HARD BATTLES
Alexander M. Brown, MD
(Note: The patient’s name has been changed for
confidentiality purposes.)
M
y scrubs and Carhartt jacket were
poor protectors from the winter
chill, as I shivered my way over to
University Hospital for a six-hour shift at the
emergency psychiatric service. A cold wind
whipped against my skin, and the smell of car
exhaust from the end of rush hour lingered
in the air on E. Muhammad Ali Blvd. As the hospital’s day-shift
workers headed home, my workday was just beginning.
Part of me felt naively courageous heading into work after six. But
I was also anxious. Would I have to defend myself from a patient
attack tonight? Would I as a third year medical student even know
what to ask these patients in an interview? After greeting the psychiatry residents on call, I peeked outside the conference room and
noticed a clipboard sitting atop the pre-screen wall. Steeling myself
for what might come, I grabbed the chart and began reviewing the
incoming patient’s information.
Tyson, a 27-year-old Caucasian male, had been brought in for
presumed mania by the Crisis Intervention Team, a group of specially trained police officers. During the nursing triage, Tyson had
stated he was “in mourning” and had been “kicked out of the house
by my partner.” A name inquiry with University’s records showed
no previous hospital visits; he was new to the system. I had been on
University’s locked psychiatric ward for the past two weeks and had
seen patients like this before, but most were known to our system.
I wondered if tonight might be the first time Tyson would begin to
carry a psychiatric diagnosis.
I called Tyson’s name in the waiting area and a scrawny guy of
average height jumped up and started firing off questions with a
feminine lilt. “You’re my doctor? Who are you?” Tyson had short
brown hair, almost a high-and-tight, with an orange T-shirt and
blue jeans. He seemed as if he were trying to control his emotions,
even though a furrowed brow revealed worry on his gaunt face. As
soon as we sat down in the consult room to talk, it became apparent
that Tyson’s history was going to be difficult.
10
LOUISVILLE MEDICINE
From the moment I asked what had brought him to the hospit [