Psychiatric Disorder

In the chaos of the ER, patients with mental or behavioral problems receive scant attention

One Sunday evening, Eileen Stratton (not her real name) found herself sobbing uncontrollably for no apparent reason. "I was shaking, my heart felt weird, I was getting very agitated and very upset." She called her therapist, who was out of town, and then her medical doctor, because she has a history of rapid heartbeat. The doctor's partner took the call and agreed that she should go to the emergency room.

Stratton drove herself 45 minutes to Jewish Hospital. They shuttled her over to the Barnes ER, accompanied by a silent young man. When they arrived, families were clustered around the desk, and the nurse was visibly harried. The young man, eager to depart, pressed Stratton's papers on the nurse. "Shit!" she snapped. "Can't you see I'm busy?"

He tossed the papers on the desk and left, says Stratton. The nurse yelled at the families, "Look, if you don't want to get run over, you better move, because I've got helicopters coming in!" Another nurse came out, and Stratton got the impression the two were fighting. She sat down, still shaking, amid the general turmoil.

Three hours later, her name was called on the PA. She hesitated at a sign that read, "Stop Here for Security." Stratton says that she "stood there with my heart beating like it was coming out of my chest. Two guards were standing around eating sandwiches. Finally one said, 'Go ahead.'

"A young nurse took my blood pressure and asked why I was there. I said, 'I don't know how to identify it -- my heart's racing, I feel overwhelmed, I've been crying uncontrollably. I'm on medication for my heart, so I don't know if I'm having a drug reaction.' She said, 'Oh, depression.'"

Stratton heard another staff person, walking by a man who thought he was having a heart attack, loudly describe an accident victim across the room as "just about the grossest thing I've ever seen." Meanwhile, a nurse was yelling directions for suppositories at a frail, elderly woman in a wheelchair: "'You put 'em where you poop!' Another woman wet her bed and was crying that she was all wet and they were complaining about her. There was no dignity."

Later Stratton overheard someone call, "Anybody seen the depressed lady yet?" but she says it wasn't until 6:15 the next morning when a psychiatrist showed up and asked brusquely, "What is your problem?"

"We were out in the middle of everybody, too, so I'm only glad I didn't have to have suppositories," she says ruefully. "I tried to explain, and he said, 'This is an emergency room.' I said, 'I see that.' He said, 'Well, are you going to kill yourself?' I said, 'I don't think so, but I don't know what that would feel like. My father committed suicide and -- ' He said, 'I don't really have time to talk to you here. You need to find yourself a psychiatrist who has time to fit you in.' Then he said, 'You must be very tired. You look tired. I'm going to prescribe sleeping pills for you,' and came back with two weeks' worth." (She later learned they were anti-depressants, which can help with sleep.)

"He couldn't wait to get rid of me," sums up Stratton. "I'm bright enough to know weekend nights are probably terrible there, and I realize I don't have a gunshot wound or a broken neck. I'm not trying to be pushy. But it was almost like people were laughing at the patients. They were totally detached, and everyone was telling you how busy they were, but there were still people standing around visiting. Like it's their territory, and they don't really want you there." She went home more shaken than before, and all she could think was, "We are getting to be such a cruel society."

"A hospital emergency ward can be as loud as a Spice Girls concert and just about as soothing."

-- Health magazine, December 1998

ER trips are hellish, no matter what. "It's difficult to do a lot of niceties down there," says Dr. Laura K. Sherman, chief psychiatry resident at Barnes. "People are dying." Still, she'd hate to see a separate ER for psychiatric cases, because she's tired of psych patients' not getting full medical care.

"It would be nice to have more space, so we'd have a quiet area," she says. "Barnes is building a bigger ER." Quiet would help; so would some basic kindness. Any chance of a pastoral-care or social worker helping out with that? "It's almost impossible," Sherman replies. "They are typically very busy doing things like telling people that their loved one is dying. And to make that determination of 'Hey, maybe we can have someone go back and sit with this person' -- well, triage would have to do that, and I don't think that's really part of their job."

Should Eileen Stratton have simply stayed home? "Oh, no," Sherman says. "My philosophy is, if you don't know where to go, err on the safe side and go to the ER. Someone might be shaky and vulnerable, but, damn, they might also be suicidal. It's very difficult to know." Does all the stress, anxiety, bloody trauma and fatigue ever destabilize them further? "There is no way of gauging that," she shrugs helplessly.

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