i am the brute squad

The following is not FACTUALLY accurate. Details have been changed, things deleted, stuff made up, all to protect identity. But it is 100% absolutely true.

Some people never go crazy. What truly horrible lives they must lead.

- Charles Bukowski

"Am I going to have a call a Code Green?" the charge nurse asked, referring to a psychiatric emergency.

"Don't call a Code Green.  Call me.  I am the Code Green."  She smirked and agreed to put the patient on the floor against her better judgment as I gave her both my hospital phone number and cell phone.  My bravado, my swagger, and my humor helped sway her.

My junior resident asked me, "should I be talking to the charge nurse?"  Huh?  I was confused by the question.  But then it became clear with one statement.  "Well, I've just never seen one of my uppers talking to the charge nurse."  Seriously?  I then explain how 90% of being a good doc is simply giving a shit and getting stuff done, which means talking to all the people that get shit done. It's a lot of work but in the end, it matters.  Remember your humanity, I tell them.

This patient had been sitting in the ER for six days.  SIX days.  I was looking for admissions and the ER attending didn't sugar coat it.  I had paid my dues in the ER and earned their respect so was treated as one of their own.  The patient had broken their elbow, had surgery with pins placed which were extruding from the skin.  One pin was missing, though.  Oh, raising my eyebrow.  The patient had removed one pin by their self.  And then proceeded to attack what they thought were demons present.  So now the patient sat in the ER pending transfer to a psychiatric hospital but no one would take the patient with one extra weapon in the elbow just waiting to be unscrewed.  My junior resident looked at me as if to say, you're joking.  No wait, you're crazy.  Indeed.  I smiled back and tell the ER that we will take the patient.  Fast forward a few days of heavy duty psychiatric medications, including an episode of me, in fact, functioning as a Code Green.  Today, orthopedics removed the remaining weapon, aka pin, and the patient is pending transfer to a psychiatric hospital, without a built in weapon.  My Texas bourbon tastes extra good today.