CAP E-MODULE - ED SCENARIO

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An Asian family sits inside the bustling Emergency Department of their local hospital as they wait for someone to come and speak with them about the condition of their son. His parents are alongside him in the room. Mom seems anxious, while Dad seems annoyed. [[Review the chart->CHART]] [[Greet the family->MEET THE FAMILY]]

Before greeting the family, you decide to review the chart first. Andrew is a 17-year-old male who presents to the Emergency Department after slashing his left wrist. Emergency services were called, and the patient was detained and brought to the ED. Middle socioeconomic class family, no siblings, no developmental concerns or delays, no past hospitalizations or mental health diagnoses. According to his parents, he was involved in many extracurricular activities and was talented in academics. During the pandemic in 2019, he became less social, failing all his classes, and seemed to be “more disrespectful.” Andrew has missed school for over 2 months and is on the verge of expulsion. [[Greet the family->MEET THE FAMILY]]

As you walk towards the room, you hear the following conversation: <<set _dialogue = [ "<strong>Dad:</strong> 有冇搞錯啊! 真係羞家啦! Unbelievable. What a disgrace.", "<strong>Mom:</strong> Honey... Please", "<strong>Dad:</strong> 呢個衰仔啊! 臨到考試前搞啲咁嘅嘢! This rotten boy! Pulling a stunt like this just before the exam!", "<strong>Mom:</strong> Honey, he’s just in pain right now.", "<strong>Dad:</strong> 痛? 佢自己攞嚟㗎! 搞到你殘廢你就知死! Pain? He brought it on himself! You’ll know to regret it (like death) when you go cripple yourself!", "<strong>Andrew:</strong> I can't fall asleep!", "<strong>Mom:</strong> He hasn't been sleeping well!", "<strong>Dad:</strong> 真係離晒大譜啊! 成日都諸多藉口,目無尊長,十問九唔應! 後生仔仔竟然學人話瞓唔着! 成日死蛇爛鱔 - 攤喺床度淨係掛住打機! 又唔執下間房,又唔沖涼! 竟然有學都唔返! 以前都話踢下波啊,而家淨係埋喺屋企. 如果學校在打電話黎投訴呢,你就知死! This is utter nonsense! Always a million excuses, no respect for your elders, we ask you 10 questions and you ignore 9. How dare you complain about not being able to sleep at this young age? Always a sack of lazy bones (like a dead snake) - lounging in bed and only care about gaming! No even cleaning your room, nor showering, and even skipping school! At least, you used to play soccer, now, all you do is hide at home. If we get one more call from your school- I swear - you’ll regret it (like death)!", "<strong>Mom:</strong> Honey...", "<strong>Dad:</strong> 你唔好當我哋係懵㗎! 我哋嗰日捉到你攞住支野係咁嗍,成個黑社會大佬咁嘅款! 你唔好話俾我哋知你又吸毒啦! Don’t think we’re stupid! The other day we caught you huffing and puffing on that thing, like you’re some mafia boss. Don’t tell us you’re taking drugs again!", "<strong>Andrew:</strong> I told you, I need weed to sleep… and it’s so noisy … it’s hard to sleep!", "<strong>Dad:</strong> 你個死仔仲駁嘴 - 仲唔認錯喎! 搞到我哋成家人夜麻麻喺醫院陪住你 - 係咪咩架都俾你丟晒先 You “dead boy” (naughty brat) still dare to talk back? You’re still not accepting your mistake! Now the whole family is sitting with you in the hospital in the middle of the night - any last shred of our dignity and face is lost because of you", "<strong>Mom:</strong> You're making a scene...", "<strong>Dad:</strong> 你好收聲啦! 一日都係你嘅錯! 成日都縱容佢 - 搞到佢都唔知似咩樣! You better shut up! This is all your fault! You’re always spoiling him - now - don’t even know what he is!", "<strong>Mom:</strong> 你做人老竇夠冇用啦! 一啲都唔識得關心你個仔! You are a useless father yourself! You don’t even know how to care about your son!", "<strong>Andrew:</strong> Shut up shut up shut up!", "<strong>Dad:</strong> 你個死仔幾時輪到你講嘢! You dead-boy (damned brat) - who said it is your turn to speak?", "<strong>Mom:</strong> Shush! The doctor is coming!" ]>> <<set _line = 1>> <div id="conversation"> <p><<print _dialogue[0]>></p> </div> <div id="continueButton"> <<button "Continue">> <<if _line < _dialogue.length>> <<append "#conversation">> <p><<print _dialogue[_line]>></p> <</append>> <<set _line += 1>> <<if _line >= _dialogue.length>> <<replace "#continueButton">> [[Introduce yourself->INTRODUCE YOURSELF]] <</replace>> <</if>> <</if>> <</button>> </div>

You knock on the glass door before sliding it open. "Good evening, my name is Dr. Williams. Are you two related to the patient?" As you slide the door open and enter the room, the Dad's demeanor immediately changes. He speaks first. "Good evening doctor. Yes, I am her father. Is everything ok with Andrew?" [[Well, how are we feeling tonight, Andrew? I heard we had an incident, what happened here? ->ANDREW DOES NOT RESPOND]]

