Tuesday, February 21, 2006

Nurse Follies: The Psych Patient

I don't care much for working Psych. In fact, it was the most loathed subject in nursing school. I remember breaking out in hives and having digestive problems for the entire semester I had to take it. After I took my psych final, I vowed to never work in that field ever.

Of course, that doesn't mean the psych floor can't come to you. The following story is such an instance.

I was a relatively new nurse at the time, fresh off orientation, and scared shitless.

I get report and the nurse tells me about the guy in room 27. He is a very tall, very large, manacing-looking black man. He has an extensive psych history, and that day, was having homicidal-suicidal ideation.

Excuse me? I ask the day nurse to clarify.

The patient, whom I will call Big Ed, was admitted for something that I don't even remember right now, but it was something that required cardiac monitoring...which brought him to my floor. That day, he had been saying he wanted to kill himself, and goes on to demonstrate his need by wrapping the phone cord around his neck and tries to strangle himself. He is given a sitter (someone who constantly sits in the room and monitors them for their safety). He then tells the sitter about his plan to attack a nurse in hopes the cops will shoot him.

Fantastic. Did I mention that I was a very new nurse??

So, my night begins. I assess my patients, saving Big Ed for last. He is pleasant enough. I ask him if he is still feeling like hurting himself. He says no, but he is hungry and can he have some toast? Sure! I get him some toast, thinking he is not going to be a bad patient at all. Heather is going to have a good night.

An hour later, the sitter sticks her head outside the patient's room and is frantic. Big Ed is trying to kill himself. I rush into the room and find Big Ed sitting in bed trying to cut his wrist with the plastic butter knife he got with his toast. I was annoyed that the sitter didn't take away his knife after she put the butter and jelly on his toast, but I reached over and plucked it out of his hand.

"Big Ed, these knives won't even cut through butter."

Not exactly therapeutic nursing communication, I know.

A frustrated Big Ed sulks while laying in bed. I deem the situation to be under control and then proceed to my evening med pass.

An hour later, I am approached by another aide who tells me that Big Ed is threatening to leave. I go to his room and find him fully dressed in overalls. We have a different sitter now, and she is doing a pretty good job of calming Big Ed down, but he is still saying he wants to hurt someone so the cops will shoot him. I call the psych doctor. She comes to the floor and looks at his chart.

Me: He is threatening to leave.
Doc: He can't leave. He's a danger to himself.
Me: I know that technically he can't leave, but if he makes a run for the door, no one is going to stop him.
Doc: Well, you can't let him leave.
Me: He's a very large, psychotic man. As far as I am concerned, he can go anywhere he likes.

The psych doctor is clearly not impressed with me, but I don't care. I value my life more than her opinion.

More commotion comes from room 27. I investigate and the patient is escalating. He is now telling us that he is definitely going to strangle a nurse so the cops will shoot him. The sitter is now standing in the doorway of the room, ready to bolt. I rush back to the psych doctor.

Me: He needs something to calm him down.
Doc: I'm not ordering anything because sometimes meds make it worse.
Me: Well, I'm also going to call the hospital police up here.
Doc: You can't call the police, it will only upset him further.

Right then, the charge nurse appears and announces that the police will be called because the patient is threating violence towards the staff. It would be in the doctor's best interest to go to the patient's room and try to talk him down. She grudgingly goes. We call the police.

Meanwhile, I follow the doc back to the patient room. He is very agitated. She starts talking him down, and it seems to be working until out of the clear blue, he has an outburst. He gets on his bed, on his knees, and points a large, beefy finger right at me.

"I"M GOING TO KILL A NURSE!!" he screams.

My sitter, let's out a terrified squeal and runs out of the room, leaving me and the doctor behind. The doctor is very calm and collected. She should be, she is a doctor and no one is threatening her life.

I, on the other hand, am about ready to soil myself.

The doctor takes leave of the room when it is apparent that this patient is now officially out of control. I'm not an idiot, I follow her out. Big Ed follows us out and starts pacing the halls like a raging bull. The other nurses begin rushing around and closing all of the other patient room doors. The psych doc, in all her infinite wisdom, decides that maybe the patient could use some medication, and please would I go get some?

This is a relief to me. Not only because Big Ed is going to get the meds he needs, but also because I now have a reason to lock myself in the med room.

The police show up. I hear the collective groan of the rest of the nurses on the unit because the two officers they sent were women. One officer, casually slips on a pair of gloves (in case she has to touch the patient...which is standard practice). She puts them on in such a manner, you would think she is preparing to pull a rabbit out of Big Ed's ass. Then, like one of those guys who direct airplanes at the airport, she directs Big Ed back to his room.

"Sir," she says firmly, "Go back to your room. It is the safest route."

For a moment, I thought he would go ballistic and she would have to use her taser (which is what the nurses were sort of hoping for)...but Big Ed finally goes back into his room where he escalates even further. He begins to get violent so the two police officers, the nursing supervisor, and the psych doctor proceed to hold him down in bed. Arms and legs flailing everywhere from all parties involved.

And here I come. I am holding a syringe with something that is going to make everything all better...I hope.

Unfortunately, the patient is covered with bodies, and moving...so I can't give the shot. The psych doctor wants me to just plow the needle into his thigh, through the denim. The nursing supervisor vetos this. More wrestling ensues until I spot a patch of flesh.

Apparently, the rest of the staff were watching this through the observation window. To this day, they tell me that I sort of dove in holding my syringe like Norman Bates.

After the injection, the patient subsequently calmed down. We demanded the medical doctor clear him to go to psych. He didn't want to at first, but he caved with six angry nurses glaring at him. It also helped that the nursing supervisor threatened to call the attending. Residents hate it when we do that.

From what I understand, the patient had another episode on the psych floor the following morning. From what I also understand, the Big Ed had been banned from returning to a few larger psych hospitals because he assaulted staff. This is information they don't tell you when the patient is admitted to your floor.

And so goes my first memorable experience as a new nurse. One of many notables which I may chronical later.

1 comment:

Ns.Eri said...

hello,nice to meet you.im a nursing student in japan.i saw your article,it's very interesting.because,i want to work abroad as a nurse in the future.i don't decide the country yet.anyway,i wil see this blog again.thanks. Eri.