Rick Pescatore, Medical Student, 08:06PM Apr 14, 2013
Last night I was called to a ramshackle trailer home tucked away in the back of a sprawling senior citizen complex I've come to know very well. The red and blue of the ambulance's rotating lights reflected off of neightbors' windows and the car hoods of passersby as we turned down the lane, and I admonished my eager driver to slow the rig as we sped past the identical plots. When we parked in front of the numbers marking our destination, I grumbled our arrival into the radio and flipped the master switch to kill the colors. We'd been here before, and Doris' story was just another chapter in the long narrative of our nation's neglected, mentally ill elderly.
The door was open, a screen door flapping free in the breezy night. I rapped on the wood frame before stepping inside to announce my presence, and found my patient sprawled on the ground. She held a bloodied towel to her long neck, and it gave an odd vibration with every yell and scream that poured out of the woman's mouth. She cried inconsolably as blood continued to trickle from around the red mess, insisting that she just couldn't take it anymore. "They all just give me the run-around!" she sobbed repeatedly.
I raced to control the bleeding, all-too-aware of the speed with which a red blood cell will leave the body, given the chance. We ripped 5x9's and 4x4's from their sterile packaging, willing the blood to stop, wishing there was some way to tourniquet the neck as bandage upon bandage soaked through. I brought the chilling suicide note from the hall table with us, shoving it into my pocket as we raced back to the waiting ambulance.
The bleeding slowed on the long drive, tamponading to a trickle by the time we pulled into the hospital's receiving bay. We rushed Doris to a waiting room and breathed a long sigh of relief as she was swept into the frenzy of care.
Doris had wanted to die last night, and what will end up as a likely victory for Emergency and prehospital medicine is still an abject defeat for psychiatric care. It was no secret that Doris struggled daily with her thoughts, but neither her mental health physician, her home nurse, nor even her occasional medic-turned-medical student was able to recognize when Doris' chief complaints became pleas for help.
I start my psychiatry rotation in a few weeks, and while I still struggle with the different iterations of schizophrenia and the multiple axes of mental disorders, I know one thing for sure. Mental health care has to improve in this country, and it will be up to today's students to change the story for tomorrow's patients in need.