I work at a psychiatric emergency service, which is basically an emergency room but for psych stuff instead of medical stuff. Most of our patients are brought in on involuntary psychiatric holds, called “5150s”. We have double locked doors keeping people in (or out, as the case may be). We are a county hospital, and we take EVERYONE, no matter how awful they may be, how many times they have tried to beat us up in the past, no matter how smelly or high or drunk they are. The buck stops here, cause there ain’t anywhere else. OK, now that you have a description of the place, on to the top 10:
10. I have zany, wacky, goofy coworkers, who make me laugh even if I’m calling in because my stomach feels like it will explode.
9. Nothing gives me the giggles like triaging out (someone comes to the door with no reason to come in, and you send them out after quick evaluation) a crack-intoxicated MtF tranny, who flashes me twice during the conversation. Then my triage nurse writes a note about the encounter and makes sure she mentions that the patient “flashed the charge nurse her genitals twice.” Comic!
8. Chocolate night- every Wednesday evening two of our doctors bring in extremely high-end dark chocolate, for a “chocolate tasting”. I have started to bring in some as well. We are excruciatingly pick, eschewing any ingredients except chocolate and sugar. Lecithin, you are dead to us! I end up with a chocolate buzz, and either furiously clean the chart room, or just giggle to myself for an hour.
7. Really smart, funny coworkers. We have psychiatrists, nurses, psych techs, medical assistants, and unit clerks. Some of my co-workers are freakin’ brilliant. Others, merely smart as heck. A couple have written books. (read Dr Paul Linde’s book Danger to Self if you want to read more about emergency psych) (Paul, you should pay me for advertising your book for you) Another does really cool fundraising parties at his house. Several call themselves “chicken ranchers”, and have many chickens, even in the city. We are generally very supportive of each other, and folks will step in if one staff person is getting overly flustered or harassed by a patient. “Step away from the tweaker Andrea, and have some chocolate.”
6. About 50% of my coworkers are gay. Which is well above the national average, and considerably above even the San Francisco average. We are FABULOUS.
5. Even when patients are insulting us, some of them do it in such a creative way that it cracks me up. Last week I got called an “ass raping gestapo bitch”, and couldn’t help but laugh. This unfortunately pissed off the patient more. (note: I did not do ANYTHING to his ass, and I am not a Nazi. I might, however, be a bitch)
4. I have gotten to know a lot of the San Francisco police and paramedics, most of whom are pretty damn awesome. (Police and/or paramedics bring in most of our patients)
3. The work is unpredictable, forcing you to be flexible and creative. We might have no patients come in for 5 hours, then get 6 in 15 minutes. While I might get flustered in the short run, I kind of like the adrenaline.
2. After working there for a few years, it is REALLY hard to shock me.
1. I really like most of our patients. The majority are indigent, many are homeless, quite a few are smelly, and most use drugs of some kind. However, every day one of them says something that makes me smile. Another one will say something that makes me admire their strength in adversity. A lot of them are really trying to improve their lives, even if it takes many attempts. Most of the homeless are mentally ill or substance abusers or both. Most of these folks have a secondary diagnosis of PTSD, they have NOT had easy lives. Yet a lot of them have better attitudes than more privileged people we see at the ER.