Alone with Crazy

Tonight's Wine Selection: Back to the Malbec. Am I too predictable, or just too busy to stop at a respectable wine store? Organized habits, wild mind.
Tonight's Music Selection: Crazy Baby, by Joan Osborne, on One of Us

"And your hands are really shakin' somethin' awful, as your worries crawl around inside your clothes...Oh how long will you be sittin' in the darkness? Heaven knows...Oh my Crazy Baby, try to hold on tight...Oh my Crazy Baby, don't put out the light..."

Duck, Darlin', 'cause here comes a shit-pie. This is what I tell myself when I pull up new patients on my caseload who reside on a certain city avenue. I don't want to say it is predictable, but...well...it's predictable. Back in my epidemiology days I analyzed homicide and assault data for trends and hot spots and recommended initiatives for "street heat", stings and SWAT initiatives. I researched predictors and attractors (strange and otherwise) and tried to explain rudimentary predictive modeling to beat cops, rogue cops, undercover cops, police chiefs, mayors, Bureau of Justice Statistics pals, Department of Justice policy types and once or twice to Janet Reno herself. She was tall, and wore sensible shoes. I say this to back up my game; I know a hot spot when I see one. I haven't completed my calculations on this quarter's caseload, but the early results point to a finding of "Damn, Girl! You landed yo'self up in a Hot Spot of Crazy!"

So I was not at all surprised today when a patient from this area verbally abused me on the phone because I was not giving her what she wanted at the moment she considered appropriate. This area of town has a lot of users and abusers of every stripe and hue. Everyone on that street seems to be a hustler of some kind, and if I had more down time from treating their musculoskeletal and neuromuscular problems I would find it damned amusing just to sit back and watch as they try to run their games on each other.

Whenever I drive down this street I get to re-visit fond memories of this house and that house, here is where I had to discharge for drunkeness, there is where customers (men...customers...) sneak out the back, over here is where is where Jenny-from-the-Block walked up and started pounding on my car while calling me nasty names. I smiled, waved, and gave her the two thumbs up. Good times. I always make my stethoscope and medical bag very visible, and usually that gets me a pass and good treatment where ever I go. But that's just bad behavior. Crazy is different. Crazy is palpable.

Crazy is when their answers have nothing to do with your questions, when they get stuck on a thought and keep repeating it, perseverating like a record with a skip. Crazy is when they burst out in nonsensical phrases, and start telling you stories and symptoms and making requests of you that have nothing to do with reality. I've dealt with many mentally ill patients in various settings, hospitals, outpatient clinics, long term rehabilitation. But it's hard to be alone with crazy, with no back up team, no witnesses, the sole clinician as someone decompensates, spirals down. You assure safety. You try to make connection, talk them down. You make your notes, you make your calls, you do the right thing. And in the end, you save your self, because you have to, and because there are more patients to see, down the same road, in Crazy Town.