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!

S

First Time for Everything

I can log a few firsts tonight:

My first confrontation with a co-worker.
My first instigation of a confrontation ever.
My first time trying to speak French with a patient.
My first time observing a glass eye at close range.
My first time taking a break to let off steam.
My first traumatic code
Working my first traumatic code death without help.
My first time being directly appreciated and recognized by a co-worker.

Which of these should I start with in my next entry?
S

Adventures in Sitting: The One that Broke Me

There was a time, y'all, not too long ago, that I was living in the valley of kittens and rainbows. Every patient, regardless of ailment or creed would get a blanket, a sandwich, and a smile (if the medical situation allowed). People weren't incapable of evil- sometimes their disease states just made them grumpy. Even my rowdy drunks didn't mean any harm- their curses and threats were forgotten by them before the next time they request an urinal or sandwich. If you were kind to them, I thought, people would respond in kind.

Oh to be young and naive! A shift in the drunk tank soon cured me of that.

Entering my shift in the drunk tank, I was given report of my 3 patients. There was Ms. Opportunist in the middle, Mr. Passed Out in the back, and Mr. Two-faced in the corner. Mr. Passed Out was passed out, Ms. Opportunist was sitting comfortably, and Mr. Two-faced was sleeping in his stretcher- he had been like that all day, the tech told me. Ok, that's fine, I replied, anything I need to know? Nah, they've been quiet all day, she said.

I was all set. My cart was equipped with water, sandwiches, and whatever else. Mr. Two-faced rolled over and woke up.

Mr. TF: Hi, miss, can I get a drink of water?

S: Sure, here you go.

Mr. TF: Thanks a lot, you're really nice.

S: It's my job.

Mr. TF: Miss, can I get just another glass? I'm parched.

S: Sure.

Mr. TF: Thank you so much. That really hits the spot.

He was very polite and kept to himself- he was easy-going and quiet. He asked for a sandwich half an hour later, stating he hadn't eaten in a day or two. No problem. He was very thankful for it- so thankful, he asked for another one. Again, no problem. He was comfortable, I was comfortable, things were good.

I checked his vital signs and breathalyzer- he was on the cusp of sobriety where the residents might release him, but still a few points higher than the dogmatic new resident might like. He asked whether he was going home, so I let him know it would be a little while longer. No problem, he said.

He was as sober as was possible for a chronic drunk, I could tell, and was getting restless. I let him go to the bathroom. When he returned, he perched on the edge of his stretcher. He acquiesced when I asked him to sit back all the way, though.

Without warning, he got up and walked to the side of his stretcher. Warning bells sounded in my head.

S: Hey Mr. Two Faced, what are you doing?

Mr. Two Faced: Just looking to see my stuff is here.

S: When you're done, can you please sit in the stretcher?

Mr. Two Faced: Sure, honey, anything you ask. Where is my stuff?

S: Isn't it back there?

Mr. Two Faced: No, where is it?

S: Let me check in the back closet..

Mr. Two-Faced: is it there? My big bag full of all my clothes?

S: Hmm, no, I didn't see it. I will call the nurse to see if she saw anything in the section you came from.

Mr. Two-Faced: Aw ****, I can't believe you guys lost my ****. again! Twenty times I come here, twenty times I lose every *** **** thing I own. I am homeless, y'know, I dont have much. **** me. **** you.

S: I'm calling the nurse, hold on.

Mr. Two-Faced: No, Get a manager over here, right now.

S: Mr. Two-Faced, I am doing all I can to locate your belongings. Will you please give me a minute, sit for a bit and we'll see what's going on?

Mr. Two-Faced: All my clothes! I don't have nothin'. All my ******** clothes. You guys better have a lawyer, cause I'm suing your ******* ****** for all it's worth. Take my clothes, eh? You'll pay for it.

S: Nobody here wants your clothes, Mr. Two-Faced, we're searching for your stuff right now.

Mr. Two-Faced: **** you. All of you are losers. You're phony. You pretend like you care then you lose all my ****. Well **** you.

S: I didn't lose anything. You were here before I came in.

Mr. Two-Faced: You work here, you lost my ****. End of story. You don't give a **** if I live or die or if I lose all my ****. You rotten *****!

S in a soft voice: I do care, Mr. Two-Faced. I'm really sorry you lost your stuff- really, I am. We're doing our best to find it and it has only been a minute since I made that call. Please, just hold on and I'm sure your stuff won't just disappear. Nobody here would want your clothes.

Mr. Two-Faced: **** you. I want a manager. RIGHT NOW. Go on, do your job, call the ******* manager cause I am gonna sue all of you *******. Dirty ******, what are you waiting for?

At this moment, Ms. Opportunist- can I please go to the bathroom?

S: Sure, but come right back.

