I got my college degree in three years, went on to medical school, knocked that out in another four, did a one year internship that included medicine and neurology, a psychiatric residency, and then finished by serving as chief resident for my training program. I swung right into a junior faculty appointment, did that gig for awhile, then answered the siren song of private practice with its polished desks, shingle on the door, and suits and ties. I did work for the Veterans Administration and the Federal Government, local counseling shops and state agencies. I did consults and sat on boards. After five years of that I left for part time mental health center work for a couple of years, then took the plunge into full time community work, where I’ve pretty much stayed for the last twenty years. I’ve seen thousands of patients, served as medical director of a clinic for a decade and even tried my hand as executive director of the place. (That was NOT my cup of tea, no sir.)
All that to say that I am not, or have not been to this point, a very well educated man.
I decided to take a job doing telepsychiatry a little over three years ago. The lure of the technology (shiny!) and the cutting edge aspects of seeing patients in emergency departments (EDs) hundreds of miles away by using slick technology, high speed data lines and multiple computers was just too much to resist. My team mates and I have now seen patients in up to twenty five hospitals (the number fluctuates from time to time), and we have done over fourteen thousand consults in the last four years, give or take. I am basically an ED psychiatrist, albeit a virtual one. The sixteen hour shifts are just as long and draining as if I were really there in body as well as soul, maybe more so. The work is isolating. The constant stream of suicidal patients and the assessment of risk is daunting and exhausting. Like any emergency department job, it is exhilarating and heartbreaking work.
I have learned more, in some ways, in the ED over the last three years than all the years that went before. I have learned how we treat our own people and how we see the sickest of the sick. I have seen how we respond to substance abuse, and how we meet our own mortality every day when we give Narcan to a woman who has just swallowed pills or sew up the wrist of someone who knew how to cut “the right way” and was almost successful in bleeding out. I have learned how helpless you feel when you realize that a patient is set on suicide. I have struggled with wanting to give up on the alcoholic who comes into the ED with a blood alcohol level of almost five hundred (that would basically kill you or me) for the fifteenth time, swearing that he can quit any time and that he does not want treatment of any kind.
I am being educated every day. There is not a day that goes by that I don’t hear of a new story, a new excuse, a new type of substance to abuse, a new way to be abused, or a new way to die.
Besides the privilege of being there to help take care of patients, I am also seeing some of the very worst things that are wrong with our health care system, specifically as it pertains to the evaluation and treatment of the mentally ill, some of our most vulnerable citizens. I would like to share some of these observations with you over the next little while. I hope that you will read them, think about them and that they will stimulate discussion and debate. We do a lot of good in the health care business these days. We help a lot of people. We also work in a system that is broken, and that desperately needs a long acting depot injection of compassion, common sense and change to insure its viability into the future.
Come with me, and I will open your eyes.