When you live in a small town like this, you get to know the regulars. Especially the psychiatric regulars. Most are your garden-variety depressives and substance abusers, but occasionally you get the REAL ONES. The psychotic, paranoid schizophrenic, the catatonic ones, the ones who smear themselves in excrement and pray in the streets. You know those by name. And apparently, so do the other mental health providers from Key West to Miami.
We get a regular in the other night. He was passed out in the middle of the street. When the police came to move him along, he brandished a knife and threatened to kill himself. Bought himself a Baker Act. The local intake deferred his admission to the Baker Act facility up the islands. I suspect his name had something to do with it. So I called to check on bed availability. Much hemming and hawing once they learned his name. I was on hold for eternity. Took a second call from the supervisor to even get permission to fax info.
Two hours later, they call back and request additional repeat labs. Ok, done deal. I draw blood, send it, fax results over.
I get a curious phone call. The charge nurse wants to know if we are going to correct his K+. It was 3.3, down from 3.4. I wouldn't even give you a banana for such critical figures. I tell her NO, because the ER doc has signed off on him and anyway, he didn't order the labs, the receiving facility did. This is what I get in response:
"ARE YOU AN RN? ARE YOU TELLING ME THAT BECAUSE THIS IS A PSYCH PATIENT, YOU'RE NOT GOING TO TREAT THEM MEDICALLY? IS IT BECAUSE THEY'RE LESS IMPORTANT?"
My response was:
"I don't have an order to treat. I didn't have an order to redo labs, but I did you a favor. This has nothing to do with being a psych patient. This is not a critical value. NOW ARE YOU GOING TO GIVE ME A BED OR ARE YOU GOING TO DICK ME AROUND ALL NIGHT BEFORE TELLING ME YOU WON'T TAKE THE PATIENT? LET ME KNOW NOW SO I CAN START CALLING OTHER FACILITIES."
The patient was transferred in 15 minutes.