I watched her from the door as Mr. Two-Faced starts pacing and screaming at me again. I have never had anyone scream at me like that, voice breaking from all the strain. What did I do to deserve this? I FED him, I thought with revulsion. I am keeping homeless psychotics like this alive so they could abuse me and abuse the system.

Mr. Two-Faced: This place sucks! All you could do is feed me bull**** about how you care and ****, but you don't give a ****. None of you care. You're heartless ******* who don't care if I live or die.

S: I do care, Mr. Two-Faced. I'm sad you can't see it.

I watched Ms. Opportunist come back out of the bathroom... and run out the door. I had completely lost control. Backing out of the room as Mr. Two-Faced tried to swing at me, I called security, and to my horror, burst into tears.

He had turned a switch and I was unprepared for his sudden outburst, after 12 hours of mind-numbing work already. He had been testing me and knew exactly which buttons to press. I cried for you, Mr. Two-Faced. You are just too broken, biting the hand that you were so thankful for, that fed you not too long ago.

Security jumped on Ms. Opportunist, pinned her down, brought her back, and restrained her. Mr. Two-Faced was thrown out. Mr. Passed Out was still passed out. And I grew up a lot that day. I will never forget the screeching voice, the angry eyes, and the semblance of civility that he put on when I first met him. Should we meet again, I have some choice words for Mr. Two-Faced.

S

To Be European?

Perhaps it reinforces bad behavior, but I can't help but scramble toward any commotion that I hear in the ER. I am drawn to the dramas that unfold as a person loses rationality. Everyone has a different way of acting out and it is difficult to tell how any one individual may be. For example, the quiet middle-aged man in the corner could suddenly jump up and attack a passerby without warning, the bratty college student might begin to scream in one pitch until she gets her way (or shut in the ambulance bay by herself), or the little old lady (LOL) might suddenly decide to throw out a few F-bombs, rip her neck collar off and yell at a nurse to get out of her room.

Today, it was the last one- My LOL, Ms. Stick, was making a fuss. She managed, with a thick accent, to curse several nurses out of the room after ripping her C-collar off.

The C-collar (cervical collar) is an uncomfortable but necessary device that holds a person's neck still to discourage nerve damage from shifting/fractured bones. She had fallen and broken her leg, and also previously complained of neck pain. The doctor went in to check to see if the C-collar needed to be re-applied.

Doctor: Hi, Ms. Stick, my name is Doctor and-

Ms. Stick: Are you the top doctor?

Doctor: Yes, I am the senior res-

Ms. Stick: Oh good, because I don't want to talk to anybody else. Doctor, I'm in so much pain!

Doctor: Yes, I know that. I have to make sure your neck is ok.

Ms. Stick: I did not break my neck, see? (starts to roll neck around)

Doctor: Don't do that! Just relax and I will check you out. (puts hands on c-spine) Does it hurt here?

Ms. Stick: A little...

Doctor:... well, we might have to put it back o-

Ms. Stick: NO! It doesn't hurt!!! It doesn't hurt!!

Doctor: ... does it hurt here? (continuing) Here? Here?

Ms. Stick: No, no, no.

Doctor: Touch your chin to your chest, like this. Does that hurt?

Ms. Stick: (grimace) A little.

Doctor: Well, now I have to put it on.

Ms. Stick: !! NO! NO WAY! Do the test again. I will answer correctly this time. It doesn't hurt here, here here here, or here! (waves arms emphatically)

Doctor: ... can we just try it for a little whi--

Ms. Stick: No!!

Ms. Stick was one of those unfortunate patients that has no visible or palpable veins. It was impossible to get an IV on her and Doctor had to come in again to use an ultrasound machine to find an artery on her ample arm in order to draw labs. I accompanied him as an extra pair of hands.

Me: Hi, Ms. Stick. I'm S and I am a technician, nice to meet you.

Ms. Stick: Nice to meet you.

Me: I would like to verify, is your first name "Hard"?'

Ms. Stick: Yes, it is.

Me: And your birthday?

Ms. Stick: April 1, 1930

Me: Thank you for answering my questions. We are going to draw some labs, Ms. Stick.

Doctor: It will be the last stick, promise.

Ms. Stick: They always have trouble with me. I like her, she is polite, unlike everybody else here. She must be European, like me!

Doctor: What about me??

Ms. Stick: I don't think so.

Doctor smiles at me- he is fresh from Eastern Europe, I am obviously not.

I held Ms. Stick's hand as we pierced her radial artery to get labs. It was like squeezing blood from a radish. We got most of them, but even with the artery, there was very little blood coming through.

Ms. Stick: They've done this before too. It is nothing they hadn't done to me before.

Ms. Stick had to go to CT scan, which would not take her without a collar. After another hullabaloo, we managed to send her there with it on. I give her credit: she is extremely spirited and independent. She had her own ideas and things were going to be done her way, because she is her own advocate for comfort and care. I liked her, despite the fuss- maybe because she reminds me a little of my mother.

S