Arrived this morning to discover that our sister team was hit with 15 patients overnight; so we insisted on picking some of them up, including one who was a “bounceback” to our team (meaning we discharged him within the past few weeks, and he came back with the same problem). This man lives in a nursing home, has severe dementia, but now his caretakers say he has “altered mental status” because he no longer talks to them. And he has a UTI. There’s no way we’re ever going to get him back to his baseline. . .

As I was walking down the hallway, I noticed our psychotic friend’s name on one of the rooms. I thought, huh, I supposed the nurses disliked him enough they would have taken his name down by now. So I poked my head in, and there he is, asleep on the bed. <aaahhhh!!> Just barely managed not to slam the office door behind me. He came back yesterday evening, and the on-call team very wisely refused to readmit him. So the “non-teaching service,” elderly doctors who are thoroughly despised by the residents for their sloppiness, took him, at the insistence of the chief of staff. He had a fight with another patient overnight. Psychiatry is now telling my resident that they’re not sure he doesn’t have suicidal or homicidal ideations, so they’re refusing to sign a note to that effect. They’re also refusing to pinkslip him to their own unit. I looked at the other doctor’s admitting note for him. It says something like: “Pt. is very pleasant, social behavior is appropriate. . . . Will consult psychiatry to rule out depression.” This on top of all the nursing notes quoting his wildly depressed, suicidal, and psychotic statements. So I wish the doctor and patient joy of each other.

The resident is of course disgusted, and promising to create a major scene with the chief of staff for endangering medical staff if the patient sets foot in our office. Of course, since he’s obsessed with us three, and me especially, I’m sure he’ll be in here as soon as he wakes up from all the ativan.