[wolf]

Sometimes the nuts end up waiting in the lobby a lot longer than is really good for them.

Our goal is to get someone from the front door to the unit in two hours. Some nights it is very, very hard to meet that goal. Like nights where we start the shift with four patients in the lobby and another six or eight join them in the space of an hour.

A week or so ago I had this guy who was totally off his nut.

He was probably a pretty pleasant guy under regular circumstances, but he'd been off his medication for the last four months or so. When we got him he was pretty psychotic. Hearing voices, couldn't concentrate, hadn't slept in a while.

We got him because he had told his case manager he was willing to go to another hospital in the area.

She said fine, let's go, and was driving him there to be evaluated.

That's when things went downhill.

Shortly after leaving his house he announced to her that he wanted to chop her head off.

She kept driving.

Then he told her that he was going to cut her up into itty-bitty pieces.

For some reason this was more disturbing to her than "I'm going to chop your head off."

She stopped the car and got out.

Yes, leaving him in the car. Alone. Not sure if she left the keys in the ignition or the car running, but we've had that happen before.

Luckily, he didn't take off in her vehicle, or start tearing it to pieces. We've had that happen too.

No, he got out of the car and started chasing her around.

Somehow his brother shows up on the scene, gets him calmed down, and takes him back home.

The case manager came in, filed commitment papers, and then I end up with him.

He was extremely disorganized, but overall, not too bad to deal with. Spent some time in an exam room, then started pacing around the lobby. We have patients do that all the time, not a big deal. One of my female coworkers found him to be kind of spooky, and wanted him placed in seclusion, which is a polite way of saying "lock him in a small room because he's freaking me out."

We need more documentation than "being spooky" to be able to lock someone up.

Didn't take more than a few minutes to get it. Actually, he'd been doing well for the first hour and a half or so he was in the lobby. After that, his patience must have just totally run out.

We hear a ruckus, and run out to find him throwing magazines and fake flowers around the lobby, and several other patients and their family members cowering in a corner.

A few husky men from nursing come out and give us a hand in escorting him to an exam room with a lockable door.

Again, he does well for a good while. Doctor sees him (with an escort) and orders a shot. This is the kind of shot that puts down bull elephants. Usually takes about a half hour to really work and put even the most agitated patient to sleep.

Not him.

First he starts pacing back and forth for a while.

Then he realizes he has some stuff in his pockets ... pulls out a bandana.

Rips it to shreds.

Then another bandana.

Rips it to shreads.

Then he finds a savings passbook in his shirt pocket.

Rips it to shreds.

Notices a box of tissues on the windowsill.

Pulls each tissue out of the box and tosses them into the air.

You know that part of the magic act where the magician appears a whole batch of hankies, and they flutter to the stage like big white snowflakes? It looked just like that.

Then he takes off his flannel shirt.

Rips it to shreds.

Long sleeve teeshirt.

Rips it to shreds.

Now, this is not going on as fast as I'm describing it. There are gaps in his performance, sometimes up to a couple of minutes as he considers his next move.

Takes off his workboots. Pulls the laces out. Throws them into the air.

Takes off his pants.

Rips them to shreds.

Sits down for what we thought would be a rest, turns out he was just taking off his socks.

Rips them to shreds.

Stands up again, takes off his tidy whities.

Rips them to shreds.

At this point, a police department comes in with another patient. The officer is starting to explain why they are there and he looks up at the video monitors and just stops talking.

"Yes, officer, he is naked, and yes he is surrounded by what was his clothing before he ripped it to shreds."

The cops stare at the monitor, fascinated by the show.

And then, as such things do, it gets better.

This man is stark naked, sitting on our (luckily easy-to-clean) couch, and reaches for the last thing that he has access to.

Luckily, he didn't rip that to shreds, but he did play with it for a while, after which he picked his boots back up and tried to rip them to shreds, but work boots are surprising sturdy and failed to yield to his attempts to rend them.

So he went back to jerking off.

And never went to happy nap land, where the doctor was sure she had sent him with the load of medications that got pumped into his rather scrawny ass. I think I've mentioned before that attractive people never get naked in the nuthouse?

There is even frosting on this particular cake.

Close to two hours after they were given the admission orders, nursing finally sends two guys out to escort naked man onto the unit. They have been briefed on what has been going on in the exam room, and have come out with a pair of hospital gowns to provide him some decorum as he is walked to his room.

I turn towards the monitor as I'm explaining the situation to them and see ... that since he's run out of things to rip to shreds, he's pissing on the wall.

This happens from time to time. After he's gowned and taken out of the room, however, I had to wade into the ocean of piss because I had to recover all of the pieces of that savings passbook. And his boots.

The only opportunity I missed was to take a drug screen test kit in with me.