Agraphia Medical Tragicomedy


Holding My Ground

Someone today threatened the lives of my coworkers.

He was a wanted man, and the sheriff had been clued in to his presence in the emergency department by his terrified wife. The nurse who brought him in from triage felt something "off" about him and notified security. At the sight of their badges he tried to bolt, thrusting his hand into his pocket as if to grab a gun.

They slammed him into the wall and he elbowed one out of the way, trying to pull something out of his pocket. When fully restrained, an unsheathed bowie knife slipped from his outstretched hand. The knife was cursorily kicked away as he was wrestled to a gurney.

He finally calmed down enough for me to evaluate him. I did my duty as his doctor and checked him over for signs of illness. Apparently he had ingested some 40 tylenol, a ton of cocaine, and some PCP as a suicide attempt a few hours prior. I drew some bloodwork and started him on treatment for tylenol overdose. At the sight of the needle he started screaming obscenities and thrashing about in his bed. At some point a nurse got kicked. The restraints went on.

It's difficult when medicine and law intersect. Every part of me was screaming "THIS IS A BAD MAN", except for a tiny doctor voice in the background saying "he also overdosed on tylenol." And so, I did my job, treating him carefully, cutting no corners in the process.

A while later I heard a ruckus outside of his room. The nursing manager was mentioning big words like "QA" and "patient satisfaction", and was demanding that his restraints be lifted.

It's rare that I take a stand against my higher-ups, as usually they have good reasons for their requests. This time, on the other hand? Nobody threatens my friends, and fists and feet can be lethal weapons in a person high on PCP and crack.

"Ma'am," I said, "this man pulled a knife on our security guards and kicked a nurse in the arm. I don't care what 'patient satisfaction' measures or 'quality assurance' protocols you think I'm violating. He is a threat to staff and he leaves this ER in police custody and cuffs, or onto a hospital floor with 4 point restraints and an escort."

She was a bit taken aback, but I think she got the point loud and clear. Staff safety comes first. On that point I will never budge.

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  1. Good for you! We need more people to stand up for staff safety!

  2. As a medical professional who has been assaulted by patients… Thank you for standing up for what is right.

  3. I have had to dismiss patients for being verbally abusive to my staff. Zero tolerance. Well played.

  4. Good for you for standing your ground. I’m astounded by those who blindly apply hospital policies (e.g., re: patient satisfaction & QA) with zero regard for the patient or situation at hand.

    Last weekend I had to stay in MRI with a patient who received 2 mg of IV Ativan b/c the tech faithfully repeated that more than 1 mg represents “conscious sedation.” The Ativan didn’t touch this woman’s anxiety and there was nothing written anywhere to support his policy, but I had to stay because he had no regard for clinical judgment and the radiologist on call wouldn’t make a judgment either way.

    The woman’s heart rate never dropped below 105 while she was in the scanner and I left my call night 3 hours late b/c of the meaningless extra work.

  5. Hey, Nurse Manager, if it’s important to you, you go and do it, and look after the patient yourself. If you want us to look after the patient, we do it our way, safely.

  6. I agree with Sunny, if the nursing manager thinks QA and patient satisfaction trumps staff safety, then by all means let her take care of the patient without restraints.

  7. Way to stand your ground and stick up for staff!! As a PICU nurse who has been hit, bitten, and kicked by teenagers much larger than myself, I am in complete agreement that staff safety should be of great importance. Afterall, if our staff is not kept safe, we can’t keep our patients safe!

  8. The whole experience sounds terrifying! But it’s good to hear that you stood up for the staff. Definitely the right thing to do.

  9. New subscriber, thought I’d say hello. I worked in the ER this summer (briefly) and it’s sad that things like this are not all that uncommon. Good for you to stand up for your coworkers, though. Sounds scary….

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