316 Bartlett Ave — EDP

Location: SEMS HQ

Time: 17:40 Friday

Conditions: Mild and clear

Equipmentfully stocked except (2) adult NC and (1) adult NRB

 

Dispatch

After a busy-ish day, you’ve managed to get back to base and are hoping to restock a few items. The supply folks seem to be in the middle of some kind of Golden Path of reorganization, however, and have all disappeared after nearly stripping the shelves. You’re wandering the halls looking for them — “my kingdom for a cannula!” — when the overhead tones blare and the radio crackles (click for audio). Damn it.

[Ambulance 61, take the response to Bartlett Ave, 316 Bartlett on the second, for an EDP. Priority 1 for the 61, 3-1-6 Bartlett, with Engine… I’m sorry, with Ladder 1. Time out 17:41.]

Click to expand

 

Response

Steve is somewhere else in the labyrinth, but you hear him acknowledge on the air. You trot down to the garage and hop into the fightin’ 61, finding him already in the driver’s seat. As the doors roll up, you remark, “Thought we weren’t supposed to say ‘EDP’ anymore.”

“That’s Bruno working the board,” he answers. “He was born when the volcanoes formed and stopped changing a little while after. He gives no shits.”

“Oh yeah. Wasn’t he the dispatcher on Emergency! ?”

“Probably.”

The street is almost ripped out of the mapbook index, and you’re vainly trying to locate the thing when Steve tells you to forget it, he knows where it is.

It’s just a few minutes until you’re pulling up at a small house. A police cruiser is out front, no fire yet. Steve calls you on scene, and when dispatch timestamps it, he acknowledges with: “KMG-365.” There is a precious silence.

You tromp up the front steps with the first-in and airway bags, and Steve hauls up the stairchair behind you.

 

Scene

At the top of the stairs to the second floor, an SPD officer meets you. “Hey. Guy needs to go to St. Vincent.”

“Uh… okay. What’s up?”

“Called saying he wants to die. We’ve been here before, similar situation.”

“Gotcha. Calm?”

“Yeah, he’s just getting dressed now.”

“You guys going to do a Section?” you ask, referring to your state’s involuntary mental health hold, which allows you to transport someone against their will if an authorized person (like a cop, but not like you) says they’re a danger to themselves or to others.

“Nah, he’s cooperative.”

You move past him into the apartment. Another officer is inside with a middle-aged man who’s shuffling around the living room.

 

Initial Assessment

The shuffler doesn’t look up as you enter.

“Hey!” you challenge. “How’s it going? I’m Sam.”

He acknowledges you briefly. “Hi Sam.”

“You looking to go to the hospital?”

“Yeah,” he mumbles. “St. V.” He walks past you holding a shoe.

“What’s your name, bud?”

“… Tony.”

Tony looks fairly well-nourished, but far older than you bet his birth certificate would avow. He’s walking okay, although a little sluggishly, and is perhaps slightly pale overall. He’s breathing without labor.

 

 


 

 

This seems all fairly straightforward. As Tony moves around the apartment with his shoe, you click your radio over to the fire band.

“Firecom, A61.”

“Go ahead 61.”

“Cancel the ladder, we’re all set here.”

“Copy the cancellation. Ladder 1, Firecom, you can return.”

You move into the room a little further. “Tony, my name is Sam. Can you tell me what’s going on? We just got here.”

“I need some help,” he mumbles.

“Yeah? Have you been having some thoughts about hurting yourself?”

“Yeah.”

“How about hurting anybody else?”

“No, no.” He sits on a low table and starts to pull on the shoe.

“All right. Have you been seen before at St. Vincent’s?”

“Yes, my doctor is there.”

“Have you received a diagnosis before?”

“Yes. Um… schizoaffective… bipolar…”

“Right on. Are you taking medication?”

“Well… no. I haven’t been able to refill it, because my pharmacy changed, and I don’t have a car, so…”

“Okay, so when’s the last time you took it?”

“Two weeks ago.”

“Do you know what you’re taking?”

“Zyprexa… Lamictal…”

“And you haven’t had anything in two weeks?”

“I took one of my sister’s Valium yesterday, but it didn’t help.”

