I mentioned a police safety check in my last write up. So what the heck is that?

On the internet it's called a police wellness check or police welfare check. The most obvious use is if someone has a suicide threat and we can't get a safety contract. Another use is if your 90 year old mom is supposed to call you each morning from another state and she doesn't.....

A safety contract is essentially saying: I can be at your house in (15 minutes, 2 hours, 24 hours). Can you promise not to harm yourself until then? I got a contract from my sister when she called me: my father and I flew down within 24 hours and then we talked. As a physician I knew how to use the system. I called her doctor and her doctor found an inpatient bed. We walked into the emergency room with them expecting us. The psychiatrist was called by the emergency room doctor and my sister went voluntarily. This has all sorts of advantages over a "hold" where it's involuntary in order to try to keep the person safe, aka from killing themselves.

My sister wrote about her experience. She told me that inpatient she felt that she was at a decision point. She could be "crazy" and hide there, or she could go home and do the hard work of dealing with all the miserable emotions. She chose the latter. She said that meeting people who were crazy made her realize that she really was not crazy. She was depressed and very unhappy, but there were reasons and she had a daughter. She was inpatient for only 3-4 days. This protected her job and health insurance and all of that. Then she did the outpatient hard counseling. I had to too: our mother had died and our mother was two people. The one on the outside who could charm the birds out of the trees and the one on the inside. We asked my father about the inside one: What was she really like? His reply: "Morose." Since all three are dead, I have my mother's diaries. Much of her writing is the really dark stuff, but it's not all morose. She writes that she's mostly pretty happy, she just doesn't think anyone should talk about any of the dark stuff. It all goes in the diary. It was very confusing as a child, since kids are connected to their parents' emotions. I think those dark emotions are all the scarier if forbidden, we don't talk about them, they are not allowed, or expressing them results in shaming and humiliation. Ours did. We learned to hide shit very young.

I considered calling a police safety check last year. A patient was using heroin. Her husband called me crying, saying that she was lying in bed, buying heroin on her credit card. I had seen this patient, who was way too young to have deep chronic bed sores on her lower back and heels, from lying in bed. Once in clinic she told me her urine drug screen might be positive because "My friend gave me something for my headache yesterday." Ok, the urine shows cocaine. "Um, how did you take it?" "I snorted it." "Uh, you are saying that you snorted something for your headache and didn't know it was cocaine?" "I didn't know."

Well, that is stage IV addiction: the stuff they say is just insane. Hello, you should not snort anything for your headache, right? The denial is so deep and crazy at that stage that you just look at the person like they have two heads. And they don't KNOW that it's crazy because they are lying to themselves first.

Anyhow, I sent adult protective services out. Now, they are supposed to deal with neglect, including self neglect, but it doesn't apply with addiction, drugs or alcohol. What the hell, right? But the thing is, you can jail people for buying illegal stuff, possession, etc, but that doesn't treat them. The only way to treat them is if they are willing.

I talked to UW Telepain. They said I could call a police wellness check and go with the police. Because I do NOT feel comfortable going to a house where heroin dealers are delivering. A couple of the UW docs discussed this. I would have the police along for safety and again offer her treatment/care/inpatient/etc. Then the UW family doc who also works with addiction folk spoke up: "Dr. L has only so much energy and time. This patient does not want help and it has been offered multiple times. Dr. L may need to save her energy and time for other people." Yes. Relief. I didn't WANT to go, since it felt hopeless and the patient was refusing to come in. I do not know if she is still alive. It is sad, but there it is.






Iron Noder: Tokyo Drift 12

How often do I use this? Once in 30 years, so far.

I type a name into the medical records system. Spinning icons show that the search is in progress. Results... one found. Thank God, I think, it's not a common name. The phone number matches what I scribbled on the pad in front of me. I hit Enter to open that chart.

A dialog pops up: Confidential record. This patient is not in your care area. Click Yes to contact your supervisor for authorization. Click No to cancel access.

Next to the Yes and No buttons there's a third one, much larger, labelled in bright red with bold letters: Break the glass. I click that one.

The chart opens, and a window full of patient information shows up. Along the bottom there's a red banner that says: Emergency Mode. All Access Logged.

I scroll down far enough to find an address. I grab the desk phone and dial a few digits. Somebody picks up on the first ring.

"911 dispatch. What is your emergency?"

"I'm a nurse calling from the ER at St. Lobart's Hospital. I need an urgent wellness check for a suicidal person at home."

"What is your name and callback number?"

I give those.

"Where is the person located?"

I give the address. I hear the sounds of rapid typing.

"Do you have their phone number?"

I give it.

"Do you know the name of the person?"

I give the name too.

"What can you tell me about the situation?"

"She called the ER just now and said she is having suicidal impulses. She said she is sitting in her kitchen, holding a gun, and resisting the urge to shoot herself. She won't leave the house alone because she's afraid she will run into traffic. She won't put the gun down." Keyboard sounds continue at the other end of the phone. "I asked her to call 911, but she refused. She knows the ambulance will take her to the closest hospital, but she doesn't like that one."

"And she gave you her contact information?"

"No, she only told me her name. I found a current address in her medical record. The number on caller ID matches the one in her chart."

"What time was the call?"

I check my watch against the scribbled notes. "Six minutes ago."

"What else do you know about the situation?"

"Nothing else. She hung up on me."

"And you said this person is armed?"

"Yes. She said she is holding a loaded gun."

Type-type-type. Tap. "Thank you. We'll have police there in a few minutes. If she calls back, keep her on the phone, and have someone call us on another line."

"Are you sending paramedics too?"

"Yes. The police will go in first, to make sure the area is safe."

I take a deep breath. "I understand. Thank you."

"Good night." Click.

For the rest of my shift I keep a close eye on the news. There are no reports of police shooting anyone. No reports of anyone shooting at the police. A suicide wouldn't make it on the news channels in this town. It would be too small a story.

I hope they got to her in time.

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