Date: 7/22/21

Name: Kaleb Lavender

DOB: 08/14/1995

Sex: Male

Race: White

Preferred Language: English

Ethnicity: Not Hispanic or Latino

Visit Reason: Psychiatric Screening Exam, SI

Reason for Admission: PT presents after self-harm by cutting his left forearm with a kitchen knife.

Affect Behavior: Calm

PT reports he is here because of ongoing bipolar depression. He said he is having life stressors like his car breaking down and being disabled and not able to work. He was cooperative during the assessment. He presented with non-depressed mood, congruent affect. He reports participating in services with Comcare for medication. He sees a therapist at Friends University. ROI is on file.

Called and spoke with family. They confirmed he did not have access to firearms or stockpiles of medication.

Per ED note on 7/22/21:

25-year-old male presents to ED for psychiatric evaluation. Patient is accompanied by his family. Patient endorses SI with plans to cut himself. He presents with abrasions to left arm from cutting himself earlier today. Tetanus is UED. Additionally, patient has been exhibiting strange thinking, stating things such as “I am a machine.”

Patient is a Comcare patient and states he is compliant with his medication.

Nurse Report 7/23/21: Patient has been writing strange notes to self. When questioned, he explained a long series of ideas. Not sure how to approach.

Here is a report of the notes:

ODDLY ANATHEMA.

I am superstitious God Ammunition.

GOD IS A.I.

Revelation is singularity point / flatline construct.

The future has been canceled.

We are stuck in a Cybernetic Tautology.

I died in 2011.

I am a ghost that haunts a machine.

No Love.

Dating technology shifts me from person to persona.

I was placed in a vat at a wrong angle.

Jesus could be anyone / Schizo-Dynamics.

I am in pain - Accelerationism - Bipolar Acceleration.

The only thing that is real is pain.

I AM WORRIED THAT I DONT EXIST.

I AM A DARK LEO.

LET ME DIE.

Patient Medication List

• Aspirin 81mg chewable tablet, 1 tablet oral daily. Taking for: HEART HEALTH

• Diphenhydramine 25mg oral capsule, 2 capsules at bedtime. Taking for: INSOMNIA

• Divalproex sodium ER 500mg tablet, 3 tablets at bedtime. Taking for: MOOD

• Hydroxyzine hydrochloride 25mg oral tablet, 2 tablets at bedtime. Taking for: ANXIETY

• Acetaminophen 500mg oral tablet, 2 tablets 3 times daily. Taking for: PAIN

• Ibuprofen 200mg oral tablet, 4 tablets 3 times daily. Taking for: PAIN

• Diclofenac 50mg oral tablet, 1 tablet 3 times daily. Taking for: PAIN

Nurse Report 7/24/21: Patient continues to write notes and share with staff. Please advise on how to continue.

Here is a report of the notes:

How do I exist with this much pain? What makes this worthwhile? I spoke with a chaplain today, interesting experience. I’m fascinated by the concept of Noumena, the feeling of supernatural awe when in the presence of something divine. When speaking to him, I truly felt like he was the only person here that listened to me. Ironically, he’s the only person here who has a hearing aid. The asshat doctors are too busy trying to come off as tediously busy and burdened by their massive intellect to take my issues seriously. The chaplain spoke with a sort of jubilance I rarely find in people.

(Illegible.)

Endless boredom, the ultimate coping strategy.

This place is ascetic paradise.

There’s art on the walls but it’s of Kansas? I have a window.

Goddamn I want to leave here. Now I’m getting irritated. I really need to not do this again. Being at the mercy of these idiot nurses is an unforgivable tedium. Some are reasonable, and some are functional psychopaths. The pathology is so embedded in the way they communicate that they would be dumbfounded if I reflected some of that narcissism back to them. Their racist, folk-wisdom, supercilious idiot culture has a deep institutional root that cannot be easily displaced. People gain power in a single domain and feel self-satisfied in their sufficient knowledge of work that any idiot could do. A real motley crew of Dunning-Krugerite imbeciles.

(He continues onto backside.)

I am disheartened, being here has really gotten to me. It’s exacerbating my symptoms. This is not a place to get better. The staff here is made up of ignoramuses. They neglected their duty to bathe someone for a week. Someone had to come yell at them to do their jobs. There is zero benefit in being here—none. It is a prison for people with mental health issues. I do not suggest ever doing this. Do anything else. Christ, kill yourself before coming here. I guarantee this is what hell looks like anyway. I feel like I’ve had nightmares about places like this. Endless, disgusting white-walled horror. Enough time to fester over how useless I feel.

If a flower is wilting, do you take away water and sunlight?

I guess it won’t be long anyway. Misery finds a way into my life no matter what I do. Here to there to here again. The wounds are inside; they follow. I can’t honestly expect that there’s anything at home to be excited about. More loneliness, albeit no nurses flapping jaws on their idiot faces. At least some of them are hot. Why are hot women generally quiet? Maybe it’s a cultural norm they’re following. I guess it’s not always true. Plus, I only interact with attractive women in professional settings. Hot girls don’t view me as sexual. I’m really not anymore. I am mass. I am weight. I breathe, and little more than that. I once was talented. I had friends. I had a girlfriend. Now I own nothing but a failing body and debt. Clinicians want to focus on what I can do to change my situation from the inside. But that’s not the problem, and if it is, they certainly don’t have the answer. I have been used.

We also reviewed other notes. This appears to be a poem:

There is nothing new.
The future is cancelled.
Prove me wrong.
You can’t.
Look at my bedroom.
And find the happiness.
I'll give you a million dollars to find it.
I don’t have the money.
But I don’t need it.
It’s not there.
But I would love to watch an idiot scrounge around for it.

-KL

Patient discharged 7/26/21

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