My craziest day, and the craziest thing that I ever saw as a scribe, happened while I was scribing for an urgent care in Roseberg, Oregon. The patient population they see is often lower-income, and there is a large homeless population that often comes into the clinic for treatment. Because Roseburg’s homeless population does not have access to primary care physicians, they often come to Evergreen seeking care for chronic illnesses or to seek care for an old injury. One day while I was working last winter, a young homeless male came in complaining of shortness of breath and various body pain. When we went in to see him, he was pacing around the room and muttering to himself about aliens, alien abduction, and how people were coming after him. After we were able to calm him down, and introduce ourselves to him, we asked him to tell us about his symptoms and what he was feeling. He went on to talk about his shortness of breath that had been going on for months and that he thought might require narcotic treatment. At this point, we assumed that he came into the clinic with a drug seeking behavior, and we were ready to tell him that he would not need any treatment with pain medications.
At this point, the physician started the physical exam, and everything seemed to be in order, until she started palpating his chest. Upon palpation, audible crepitus was heard, and the patient stated that his shortness of breath was suddenly exacerbated. The clinician immediately left the room to consult with an attending physician, and together they decided that the patient was either suffering from necrotizing fasciitis or from a pneumothorax, which are both life threatening. The two physicians decided on a treatment plan and went into the room to see the patient, but when he saw the two people entering the room, he became very distraught and started backing away. The patient went on and on about how we were working with the aliens, how he was in danger being in our clinic, and that he should never have come in. After assuring him that we had no ill intentions towards him, and trying to communicate that he most likely had a life-threatening ailment that needed emergency attention, he still remained frantic and terrified.
Even though all the staff in the urgent care were assuring him that he was safe, we were not able to calm the patient down, and he fled the room and ran outside of the clinic. The physician I worked with tried to chase after him, yelling that he needed to return or he would most likely die. When he didn't listen to her and kept running away, she was forced to call the police and report that he was a danger to himself as he had a life-threatening condition and refused medical treatment during a presumed psychotic episode. The police were never able to find him, though, and the man never received the treatment that he needed. Though today we don't know what actually happened to him, my physician postulated later that he probably passed away soon after leaving the clinic. This was one of the most high energy patient interactions I had ever been a part of, and I witnessed one of the most intense psychotic episodes in a patient that I have ever seen. This experience really showed me how quickly normal office visits can turn absolutely insane, and how I will most likely deal with this one day when I am a physician. It also showed me the importance of staying calm in such a crazy situation, as it could have been a lot worse if my physician had not remained so level headed during the encounter .