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DoctorsDoct can help patients with issues of mental health
Avery pleasant young woman named Beth came to the emergency department a few months ago for nausea, vomiting and abdominal pain. As I was looking over her chart before I went into the room, I was checking to see whether she had any medical problems or had ever had surgery.
I noticed that a few of the questions that the triage nurse had asked were marked in red because they were considered abnormal. There is a set of questions patients are asked when they check in to screen whether they feel safe at home and in their relationships, and whether they feel as though they might harm themselves or someone else.
The nurse’s note indicated that Beth felt safe at home, but she admitted to feeling very depressed and occasionally suicidal. This broadened my ideas for what could be causing her symptoms.
Beth was very quiet but pleasant when I evaluated her. I noticed that she did not make eye contact when talking and was constantly staring at the ground. She told me she was having pretty severe upper abdominal pain with uncontrolled nausea and vomiting for the past day.
Her abdomen was fairly tender, especially in the right upper quadrant. She grimaced when I touched her. I used a light to look at her eyes and noticed that the whites actually looked a bit yellow. I initially thought her skin had looked a bit yellow when I first saw her, but I didn’t realize how yellow it was until I removed the blanket she was huddled underneath. My concern for Beth grew after I examined her.
I ordered numerous laboratory tests and then I went back to her room once things had settled down and everyone else had left her room.
I walked into her room, closed the curtain and sat down on a stool next to her bed. She continued to be somewhat elusive and would not make eye contact. I tried to talk to her about lighthearted topics and then I explained to her that I was there to help and take care of her. I needed her to be honest with me so I could do the right things for her. I touched her hand and she finally looked at me with tears in her eyes.
She broke down and started crying. I handed her a box of Kleenex and let her talk uninterrupted. She told me about how she recently had lost her job and was having trouble paying her rent. Her boyfriend of several years had ended their relationship and was dating someone new. She was estranged from her family and had not really developed any friendships since moving to Columbus from another state. She really didn’t have anyone to talk to and felt overwhelmed with everything going on in her life.
As we were talking, the nurse interrupted me to tell me that there were some critical lab results of Beth’s that had just returned. Her liver enzymes were abnormally elevated and the yellowing of her eyes was due to jaundice, a buildup of bilirubin in her blood that was due to her liver not functioning properly.
Beth finally admitted that she felt so desperately bad that she had attempted to harm herself by overdosing on medication. Tears streamed down her face as she told me she took an entire bottle of Tylenol PM, hoping she would not wake up in the morning. She woke up with abdominal pain and that is when she started vomiting.
With that vital piece of information and her abnormal lab values, I started a medication called N-Acetylcysteine, which is an antidote for Tylenol poisoning. This medication that goes through an IV is used to prevent injury to the liver. Tylenol overdoses can be life-threatening due to the toxic effects of Tylenol on the liver.
She was admitted to the intensive-care unit for close monitoring and thankfully had a fairly good recovery. She went to an inpatient psychiatric facility once she left the hospital for aggressive treatment of her depression with medications and counseling.
Beth confided in me that she was embarrassed by how she was feeling and had regrets about trying to harm herself. She didn’t know how to tell us what she had done. I thought a lot about that.
Mental illness is prevalent in our society and has some role in a large proportion of emergency department visits. We pride ourselves on being there to take care of anyone at any time for any reason. Mentalhealth issues are no exception.
There is a national suicide hotline that is available 24 hours a day at 1-800-273-8255. If you or someone you know is experiencing thoughts of wanting to harm himself or anyone else, please call the suicide hotline or go to the nearest emergency department. We are here to help.