The Backroom of PES (Psychiatric Emergency Services)

9 years on the night shift at the psych er

The Backroom of PES (Psychiatric Emergency Services)

Following last winter courses orchestrated by Leslie Pertz on Interpreting in Mental Health it seems appropriate to enhance our views on mental 9 years on the night shift at the psych erhealth settings by reading about providers’ experiences at work. Among many books available on the subject it called my attention “Weekends at Bellevue” by Julie Holland, M.D.

The book is a memoir written by a clinician that spent nine years working as attending physician (psychiatrist) during the weekend’s night shifts at the psychiatric emergency services of Bellevue Hospital, one of the oldest and highly recognized public hospital facilities in New York City, a hospital that traces its roots to 1736 when a six-bed infirmary opened on the second floor of the New York City Almshouse.

This is not a book just about PES (Psychiatric Emergency Services), but much more. It is an intimate autobiography/memoir of a doctor working at PES. In the book, which follows life along those nine years in and out of Bellevue, the author discusses how her career and related encounters, both with patients and staff personnel alike, has shaped her character.

I have learned so much from my patients over the years. The purpose of this book, above all, is to share what I have learned, in the hopes that it may help people to understand some of what I feel is the “human condition” in psychiatric medicine. (…)

Interspersed between her own experiences the author describes a plethora of characters that often roam there, providing us with a bright palette of the most common mental disorders treated at emergency settings, and also of some of those individuals that due to their condition require long-term follow up; an important part of psychiatric medicine that the author, regrettably, is unable to fulfill in her capacity as emergency doctor:

  • MICA patients: mentally ill, chemical-abusing patients. (.p53)

 (…) if there’s one thing I’ve learned in my few months at CPEP [Comprehensive Psychiatric Emergency Program] it’s this: If they [patients] want to stay, they need to leave; if they want to leave, they need to stay. It seems to hold true ninety-five percent of the time.

  • Cutters: patients with arrays of symmetrical cuts on their arms. [Neurotic self-mutilation versus psychotic self-mutilation]
  • Antisocial personalities: patients with tattoos on face and neck.
  • Frequent flyers: patients whom the staff sees over and over again usually due to alcoholism and drug addiction.

There is also some discussion on the use and effects of some drugs commonly seen and/or used in psychiatric settings such as Sernyl (PCP – Phencyclidine), a dissociative drug, ecstasy (MDMA – 3,4 methylenedioxymethamphetamine) a psychoactive drug, or Ativan® (lorazepam), a benzodiazepine medication.

Likewise, not really describing vicarious trauma sensu stricto, the book addresses the toll that clinicians may have to pay due to those same challenges and pressures they face in their daily routine, even in cases where work becomes constricted to a few nights a week.

Even the lying patients are still coming to the hospital because they are in need. Don’t send them away empty-handed.

 (…) For many reasons, parents and siblings get burnt out. It is exhausting to care for someone who can’t care for himself, and mental illness lasts a lifetime.

Although, no Interpreter is involved or even mentioned in any of the book’s portrayed clinical encounters, Dr. Holland’s narrative may help us to understand the backroom of a facility as such; therefore, allowing us to better comprehend how the system works and be better prepared when asked for help with one of their psychiatric patients by, for example, being familiar and especially attentive to putative doorknob statements.

(…) Seasoned shrinks know that those things mentioned [by the patient] as the patient is leaving the room are often the most important things they will ever say, the things they don’t really want to give up. On the other hand, doorknob statements can be a well-timed manipulative ploy. (…)

As Interpreters, those are crucial moments within the encounter in which if we do not pay extra attention because we are not aware of them, something important can be irreparably missed. Moments, when sensing the approaching ending of the encounter, if that was specially long and exhausting, we might tend to put down our guard and, therefore, highly influence the outcome of the interview and future patient’s care plan; mostly because of doorknob statements, due to their nature, are not meant to be repeated.

In summary, the book offers a nice overview of a psychiatric emergency facility, with incursions on its roaming personnel (staff, patients, families, visitors…) as well as on frequent diagnostics and available treatments and Band-Aids along with commonly used drugs, leaping on the life of staff personnel inside and outside the facility, providing readers with a comprehensive and intimate portrait of the unit.

 

References:

  • Holland, J. 2009. Weekends at Bellevue: Nine Years on the Night Shift at the Psych ER. Bantam Books, New York. 320 pp.
  • National Institute of Drug Abuse (NIDA); https://www.drugabuse.gov/publications

 

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