"I don't get it"

We had a frequent flier come in who'd overdosed again. It was a few months ago. I just thought of it because of an episode of "ER" I watched. This situation is common in the ER. We call them underdosers, as in "I took SIX TYLENOL and was trying to kill myself." Obviously, they aren't. You can kill yourself with Tylenol, but it takes a lot, and it's a really really bad idea and results in a gruesome death, in case any readers are wondering (same with aspirin). This patient, I don't think was necessarily an underdoser. I think she tries to kill herself a lot and has bad luck, as in someone walks in on her and calls EMS. At any rate, I wouldn't call her your normal everyday attention seeker, but she fell into the category of patients who annoy everyone because they seem to be constantly trying, and failing, to kill themselves.

Her primary nurse, predictably, was annoyed. "I just don't get it." She said it a lot. "I don't GET IT."

My response was, "You don't have to 'get it.'" I normally let people treat their own patients and stay out of it, but I was irritated. This patient had just tried, apparently with some gusto and determination, to KILL herself. So she was having a bad day, we can probably assume. Did she really need to deal with an ER nurse with attitude, who just "didn't get it?"

Do we need to "get" cancer pain to treat patients who have it? Do we need to "get" the emotional anguish of a parent whose 2-year-old has just been diagnosed with diabetes in order to treat them? No, but for some reason nurses seem to think we need to "get" emotional pain in order to treat psych patients. Why? Give me a patient who has just tried to legitimately kill herself, and you've got yourself a medical emergency. DEATH is a medical emergency regardless of its ultimate cause. The underdosers and attention-seekers also need treatment, because if you are trying that hard to seek attention, you need it, and you deserve it, because you too have a treatable disease process. But you can also wait. We can let the screeners "get" you. There also exist patients who don't really want attention for their psych issues but have to come to the ER anyway (cutters, I'm looking at you), and this is a bizarre suggestion, but maybe we should listen to these patients when they tell their stories. What is our problem? Either patients actually ARE attention seekers or they are just doing stuff so weird that it CAPTURES our attention and we say "crap, that patient is attention-seeking" (when the patient just may want to get sutures and be on his merry way). We need to rethink our assumptions with psych patients.

As for the underdosers and the patient who prompted my post: it's a fine line sometimes between attempted suicide and attention seeking. Sometimes it comes down to what the patient says (don't be afraid to ask: "did you mean to kill yourself?" You won't be putting ideas in their head. They'll often tell you. And for god's sake chart what they say). And we don't have to "get it." We have to treat them. Medically. And that includes being nice---not fake nice, but actually realizing, "Something so horrible has happened that you have in fact attempted to destroy yourself, which goes against evolution and self-preservation. Although it will horribly inconvenience me because I will have to sit with you, forsaking other emergent patients, I will realize that I do not need to 'get it' in order to treat you competently and professionally, and, if I can pull my head out my ass sufficiently, perhaps even compassionately."

I'm freaking myself out lately with this pro--psych nurse stuff. I can actually see myself some days doing that instead of starting finger IVs and shocking people up from the dead. But that's probably just a result of too much rest.