Saturday, November 19, 2011

The Right to Fight

Have you ever heard a person scream? Really scream? The primal, wordless screech of pain or despair that issues from deep within the lungs, blasting through the vocal cords? The kind that will make you unconsciously grit your teeth until you realize your jaw hurts?

Mrs. Independent was found unconscious. She lived alone into very old age with no known family and a history of Alzheimer's. She woke in the ambulance and put up a violent fight. Apparently she had been a veteran of some sort.  As she entered our trauma room, she let a loud, frustrated scream free.  She wanted nothing to do with us and was determined to let us know.

She balled up her fists and struck at us, but we had to restrain her arms in order to put an IV in.  She thrashed her neck, but we had to hold it still to avoid damage. She tried to kick, but we had to hold her still to check her back.  We pleaded, cajoled, chastised, but it was no use. She had a mental will of steel and would not submit.  Sadly, she knew exactly what was happening and made it purposefully difficult for us to do anything.  She continued her long, high-pitched screaming.  It was barbaric, but we had to hold her down as the knock-out medicine was pushed through her IV.

She went into a fitful sleep, but as we tried to continue interventions, she woke and began her long, sharp scream.  "I don't want any of it! Let me Gooooo(escalates into scream)!!!!!!!!!!!!!" "AEEAAAEEGGH"

And so it went- I stayed by her side for most of the shift, holding her head down firmly, fingers planted on her clavicles so she couldn't sit up.  Her screams echoed through the busy adjoining rooms and there was a silence after each, punctuated by beeping monitors.

"Were you a veteran?" I tried to talk to her. She paused for a split second and I took this as acknowledgment.
"Where did you serve?"
"Let me gooooo (octave increase)!!!!!!!!!!!!!!! Pleeeeeee (octave increase) aseeeeeE!!!!!"

It became an interesting case for me to watch. Usually, a patient acting out tends to demonize certain workers and reach out to others. Despite our best efforts, each new provider or service worker, whether it was a surgery resident, nurse, technician, chaplain, or social worker, she gave the same response. In fact, she screamed louder.  As I was a constant presence throughout the ordeal, I found it enlightening to observe the different methods of approach.

I usually approach distressed patients in a solemn, sincere, and calm manner, whereas there are others that try to meet the patient at their level of energy.  Although this other method can be very successful in certain cases, I find it distressing to acquire so much negative emotional energy on a regular basis.  For Mrs. Independent, nothing worked- she had  created her own impermeable self-discipline in her former life and has since held tightly onto her own ideals of dignity and independence.  Hard-headed, intelligent, fearful, she had estranged her own family to live here alone to the advanced age of 90.  She'd been through so much and now she had to put up with us and the folksy b-s of "so young lady, how did you come to be here today?"

Her high cheekbones were defined, but not gaunt. Her brow, though cut open, was still proud. She was absolutely furious with our intrusion into her well-controlled life and let us know it. There was nothing demented about what she was doing, but from a cursory glance from the busy modern healthcare system, it was easy to dismiss her to be psychologically incompetent.

Much against her wishes, I'm sure, Mrs. Independent was admitted for further observation and tests. As I watched her wheel down the hallway without screaming, I knew she was merely saving her energy, planning her next method of escape.  If anything, we had probably wakened her survival instincts.  Woe be unto the unsuspecting civilians upstairs!


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