Category Archives: care of the mentally ill patient

Fascination! And more …

Ok, let’s address some more of these writing prompts!

quixoticfaith asked me to expand upon several issues, and was “fascinated” regarding number four. (When my son disappeared when he was a child, and when he was AWOL from the Army). This was already addressed in a former blog post, Noise and Runaways.

Prompt #11 was: What is the difference between being treated for physical problems as a bipolar in the ER, when the bipolar diagnosis is known, versus when I withhold that information. Writing letters of complaint to the hospital, even though I am not one to complain.

There are two times that I can recall that really burned my britches in regard to medical treatment, and stigma against mental illness. The first is when I went to the ER with complaints of severe chest pain. This pain was not typical of any I had had before, and as a nurse I know that women’s heart disease is of great concern. I didn’t want to mess around with it. When I first got pulled into a room, and the nurse began to go over my health history, I “mentioned” that I had a history of bipolar disorder.

Suddenly I was whisked away to a separate section of the emergency room, “just in case you get anxious, dear. You won’t have to be around other people and be bothered. We’ll see you just as soon as we can.” Wham. The prison doors were shut. I was in a locked unit, and I spent the next I-don’t-know-how-long waiting to be seen. It seemed like hours. Guarded by a man in uniform, not monitored by EKG, nothing. The only concern they seemed to have was my mental health status, not my heart. I was not at that time experiencing any anxiety, other than what one would normally have with an episode of chest pain. I was not manic, or suicidal. Just, “by the way,” bipolar.

Finally, the doctor came in with a very serious expression. No eye contact. Very little in the way of a conversation, an exam, or diagnostic testing. After he was done, I was scuttled out the door with no discharge instructions, and no explanation for the symptoms I’d been experiencing. I almost felt like I’d been assaulted.

That incident resulted in letter #1 to the powers-that-be at the hospital. They had no right to treat me any differently than any other patient who comes in with cardiac type symptoms. They had no right to be concerned that I might “flip out,” just because I had a diagnosis of bipolar. And most of all, they had no right to not pursue and diagnose my cardiac symptoms. I came to one conclusion: The next time I had to come to the ER with a medical concern, I would not disclose my psychiatric diagnoses. They might discover it by other means, I suppose, but I would not volunteer the information. Sure enough, the next time I came to the ER with that in mind, I was treated with respect and concern that was just like that given to any other patient who presented to them.

Incident #2 was at another time, when I had been admitted to the psychiatric hospital for a manic episode. Shortly after my arrival, I began to have cardiac type symptoms, this time, much more severe. This psych hospital was affiliated with the same one that had put me in the back room of the emergency room. The psych hospital did take my blood pressure, and it was 200 something over 100. I was obviously very concerned. But it took me two hours to convince the physician’s assistant that I should be seen by a regular physician. My rights as a human being were being violated, and she would not even consult with anyone else to see what she should do, when I insisted. I believe that refusal had everything to do with the fact that I was having symptoms of my mental illness, and therefore was considered incompetent to make a decision regarding my care. Not cool at all.

Finally, the physician’s assistant agreed to consult with the doctor on call, and I was taken to the regular ER, accompanied by a psychiatric technician. She was a very nice woman, but a very meek one. She was not willing or able to ask for what I needed from the hospital staff. Eventually I was sent to radiation for x-rays and a cat scan, after which I was told that I had a pulmonary embolism, or blood clot in the lungs. This is a very serious medical condition which needs to be treated right away, or sudden death can occur. The doctors told me they would give me medication to dissolve the clot, and I was put in a darkened hallway to await treatment.

Here I was, in full blown mania and alone with the psych tech, waiting for them to save my life. I don’t mean to be so dramatic, but that was how I felt at the time. I had no monitor, and no emergency room staff available. Just a “wait here for a minute,” which became two hours. All I could think about was a man who had died while in my care when I was working as a nurse. He was a patient in the intensive care unit, and had turned blue and died within seconds. I was so shaken at the time by how it had occurred that I even attended his autopsy, to see if there had been anything that I could have done. I remember seeing those big maroon clots in the medical examiner’s glove, as he showed me what had caused the man’s death. And here I was in the hospital, awaiting what I thought might be the same fate. My symptoms of mania continued to escalate, along with the continued chest pain, but the psych tech would not intervene. To me, it was obvious that I needed some attention and care, but I felt like no one was listening.

Finally the resident came to me to tell me that they’d been mistaken, that there was no blood clot after all. Hence, letter #2 to the hospital after I was discharged from the psych hospital. First of all, I explained how the PA at the psych hospital should be disciplined and instructed for not acknowledging my right to be seen by a physician. Second of all, the regular hospital should have provided me protection and support, given my manic condition and severe anxiety. And whether I was manic or not, I should not have been tucked away in a hallway waiting for treatment, given the severity of the diagnosis they thought I had. It was total neglect all around, and certainly the results of that could have been tragic. This is to say nothing of the terror I was experiencing in a state of heightened awareness and emotions.

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Well, then! Stay tuned, because I am going to have a part II to address some more writing prompts! But it’s before noon, and I’ve had more than one cohesive thought; I think I have done pretty well this morning!

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