The following story is true. Names are changed to preserve people's privacy. (It's also long. It was a long, strange night.)
I work with a specialized program that provides therapy and psychiatric access to severely mentally-ill people in their community, where they live.
Recently I got the call that one young dude was voicing suicidal ideas with a specific, credible plan. People went over and talked with him and thought they had contracted with him and he was going to be ok.
I then got another call that he simply changed his plan and remained actively suicidal so I said he's gotta go to the hospital.
And as he is poor and doesn't have his identification with him currently (some of the young people we work with lose all their stuff or haven't really understood the importance of their ID) so that meant we had to go to Grady Hospital.
To their psychiatric emergency room, one of the most notoriously long waits in town.
As is the nature of psychiatric emergencies this was not at all convenient. The calls came in such time as to get me headed into downtown Atlanta after 4pm. Traffic Hell. I was to meet one of the team members who was driving this guy to the hospital where I would take over and get him up to the psychiatric floor deep in the heart of this huge hospital. I had remembered to not go to the main ER but I had never actually been to Grady before.
The entrance is grand. The inside reminds me of an Embassy Suites hotel, open and spacious. We made out way to the interior of the place, an older part that was significantly less grand and more like the hospitals of yore, in which I worked years ago.
We got to the proper elevator essentially by chance and took it to the psych floor. There was a security desk and metal scanner procedure to go through and they took my ink pen. I had plans to document a number of things but, oh well. We got through this and walked in to the unit and opened the first door on the left and walked in. The next 12 hours were something else.
The main waiting area of the Grady psychiatric ER is the essence of spartan and minimal. it's like a long box, wall on one side and bank of windows across from it on the other side. There is a triage room forming the corner of the entrance corridor and the registration area is at the other end.
We sat along the wall nearest the registration window.
There were about 15 people in there when we arrived and over the course of the night some would go and new folks would come in. There were a variety of people there but just myself and 3 other white folks all night long: everybody else was black. My client is black.
For the next I-don't-know-how-long we just sat there. Nobody came to ask us why we were there; I didn't see anything to "sign-in" on; I saw no particular instructions on what to do, so we sat there. After a bit I went and asserted myself at the triage room. I was told that somebody would talk to us "soon".
My client, whom I will call "Homes" is about 20 years old. His background and upbringing pretty much suck. His mom is very ill and has chronic drug abuse issues. So bad that he has spent most of his life being raised by other people, relatives of mom, mostly. Some of those folks were good and tried everything, but this sort of illness wreaks havoc on a family. He talks about hanging out with guys selling crack and other drugs and telling him to "just not look" while they do.
He has what appears to be a mixture of manic-type symptoms with some schizophrenic qualities. He had taken his last dose of meds, which, apparently, weren't doing the trick for him anyway, about 9 am and it was about 430pm when we got to the waiting room. Over the next 12 hours Homes would unravel next to me as I watched a parade of different people with different stories float past me.
Homes also had not eaten since early morning and was starting to complain about being hungry, ruminating on how he still had ten dollars at home that he could have brought along and got a Big Mac™. As the night wore on he would come back to this again and a again, getting progressively more frustrated with the wait and being hungry.
Around us an older woman was dressed in a very nice older style dress, with one lazy eyelid. All the other folks, n matter how rude, showed some sort of deference to her.
There was a lady just in from Savannah: her 2nd night in Atlanta and she's at Grady Psych Er. Not good. She was very poor, had an history of crack cocaine abuse she spoke about openly. She was purportedly clean for some time. Overweight, out of shape, missing upper teeth. We'll call her Julie.
There was a black guy, probably about 38 or so, maybe a little older, shaved head, athletic shirt, black jeans, short. He had a nice smile and some pleasant demeanor. He said a couple of funny things, 'helped himself' to some food that the older woman I first described above had somehow acquired. He appropriately structured a couple of different guys, an older man and a younger man, telling them to sit down and be quiet or they'd never get out of there, which was true. We'll call him Tony.
There was another couple there, the guy was from nNew Orleans. Tony indicated he was from NOLA as well and they quickly compared names of local guys to establish authenticity. Tony passed the test.
One harsh girl in a basketball jersey, leopard-print bra and ballcap/bandana sitting around talking about smoking crack. Hard-headed with a big brace on one leg. She turned out to be married and her husband showed up with food for her, seemed to cool her out, but she was a roughneck girl, for sure.
Crack and cocaine became the topic followed by Tony saying cocaine and weed are the same and the guy from New Orleans saying "No, man, its just an herb". I just stayed out of it ;)
Tony put the moves on Julie for the next several hours, eventually getting all kissy-faced with her and hearing her ask if she could stay the night with him. They shared a hospital blanket.
A homeless older white guy came in. Very short, very dirty with a funky, messy beard: a poverty-stricken Yosemite Sam. He walked slowly back and forth most of the night, fists clenched and occasionally making these wheezing sounds, as if this was his was of getting attention or issuing a treat or warning. At one point a security guard told him to knock it off and sit down. He did for a little bit and then when the guard left, he resumed, though not with as much intensity. At one point my patience wore thin and I said , lowly, "I feel a disturbance in the Force" as he sounded like some pathetic Darth Yosemite Sam.
About 930 pm I made a plan to get me and Homes something to eat. A security guard assured me "Homes isn't going anywhere". I thanked him and told him my plan. Unfortunately there was a KFC and a McD's and vending machines. I will NOT eat fast food but I will rationalize french fries when I am starving. I got Homes a Big Mac and some fries and a cola, I got fries and a cola and zipped back to the Waiting Room.
Homes was happy to see McD's, having no earthly clue what a proper diet is. He inhaled the Big Mac and fires.
