Weekends at Bellevue Read Online Free PDF

arrive. The crowd assembles, the nurses are called over to join us, and it’s a little after 8:30 when the CPEP director instructs me to begin the Monday morning sign-out. It’s time for me to download what I’ve been doing all weekend and who’s still left in the area.
    Mostly what I’ve been doing is trying to stem the tide of patients flowing into CPEP. When there’s a slew of patients on triage and no empty beds upstairs, I can call my own 911, the EMS diversion desk, and beg them to take us out of the loop. It’s a number I know by heart already. An EMS is quick to remind me, diversion is a courtesy. They can make an announcement to all the ambulances, telling them we’re full to the brim, but they can’t guarantee compliance. And once an ambulance shows up, I can’t turn them away. And the walk-ins are still going to come regardless of our diversion status, so there’s only so much I can do to relieve the pressure of the incoming patients on the area.
    I begin morning report with an announcement. “Listen up. We’re on diversion, confirmed by EMS operator 8758. It’s good till noon, for what it’s worth. Okay, here we go. Starting with the voluntary admissions, on a 9.13 is Mr. R. He’s a fifty-two-year-old African-Americanmale with a history of schizophrenia and alcohol abuse, and he’s hep C positive. He walked in Saturday night saying he’ll kill the person at the shelter who stole his meds and wallet. He’s got a history of aggressive behavior, though nothing recent. Also, he did a stint at the Greenhouse drug rehab program not too long ago. He’s on Zyprexa for his psychotic symptoms and behavioral control, and a Librium taper for the alcohol withdrawal. Keep an eye on his vital signs. Also, rule out malingering. He could be faking it, just looking for a better place to crash, and the homicidal threats are bogus.
    “Then there’s Mr. J, thirty-five-year-old Hispanic guy, also with schizophrenia, who was referred from the walk-in clinic on Friday. He’s been noncompliant with his outpatient treatment, showing up sporadically, going on and off his meds. He’s getting delusional, says he’s going to confront people with tattoos and piercings because they are in league with Satan. That should keep him busy for a while. He’s on Risperdal one milligram twice a day.
    “Moving on to the involuntaries, Ms. D is a fifty-three-year-old black female brought in by EMS from the Port of Atrocities Bus Terminal on Saturday morning, where she threw a fit because she felt that someone had touched her. She was almost arrested, but once the cops got a sense of her, they decided to make her an EDP so they could just drop her off here instead of taking her downtown and booking her. They made the right choice, actually. She’s pretty intense, irritable, paranoid, disorganized. She came with a notebook full of stuff about the Devil and God doing battle inside her, that sort of thing. She denies a psych history, but she looks like a street schiz. Also, she’s got a history of cardiac issues, hypertension, chest pain. She needs blood pressure meds written before she goes upstairs.
    “Mr. S is a thirty-six-year-old Hispanic man with a history of depression who currently lives with his sister and is unemployed. He recently returned from Puerto Rico with worsening depression. He banged his head repeatedly against a wall in a suicide attempt on Saturday, got bandaged up in the AES Saturday night, and then started head-banging here, too. Head CT is clear; he’s neurologically intact. His utox is positive for cocaine. His ex-wife says he’s been depressed for years and he acts out whenever they have a fight, which they did recently in PR. He seemed calmer on Sunday, but he was pretty agitated on Saturday. He’s on Lexapro for the depression, and prn Librium as needed. He’s adrinker. No signs of withdrawal so far, so we haven’t given him any, but keep an eye on his vitals.
    “Mr. A is a twenty-four-year-old