Flying Over the Cuckoo’s Nest

This morning I walked into work and was immediately confronted by one of my greatest fears: the psychiatric area of the Emergency Department was “at capacity” and the patient overflow would be dispersed throughout the remainder of the ED. As a result of some cruel irony by the Universe (considering my boyfriend is a psych nurse) those patients were mostly all “dispersed” to my assignment. I therefore spent a harrowing 12-hour workday amongst a constellation of human despair. My day as follows: my first patient is brought in by medics because she is “suicidal”. She starts by chatting incessantly about her (equally crazy) roommate’s antics while I attempt to obtain an accurate medical history. She interrupts me multiple times, once to stare at me directly in the eyes and sing an original song entitled, “I’ll never, ever, ever, ever forget you”. At one point she even floats the idea of friendship bracelets. I leave her with her imaginary friends to go meet my next patient, a gentleman who was brought in by County PD after he had been found completely naked and running through the city streets. Upon arrival, he insists that he’s wearing clothes (although the image of his naked taint burned into my retinas says otherwise) and at one point he even attempts to use his exposed genitals as a negotiation tactic for a turkey sandwich. His shenanigans eventually earn him a 24-hour commitment to an inpatient psychiatric facility and a 1:1 safety sitter who looks to be about 20 years old and whom he will solicit upwards of 15 times for a blowjob during her 8-hour shift. As I’m mixing an IM medication to calm him down, I’m interrupted by the first of what will be many call bells from my first patient and evidently my new BFF. She has rung her bell to ask if I like dogs. Throughout the course of my shift, she will hit her call button somewhere between 12 and 16 times exclusively to tell me that she is brushing her teeth, proving that though she may be socially subpar and possibly also suffer from a spectrum disorder, she has phenomenal oral hygiene. I walk out of her room as I’m met with a new patient, a man whose face is covered in blood after “those little bastards at the roller rink pelted rocks at me with a slingshot”. He’s rambling about how he used to do blow off the deck of his private boat when I hear New BFF’s call bell ring again. She asks if we have any pears. I walk out of her room, literally at a loss for words and come back to see my patient’s blood-covered mouth belting out an intoxicated albeit touching rendition of Phil Collins’ “In the Air Tonight” (complete with overzealously pantomimed air-drum solo). I escape to my fourth and final patient’s room. He’s an ED “regular” named George who comes in routinely when some well-intentioned but misguided “Good Samaritan” sees him on the side of the road, passed out in a haze of mouthwash and regret, and calls 911. George drinks bottles of Listerine (which he steals exclusively from CVS and is always the same flavor- the nasty, flavorless yellow one, which he claims has the highest alcohol content) until he gets just drunk enough to lose control of his bodily functions somewhere around 4th Street, at which time the local paramedics will dutifully heave his half-limp body into their ambulance and dump him off in our triage area. So they bring him in and he’s almost completely unresponsive, even as we sternal rub him as hard as we possibly can. The medics have inserted a nasal trumpet (an artificial airway that is initiated on unresponsive patients to essentially guarantee a patent airway en route to the hospital) so I shove an ammonia packet up George’s nasal trumpet to no avail. He mouth-breathes the stench of the worst flavor of Listerine into my eyes as I try to find a vein on his arm to obtain IV access so that I can medicate him with Narcan in the hopes that today he chased his Listerine with some heroin and we can easily reverse his lethargy without having to intubate him. As I look for a vein, I’m distracted by the literally thousands of bed bugs crawling all over his body. A disgruntled ED doc comes to his bedside and in an effort to elicit a response to painful stimuli, he takes a needle and gently pokes George’s left foot and then right foot, neither one generating any kind of reaction. At this point I chime in “to be fair, George has loss of sensation to one of his legs from a prior CVA and also neuropathy to his bilateral legs from decades of diabetic noncompliance”. The doctor rolls his eyes and mumbles something about, “possibly making this job even harder”. Another nurse adds, “also this might not be medically relevant but he pooped in the Employee parking garage last week”. Exasperated, the doc walks out of the room and we get to work setting George up comfortably so that he can sleep off another Listerine binge and question why we ever chose this career in the first place. As I leave his bedside, my new BFF rings once more to ask if we can braid each other’s hair. I silently curse my boyfriend and his co-workers under my breath as I back slowly out of the room, slightly fearful for my life. I finally make it through my shift and arrive home to find the only true remedy for such a mentally and emotionally exhausting day… a plate of bacon. I drown my sorrows in greasy meat as my dog empathy-eats a few slices. We head upstairs to bed where I wake my boyfriend to whisper a thank-you for the bacon and to provide a gentle reminder that if I walk into work again tomorrow and I’m forced to have one more conversation with my new manic BFF or see any more of Creepy Naked Guy’s creepy naked taint, then I will walk my ass across the ED to the locked psychiatric unit and sign myself in as a patient.