Just the other night, I had two admits come onto my unit. One was a bipolar med seeker. And the other was a heroin detox patient. Both of which were in their 20s. To make the story short and to the point, 15 minutes in, I got the order to discharge them AMA; and kicked the garbage out to the curve, without even as much as a “goodbye.”
Before everyone gets their panties all in a bunch, let me say that I can’t even imagine what it’s like to go through an addictive problem, etc. But, I do believe that their is a fine line between wanting to actually get help or just bull craping the system.
Ms. Bipolar Med Seeker.
Both of my admissions came within 2 minutes of each other. My first admit was a bipolar med seeker. The nurse, at the facility she was coming from, specifically stated she is a SUPER Med Seeker. She complained about every damn thing and threw a fit if she didn’t get her Lorazepam, aka Ativan. For those of you who don’t know, Ativan is classed under benzodiazepines, which are highly addictive. Coming onto my unit, wasn’t any different.
She sat down, on the floor in the hallway, crying excessively, like a little 4 year old. I asked her “What’s the matter?” She yelled at me, asking me “Why the hell didn’t I get any medications yet?!!!” “Why aren’t you guys helping me?” “I was f***ing raped!” “You aren’t listening to me!” “I need my meds!”
Trust me. This went on for a good 5 minutes. In my experience, the only real way to deal with bipolar med seekers, is to be absolutely strong and firm with them. And as you’ve probably learned in school or will learn, if they staff split, create a point of contact for all matters/concerns. I’m sorry, but with me…there’s no Mr. Nice Guy here ladies and gentlemen. And daddy has no time for your bs : /
She finally worked my last nerve…so, I sternly told her to pick herself up and go to her room to just “sleep it off, until your doctor sees you in the morning.” She continued to cry even louder and expressed various derogatory statements. She called me various things like rapist, stupid f***, etc. Nevertheless, sh got herself up and screamed back to her room, slamming the door behind her.
When I work…what ticks me off the most, with any patient, is when they trigger and/or cause a decompensation of linear treatment for any of my other patients. In psych, one trigger always leads to another…which is why the bad ones always get isolated, getting rid of unwanted behavior real quick. If patients can go from 0-60, you better believe nurses can too.
Shortly after, I called the doctor stating my claims on the patient, how she presented, what she wanted, and that she was just disrupting the milieu for her own personal cause. Got orders and immediately represented myself to the patient.
I calmly knocked on her door, asking if we could talk. With an entitled attitude, she immediately asked me “Did you f***ing get my meds right finally?” I quickly began explaining to her that her tone and attitude wasn’t necessary, at that moment in time. Of course, she continued to bicker throughout this whole conversation. I further explained to her that the doctor wouldn’t see her and talk about medications, until the morning. I also reminded her that she came to the facility voluntarily, wanting help. Unfortunately, it seemed as if my reasoning was going in one ear and out the other. Sadly, “help,” to her meant “getting more drugs.”
I ended our mind numbing conversation with a only few simple questions. One being most important, “Can I expect you to be cool and calm, on my unit?” She responded quickly after, “F*** You. No.” From that point on, I turn around and walked back to the nurses station, wrote a telephone order for “Administrative AMA discharge, due to noncompliance with program,” and had my team on the floor escort her out…and just like that from 0-60, she was gone.
Ms. Detoxing of Heroin.
Round 2. There she came, confidently walking up to the nurse’s station. I stood there getting introduced to her, by the intake coordinator. She was certainly alert and oriented times 3-4. However, the exchange of pleasantries was far from many.
I gave her the usual work up, “Please place all your belongings on the counter. Per protocol, I will have my team search through your belongings for any type of contraband, etc. And they will also inventory everything, so that everyone will be accountable for your things.”
She was initially compliant. Dropping off her things, she suddenly became increasingly hesitant. She told me “I have Restoril pills in my purse.” Restoril is temazepam. It’s used for sleep. It’s a benzodiazepine. It’s a narcotic, just without all the street hype like Ativan.
I’m surprised, amongst drug abusers, it isn’t more commonly known. If you come into a detoxing facility, it better be known that you will most likely NOT get your drugs back. It will be confiscated, under doctors order. But then again, that’s my understanding of how things are handled. We do live in a wild world though.
So, I told her simply and straight to the point, “I should probably tell you now, so that there are no surprises, you may or may not get your Restoril back. It will all depend on what your doctor thinks.” And right after I said that, my golly, she threw a dang fit. She got loud, extremely irritable, cursing, using derogatory language, etc. And there I stood, thinking she was one of my ex-GFs, on a hunger trip. Lol.
What ticked me off the most was the fact she kept on yelling saying that she didn’t want to be admitted to “some Looney Bin.” A Looney Bin? Seriously woman? That’s a little insensitive and shallow, for being a person who is just as “Looney.” Hell, we’re all “Looney,” at some point. Needless to say, I called her doctor, and he agreed with my thoughts.
To keep things short, let’s just say it all ended just as the first patient did. The truth is, when your a detoxer and you come in voluntarily, it’s obviously going to be hard. Regardless, I don’t have the time nor the patience to give a 5 star treatment, smiles galore, etc., to someone who obviously doesn’t really want help. Trust me…there’s another homeless, psychotic patient out there who is waiting for your bed.