Kathy Visits the Psychiatrist: Part 2

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by Nurse Beth Nurse Beth, MSN (Columnist)

Specializes in Med Surg, Tele, ICU, Ortho. Has 30 years experience.

My older sister Kathy was diagnosed as developmentally delayed as a young child. Later in life she was also diagnosed with schizophrenia and today, at age 69, she has dementia and is nearly deaf. She was dealt a bad hand but she is spirited and generous. She’s outspoken and has no filter. Life with Kathy is never boring.

In the waiting room, waiting for discharge paperwork.

Kathy Visits the Psychiatrist: Part 2

In Part 1, Life With Kathy Is Never Boring, I take Kathy to her psych appointment. Here in Part 2 we have seen the NP and are in the waiting room waiting for her discharge paperwork.

After seeing the NP, Kathy and I sit and wait for her discharge paperwork.

Finally, I am called up to the thick plexiglass window with a tiny half-moon cut out at the bottom to speak through if I bend over and stoop low enough. The young woman on the other side has massive black false eyelashes precariously balanced on her eyes. They look very heavy and I hope they don’t come unstuck and fall off. Or get uneven.

“Here’s all her paperwork,” she says, pushing several pieces of paper through the slot. I could just grab them and go but something tells me to look through them.

One is for lab work. The usual suspects. Electrolytes and cholesterol. One is verification of a doctor’s visit. One is a follow-up appointment with Dr. Perez. “Wait,” I say. I explain that Harjeet, her NP, is specifically referring her to a dementia specialist, Dr. Malee. Not Dr. Perez.

Without looking up from her computer, Eyelash Girl says that Kathy has to see Dr. Perez because that’s who she saw before. It’s in the computer, after all. She seems entirely unimpressed with the NP's orders.

I take a breath and explain. Kathy is being referred to a dementia specialist. Because she seems to be having dementia. “She talks into her TV remote control as if it’s a phone,” I repeat, holding up an imaginary remote control to my ear for emphasis and clarification.  "She talks to my husband, Bob. Through the remote control."

Surely that will work.

It doesn’t escape me that I am doing a song and dance trying to convince this office assistant to follow the provider’s orders.

She and her eyelashes remain mute and expressionless, staring at her computer.

I wait. I’m not leaving. It's a standoff.

Finally, Eyelash Girl says “I’ll have to ask the NP. He’s still writing his notes.” To stay on her good side, I do not immediately ask “Why would you discharge us if he’s still writing his notes?”

I merely think it loudly.

I obediently return to my seat. It strikes me that we’ve been in the office for over an hour so far, and approximately 15 minutes, or 25% of it, was with the provider. I amuse myself by doing the math.

Kathy leans towards me, “There’s a mouse behind that plant. I can see his eyes”.

“I can't see it, Kathy”.

“Well, you never had a good eye for seeing mice, Sis," she says a bit condescendingly. "It's going up the wall. See?"

I know there's no mouse but I look anyway. 

We wait. There is an inane game show blaring from the wall-mounted television. It seems to be called Are You an Idiot? or something of that nature. There’s way too much loud shrieking and hysterical laughter.

I glance across the room and see a sleek-looking water dispenser in the corner. Oh good, a diversion, and I’m suddenly thirsty. I cross the room to the dispenser. But there are no cups. I look behind the dispenser and almost laugh at myself. Am I seriously looking for cups in the corner? On the floor? Resigned, I return to my chair.

I could ask for a cup. Should I ask for a paper cup for the water? Should I ask them to turn off the loud TV? I do neither. Better if Eyelash Girl stays focused on the discharge papers. 

We wait. Eyelash Girl finally calls me again and presents me with a new, improved bunch of papers, including a referral to the dementia specialist, Dr. Malee. Yay. Relief. “Thank you!”

I quickly read through the discharge summary searching for the all-important order to increase her antipsychotic Risperdal from 1.5 mg/day to 2 mg. I can’t find it. Not sure how all this works, I ask, “How is it communicated to the facility that her meds were adjusted?”

Again the now-familiar blank, uninterested look. Maybe I am asking it wrong. I take a deep breath and try another tack.

“Kathy is my sister. She has been seeing rats and mice in her bedroom. That’s terrifying for her (pause for effect). The whole reason for this visit is because of the rats and mice (second pause). Her NP changed her meds, and it’s not here on her discharge summary.”

I wait for her to appear alarmed, or concerned, or just to react at all.

The eyelashes move so I know she’s still alive but her face is impassive.  “I’ll have to ask the NP. He’s still writing his notes.” Right. He must be a remarkably slow typist.

We wait.

The game show ends and Kathy announces she has to go to the bathroom. We walk to the bathroom. Or rather, I walk and Kathy shuffles, using her 4 point cane.

Finally, we get the correct orders but I wonder what would have happened if I wasn’t here to question and advocate. Surely a transport driver from the facility wouldn’t ask. Kathy would just go on with her current medication, and who would ever catch it?  They should manage all this electronically, but they don’t. Should I complain to Eyelash Girl’s supervisor? I don't want to get anyone in trouble and I need to cool down a bit.

Kathy interrupts my thoughts and eagerly asks “Are we going now? Are we going out to breakfast?” She looks so guileless and hopeful, asking with her bright blue trusting eyes, but I brace for her disappointment and guiltily say “No, we have to get you back.”

... stay tuned for more Life with Kathy stories.

Hi! Nice to meet you! I love helping new nurses in all my various roles. I work in a hospital in Staff Development and am a blogger and author.

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5 Comment(s)

canoehead, BSN, RN

Specializes in ER. Has 30 years experience. 6,826 Posts

I think this falls on the provider. If he doesnt send out the right orders the secretary has no way of knowing. 

Nurse Beth, MSN

Specializes in Med Surg, Tele, ICU, Ortho. Has 30 years experience. 147 Articles; 2,614 Posts

12 hours ago, canoehead said:

I think this falls on the provider. If he doesnt send out the right orders the secretary has no way of knowing. 

I think the orders should be electronic between the doctor and the facility but thats just wishful thinking, I supppose

Kitiger, RN

Specializes in Private Duty Pediatrics. Has 43 years experience. 1,699 Posts

1 hour ago, Nurse Beth said:

I think the orders should be electronic between the doctor and the facility but that's just wishful thinking, I suppose

When the orders are electronic and wrong, it's harder to fix after the fact. I learned the hard way to read the orders on the discharge paper before I leave the exam room. But even then, the electronic order is sometimes different.

Nurse Beth, MSN

Specializes in Med Surg, Tele, ICU, Ortho. Has 30 years experience. 147 Articles; 2,614 Posts

On 6/22/2022 at 7:43 AM, Kitiger said:

When the orders are electronic and wrong, it's harder to fix after the fact. I learned the hard way to read the orders on the discharge paper before I leave the exam room. But even then, the electronic order is sometimes different.

True, nothing's fool proof

On 6/21/2022 at 5:05 PM, canoehead said:

I think this falls on the provider. If he doesnt send out the right orders the secretary has no way of knowing. 

I think the secretary was discharging us before the provider finished his notes/orders

Kitiger, RN

Specializes in Private Duty Pediatrics. Has 43 years experience. 1,699 Posts

The doctor used to hand me a prescription that I read, and then took to the pharmacy. I liked the fact that I could read it and say something right away if it was wrong or incomplete. Oh well, the times, they are achanging. Changed, actually. 🙃