In January 2006, at the recommendation of my general practitioner, I entered the emergency room (ER) of a top-notch teaching hospital with a painful physical ailment. Although I have schizophrenia, I did not come to the ER for psychiatric complaints, only physical ones. However, when the triage nurse asked me what medications I was on, I told the truth, revealing a host of antipsychotics and antidepressants. My divulging which medications I was on led to my being asked by the triage nurse what I took them for and my answering, “I have schizophrenia.”

Unbeknown to me, with those three resounding words—”I have schizophrenia”—I had put into action a series of events that would shape my ER visit negatively and dramatically, as well as cause me to question if there was not some way to reform ER policy to avoid what I went through. The triage nurse focused on my schizophrenia to the exclusion of my corporeal ailment. Rather than probing for the source of my physical pain, she asked, “Do you hear voices and are you hearing voices right now?” I tried to explain to her that I was in recovery and that the voices, per se, were not
my reason for presenting at the ER. I felt threatened by her questions but mostly helpless; after all, I had chosen to tell the truth about my brain illness—was I going to regret that decision? Was there another option open to me at that time?

When my blood was taken, I was tested for all illegal narcotics (despite the fact that I have never engaged in drug-using or drug-seeking behavior), then taken outside the main ER area and left in the lobby of the emergency department, where I could be kept under the vigilant watch of intake receptionists and/or nurse interns. I began to notice that instead of being left alone, a hospital staff member appeared to be with me at all times. My attending physician later confirmed that I had been placed under constant surveillance, but I was not told why.

After my blood and urine were screened for toxins, my belongings were taken away from me and locked up behind a steel door. I was dressed only in a hospital gown, placed on a gurney in a room surrounded by Plexiglas windows, and not told why I was isolated in that room, why I was being tested for illegal narcotics, and why, of critical importance to someone with paranoia, I had been assigned a “sitter,” a person the hospital hires to literally sit in a chair and watch you. My sitter was an elderly woman who carried a large pile of newspapers and complained frequently that her back was aching. She did not speak to me, never introducing herself or explaining why she had been assigned to stare at me for hours. While in the ER with the sitter I felt paralyzed and powerless. Being watched without explanation is embarrassing, confusing, and frightening. It strips away human dignity and exacerbates paranoia, especially for someone with schizophrenia, like me. This treatment also can wipe away one’s ability to advocate for oneself because of fear of possible consequences. Was I considered threatening or potentially violent, unpredictable or a flight risk? Would they call for backup support or report me to some kind of authorities? Did they think I was lying about being in pain or exaggerating my illness? Would they admonish me and send me home humiliated for needlessly taking up their time?

After I had been unnecessarily observed by a sitter for about 4 hours, my attending physician arrived, determined that my ailment did not require hospitalization at that time, and discharged me from the ER to my home. Feeling shaken and very unsure of myself, I expressed my dismay about being watched to this doctor and asked for an explanation. I learned from him that in this large hospital there were separate ERs for psychiatric needs and for medical (nonpsychiatric) needs. I had been erroneously triaged by a nurse to the psychiatric ER—placed on this track as a result of speaking openly about my schizophrenia and the medications I took for my illness. The doctor apologized, but I could not help wondering: Who else and how many? I am a slender, blonde, blue-eyed, Ivy-league-educated woman who works at the management level in the mental health field, and I was not in psychiatric crisis. What must the ER experience in triage or in the psychiatric unit be like for individuals with mental illness who have cultural barriers to surmount, or appear more threatening than I, or who are not able to speak up for themselves for any number of reasons?

It would not be long before I was back in the ER, having to wrestle with questions of veracity and ingenuity with regard to my mental illness in order to advocate for getting myself the best possible care for my physical illness. In July 2006, I again entered the ER of the same university teaching hospital with a different serious ailment. After my previous intimidating experience, my general practitioner and psychiatrist both had to struggle to convince me that I needed emergency care. Terrified of not getting the medical services I needed and traumatized by my January ER experience, I vacillated about mentioning my schizophrenia diagnosis to the triage nurse. I decided not to discuss my diagnosis of schizophrenia, and that made all the difference. I sat in the waiting room with other patients, my blood was not taken in the lobby, and no staff person sat near me at all times. When I was called into the ER, I was placed on a gurney in a room where I could keep my belongings with me and use curtains for privacy. The medical ER was much quieter than the psychiatric ER, and the questions the doctors and nurses asked related to my physical symptoms. I received excellent, considerate, and thoughtful medical care and was subsequently admitted directly to the hospital from the ER.

I am left pondering the rock-and-a-hard-place dilemma of being honest and providing
information about a long-term serious mental illness when it is not the proximate cause for a visit to an ER. I would hope that all hospitals would have staff who are educated and unprejudiced about mental illness versus physical ailments. As a general rule, I try not to lie and do not like to be disingenuous; it feels especially wrong in a hospital setting where staff have a legitimate need to know about drugs and symptoms. In my personal life and professional roles I speak openly about my mental illness and train others to do the same to help eradicate stigma and educate others. Yet, because of the difference in medical care I have experienced from saying “I have schizophrenia,” self-preservation (self-care) leaves me honestly unable to predict whether I would say it again in the same circumstances.