I work nights. I realized, around 4 a.m. the other night, that every patient I had seen so far in that shift—and it had been a busy shift—was crazy. To put it more formally, every patient had some sort of definable psychiatric disorder, either as their "chief complaint" (whatever issue brought them to the ER) or as a complicating factor.
The first patient I admitted to the hospital that night I diagnosed with "1. Acute diverticulitis. 2. Homicidal ideation." She had called 911 because she had stomach pain. Then she threatened to stab her sister, the medic, and the policeman the medic called to help.
And there was the patient with Munchausen's Syndrome and borderline personality disorder who had a history of spitting into or injecting feces into her IV lines, and who now had abdominal pain. No one wanted to risk putting an IV in her. And the guy whose chief complaint was that his feet had been chewed on by alligators. Decades ago. He comes in once or twice a week for this problem.
There are a couple of factors at play here. My hospital is one of only two hospitals in the county with a psychiatric crisis center. Thus, medics tend to bring patients with psychiatric issues here. And the patients themselves get used to coming to my hospital and tend to come here voluntarily. Hospitals with an expertise in a certain disease tend to collect a Kuiper Belt or Oort Cloud of patients with that disease. Every so often the orbit one of one of these patients brings them crashing into the ER, creating a minor extinction event. ("Medic 19 just brought in Sweeny Cowflop on a 302, he's in restraints in Room 3, and I'm going to lunch, see ya!")
Another factor is the role of the ER in society. [Changing metaphor alert. Insert siren.mp3.] Society is a web of tightropes, on which we all balance with varying degrees of success. When we fall, there are nets to catch us: friends, family, the social service system, the police... the ER is one of the lowest of those nets, catching those unfortunates who have fallen through (sometimes having deliberately cut themselves out of) all the others. Crazy people fall off their social tightropes a lot, and tend to be caught by the ER.
And it's the night shift. Disturbed people tend to have disturbance of normal day/night rhythms as well. Sort of like... me. Uh.
Sum all the above elements, and the result is that I see an awful lot of patients with psychiatric problems, everything from mild anxiety to full-bore screaming psychosis. I actually don't mind all that much. I've gotten used to it, and figured out what to say next when the patient tells me he's having chest pain because two demons, who look like black rats with claws, are sitting on his heart and digging their claws in. And their names are Edgar and Bernard.
== juyou == request, demand
|How this character arrived at its present meaning is obscure. Top radical is 'rain' (雨).Henshall suggests taking the bottom radical as a 'rake', and as a mnemonic: 'Rain falls on rake: need new one.'|