Finally!

So after one year of residency, half of which was in Emergency Medicine, I am finally in an actual emergency room full time.

I'm LOVING the shift work. Granted, the hours would be much sweeter if I didn't still have my academic half day and my family medicine clinic half day in addition to my emerg shifts, but I'm loving it none the less. I have an impressive talent for being able to fall asleep any time, any where. So it didn't take long to adjust.

The upside? Well, it's emerg. Nuf said. The downside? The hospital I've ended up at isn't the trauma centre for the region. Nor is it the cardiac cath centre. Or the stroke centre. Sigh. You can see where this is going. Calling it a glorified walk-in clinic isn't all that far from the truth. But it is the regional centre for... ready for it? Emergency Psychiatric Services. Thank God for that month I spent in Emerg Psych last year. At least I'm not completely unprepared.

The patient of the day came in the form of a 19-year-old boy brought into the ER by his father, who was requesting the services of the emergency psychiatric team. He was claiming that his son was apathetic, lacked focus and wasn't able to concentrate. Fair enough... these can all be early signs of clinical depression. When I actually interviewed the kid, however, he turned out to be the most pleasant and normal person I had encountered all day. His mood was good, he denied any suicidal ideation, and he joked with me throughout our conversation. He did admit to having trouble finishing projects... he found he just lost interest in them easily. He had also gotten into university for the fall, but it wasn't to his first choice school and he was seriously thinking of taking a year off to reevaluate his career goals. No signs of depression that I could see.

So I called in the father to join us. The father was quite distraught. I asked him straight out why he thought that his son needed a psych assessment. The father, in English heavily accented with an accent that may have originated in India (I'm not great with identifying accents) told me that their family owned a store. The father had been trying to get his son to work at the store, but all he did was sit behind the counter and watch television. He didn't want to go to university. He didn't work hard at school like his sister. He wanted to hang out with his friends and play video games. He argued with his parents. Obviously, concluded the father, his son was mentally ill. He had asked the family's doctor to provide a referral to a psychiatrist, but they were told there was a three month wait. So here they were.

It was difficult to stifle a giggle. I explained that the purpose of the emergency psychiatric team was to identify people who were at immediate risk for harming themselves or others. I assured him that I saw no signs of mental illness in his son, and that if he continued to have concerns he could see his family doctor for family counselling.

Obviously there was a cultural component here, but what was I supposed to diagnose this kid with? Teenage boy syndrome? Sigh.