Natasha Lim shut her door and sat down heavily in her chair. Looking at the clock, she saw it was about 2 AM. "What is it with this city and the end of the month?" she wondered aloud in annoyance. Whenever the city's homeless population needed three hots and a cot it seemed that Bellevue's ER was they first place they hit up. Leaning back, she tilted her head to relieve her tense neck muscles when her door flew open.

"Doctor, you better get out here. EMS brought in a live one," the harried nurse informed her.

Grabbing her white coat and following her out the door, she could already hear the commotion coming from the ER holding area. "What the hell is going on?" Quickening her pace, she made her way towards the ruckus and was surprised to see a young Asian man strapped to a gurney, screaming as he thrashed to free himself while a frightened-looking girl tried in vain to calm him. "Who is this?" she demanded of the EMTs who had wheeled him in.

"Brought him in from Madison Square Garden. We got a call from some doctors who were providing medical advice during a martial arts contest saying that this guy flipped out and was screaming like he was in pain." The tech scribbled a few things on the clipboard he was holding and handed it to his partner.

Not understanding, Dr. Lim looked at him with confusion before asking, "If he's screaming in pain, why did you bring him to the Psych ER?"

Regarding her as if it she had just asked him the stupidest question in the world, he retorted, "Because this guy is fucking psycho. Can't you tell just by looking at him?" Rolling his eyes irritably he waited for her to relieve his team.

Finally noticing the policemen flanking him, she continued, "And why is NYPD here?"

Sighing in frustration, he shot her another annoyed glance. "Lady, do you have any idea how many people it took to get this guy into the gurney? He's the fucking winner of the martial arts contest he was in and he's hella fucking strong. We needed the cops because he was starting to become dangerous. He was taking swings at anyone who came near him." Sure enough, upon closer inspection, the EMTs and the officers were sporting numerous angry bruises and cuts in various places.

Trying to regain her composure, she looked at the boy. "Did he say what it is he's screaming about?"

"You got me," he shrugged. "He's only speaking in Japanese and apparently his girlfriend / sister / companion / whatever she is doesn't speak a fucking word of English." Looking around impatiently, he added, "Are you going to call security any time this century? We'd like to get the hell out of here if that's alright with you." His voice dripped sarcasm.

"Oh, of course." Finding the nurse, she shouted, "Get me 5 of Haldol, 50 of Benadryl and 2 of Ativan, stat."

"PO or IM?" she asked.

"Intramuscular of course! Are you going to try to put pills in his mouth? We need to get this guy calmed down so we can figure out what's going on with him." Running back to her office, she phoned hospital security and alerted them to the situation in the Emergency Room. "Oh, and uh…you might want to bring a lot of guys," she warned. Hanging up, she went back to see how the patient was doing and found that he was still shouting at the top of his lungs while the unfortunate nurse tried to hold him still long enough to inject the sedatives into his shoulder muscle. Twenty minutes later, he was fighting just as hard to free himself and the security guards seemed reluctant to get too close to him. Frowning, Dr. Lim ordered, "Give him another."

"He's only sixteen," the nurse objected. "That's a lot of antipsychotic."

"Well apparently his body isn't, because that didn't even faze him. Give him another! I'll be back in a moment." Crossing Bellevue's Emergency Room, she pulled aside one of the ER physicians. "Dr. Bakshy, I'll need you to medically clear a patient for me in an hour or so."

Looking up from his chart, he smiled pleasantly in spite of working the graveyard shift. "I'm pretty free now," he said amiably.

"Well, the patient is going to need a moment to…calm down?"

"Ah, an end of the month special?" he joked knowingly.

"I don't know, but we're trying to get him sedated." She cringed as another scream cut through the air, causing the other patients to look around.

Hearing the banging and yelling at the other end of the ER, he raised a brow and asked, "Is that him?" She nodded solemnly. Smiling warily, he turned back to his chart and quipped, "This should be fun. You gotta love working in Manhattan. Call me when he's more sociable."

