Monday, September 06, 2010


When I arrived for my shift this am, I was passed off the following cluster patient:

Friday night, EMS responded to a 50 year old guy laying alongside the Interstate. He had no idea who he was or how he got there. He complained of knee pain and shoulder pain. They were kind enough to tote him to my ER where his evaluation revealed that he had a fracture of his clavicle and tibial plateau (knee). Neither requiring anything to be done except a knee brace, a sling & a walker (since he can't use crutches with a broken collar bone).

Wallet biopsy uncovered an ID that they linked to a medical record and learned that he had been to our ER several times, homeless and with a history of schizophrenia. Usually with complaints of "toxic waste coming from his butt" or "lightening bolts coming from his navel" (always off of his psych meds whatever they are). On two occasions, he had tried to assault the nurses. On each occasion, he escaped before anything was done to or for him.

After a nap and a meal, he told the staff that he had been working in the oilfields in Costa Rica when he got a call from Brazil that his mother had died, so he was hitch hiking to his home in Rhode Island. While the car was speeding down the Interstate, someone had opened the door (from the outside) and pulled him out of the car, leaving him injured along the side of the road?!?

So, after he was medically cleared, the mental health people evaluated him and decided that he was psychotic (no kidding)! BUT, it was a holiday weekend and all of the intake personnel at the psych hospitals that accept Medicaid were taking the weekend off. The MHMR folks would be happy to return on Tuesday to try and place him somewhere!

Trauma service wouldn't admit him since he didn't have any serious trauma issues. Ortho wouldn't admit him since he didn't need any in patient ortho care. Medicine wouldn't touch him with a gloved 10 foot pole since it certainly wasn't a medicine issue...

So, the guy has so far laid around in our ER for almost 80 hours waiting for "placement".

Late this afternoon, when we really needed our rooms, we contacted MHMR again and tried to lean on the caseworkers to do something with him. That's when they informed us that in order to place him in a psych facility, he would have to be freely ambulatory without braces or assistance! The psychiatrists wouldn't take him since they "wouldn't feel comfortable" with his orthopedic injuries.

So, he continues to lay there and tomorrow we'll try to get him into some sort of nursing home for rehab (which they will most certainly refuse because he needs acute psychiatric care)!

Gotta love modern medicine!


  1. It's obvious to any sane and humane person that this guy belongs in a long-term psych hospital for HIS OWN WELFARE. Scum commies and ACLU vermin have made that impossible. You can read the whole sad story in E. Fuller Torrey's book "Nowhere to Go - The Tragic Odyssey of the Homeless Mentally Ill."

    All decent people should be outraged by this situation, but outrage doesn't get us far these days, does it? The patient you described is a person who can't think victimized by people who won't think.

  2. I think there are a lot of mentally ill people who are shuffled around because nobody wants to deal with them. A few years ago, at a town south of us, a disturbed young man shot and killed several people before he was taken into custody. He had a lengthy history of mental health problems and arrests. His family was low income, and had tried like crazy to get him committed ... only to have him repeatedly returned home to their care. They had warned several social agencies of his violent behavior, but got little assistance. I think he killed four people and injured a couple of others before he was finally admitted to a state-run facility. At the time, there was much hand wringing about the incident - but I doubt whether anything really changed in DSHS's procedure for identifying the people like him who slip through the cracks.

  3. That ain't no Cluster Patient that's my Uncle Jocephus!!!!!!!!!!!!!!!!!!!!!
    Ummm I mean it SOUNDS like my Uncle Jocephus, except for that part about a "Home in Rhode Island"
    guess there could be 2 "Jocephus George Wallace Robert E. Lee Drackman"s


  4. all of the intake personnel at the psych hospitals that accept Medicaid were taking the weekend off.

    Give us a couple years of ObamaCare, and that will be all of us. They'll enjoy their weekends off and we'll be left to fend for ourselves. Calling Aldous Huxley...

