Time Out

[trailerparkmedic]

Did you know that time out is almost as effective for grownups as it is for kids?

I was back with the psych patients. One of them was also an asshole. He came in and immediately started whining about a tray.

A: "I ain't eaten in 3 days, man."
Me: "Gee, that's too bad. We've already put in a request for a social worker, so I'll be sure to let her know that you need information about soup kitchens."
A: "That don't help me now! I need a sammich! And lots of juice!!"
Me: "Like I said earlier, the trays will be coming in 1 hour. We don't have any extra food at this time."

So, an hour-ish later, the trays come and the patient gets his.

A: "This is bullshit! I don't eat fish! Gimme another tray!!"
Me: "We only have that one type of tray in the ER. I can get you a sandwich if you'd like."
A: "No, I need something warm, not some damn sammich."
Me: "Well, those are your only two options. Let me know if you change your mind and would like a sandwich later."
A: "You're violating my rights! Bitch, get me a sandwich!!"

At this point, he threw his tray at me. He missed me; lucky for him. Otherwise, I'd have pressed charges.

Because he was mostly being annoying and "not directly threatening staff" (can you tell we didn't have an ER resident that day?*) we couldn't tie him down or "treat his agitation" (we don't chemically restrain patients). We did put him in timeout, since we don't need a doctor's order for that. Time out is a hallway next to the main beds. We can keep an eye on the patient through the doorway but even when they're screaming at the top of their lungs, it's much quieter and less likely to set off the other patients. Usually when we put people in timeout, they give up immediately and it's boring. This guy was funny because he sounded like a 3 year old.

"You can't ignore me!" followed by loud screaming.
"Help! I'm starving to death!!"
"This is SO UNFAIR!"

After about a half hour of this, he actually shut up! Who would have thought?



*For non-medical folk: I work in a teaching hospital, which means the doctors are residents. Residents are still learning, so while they have their specialty, they also have to rotate to other specialties for a month or two to learn. We generally have half ER residents and half rotating residents from other specialties at any given time. The ER residents have NO problem backing up the nurses with lots of sedation and restraints for patients like this one (because throwing a tray at me is pretty damn threatening) but the rotating residents are often hesitant to use as much as we need, especially at the beginning of the month when they don't understand how intense the crazy can get.

[Ghel]

You seem to understand that it's an attention-getting technique, just like with the 3-year-old. Sad part is that it must have worked often enough to make him think it'll work now.

What's that old saying? "Beggars can't be choosers"? If only that were true.

[BlaqueKatt]

Sad part is that it must have worked often enough to make him think it'll work now.

sadder still is people like this can keep others from seeking the help they need.....

[Midnight12]

and yes that is sad Blaque cat, but the sadder part. a kid gets the fact that hey i am being ignored if i stop or behave i will get positive attention very quickly. adults take longer...often much much longer

[PepperElf]

and to be honest... if he hadn't eaten in 3 days i seriously doubt he'd be turning food away.

[NateTheChops]

When I spent some time in the psychward on a 72 hour watch they were pretty accomadating. Since I wasn't violent I had the run of the floor, which actually included access to the refridgerator and the little kitchen area in the common area. Juice, sandwiches, etc. There were regular mealtimes of course, but during the day you could grab a snack if you needed one.

But this was the actual floor and not the ER and it's not like I knew this ahead of time when I got placed there.

I was back with the psych patients. One of them was also an asshole. He came in and immediately started whining about a tray.

I'm going out on a limb with this guy and calling "malingerer". He seems to have been aware enough to make demands, which tells me he probably got himself in the psychward on purpose to get free food and a place to sleep, but that's just a guess on my part.

[Sapphire Silk]

and to be honest... if he hadn't eaten in 3 days i seriously doubt he'd be turning food away.

He'd be snarfing it down. Most of the folks who claim to be starving actually could use to lose a few pounds. Food simply becomes a control mechanism.

When I spent some time in the psychward on a 72 hour watch they were pretty accomadating. Since I wasn't violent I had the run of the floor, which actually included access to the refridgerator and the little kitchen area in the common area. Juice, sandwiches, etc. There were regular mealtimes of course, but during the day you could grab a snack if you needed one.

But this was the actual floor and not the ER and it's not like I knew this ahead of time when I got placed there.

ERs usually don't keep a lot of food on hand. Most of the places I worked, we had a small fridge with a few sandwiches, juice, sodas, and crackers that was primarily there for diabetics with low blood sugars. I used to be pretty free giving patients drinks or crackers as long as they weren't NPO (nothing by mouth), but wouldn't give out the sandwiches without a good medical reason. If the patients were admitted, but held in the ER pending a bed assignment I'd order them a tray from the cafeteria at mealtimes.

I'm going out on a limb with this guy and calling "malingerer". He seems to have been aware enough to make demands, which tells me he probably got himself in the psychward on purpose to get free food and a place to sleep, but that's just a guess on my part.

He may well have been having an exacerbation of a mental illness. But even in acute psychosis, a lot of patients have enough wherewithal to know how to be manipulative. In that case, the proper course of action is to set boundaries.

[trailerparkmedic]

ERs usually don't keep a lot of food on hand. Most of the places I worked, we had a small fridge with a few sandwiches, juice, sodas, and crackers that was primarily there for diabetics with low blood sugars. I used to be pretty free giving patients drinks or crackers as long as they weren't NPO (nothing by mouth), but wouldn't give out the sandwiches without a good medical reason. If the patients were admitted, but held in the ER pending a bed assignment I'd order them a tray from the cafeteria at mealtimes.

Wait times in our ER are beyond ridiculous--today was a good day because none of my patients hit the 24 hour mark. I order trays for everyone who has been with me for at least a hour at meal times, because they probably spent 4 or 5 hours in the waiting room and they'll spend another 5 or 6 hours waiting for the CT scan to be done and read.

We don't have crackers, but we do have a large stock of sandwiches that are replenished 3 times a day. They're not particularly good so I know most people eating them are legitimately hungry. I give them out without reservation to people after breakfast and lunch, but I won't give them out after dinner because they need to last through the night.

Nate, a large number of the psych patients I see in the ER are there for suicidal thoughts. You can be suicidal and still be very "with it" and aware of your surroundings. Most of our psych patients are homeless, which means they have a certain level of functioning even if they are hearing voices. The ones who are just overwhelmed and don't know what to do tend to be younger with new onset problems, and we like to keep them a bit separated from the "been there, done that, got the t-shirt three times this month" crowd.