You turn towards Andrew to address him. "Well, how are we feeling tonight, Andrew? I heard we had an incident, what happened here?" Andrew does not respond. He seems to be looking away and not present in the conversation. His father turns towards him to whisper. "冇啲禮貌! 醫生同你講嘢仲唔快啲答佢! No manners! The doctor is talking to you, answer him promptly!" The father turns back to you. "Please give one minute, Doctor. Please. He is tired." Andrew begins muttering. "The stupid voices.. So stupid.. Stupid" [[Are you hearing voices? ->ARE YOU HEARING VOICES]]

You ask Andrew if he is hearing voices. He says, "They keep talking and talking and talking and they won’t stop laughing at me!" [[And how long have you been hearing these voices? ->HOW LONG VOICES]]

"And how long have you been hearing these voices?" Andrew shrugs. "Maybe a few weeks?" [[Andrew, were you trying to hurt yourself? ->HURT SELF]]

"Andrew, were you trying to hurt yourself?" At this point, his mother jumps into the conversation. "No, Doctor! He will never hurt himself." You turn towards the parents and say, "Please let Andrew speak for himself." The father turns towards the mother to whisper something. "都叫你唔好咁多嘢講㗎啦! (I told you not to talk so much!)" Andrew turns towards you to speak. "Yeah … the voices told me to cut myself ... if I don’t, they’ll kill my family … but … you know all this already, don’t you? … so why do you pretend not to know and ask me all these questions? … you must have been sent by them … I’ve got nothing more to say to you …" [[Reassure Andrew and ask one of his parents to step outside for a short conversation. ->STEP OUTSIDE]]

"Andrew - you are safe here. You don’t have to talk to me if you don’t want to. I will get you some special doctors from psychiatry to help you. Mr. and Mrs. Lee, it seems we need to have a very important discussion about Andrew’s health. Could one of you step outside with me?" The parents look at each other for a second. The mother chooses to stay with Andrew while the father follows you outside. [[You lead the father to a nearby family too to discuss your impressions with him. ->IMPRESSIONS]]

You sit down with the father in a nearby family room. The father immediately turns to you with a serious look. "Please let us know what we should do." [[Andrew is probably experiencing what is known as First Episode Psychosis. ->FEP]]

"Andrew is probably experiencing what is known as First Episode Psychosis." The father looks at you suspiciously. "I not understand. “Psychosis”? What, like you’re saying he’s crazy?" [[He is not crazy, he is suffering from a type of psychotic disorder. It is hard to tell at this moment. ->PSYCHOTIC DISORDER]]

The father looks upset. "Doctor, I think, maybe, there is a mistake. What is “psychotic disorder”? Is it serious? Please help him. What can we do?" "I’m sorry, Mr. Lee, but there is no mistake. The psychiatry team will come to see your son, and answer all your questions. In the meantime, I’ll just order some blood work and a drug screen. Thankfully Andrew does not need any stitches, so he’s medically cleared as far as I’m concerned. Of course, he can’t leave here yet till the psychiatrist comes. So please just sit tight, wait here with Andrew, and we will page psychiatry. Don’t worry so much, ok? Everything will be just fine." [[The father walks back to his family as you leave. ->BACK TO FAMILY]]

<<set _dialogue = [ "<strong>Dad:</strong> 黐線? 佢先黐線啊! 係咁椅傾一兩句,就話我個仔黐線? 呢度啲醫生咁化學㗎. 都唔知加拿大搞乜鬼. 一陣又話大麻係合法. 一陣郁啲又話有精神問題. 我哋後生嗰陣時候係咁捱啦,又唔見我哋有事? 呢度啲後生仔,冇事生事,身在福中不知福. Crazy? She’s (the doctor) the crazy one! Just from a few sentences and conclude my son is crazy? The doctors here are so unreliable. What kind of country is Canada? In one moment, all the talk is about legalizing marijuana. In another moment, any little thing is considered a mental illness. When we were young, we went through all kinds of hardships, you don’t see us having problems! Young people over here, create trouble out of nothing, “living in abundance with no appreciation” (Chinese idiom)", "<strong>Mom:</strong> We need to find out more information … and find out what the doctor meant by “psychotic”..", "<strong>Dad:</strong> 你咁都信佢講? 你哋一個二個激死我呀.同你哋講嘢都嘥氣嘅. You would even believe this (mental illness)? You two are making me angry to death. It’s a waste of my breath talking to you two!", "<strong>Mom:</strong> Please don't say that...", "<strong>Dad:</strong> Andrew - 你好嘢啦 - 而家捉你見精神科醫生啊. 問你驚未. Sigh … 總之 - 生嚿叉燒好過生你！Andrew - you’re good - now they will force you to see a psychiatrist - see if you’re finally scared. Sigh … it'd be better to have given birth to barbecued pork instead of you!" ]>> <<set _line = 1>> <div id="conversation"> <p><<print _dialogue[0]>></p> </div> <div id="continueButton"> <<button "Continue">> <<if _line < _dialogue.length>> <<append "#conversation">> <p><<print _dialogue[_line]>></p> <</append>> <<set _line += 1>> <<if _line >= _dialogue.length>> <<replace "#continueButton">> [[End of Scenario->END SCENARIO]] <</replace>> <</if>> <</if>> <</button>> </div>