New Understanding Within UNC Psychiatric Emergency
Kendall Barbour spent time shadowing the nurses and physicians in the Psychiatric E.R. at UNC Medicine. There, she was able to connect with a recently-admitted psychiatric patient through simple listening and communication.
CHAPEL HILL, N.C. – As the sun sinks low into the warm sky overhead, several ambulances surround the entrance of the University of Chapel Hill Hospital’s Emergency Room on a routine Tuesday evening. Located in an isolated corner behind the UNC Hospital System, a seemingly constant shadow is cast over the small sectioned-off portion of Emergency Medicine.
Within the Emergency Room itself, a security guard stands planted alongside a metal detector immediately in front of the entrance door. Families fill the waiting room, anxiously tapping their feet and speaking in hushed tones. Upon arriving to the Emergency Department, the Main Emergency Room is reached by a clear, marked path presenting itself.
The Psychiatric Emergency Room proves a bit more difficult to find. Located within the UNC Psychiatric Hospital, the Psych E.R. resides deep within the hospital, hidden behind multiple restricted doors, winding hallways, and authorized entry ways. Privacy and discretion present themselves as key elements within the atmosphere.
Upon entering the Psych E.R., nurses swiftly move about their station within the center of the room with purpose and familiarity. The perimeter of the room is surrounded by light blue curtains drawn halfway encompassing patients in their beds and ensuring privacy, casting shadows over the individuals that lie behind them. The room is without windows or doors other than the locked main door near the front of the room that requires an authorized fob to enter and exit through. Sounds of equipment beep throughout the room and a woman’s unintelligible shrieks can be heard from an enclosed room near the back.
Isolated in the back of the room are numbered padlocked cubbies visible from the nurses’ station. Their numbers correspond with the numbers above each patient’s bed. Within the cubbies, each admitted patient’s personal belongings such as phones, clothes, and miscellaneous items are stowed away and inaccessible to unauthorized personnel. All entering visitors are instructed to remove their personal belongings as well and allow them to be placed within the patient’s assigned cubby.
The nurses, dressed in maroon scrubs, continue about their afternoon schedule, attending to patients, finishing paperwork, eating an afternoon snack, and making small talk with one another.
The attending physician within the UNC Psychiatric Hospital makes rounds amongst the patients, moving throughout and in between the light blue curtains. Several colleagues follow him closely. While the nurses within the Psych E.R. are each clothed in maroon scrubs, the psychiatrist wears a plaid button up with dress pants, distinguishing his position. In addition, he carries several cases of paper with him throughout his meetings with patients and his identification badge is visible, clipped to the pocket of his shirt. He carries himself professionally and treats his patients with respect and understanding.
The psychiatrist approaches a patient who was admitted only the night before. The patient’s curtained room is nearly identical to the others. His area contains one hospital bed, a food tray, a few chairs, and a heart monitor. However, not each patient is connected to the heart monitor. While some patients require close physical monitoring, others are simply there to rest and discuss their situations. Each room has a decent view of the television. There are very restrictive television hours and the volume remains constantly muted. Unlike most hospital rooms, there is no harsh lighting. Most rooms are darkly lit. The sounds of various patients moving, rustling, moaning, and snoring carry throughout the department.
The psychiatrist begins to discuss the current status of the patient. In addition to being admitted less than twenty-four hours before, the patient currently suffers from depressive bipolar disorder. The patient begins to discuss what led him to the Psychiatric Emergency Room.
Recently, the patient has gone through a very serious break up with his ex-boyfriend. He explains that the entire ordeal took a serious toll on him. He had undergone extreme emotional trauma and attempted to reach out for help before finally being driven to the hospital.
He attempts to communicate how serious their relationship was and the implications that came with their break up. They shared a cat, they were buying a condo together, and they were close with one another’s families. He recounts a trip they both took to visit his father who is terminally ill with cancer. He continues to recall close and intimate moments that he and his significant other shared throughout the course of their relationship. He expresses how much the relationship meant to him and how serious it became so quickly. He then moves onto their separation.
The patient explains that, months ago, his ex-boyfriend other took a trip with friends to Puerto Rico and asked him not to come. His ex texted and called throughout the trip. He decided to remain in Puerto Rico, and, after a few months of long distance communication, he suddenly ended the relationship. The patient communicates how sudden and shocking the split was. He states, “everything had seemed normal in the months before and finally one day it was ‘I don’t love you anymore.’” He mentions that everything had been fine the day before and he never suspected anything and suddenly everything that they had built together came tumbling down. As he progresses through his story, tears begin to well up within his eyes. As he shares his hardship, he stares off in the distance and recalls his feelings of rage, despair, and loneliness.
The patient then begins to discuss how he dealt with these feelings and how the situation resulted in this arrival to the emergency room. In the aftermath of his split with his boyfriend, he began texting him non-stop. “I just wanted to be heard and listened to,” he confesses. He also reveals that he recently switched his medications for depressive bipolar disorder and increased the dosage.
Finally, his boyfriend stopped returning his texts and phone calls. The patient admits he then eventually ended up calling the Crisis Line, a non-judgmental listening, crisis intervention and suicide prevention hotline. However, he reveals he was left on hold for an extended amount of time. Finally, his financial adviser came over that night to discuss the condo he and his boyfriend were building together. Seeing the state the patient was in at the time, his financial adviser felt obliged to drive the patient to the hospital immediately. The patient states that he’s “glad the hospital admitted me because they could have let me go.” He informs me that the doctors took his cellphone to prevent him from contacting his ex.
In order to communicate his condition and fully explain how his mental health allows him to process emotional trauma, the patient states, “Take the letters a, b, c, d, e for example. All of these letters are in the correct order. However, when the letters get mixed up and out of order, it is a much bigger deal for me than it is for others.”
The patient discusses how he relayed this information with his doctors and how helpful they have been. He feels that the hospital has treated him kindly and been exceptionally understanding of his situation. He states that he has felt free to confide in his doctors and was even offered the option to conduct his treatment through outpatient. However, he felt that his situation and current mental state were better suited for treatment within the hospital itself.
The patient states that the therapeutic discussion and disclosure of such deep and personal feelings have genuinely improved his emotional state. From the near moment I arrived to the very end of my stay, I discovered the deepest feelings of a complete stranger through simply listening, and he felt a release from confiding in an individual who was willing to listen.
Windham, Jacob. (2015). Emergency room beds [Image]. Mobile, USA. Retrieved from https://www.wunc.org/health/2015-12-16/study-nc-psychiatric-hospital-would-need-to-at-least-double-the-beds-to-decrease-waiting-list#stream/0.
(2018). Emergency room map [Figure]. UNC School of Medicine, North Carolina, USA. Retrieved from https://www.med.unc.edu/pediatrics/specialties/emergency/emergency-room-map.