Another twenty minutes had passed and though the sedatives had taken the edge off the adolescent, they had not completely knocked out the patient. The nurse gaped at him, still struggling to free himself. "Dr. Lim, he's fighting the sedation!"

"I'm really hoping he loses that fight," she replied dryly. After what seemed like an eternity, he finally appeared to have gone to sleep. "Send him to Dr. Bakshy to be medically cleared. I'm going to inform the inpatient ward that they should be preparing to receive the patient afterwards."

A few minutes after she had signed out the patient to the nursing staff on the inpatient floor, the ER intercom startled her as it announced, "Security to X-ray! Security to X-ray!" Sprinting towards the X-ray room, Dr. Lim saw four people unsuccessfully trying to restrain the agitated teen. "Give him another PRN!" she shouted. Grabbing the syringes, the nurse gave him his third series of injections and his physiology finally gave in to the effects of the drugs as he slackened in the staff's arms. "Get me a medical bed and four-point restraints!" Looking at his drowsy form suspiciously, she amended, "And in case he gets a second wind, get a fourth dose ready now."

An hour later, she went to find out the results of the boy's workup. "Your kid is quite the specimen," Dr. Bakshy whistled in wonder while flipping through his results. "He's in great shape and physically, there's nothing wrong with him except some old healed fractures of indeterminate age in the upper extremity."

"He's medically cleared?" Dr. Lim peered over his shoulder and scanned over the lab values and imaging results with disbelief.

"CMP, CBC, UA, Head CT, even his UTox – all within normal limits. It's not infection, it's not pain, and it's definitely not drugs."

"Then he's psychotic," she mused. "His workup is completely negative so it can't be delirium."

"You've got a winner," he agreed with a grin.

She looked over at the sleeping boy. "He's so young. I hope it's not what I think it is."


The shrill sound of Maria Chan's pager jarred her awake. "Shit!" she swore under her breath. Rubbing her eyes, she looked at the screen and sighed when she saw it was the inpatient floor. She hated taking weekend overnight calls and couldn't wait for residency to be over. "Just my luck, have to do a fucking admission at 4AM." Trying to shake off her drowsiness, she stuffed her feet into her crocs and headed for the inpatient unit.

When she unlocked the door to the inpatient psychiatric ward and walked in, she was accosted by the nursing staff. "Oh my god! Dr. Chan, what took you so long? This guy is going berserk and we don't have any PRN agitation meds ordered for him yet!"

"That's just fabulous," she muttered irritably. "Where is the patient?"

"In the seclusion room. He's in four-points."

Even more annoyed at this information, she snapped, "If he's in four-points, then why are you in such a hurry to get PRNs ordered?"

Equally annoyed, the nurse shot back, "Because he's getting ready to break out of them as it is."

"They are the leather four point restraints right?"

"Yes, Dr. Chan," was the tight-lipped reply.

Unnerved by the frantic atmosphere of the unit, Maria quickly ordered the medications and then went to get a peek at the instigator of all this attention. Peering into the seclusion room, she saw a young Asian man trying with all his might to break out of the leather restraints, shouting unintelligibly as he did so.

"That was after three sets of PRNs," the nurse who appeared behind her reported.

"Did you say three?! Holy shit!" She stared through the window in disbelief.

"Now do you see why we were so anxious for you to get those orders written?"

"Okay, well, uh…I guess I'll try to get the history and do the physical." This was only her sixth month as a psychiatry intern and Maria had yet to deal with a truly violent patient, so naturally she was a little nervous.

"You won't get much out of him. He only speaks Japanese." Checking in on him one more time, the nurse made her way back to the nurse's station.

Figuring that it was pointless, Maria went back to the nurse's station as well and pored through the chart. "Where are the ER notes and the EMS notes?"

"Haven't put them in yet. Here." The clerk handed her the sheaf of papers without looking up from what he was doing.

Pulling out a blank history and physical form, she began recording what little information there was on the agitated teenager. "You've got to be kidding me," she said under her breath as she read the report. "This guy's got schizophrenia written all over him…"