Monday, April 16, 2012

Quack/Attack Part 2

     Gottswin angered me again today.
     I was with Mrs. Frumberg and her son Erik. Erik had been in the psychiatric center for a week. He was stabilized on medication for his oppositional defiant disorder and was ready to go home. All he needed was a discharge order. Unfortunately the physician on call for the weekend was Dr. Asshole. Psychiatrists rotate being on call to give each other a break, and today the chief quack in-house was Gottswin.
     Mrs. Frumberg had already waited two hours for Gottswin to show up. He had been playing golf all afternoon, pretending he knew a nine-iron from the flagpole, and he arrived buzzed from too many Rolling Rocks stuffed into the tee pocket of his golf bag. His curly brown hair looked dirty and his face was cooked red from the sun. He stumbled onto the adolescent unit with a goofy smile. I started to explain that Erik needed to be discharged, but he held up a finger and ambled into the bathroom. After twenty minutes, the toilet flushed and he staggered outside, wiping what looked like vomit from his mouth.
     Mrs. Frumberg was very nice. She spoke with a slight German accent, and didn't want to offend the all-powerful doctor. I wanted to tell her that Gottswin was a fraud, that she shouldn't respect a man who tried to give a thrashing boy a shot in the butt and ended up piercing his sciatic nerve, but I couldn't. I might lose my job, or at least bolster my reputation as a slowly-declining nutjob.
     So I tried patience. I walked Mrs. Frumberg and Erik around the psychiatric center, giving her a tour. To my dismay, everywhere we went, Gottswin lurked like a drunken apparition playing hide-and-seek with us. When we went to the cafeteria, he was there eating french fries. He smiled at us, pretending he was getting a quick meal on the run, then dunked a french fry into his ketchup and stuffed it in his mouth. When we went into the day room, we found him talking on the phone with his current whore-of-the-month. When we wandered into the hallway, we saw him through the window of his office, drinking coffee and playing a game on his cell phone.
     I wanted to pummel him. Mrs. Frumberg and Erik had been waiting four hours for a simple discharge order so they could drive home (three hours away) in the waning light instead of total darkness. Mrs. Frumberg's vision wasn't very good and she preferred to drive during the day.
     "It's quite okay," she told me. "We can always stay the night and I will rent a motel until the morn."
     I gritted my teeth and knocked on Gottswin's door. He frowned at me, annoyed. When I yelled through the closed door that Mrs. Frumberg was waiting for a discharge order, he scowled and held up a dictation note and prescription slip with Erik's name on it. Then he shooed me away and continued writing his clueless evaluation of Erik, gleaned entirely from other staff's observations. If Erik had a third eye on his neck, Gottswin wouldn't have noticed.
     Half an hour later, I was able to escort Mrs. Frumberg to her car. I apologized, but she claimed this wasn't necessary. "I understand the doctor is busy," she said. "His time is worth valuables."
     When they were gone, driving to the nearest Holiday Inn, I re-entered the psych ward. Gottswin was sauntering into the bathroom again, as if he were the very definition of "cool". I glanced behind the nurses' station. The LVN in charge was outside on the patio, giving a boy his insulin shot. I hurried into the medication room, grabbing a bottle of liquid Haldol and stuffing it in my pocket.
     Gottswin's office reeked of exhaled booze. I unscrewed the cap and poured half the bottle into Gottswin's coffee. Probably about 50 mg. Because he would be gulping it without Cogentin, the side-effects would be...considerable.
     I rushed back to the nurses' station and replaced the bottle. Gottswin trudged into his office a few minutes later, plopping down and draining the Styrofoam cup. He grimaced sourly and tossed it in the garbage.
     I hoped to God he would get into his car and drive home. The Haldol was a major tranquilizer and he would be near-comatose in half an hour. He would fall asleep at the wheel and drive his car over the bridge. Or plow into a tree and smash through the windshield, too sedated to remember his safety belt.
     My fantasy didn't come true. Instead, Gottswin suffered a severe EPS reaction where his eyeballs rolled back in his skull and his neck became so rigid he couldn't unglue his head from his shoulder. He lurched out of his office, moaning and gibbering like a zombie, groping at the walls. I wanted to trip him, to make him fall on his face and then kick him in the head.
     But I couldn't laugh at his misery. I had to act innocent. So I took him by the arm and guided him toward the bathroom, whispering that it would be all right, that I would get him medicine to unlock his neck muscles and tug his eyes back down so he wasn't blind for the next 12 hours. I lay him down on the floor, where he sprawled like a drooling idiot, teetering between awareness and unconsciousness. Then I patted his head, exited the bathroom, and locked the door.
     He would stay there for the next four hours.
     Exactly the amount of time it took for him to write Erik's discharge summary note.
   

3 comments:

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  2. This is not SPAM, relax. Great story and great theme! I was hoping your book on Amazon was going to deal more with psychiatry like your BLOG here does, but anyway...

    Just wanted to supply a first-hand experience with Cogentin and Haldol. Cogentin is a weak drug compared to Haldol's strong side effects, especially as it is prescribed. Anyone who thinks that Cogentin is the answer to all of Haldol's problems is full of it. It is an acetylcholine inhibitor, and is really meant only to take care of the restless leg syndrome caused by large doses of Haldol (compare this to Parkinson's, they almost mimic each other in biochemistry). The only reason why Cogentin is chosen is because acetylcholine inhibitors are not dopamanergic, but serve almost the same purpose of eliminating anti-Parkinsonism to our knowledge. 50mg of liquid Haldol in one dosage is not really enough to warrant Cogentin, I wouldn't believe. The effects of Haldol have to build up in your system to experience the side-effects that Cogentin is intended for. Oral administration is not like getting it IV. You really want to avoid Cogentin if you can, since it causes major urination problems that a doctor might even prescribe Flomax for (disgusting!). No one really wants all that polypharmacy.

    FYI.

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    1. Excellent comment. Thank you! I recall (when I worked in a psychiatric center for 5 years) a 10 year-old boy ingesting a small dose of oral Haldol. Thirty minutes later, his neck had locked up due to tortocollis and he had troubled controlling his eye muscles. He gulped a dose of Cogentin and was fine an hour later. This was the inspiration for this entry.
      My book is science fiction, but it does employ many medical and psychological aspects. Thank you for reading!
      --Jeff

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