A couple of days ago, I saw this middle aged lady on consults. She has end stage renal disease, and was getting dialysis at an outpatient dialysis unit. She also has bipolar disorder, and is very prone to angry outbursts, verbal aggression and threatening people verbally. One fine day, she ripped off her IV and threatened to 'kill everybody with Hep C'. Her treatment was terminated and she was asked not to return.
Since then, she has been coming to the ER, gets admitted and dialysed, discharged, and then back again in a couple of days. This time she again pulled off her IV and got extremely upset while in the ER, and we were consulted for 'history of schizophrenia, bipolar, and mood disturbances.' She was started on a low potency mood stabilizer (thats the only one she could tolerate, apparently) and she refused Risperdal consta (long-term antipsychotic) shots.
When I went in to see her, she was eating beef jerky, talking on the phone, crying, and immediately told the person at the other end, 'Well, here's another Angel of Mercy to see me. I better see what they want.' She knew she would die without treatment, and that 'the bitterness in my head and my mouth are going to kill me.' The staff up on the floor have already suffered some of her outbursts, and don't want anything to do with her. She had huge gift bags by her bed, full of lotions, perfumes and gifts she had bought for the family who 'don't want anything to do with me because I burnt my bridges.'
I couldn't help feeling sorry for her. She has a creatinine of 14.9 and desperately wants to live. How much of the anger is Bipolar and how much is just her? I don't know. But she deserves a chance at life. The hospital is now going to draw a behavioral contract after which she might get treatment again as an outpatient. I hope.