Saved By the Benzo

Bringing people back to life. It’s undoubtedly the most exciting part of our jobs in the emergency department and the reason why so many of us are drawn to emergency medicine in the first place. Most ER docs can tell you off the bat about their most impressive ‘saves:’ how many rounds of CPR they cycled, how quickly they were able intubate or throw a chest tube in, or that one time when the ED thoracotomy actually worked.

I was on my first call day in the psych-ER one Saturday morning (and if you didn’t think the words ‘emergency-room’ were enough to get your blood pumping, just add the word ‘psychiatry’ in front of it), which meant we’d be seeing whoever came through the ED throughout the night before awaiting formal psychiatric evaluation. Patients usually ranged from those acutely psychotic after a few days of a meth binge to the occasional homeless person feigning suicidal ideation for a few hours of shelter.

Our first call of the morning was for a girl on a 5150-psych hold brought in by airport police.  A couple of burly officers gave informed us that she had just flown in from the East Coast hoping to make a career in acting work when she had been seen emptying her multiple suitcases full of clothing into a garbage can in the baggage terminal. When she couldn’t explain herself much further and became oppositional officers decided it best to bring her in.

My resident and I walked into the barren bleach-washed psychiatry holding room to meet her. She was sitting up in bed completely still, eyes wide open and fixed to the blank wall on the opposite side of the room. Her fists were clenched.

We introduced ourselves and asked, “Can you tell us why you’re here today, miss?” She mumbled incomprehensibly, “I…just….for….no… .”

“Can you tell us your name?” No answer.

Her eyes, unwavering, began welling with tears and her lips quivered. Even if she couldn’t tell us, she was clearly scared to death by her inability to respond to even the simplest of questions.

We stepped outside the room to meet with the intake nurse who, just moments before we arrived, had amazingly been able to engage in full-on conversation with her.  She laid it out for us: “Young girl with bipolar disorder who’s been off her lithium for over a week now. Her mother doesn’t know where she is, she hasn’t slept in days, and her ticket to California had apparently been a last-minute purchase.” No further comment on the fact that we were told she was an aspiring actress. In a Los Angeles psych-ER, the quickest way to tell if someone who says they’re an actor is telling the truth as opposed to delusional thinking is to try and find their IMDB page. I ran to a computer. No luck in finding hers.

We head back in. “Can you move your hands for us?” She couldn’t. “We’re going to try for you,” we say before lifting her arm up so that it was horizontal with the bed. We suddenly let go. Without prompting she held it in place, exactly where we manipulated it, almost like a marionette. We lightly pushed the top of her hand and she began to slowly move her arm in the direction of the force, all the way down to her bed. If it wasn’t obvious to her, it was to us: she was in the midst of full-blown catatonia.

Saves come in many different ways in the ED, not all requiring the heroic measures we’re used to seeing in the trauma bay. After setting up an IV and giving her a few simple shots of Ativan (a type of benzodiazepine "benzo" drug), she snapped back to life, albeit a little dazed from the experience. She was transferred out shortly thereafter, free to get back on meds and lead a productive life.

“Off to the next patient,” my resident told me. “The morning is just getting started.”

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Rob Physician Grind Narrative Medicine

 

Rob

Med student and aspiring ER doc. Hobbies: Climbing on rocks aka rock climbing 

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A Shift

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