I was making visits and practicing SOAP notes on the patients on a medical floor of the hospital where I’ve been placed for this rotation, and as I stood at the counter of the nursing station perusing my next patient’s chart, a commotion arose in a nearby patient room. From where I was standing, I could see inside.
The patient was a young woman, probably around 30 years old, who had been admitted for cellulitis (I don’t know any details). She also had schizophrenia and was experiencing an acute psychotic episode right there, right then. One time I glanced up, she was standing on her bed, jumping a little. Another glance found her cornered by a nurse, looking for a way to escape. She was constantly muttering senselessly, and was clearly not aware of where she was or what was going on. She seemed agitated, but not particularly violent. I looked up again, and she had been put in a vest-type restraint that kept her on her bed.
Now, this was a medicine floor she was on, and as I listened to the clinicians and staff discussing her situation, I realized that they were eager to transfer her to a psych unit somewhere. I listened in as a PA at the station made a few phone calls, but it was readily apparent that no psych unit wanted to take on a medical patient, even if her psychiatric concerns were presently the more acute of her ailments, and even if her attending physician felt it would be safe for her to continue treatment for the cellulitis with oral antibiotics.
I never saw the resolution of this situation, but because no one else would take her, I think she ended up staying, despite the wishes of the family and the clinicians on the unit.
Where should a patient like this go? When a person needs help for both a cardiac and a digestive issue, they can go to the medicine or telemetry unit, where both will be addressed. Why is it that the medicine unit cannot handle a psychiatric problem and that the psychiatric unit cannot handle a more classically medical problem? Is there no house psychiatrist who can help manage patients like this?
Anyway, the situation was stressful, and frankly just sad. Mental illness is such a common occurrence anymore that we ought to be better prepared to handle situations like these without the contention, uncertainty, and drama that I saw surrounding that unfortunate woman on the unit.
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