What Time Are We Leaving?

It hasn't been a terribly tough day today, but it has been a kind of tough week. Some staff are out on vacation, so everyon'e got an exrtra load. And Friday's can be difficult for some patients because they're anticipating how bored and neglected they'll probably feel over the weekend. Different staff, not as many groups, no meetings with treatment teams. All there is to look forward to is smoke break and maybe a card game or two. Some patients seem really not to care, and in fact seem to prefer really being left alone.

Other patients, though, metaphorically grab on to your pantleg as you're trying to get out the door, making any bid they can for more attention. At the same time, you're feeling in a particular hurry because it's Friday, you're tired, it's been a long week and there's still a little summer left, so wouldn't it be great to get out of here early. Your main motivation, though, honestly, is to get out the door before the "Friday at 4 crisis".

Today I got a little lucky -- none of my patients (at least so far -- it's only 4:20) have become suicidal or demanded discharge at the very end of a Friday. The Friday at 4 suicide threats are a much bigger plague for outpatient therapists. My patients are already in the hospital, afterall, and the evening staff really can handle it. On the other hand, the sudden demand for discharge can wreak a little more havoc if the patient is basically stable and able to take care of him or herself. It's a tough spot to keep someone in a psych. hospital over a weekend essentially against their will if your main justification is that it's your turn to bring the limes to margherita night, and you didn't have time to pick them up last night. In this case, it's usually easier to just go ahead and do the discharge paperwork, because you'd probably spend more time arguing about it with the patient if you did't. And you can avoid all the other patients seeing that you're still here, and looking vulnerable, and start circling with their own crises like a pack of lunatic wild dogs after a wounded bunny.

No, the worst of it today was one patient coming up with six or seven very pressing issues that she's "freaking out" about, but in reality, at least five of them really can until Monday. And another patient came up to me as I was unlocking the the unit door to leave. She had a towel and a toothbrush in her hand, and she asked me if she had time to take a shower as if I were going to be taking her with me.

Enjoy the weekend,

Madeline