"I Feel for These People."
There must be a better place for the psychiatric cases to come than into a busy Emergency Room. One woman had been in and out and back again all in one morning. She was frustrated and so was the staff, with the exception of one clerk who seemed to calm
her by talking about God. After she had spoken to this brain damaged and drunken woman, I asked her, "What do you do that makes this woman appear to listen to you?"
The Black clerk told me, "It's just that I feel for these people. This woman has been in and out of jail, drunk, on drugs, the whole works."
Like a ball at the bottom of a pinball machine, she had missed every cup on its way down, and perhaps the machine was tilted too.
The staff has difficulty doing psychiatric work because the community often works against them. These troubled people come here and become patients in a desperate effort to compensate for the absence of any viable social supports. They are isolated, li ving alone and usually unemployed. We don't have enough foster homes for children, but we also need some for these single adults. So there is comfort in the idea of belonging to God although evangelism seems strange in the Emergency Room.
By now this patient had fallen out of the gurney in the small room and was eating her lunch on a chair. A Chicana orderly got her back on the bed and told her that if she did not stay in the bed, they would restrain her there. She got back on the bed a nd then dropped her spoon. She called out for the orderly who returned to tell her to use her fork because she had no more spoons.
"I can't eat soup with a fork." "Then pick up the cup and drink it," the orderly snapped back. "You're doing all this to spite us!" Then she left the cubicle. Afterwards the sympathetic clerk came in and calmed her. The patient cried out, "My back hurts. My head hurts." The clerk was still with the patient when a doctor passing by noticed he was needed. He heard the woman's complaints and said, &q uot;You tell me what we should do. You had a shot for pain, you'll take a shot of anything as long as it is a shot!"
The clerk told the doctor that he was not understanding. Then the patient told the doctor he was not a "jazzman." Exasperated, the doctor exclaimed, "How do you help someone like this? You tell me. You pick a way!" He left, and t he clerk talked about God again.
The Emergency Room was filled with patients by now in each of the twenty cubicles, and the overflow was in the aisles. The chief resident decided to use the next case for a teaching case, a man with a Paget's, pachydermal periostitis. He asked the inte
rn to identify the disease, and there were many wrong guesses. He offered a hint: the face of a Paget's looks like a lion.
An unusual case is sometimes easier to recognize than the ordinary ones. And since there are so many patients who are such a nuisance, a Paget's is much more interesting to the interns and residents, even though there is less they can do to help.
The face of a Paget's looks like a lion.
Department of Emergency Medicine
