My new rotation for the past two weeks has been to manage the psych calls from the emergency room. The hours are nice (11-4:30), but it can be a bit zany. I get called for just about every drunk guy in the ED, because apparently every drunk guy that comes into the ED also endorses suicidal ideation. Lovely. After 4:30 I put away the dedicated psych admit phone (that of course I get to carry...). And then transfer my pager over to the system wide psych pager and hold that until 8pm, when the night resident takes over. Some days it's been zany, and other days not at all.

I've seen a transgener patient with psychogenic seizures, borderline personality disorder, and (because the rest wasn't enought) hereditary blindness.

I've (twice) seen a rapid cycling bipolar patient whose cycle is so rapid that she's floridly manic in the morning, but slides into a depressive state in the evening. When the regular hours C/L team seems her in the morning/afternoon she's (again) floridly manic. For some reason two days running she asked to speak with psychiatry (which after 4:30 is me). By the time I get there she's anything but manic.

More often than not, after hours I get the typical calls -- suicidal patients in the ED who may or may not actually be suicidal. Once in a while a patient will plotz somewhere on the floor and it's my job to make sure that they don't leave without being fully evaluated. Sometimes they ask for something to help calm them down, sometimes it's obvious they're about to threaten the staff.

All in all, it's been a pretty cool rotation.