But the levee was dry

So many changes, so little patience to write about it all.  I guess I’ll start with my latest. 

Decision to leave my job. 

I’m still 70/30 on the whole thing, but that’s still enough for me to cut ties and go. There is so much wrong with what I’ve seen and sometimes been a party of that I cannot take it anymore. I’m going into private practice where I belong. Where I’m my own boss, I make my own decisions and my own hours and I only answer to (technically) the insurance carriers during an audit of my files. I’m fucking done, y’all. 

This hospital work is draining. I thought it would be easier because you don’t form attachments to people; they’re in and out – goodbye!  Nope. Not this population. I see the same people week after month, month after year. Each time, coming into the ER with the same problem, same story:

Suicidal without a plan.
Withdrawal from drugs.
Chronic back pain that’s causing some suicidal thoughts – but they’re allergic to all pain medications except for Dilaudid.
Suicidal with a plan to OD on heroin; is an IV heroin user up to 1 gram per day usage – no history of attempts. 

Now, when I say the same people, I don’t mean the same backstory. I mean the same fucking people. Joe Blow and Heywood Jablowme come in two, maybe three times a month. I’ve had patients discharged at 10AM denying suicidal or homicidal thoughts and come back at 2PM, saying they are suicidal and now, homicidal with no defined target or plan.  And can they have something to eat?  Because, well what the fuck else is this place for?  I’ll go in to talk with them and ask how I can help them, what has helped in the past and some will turn me away. Because, you know – they really need some rest. Nevermind this is an ER and 5 beds away we have people having heart attacks and dying. People treat this place as a drunk tank or a free bed and breakfast. It drives me up the wall. 

What makes things worse is policy. In the ER, it’s liability and licensing. Patients who even breathe the words suicide or harm are begging to be petitioned. (A petition is a legal document that allows hospital staff to hold a person involuntarily until they can be examined by a psychiatrist or psychologist to determine if inpatient psychiatric hospitalization is necessary).  Patients don’t need to be petitioned because they have had thoughts of suicide.  People with major depression have thoughts of suicide regularly and have no intentions of committing suicide. Petitioning them could prevent them from being honest with mental health personnel in the future when they actually do have the desire to act on those thoughts.  

But lo and behold, they get petitioned and held for hours until they are evaluated by social work.  Here’s the fun part. Depending on which social worker/counselor one gets, one’s outcome for getting placed inpatient or discharged home differ.  It’s fucking subjective. I spent most of my first year trying to avoid putting people inpatient if they didn’t need it – and was fought by other social workers who would change my disposition after I left for the day (which would set me off), physician assistants, nurse practitioners and doctors.  

I realized at year two, I was fighting a losing battle. It was even more of a loss when the “frequent flyers” became more aware of what was needed for hospitalization.  Patients who we know have a very, very low likelihood of harming themselves or others, yet report otherwise with plans?  No doctor would take the liability; they go inpatient despite all of us gritting our teeth, knowing full well they are malingering. 

There are 2 sides to malingering, as far as I’m concerned. One is that the resources being used to care for the malingerer could be used for someone in a real crisis and that really chaps my ass.  Two is that someone who takes to malingering needs some type of help.  To feign illness for any type of secondary gain (e.g. Financial resources, medical care, etc.) takes a lot. The dedication used to feign illness could have been used to obtaining whatever the secondary gain was. 

Anyway. Yes. The ridiculousness. 

There is no upward mobility in the hospital unless you’re a nurse and I will be goddamned. 

I miss doing therapy. I miss actually helping people that want to be helped. Every now and again, maybe once every 2-3 months, I run across someone who is legitimately looking for help and legitimately sick. That is awful considering how many people I’ll see in a night. Many of the people I see want pain meds or a bed to sleep in and food because they’re homeless. Some people just love the attention they get in an inpatient facility because it’s more than they get at home. None of these reasons are good enough to go to an inpatient psychiatric facility – NONE – yet these are the only reasons lately that I’ve been seeing people going. I get defeated seeing it. What good am I if this is all I’m doing? Filling beds with people that don’t need the help?  

We’ve tried countless times to help the homeless people who come in, but most don’t want the help. They dismiss the shelter referrals we give out and have burned all their bridges at local transitional homes. It burns you out when you’re doing all the legwork, people do nothing and expect the world. The expectations along with the entitlement when one is not putting any effort is beyond irritating and exhausting. 

I’ve got more but I’m tired of writing. 

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