Splendid.

Tony is wearing one shoe now and there seems to be no sign of another. “You have another shoe there, my friend?”

“I don’t know where it is.”

“Uh… okay, let’s look.” You wouldn’t be quite so passionate about this, but you’re disinclined to carry him, and he’s probably going to want shoes when he leaves the hospital. You enlist Steve’s assistance, and a few minutes later you manage to uncover the shoe’s mate beneath the bed.

“Okay, all set? You have everything you need — wallet, keys, whatever?”

Tony pats at his pockets. “I think so.”

“All right, let’s head out. We’ll zip you over to the hospital and they’ll see what they can do for you.” You herd him down the stairs, staying close enough to catch him if he decides to take a header.

Outside, you pop open the doors to the 61. Some crews would park Tony in the tech seat, but you prefer to keep patients on the stretcher so you can roll them wherever you want, if need be. You toss off the straps and direct him to lie down, then throw over a blanket and buckle him in.

 

 


 

 

Steve pops the truck in gear and starts steering toward St. Vincent’s.

You take a moment to palpate a radial pulse, which is strong and regular at 80. A quick blood pressure comes back as 132/74, and he’s breathing around 18 times a minute.

“Anything else bothering you? Pain, dizziness, nausea, that sort of thing?”

“No.”

“Have you felt similar to this before? Especially when you’re off your meds?”

“Yeah.”

“All right. So how are you feeling right now? What is it specifically that’s bothering you?”

“I’m… I don’t want to talk about it.”

“That’s all right. Is there anything going on in your life that’s been especially stressing you out lately? Or do you think it’s just that you haven’t been taking your medication?”

He shrugs, and there’s a long pause. He finally answers, “It’s been rough.”

Fair enough.

Plopping into the tech seat, you ask, “How old are you, Tony?”

“44.”

“Thanks.” You dial up St. V’s and give this notification (click for audio):

[Evening St. V, Scenarioville Ambulance 61. We’re about 8 minutes out with a 44-year-old male, self-presenting with a complaint of SI. Voluntary and cooperative, no medical complaints, doing okay. We’ll see you shortly, any questions or concerns?]

“Thanks, St. Vincent’s out.”

You return to your seat. “What was your last name?”

“Dilorenzo.”

“And your date of birth?”

“8/14/69.” You jot those down.

“Any allergies?”

“Nah.”

He’s clearly not looking to chat, so you spend the remainder of the ride gazing out the rear windows, trying to remember the name of the dumb firefighter on Emergency! with the mustache.

You pull into St. Vincent’s, roll inside, and a nurse directs you into a room. You let Tony walk over to the bed, situate him, and step outside to give report to the nurse, telling her… (click for audio)

[So this is Tony Dilorenzo, he’s 44. History of schizoaffective disorder, bipolar, takes Zyprexa and Lamictal. Hasn’t had either in a couple weeks due to some practical problems getting refills, so he’s been feeling worse and worse; doesn’t really want to get into specific symptoms, but he has been having some SI, so he called us for help. No medical complaints. Sounds like there are some personal stressors but he didn’t want to share. Nice and cooperative, kind of a flat affect, but no problems. He’s followed here.]

You shake Tony’s hand and boogie out to the truck.

“Who was the guy with the mustache?” you ask Steve as he pulls out.

“Chet Kelly.”

“Thanks. You’re old.”

 

Discussion

Diagnosis: exacerbation of underlying schizophrenia and mood disorders by social factors and medication non-compliance

A fairly typical call for an urban system. Although some of the psychiatric patients who are truly “crazy” in the stereotypical sense — delusional, hearing voices, etc — may have a diagnosis of schizophrenia (schizoaffective disorder is essentially schizophrenia plus a mood disorder, such as depression), schizophrenia embodies a wide spectrum, and many are simply like the majority of psych patients: regular people with a generally-manageable illness.

“SI,” or suicidal ideation — thoughts of self-harm or wishing to die — usually buys anybody an involuntary hold, even when they’re cooperative. This patient will probably be admitted and held until the psychiatry service (or that of an outside facility) feels that he’s safe to care for himself.

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