I didn't get 5 fries in my mouth before Yosemite Sam came, holding out a handful of change saying "Ill give you seventy cents for some of those fries." I froze momentarily. I know he's hungry, but so am I. Situations conspired today to make it such that I ate almost nothing and now it's 930. I tell him no deal, but if it's any consolation, they aren't for sale to anybody. It's very difficult to turn people down like that. It's a stress.
A little later crack lady and Tony were off to get some food and they collected some change to get Yosemite Sam something - I caught up with them and gave the rest of the change in my pocket for that. Tony smiled and said "I knew you had a heart". Terrorist fist jab. They eventually returned with food and a chicken sandwich for Yosemite Sam.
During all this Homes was coming off his meds and the frustration of the long wait and no tv and all sorts of young people issues swirled into the beginnings of decompensation: the emergence of psychosis. He didn't start hearing voices or anything , but his conversation went from pleasant to focused on killing and death and mutilation.
About 10 pm or so, I saw police bring somebody in. A white guy in a blue jacket and red suspenders that weren't being used at the moment. I heard an odd sound and saw the guy talking and touching his throat at the base, as people who have electronic voice boxes do. The sound was somewhat like that. I thought nothing of it.
Until he came around the corner and sat down.
This guy walked from around the corner and onto the top of my "Freakiest Things I have Ever Seen" List.
I have worked in mental health for 25 years; inpatient hospitals, outpatient clinics, urban and rural areas. I have seen people hallucinate, responding to voices. I have had people screaming at me that because I am so irritating they are forced to rub butter on their ass. I have seen substance abuse patients try to break the windows out of a 4th floor unit to escape. I have even been attacked in a parking lot in the middle of the night - and beat them to a bloody mess.
This guy was hallucinating for more intensely than anybody I have ever seen, personally. He was making his voice make that sound - constantly. It sounded to me like he was speaking in tongues. His eyes were simply wild. And his face was flushed with a red tint. He was almost glowing. His speech was accompanied by a variety of hand activities: sometimes he was actually "twiddling his thumbs". Sometimes it was 'pill-rolling" behavior, a sign he's been over-medicated in the past with certain medications that aren't in use anymore. He would also lay down of the floor and continue his vocalization and pill-rolling while trying to get comfortable on that nasty floor.
But he also did something that reminded me of nothing so much as 'Danny" from "The Shining". In that film Danny was a little boy who stopped talking to his mother like a little boy. He spoke in a raspy, mechanical voice and twitched a finger in rhythm to his speech, telling his mother "Danny isn't here anymore Ms. Torrance". The famous scene of him walking around saying "Redrum, redrum" may be more familiar to people.
This guy would have all of his fingers and thumbs going in some sort of unison with his vocalization, which was odd enough. But at one point, for whatever reason he made eye contact with me and his vocalizations intensified notably and he raised his arms so they were more outstretched amd gyrated his fingers in synchronization, his eyes still just wild and his face flushed. I wondered if he had dropped 20 hits of LSD.
If I had seen this occur in a scary movie, I would have said "that's really creepy and very original". Having it occur 10 feet from me with no barriers in place was not what I needed on top of all the other stresses I had that night. I know I could clock the guy out if a physical altercation had proceeded - that's not the point.
The guy was the best example I can summon of possible demonic possession. I can easily see why folks would think such a thing about people with severe mental illness once I saw this. I didn't feel particularly unsafe so much as I thought I had seen about everything and this clearly put an end to such thinking.
So I am keeping an eye on this guy, keeping an eye on some of the others who had come in (blood-stained shirts bandaged wrists for 2 or 3 of them) all the while my client is muttering on about "n****r this and Fuck that" and all his ideas about killing the roomie who irritates him. It was really quite a trip.
At 230 am the next day we finally see a counselor who does an assessment. I am concerned she is trying to talk him out of his statements, leaving me with the possibility of having to leave the hospital with him still unglued. I advise her clearly that the client was suicidal earlier and he's unraveled to the point of homicidal ideation. Luckily, he is known to them and he is ranting on about his hatred of this other guy.
We see a psychiatrist at 4 am or so and after some discussion there's no way he's leaving the hospital tonight. At 530 in the morning, 13 hours later, I FINALLY turn him over to the hospital staff. He asked me to walk him onto the unit, which I arrange to do. He got all child-like once he realized this was all real and happening. But the last thing he tells me is to tell the guy he hates he'll be coming for him. "Tell him" he said. Icing on the cake of the night.
I left...to find the parking garage in which I had parked...was locked. 6 am somebody opens it and I get to finally go home. I'm so tired and so hungry. I got home and sent a couple e-mails to provide details to the company and oddly, burst into tears. It was far more stressful than I have let myself believe.
This sort of experience is TYPICAL for Grady and is fully exacerbated by the crisis in healthcare and the reluctance of insurance companies to treat mental illness properly. There is no money to make this better right now. The mental health options are few here - private companies of varying competence are the most numerous outlets, community mental health is almost gone.
Proper healthcare in this country would alleviate a lot of the suffering these people go through, would relieve the strain on Emergency Rooms across the country.
Update [2009-9-20 13:16:18 by xxdr zombiexx]: Lest I appear to be dogging Grady out, the nurse's are burnt to a great degree but I know managed care is largely responsible for this. They all do the work of at least 2 people. The Security Guards - Grady seems to have a small militia of guards - were great. Homes liked them. They set good limits on people and were nothing but helpful.
Also, this story is related to the dynamics in another diary: Medicaid, Poverty and Contempt. That is also in full effect despite praising of the nurses. Grady gets denigrated in the public by the dynamics detailed in that post. Read it. - Doc