Homicidal suicidal patients were rare and disturbing on psych, carefully locked up behind doors, but when they’re loose on the medical floor, and security refuses to help, they are downright scary.

So this morning I went to check on our dear friend. He was waiting in the hallway by our office, and could barely let me finish talking to another patient. We got back to his room, and he told me that he was very anxious. Abdominal pain? “A non-issue, non-concerning, completely not serious.” But very anxious, and upset about his life being wasted and hopeless and a failure. At this point I had not yet realized how manic he had become, so I suggested that with prayer and God’s help his life could still be turned around. He got agitated again and said that would be as useful as praying to the water tower outside. So I decided to just stick to the medical side, checked his belly (much better), and promised him ativan and any other necessary benzos (mental qualification, only one needed at a time) as soon as I could get ahold of the doctors. By the time I got out of his room, I was convinced he was definitely suicidal, possibly homicidal, and certainly unhinged.

He then followed me around all morning, complaining of anixety and abdominal pain alternately. On rounds, the attending asked why he came to the hospital, and he said, “I quit smoking four weeks ago. I think that’s quite an accomplishment. Now, I did backtrack, and smoke the last two days, but I don’t consider that a failure. It’s – it’s – it’s something to take under consideration, definitely, it’s a situation, but it’s not a problem.” So we all got out of the room.

Later on the resident went to check on him before consulting psychiatry, and he tried to hit her. So she paged psych and security both. Psych didn’t answer for half an hour, which felt like forever with him standing in our doorway yelling that he wasn’t angry, and the resident had an attitude problem, then marching off, apparently to leave the hospital, then coming back to argue some more. Security arrived, very comfortable-looking in slick black uniforms, gold badges, leather belts, and informed us that they’re very sorry, but they can’t restrain a patient without a pink slip (involuntary admission for psychiatric reasons form). And lo and behold, in this unique hospital, internists can’t sign pink slips; only psychiatrists can sign pink slips. And of course psych wasn’t talking to us.

So he continued to behave very threateningly, while we paged psych without avail. Finally I went upstairs to the psych unit, found it deserted except for a couple patients and one nurse. When she heard the words “homicidal, suicidal, manic,” she became very helpful, and paged her doctors till she tracked them down in a staff meeting. They then called the resident and cheerfully told her not to bother them if the patient wasn’t on the floor. They certainly weren’t going to go talk to him while he was out smoking.

The patient is now sitting in front of the nurses’ station, taking off his clothes and folding them. We paged