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For example: “My boss said if I miss one more day of work, I’ll lose my job, and then I’ll have no way to support my family.” Or: “My rent payment is due tomorrow, if I miss it I’ll be evicted and all of my stuff will go to the landfill, and there’s no way I can handle this through Internet or telephone or asking a friend to help.” I assume 90% of these stories are false, but the 10% that are true are still bad enough to more than outbalance any good we can do.) After that, my reaction to these people was “Yes, you may be angry now, but you will thank us later.” This is true of many people, including some of the most histrionically upset.
I thought about this because as of today I am halfway done with my four-year psychiatry residency.Failed suicide attempts also have their own interesting way of clearing the mind for a little while, so they’re in a sort of grace period.Sending these people to a psychiatric hospital makes the public feel good because they’re Doing Something About Suicide, and makes psychiatrists feel good because after a few days they’ve stopped being suicidal so it looks like we’re Making A Difference. There’s no boyfriend to get in a screaming match with, no boss pushing you to work harder, and no drug dealers to get heroin from.There’s a similar idiom around “Bedlam”, which comes from London’s old Bethlehem psychiatric hospital.In fact, psych hospitals are much more orderly than you would think.To the degree that it is all security theater, it’s really hard to give an honest answer to a patient asking why they have to stay in hospital.
When I first started this work, my reaction to these people was “Come on, it’s only a week, it’s not like you’re stuck here forever, just deal with it.” This lasted until I remembered that when some stupid policy forces me to come into hospital on a day I would otherwise have off, I freak out, because I value my free time too much to be okay with having it taken away from me for bad reasons.
Yet in the two years I’ve worked at Our Lady Of An Undisclosed Location, years when each doctor has talked to each of their patients at least once a day, usually alone in an office, usually telling them things they really don’t want to hear like “No, you can’t go home today” – during all that time, not one doctor has been attacked. I am constantly impressed with how deeply the civilizing instinct has penetrated.
When I go out of the workroom and tell Bob, “I’m sorry, but you’re disturbing people, you’re going to have to stop banging on the window and shouting threats, let’s go back to your room,” then as long as I use a calm, quiet, and authoritative voice, that is what he does.
But my last time on call, somebody also had a seizure, and I sort of strolled in half-asleep, ordered the necessary tests and consultations and supportive care, then strolled out and went back to bed.
And then there are the little things, like learning to tune out a psychotic guy banging on the window and yelling threats at you. It’s interesting that psychiatric hospitals are used as a cliche for “a situation of total chaos” – I think I’ve already mentioned the time when the director of a psych hospital I worked at told us, apparently without conscious awareness or irony, that if Obamacare passed our hospital would have too many patients and “the place would turn into a madhouse”.
Some clever person might ask: “Hey, don’t most psychiatric medicines require more than a week to take effect? The most common type of case I see is “person who was really angry, said ‘I’ll kill myself’ in a fit of rage, and then their partner called the cops and they were brought to hospital.” These people stop being angry after a day or two and then no longer make these comments, even assuming they meant it in the first place which most of them don’t.