  5. RE:E. Fuller Torrey
    E. Fuller Torrey loves brains and has a collection of hundreds.
    He can not find mental illness in the brain though.
    People make decisions.
    The psychiatric medications you cite for making people well, shrink the brain.

    You want the mental patient to be smart, but are chemically disabling the brain.
    Hows that working for you?

  6. Dr. Nancy C. Andreasen

    A. I haven’t published this yet. But I have spoken about it in public lectures. The big finding is that people with schizophrenia are losing brain tissue at a more rapid rate than healthy people of comparable age. Some are losing as much as 1 percent per year. That’s an awful lot over an 18-year period. And then we’re trying to figure out why. Another thing we’ve discovered is that the more drugs you’ve been given, the more brain tissue you lose.


    A. Well, what exactly do these drugs do? They block basal ganglia activity. The prefrontal cortex doesn’t get the input it needs and is being shut down by drugs. That reduces the psychotic symptoms. It also causes the prefrontal cortex to slowly atrophy.

  7. dear mark ps2,
    huh? i mean really, huh?

  8. priceless: couldn't disagree more. I have full confidence that our "smartest" administration EVER (according to NBC & Babs Streisand) knows a thing or two about human behavior. Surely things can only improve under Obama-care. When you cut folks salaries, give them more work, create more regulation, and generate more paperwork, they will certainly work much harder. It's counter-intuitive to me, but I'm not as smart as Obama & Pelosi.

    mark ps2: i'm really sorry you laid around our ER for almost 100 hours. Glad you found some way to get onto the internet. Hope you make it up to Rhode Island after they get your meds adjusted.....WOW!

  9. Are the posters above implying that antipsychotic drugs are bad for psychotic patients such as the one described? Ridiculous. Sounds as if some anti-psychiatry wack-jobs have found your site. I say give them a barbed wire enema, a spinning back heel kick to the side of the head, then make them eat the cleaning lady's vomit and read Ulysses upside down.

  10. ha! just put this guy in the dumping ground. by which i mean on-call general medicine, of course. aren't cases like this what they're here for?

  11. "implying that antipsychotic drugs are bad for psychotic patients."

    I am not implying it. I am telling it.
    Dr. Nancy C. Andreasen told it on the article.
    1% of brain loss for every year on antipsychotics.

    In an emergency situation yes of course antipsychotics are necessary, but the continual use does not work. The mentally ill person must learn/be taught to use their reason. Look at John Nash for example.

    Look up the author Robert Whitaker
    "Why has the number of adults and children disabled by mental illness skyrocketed over the past fifty years?" is the question he asks.

    Administering drugs continually for stupidity is a self fulfilling paradox that the "patient" can not escape.

  12. uh, heh heh... i wonder what the average human loses in 'brain' per year... hmmm... i think that in some apparently normal humans the number is a lot more than 1%.

  13. "a lot more than 1%" yes I agree.
    Voluntary from legal drugs like alcohol and illegal drugs .

    Sorry for the rant below, but its the freedom of the Internet.

    The difference in brain tissue loss is that a supposed doctor, a psychiatrist is prescribing drugs that affect the consciousness of their patient.

    If the patient can not have a chance to self reflect on their behavior (self insight), to possibly change their ways, then the psychiatric diagnosis and prescription is a crime for profit for the pharmaceutical companies.

    The patient believing themselves ill do not take responsibility for their health and actions. They blame it on the mental illness the doctor diagnosed. The seriously mentally ill have a 25 average shorter life expectancy.

    Serious Mental Illness Suffer From Lack of Integrated Care, (Psychiatry News January 5, 2007 Volume 42, Number 1, page 5)

    "The report documents striking evidence from state studies showing that people with serious mental illness die on average 25 years earlier than the general population and that about 60 percent of these premature deaths are from natural causes such as cardiovascular and pulmonary disease."

  14. Dear 911Doc,

    You are still, and always will be, my hero.