Abstract
Emergency psychiatric consultations present with unique and dramatic difficulties. A case is presented of a young male with multiple fractures, whose poor relationship with nursing staff and physicians led to inordinate difficulties with his case. After four weeks of hospitalization, a crisis emerged following an episode where the patient spit on a nurse and had a physical altercation with his surgeon. The surgeon refused to see the patient any longer; the nurses threatened to resign in preference to caring for the patient; and the patient insisted on leaving the hospital. Yet, his medical condition made that impossible. Emergency psychiatric consultation was requested. The consultant took control of the situation resulting in a sudden dramatic behavioral change on the part of the patient. This change was sustained during the rest of the hospital course, which proceeded smoothly. Emergency psychiatric consultations occur under certain very difficult circumstances but they can provide great therapeutic opportunities.
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