out in hives from the intense effort required to hold himself in control.

He’d get sick, sometimes terribly sick, with a chest cold…or flu…whatever was going around…because his immunity wasn’t good.

He also had periods of terrible pain. 

Over a period of months, there were times when he’d roll in the floor with pain, and eventually the pain would pass. 

During those attacks, he resisted going to the hospital due to a fear he’d be in the ED all night and then sent home without help. 

The anxiety that accompanied his mood disorder made hours in an ED cubicle almost unbearable. 

So he’d avoid treatment rather than quake in that miserable setting.

On the day in question, the pain lasted longer than he could bear so he asked to go to the hospital. 

Upon arrival, he was placed in the dreaded cubicle and piece by piece, over a period of hours, he was worked up for his abdominal pain.

An MRI revealed a hot appendix, but by the time that was discovered, he’d been in the cubicle 6 hours, and his anxiety was reaching unmanageable proportions.

In spite of taking his medication daily on schedule, with the support and help of his family, he didn’t have the ability to cope with the severity of the pain and the rising anxiety.

Once acute appendicitis was diagnosed, plans were made for emergency surgery.

Like any good ED nurse, his nurse worked swiftly and efficiently to bring consent forms, hospital gown, and all the trimmings to get him ready for surgery.

BUT. 

That swift, almost forceful, demeanor was the last thing Jeremy could deal with in his current frame of mind.

She told him he needed immediate surgery, so please put on this gown, sign these papers, and she’d return in five minutes.

As she said it…he backed against the wall.  

“What’s going on..?

“..Surgery??

“For What...??”

“…no…I don’t think I want to do that…. I need to think about it…”

Efficient nurse says, “ There’s no time to think! Your appendix could burst! You need to have emergency surgery now! If you don't hurry and get into this gown, I'll have to call security...”

“You can’t force me… I’m outta here!”

And with a few expletives, Jeremy pushed past the nurse he believed to be “bullying” him with plans to do him harm and ran down the hall and straight out of the hospital. He was striding across the hospital parking lot at a quick clip when his mother was pulling in to park.  

He ran to her car, jumped in, and said, “Drive.”

She'd seen him like this before. She knew that resisting or arguing could result in bodily harm to him, as well as damage to property, and intervention by police.

So drive she did.

Experience told her to get him calm and cooperative, then figure out how to handle the hospital situation.

The rest of the story is the usual tale about how a mother calms her ill son, takes him home, coaxes him to take his medicine, and soothes him to go to sleep.

Then, a nurse from the hospital called asking what happened.

After hearing the story, she set about to try to get him back to the hospital to get his surgery before he experienced a healthcare disaster with his appendix.

She also worked against the pressure that the surgical team had assembled and had an operating room and she’d just be able to hold them for a limited time.

But Jeremy’s mother explained…you can’t push a paranoid person with bipolar disorder.

After a few hours of back and forth phone calls, and while Jeremy napped - and his bipolar brain “rebooted” - the nurse contacted the police and EMTs and sent them to Jeremy’s house to try to gently cajole him to return with them for the treatment he needed.

A soft spoken officer entered Jeremy’s dark bedroom where he slept and gently woke him and convinced him he was there to help him. His authority helped to keep Jeremy’s “rebooted” brain quiet while they returned to the hospital.

The end of this story was a good one. Jeremy was calm through the process of preparing for surgery…and those terrible attacks of abdominal pain were behind him.

But here’s the point.

Whereas the average Joe in the emergency department takes the serious demeanor of physicians and staff as a signal to comply, anyone with a disorder that includes intense anxiety may not interpret that authoritative tone in the way it’s intended.

This scenario plays out across the US in hospitals every day, and because it’s not the usual experience in the ED, staff may not be prepared to respond in the most productive way.

These personnel are trained for sharp thought, quick actions, and life saving measures. 

But it’s a more delicately refined skill to do that with patience, a soft voice, and a soothing attitude.

And yet, that’s what most mentally ill patients need. 

Gentleness. Understanding. No sense of pressure.

Nothing to trigger the flight/fight response.

In this case, there was no tragedy. 

But in too many cases, the flight/fight response can result in unnecessary calamity and heartbreak. And shocking headlines from tragedies that could have been avoided.

If you’ve observed a scenario like this in your healthcare facility, even if you’ve had standardized training provided to your personnel, consider bringing in a family member who has a strong working relationship with their mentally ill loved one, to teach your personnel their loved one’s perspective.

Empathetic training can divert disaster for everyone concerned. 

Cyndee Davis is a copywriter for mental health, nutraceuticals, and alternative health.

https://cyndeedavis.com, https://ocavancopy.com