Lessons from the ER-#2- Paranoia Strikes Deep

Unfortunately I have admitted two patients in the last few days during my night shift who have not made it to see daylight. One patient I unfortunately expected to die and therefore was not surprised. The other was a tad more bizarre. He was a paranoid schizophrenic sent to the ER from the local psych hospital; let's just call him Mr. Noid. He came in complaining of "someone trying to kill me through my stomach". At the time I thought this was just his way of interpreting the fact that he hadn't had a BM in about a month. He received an extensive workup in the ER, including a surgical evaluation. We struggled to maintain his blood pressure but he seemed pretty aloof to all of the commotion. Not minutes after arriving in the ICU he "coded"- no pressure, no pulse. After tubing him, breaking a few ribs with effective CPR and injecting several rescue medications through his IV without effect, I declared him dead. I guess the saying is true, that just because your paranoid doesn't mean someone's not out to get you. I know that after two deaths on my watch I too am beginning to feel a little paranoid. Cause of death for Mr. Noid is still unknown.