Let me give some background: (I’ve skewed a few details for privacy)
I am a PGY-2 IM/Ped’s resident
This is a 35 yo male who has been dealing with depression since childhood. He had severe trauma as a kid and it’s been refractory to many of the treatments and therapies we’ve deployed. Several years ago, he had a suicide attempt that landed him in the ICU. I wasn’t a physician at the time and I was not overseeing his care (obviously). I saw him 10 months ago in the clinic where he seemed like he was down and needed to get something off his chest. Well, he opened up and said he was planning to kill himself that night and he didn’t know how to say goodbye to his family. I spent almost an hour with him and eventually said that I didn’t want him to do that and I couldn’t let him leave my clinic without being admitted to an inpatient psychiatric facility. He eventually agreed, and he spent almost a month in the psych unit. Eventually, he was on a cocktail of psychiatric medicines. He lives alone but he agreed to move back in with his parents who are very supportive. They agreed to remove weapons and drugs from the home and to keep his psych meds under lock and key. I saw him a few weeks after that and he was doing remarkably better!!! I was very happy that we helped this man. I told him not to think about that time but to look forward, and I gave him my personal cell phone number and said if for whatever reason the suicide hotline is not working, call me if all else fails…
This morning he called sort of mumbling and very difficult to make out his words. He said “It’s over for me…” I asked where he was and he said home. I pulled his address from the patient record and called 9-1-1. Since the address of this person was a block from the hospital, I got in my car and drove there to find him in the garage partially open with the car running. The ambulance and FD arrived and I identified myself. They kept asking if I was sure that this was happening and this was the right house cause it could potentially be a liability for all parties involved. I said I’d risk it, and then the FD opened the garage door. There he was in the driver seat, a completely empty bottle of booze and vomit on his shirt and around his mouth. I let the medics do there thing to secure an airway. They brought him to the hospital I was at. His Carboxyhemoglobin was 47% and he was immediately taken to the ICU. I notified the grandparents and they said that he was fine when they left for work. They had gained confidence with his treatment and stopped observing him take his medications. They just simply gave it to him. Lithium levels were undetectable.
Brings me to my final point. My handling of the situation… I was scolded by an administrator for doing this and putting the “hospital at risk.” This patient could’ve been dead, and not in our ICU. I don’t regret doing what I did. I regret I couldn’t get there sooner. Thoughts?
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