Today my last patient was being discharged, so you can imagine my delight when three new patients turned up at once. We handed them out between the four of us depending on who had the least patients.

I got a 24-yr-old lady, who just had a baby, who was proposing to feed it chocolate. To say the least, this concerned the staff on the OB floor. She ended up on our floor after she proposed that jello would also be a good idea. Now I was puzzled when I first read the notes in her chart. Ok, so chocolate and jello aren’t good for a newborn. But, at least she wanted to feed it! I thought perhaps some “patient education” would be good, but not really psych meds.

Then I went and talked with her. I asked whether she wanted to feed the baby chocolate. She said no, just she knows for sure that her baby likes chocolate. Then she ranted at some length about “college students” trying to tell her how to feed a baby. My first clue that there was a serious problem was the fact that she had to repeat the first half of every sentence about four times before she could get the words together to finish it. Imagine listening to that for 2 hours. Plus, although she was smiling and cooperative, ready to answer questions, she couldn’t connect two ideas enough to answer. Ask about her older son, and she would tell you about her dog who was stolen. Ask what kind of dog it was, and she reveals that she’s currently hallucinating about fishers from Italy helping Moses pull canoes out of the river. I quickly concluded that she did indeed need to be in the hospital, and continued trying to elicit a history from her. I decided to check whether she used drugs. She said she thought she’d been sent over to us because a drug screen came back positive for heroin. She didn’t know how it got there, though, because she hadn’t used heroin recently. At least, she had been “around” some, but she hadn’t used it. At least, maybe she had used it. . . I asked permission to call the NICU and check how the baby was, and she said no, it would disturb her baby to receive a call from the psych unit. It took three pages to write up every single remark she’d made. We were all laughing, but it’s tragic, too. She’s so young, and with a new baby. Can you imagine having a baby, and then being swept off to the other end of the hospital and being locked up away from it? I think it would make someone crazy if they weren’t already. But if she’s been doing drugs, she’s automatically lost custody; nobody had dared to try explaining that to her yet.

I somehow ended up with call for the first weekend. So me and one resident get to show up at 7 tomorrow to look at everybody’s patients. We were delighted to shift four patients out today, two to the state hospital for hard cases. Those two had to go through probate first to be declared in need of involuntary hospitalization. Their court-appointed lawyer had a delicate task. Just as the court (accompanied by curious medical students) was sitting down to start, there was a loud crash and a scream in the hallway, and the PA began to announce calmly, “Code Violent. Code Violent.” We all (except the judge) rushed out, to see one of the subjects of the court hearing sitting on a chair, with a smashed table in front of her. When her turn came up, the judge insisted that the lawyer go see if she would come to court. The lawyer took an escort, and presently returned to explain that the woman had threatened to stab him with a pen, and was now being put in restraints. My resident was a little shaken, since earlier in the morning she had gone and bent over the patient’s bad, with hardly any precautions. The lawyer, needless to say, did not attempt any objections to the court ordering her into further hospitalization.

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