Meeting In The ER

One of the saddest parts of my job in behavioral health is when I meet a young adult in an emergency department. A young adult who typically is in their late teens or early twenties. A young adult who has just made that faithful step towards independence. That step to be "on their own" for the first time. Maybe they have gotten their own pad or started college. Then I meet them in an emergency department for the first time. Sometimes an emergency department in a town away from home. Totally unfamiliar. Totally scary. Their emotions locking up or becoming more extreme with every passing hour. New voices. In their head. Whispering. Commenting. Biting. Commanding. Their thoughts derailing. Their knowledge of time, space, and location slipping on the ice that is freezing parts of their brain. Strange ideas such as the television communicating messages to them or that agents from a foreign country are watching them drift like plywood in a dangerous current. Regular activities to sustain well-being such as sleeping, eating, or drinking are forgotten as the shifting sands of their thoughts slide and spiral as if they are in a blender. Sometimes thoughts of killing themselves or striking out at the people around them, while the taunting voices pound away, and the fear stumbles in flood to the surface with the filters that stop the action are burned away like parched paper under the flames of disorganization. All new experiences for a young adult just trying to stand on their own two feel for the first time. All happening at once and now they are in an emergency department. An emergency department already flooded with patients and staff who don't want to deal with "those" kind of patients. Doctors knowing that this person is going to take up an emergency bay for hours upon hours. Then I am called in. Sometimes in the middle of the night and sometimes right at lunch. I walk in and see this young adult with that look. The look of fear, desperation, and loss. I conduct my interview. I try to build rapport. I try to establish a mental life raft. Many times it is already too late. I observe. I collect. I pray. I pray that all of these symptoms add up to something else. Anything else. Anything that can be fixed quickly. Like if the drugs clear the system or that they have a serious infection or maybe a drug interaction. My hopes drop as I am told that there is no other cause and that the drug screen results are negative. No drugs, no infection, and all signs pointing to a psychiatric diagnosis. A diagnosis that will follow them for life and dictate how they see the world and how it sees them. All within the mind and body of maybe a 18 year old, a 20 year old, or a 22 year old. The deeper sadness creeps in as a meet the parents. Full of fear. I am a stranger. I am an informant. I am the bearer of bad news as I explain that their child, now a young adult, is suffering symptoms of their first psychotic episode. That they are losing touch with reality. They are losing touch with who they were, are, and who they planned to be. I listen carefully to the questions. I answer them with care. I advise to a course of action. Typically it is to send their young adult to a psychiatric unit for their own safety and treatment. I feel like a judge handing out a life sentence and the hopes drift away from their parent's eyes. It is a deeply personal moment. I am filled with deep sorrow. A sorrow that I have felt too many times as I have made too many trips to an emergency department to meet a young adult.