(The following essay was written several years ago, inspired by a patient affected by another senseless murder. Identifying information was changed. )
“They killed my brother this evening! You cain’t send me home!” Ashana insists. Her right forearm flicks up and down rapidly at her side. “I’m not safe! I might hurt myself!”
19 year old Ashana refuses to leave the triage hospital bed. A few hours ago, an ambulance brought her to our unit. She is due to give birth to her second baby in a month or so. We determined that she and her unborn child are healthy. She’s not in labor and is medically cleared to go home.
“Why would you hurt yourself?” I ask, resting one palm upon her denim covered shoulder.
“I might do something. I don’t trust myself now.” Her fingers click as her right arm absent-mindedly flails, alternately thumping the mattress below and swatting her own ripe abdomen. She turns her head side to side. “No, no, I have to stay here!” She stops moving for a moment. “I don’t know what I’ll do if you send me away. I’m upset. The cops, they don’t do nothing. It ain’t right! He just be walking down the street, someone shot him from a car and drove away. Ain’t nobody seen nothing and my brother be dead. I need to stay here. I’m afraid I might hurt myself or do something to hurt my baby!”
Ashana agrees to wait a few minutes for me, while I negotiate on her behalf.
I find Sean, with furrowed eyebrows, walking down the hall.
“Are you available for a non-urgent consultation?” I ask, approaching my obstetrician partner for the night.
After Sean nods for me to talk, I begin. “I have someone in crisis because her brother was just murdered. She’s medically stable at 36 weeks gestation. I want to admit her overnight for a Psych evaluation in the morning.”
“We can’t keep her.” Sean responds as I expected. “There is no medical indication. We are too crowded already. And no insurance nor medicaid will pay for a psych admission on an OB unit. We have too many non-billable expenses. She’s a Psych case, not an OB case.”
“Sean, you know the Psych unit won’t accept patients this late in pregnancy. She needs to stay overnight and get a hold of herself. Her brother was just murdered, for God’s sake.”
Sean shakes his head, “We practice obstetrics. She doesn’t need us today.”
“Sean” I flirtaciously lock his eyes with mine,“We dedicated our careers to keeping mothers and babies healthy. Ashana is asking for our help. She had nowhere to go. She is here alone. Believe me if I could avoid this, I would. Unfortunately, this hospital’s protocols require me to consult with you for a non-labor situation.”
“I won’t authorize it.” He responds, “We are not a psych unit!”
“That’s news to me!” I smile and tilt my head to the right. We both roll our eyes and chuckle remembering various family dynamics we daily encounter. “Seriously Sean, I refuse to discharge her home. So, it’s your choice. I can transfer her to you right now. Then you can discharge her. Let’s see how you feel when she’s found injured or dead after you sent her home.”
Sean leans his head back, looking toward the ceiling. He doesn’t have time for this. “If we admit her, the chart will be reviewed for a non-billable diagnosis.”
“Fine.” I quip. “I’ll talk with the hospital’s interrogation board the same way I’m talking to you.”
“What do you suggest?” He sighs.
My cheeks broaden to a smile, knowing I’ve won my friend over, “I’ll keep her overnight for fetal observation, per your consultation. She’ll eat dinner, then I’ll order either Ativan for anxiety, or Morphine to knock her out for a night’s sleep. In the morning, Psych can make a plan for her. She’ll be here less than 24 hours so the cost will be minimal.” After a brief pause, I add, “Sean, your heart knows this is the right thing to do.”
Sean’s shoulders relax. He nods assent.
I give him a quick thank-you hug, then turn to walk back to triage.
Sean calls out, “Don’t make a habit of this!”