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The daily life of a medical resident..
a.k.a "It's 2 AM and I'm looking at urine outputs."
Me and 1013. 
Thu, Mar. 4th 2010
In the library of forms that one uses in the great state of Georgia, form number 1013 starts off with the words "Emergency Admission and initial civil commitment"

Funny how a number takes on a life of its own when you refer to it often enough. The classic combo of 5 mg Haldol plus 2 mg Ativan is now a "B-52", so named because it "takes out" any target you use it on. 20/20 vision. GCS 15.

A Ten-Thirteen is how you commit someone to the hospital against their will. Not uncommon in my line of work where we get overdoses, drunks in fulminant delirium tremens, and the occasional psych complaint in addition to heart failure and pneumonia. So issuing a 1013 form in the ER is routine.

Doing it from the clinic is significantly less common. So of course, I'm the only intern who has had to do it. Twice, now.

The first time, it was a very dear patient who was struggling with depression as I struggled to get them on the right combo of meds. They came in, worse than usual and I asked the Gryphon House approved question "Do you ever think about hurting yourself?" as I chanted to myself "Please say no, please say no..."

But they did. And they had a plan. And they had the means carry out their plan at home.

I trudged out to the work room, knowing what's coming next. An involuntary ride to the ER with our helpful neighborhood EMTs as they kept telling me "But you know me! You know how much I love my children, I'd NEVER do it!" As your doctor, I am obligated to see to your safety in the setting of self-harm, even if you don't want me to.

Our veteran attending kept telling me that I did the right thing as the ambulance pulled out of the parking lot, even as he knew I wasn't hearing a word.

I nearly cried when they showed up at the follow up visit. "I know you were just looking out for me Dr. Zechar, I'm not mad."

I saw them again today. Doing so much better. God Bless Elavil.

But Fair warning: if you ever offer to see a fellow resident's work-in patient in clinic because they're swamped and it's 4:00? It WILL be a nightmare.

Which brings me to 1013 number two.

A routine check on how a patient was doing on their new SSRI depression med was met with a torrent of psychiatric issues - self harm, attacking family members, auditory hallucinations, visual hallucinations, mood instability, even dissociative symptoms.

I had to tease the nurse who gave me the "shouldn't take you but a minute" patient when we were calling for EMS. "See if I do YOU any more favors!" :)

Happily, they went without any issue - but the 1013 was tucked in the back of the admission note, just in case. With the same attending physician's signature as the first ordeal.

Perhaps it's my psych background that helps me find more issues, or the crazy is simply drawn to me... either way, Dr. B has threatened to run away the next time I try to staff a patient with him.
Wayne State University Class 2009
Comments 
Fri, Mar. 5th 2010 (UTC)
It's a 302 form in Pennsylvania. This brought back bad memories of having to 302 one of my inpatients in the middle of the night while on call for threatening to kill himself (and I still know he took pills that he had with him, because there were less in the bottle than there should have been, WHATEVER) only to have the psychiatrist the next day dismissively tell me "oh he was only attention seeking."
Fri, Mar. 5th 2010 (UTC)
It's always creepy when you put someone you know well into a psyc ward against their wishes. I had to do it to my own wife (then girlfriend) back at Uni...
Fri, Mar. 5th 2010 (UTC)
Anonymous
Thank God there are physicians like you who can & will make the hard decisions in the best interest of the patient and the loved ones who would blame themselves if something did happen.
Fri, Mar. 26th 2010 (UTC)
*hugs* Thank you, you rock.

And I'm so glad that patient #1 is doing better.

Bless you. I hope I can handle similar things with the kindness and maturity you have, if/when I'm in a similar situation as a PA.
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