First of all, I want to thank everyone who visited the site and those who commented since my last nursing post, the Double-Edged Sword! It’s so humbling to read comments from nurses from different areas, different parts of the world, and different life stages, and know that I was able to give a voice to a common theme. Honestly, I had no idea that this post would be so popular as I was simply trying to express those nagging feelings in my gut that wrench at me from time to time. It’s cathartic to verbalize those emotions and it seems like it was for everyone else too. It’s a dense topic, arduous to navigate and process through, and we all couldn’t do it without the help of others. Thank you for your support, your dedication to the nursing profession if you fall into that category, and to those non-medical people who provided another viewpoint to the topic of compassion fatigue or emotional guarding. I appreciate every word.
I use the word “cursed” mostly as a nervous joke but the following patient got under my skin, even brought me to sheer panic, and you will soon understand why. For a period of time, one particular bed haunted me with disturbing patients and I vowed that if I was ever admitted for an accident, I would demand any bed but this one. For months, I subconsciously picked assignments on other sides, not wanting to relive some of the grevious experiences I encountered with patients in that bed. Here is one chilling tale…
His eyes seemed to glow nefariously, like a smoldering flame, darting back and forth suspiciously across the room. He refused to speak, only grunt at anyone who came near him. His hands were calloused, spindly ropes of non-compliance, clenched into fists beside him in the bed. Without staring at him for too long for fear of meeting his eyes, I could see scars lined up across his worn face as evidence of dark days. I also noticed the scars on his arms surrounding his veins, confirming his drug habit.
“Sir, can you tell me your name?” I asked hesitantly. He only responded with an aggressive, animalistic sound.
It was the beginning of the nightshift, the winter pitch-black sky peeking out at me from behind the blinds in the room. With only distant beeping noises, the unit was quiet, contrary to the usual raucous nighttime routine inherent to an active intensive care unit. This room, separated only by curtains from the vacant adjoining beds, was situated at the end of the dim hallway and the hazy florescent lights flickered inconsistently as if to confirm my suspicions. Feeling unsettled, I wondered if anyone would be able to hear me scream at the nurses’ station at the other end of the hallway.
I watched him for a moment, noting the labored rise and fall of his chest. The slits for his eyes rested barely closed, as if he was watching me covertly, prepared to react at any sudden movement. He was a rough man, well accustomed to the hardships of life with mental illness and the dangers of living on the streets. With an anonymous address listed for a location under a highway, he was brought in without family or friends. I don’t remember his diagnosis or his chief complaint but I recall feeling sorry for him, wondering what set of circumstances landed him here, alone and broken. But despite my compassion, the lingering sense of uncertainty remained, weighing me down.
Only about a year out of nursing school, I gathered my supplies, stuffing my pockets with alcohol wipes and saline flushes, and threw my stethescope around my neck like a good novice nurse. With my relative lack of experience, I couldn’t see the dangers lurking behind his disconcerting eyes. I wasn’t prepared for what would happen. I entered the room trying to be confident, chalking up my intuitive fear to cowardice.
“Sir, my name is Natalie and I’m going to be your nurse tonight. I just need to do a quick assessment and then I’ll let you get back to sleeping.” He didn’t respond, didn’t move. He sat there motionless, like a cat waiting to pounce on a mouse.
I checked the alarms on the monitor, running through my safety assessment with one eye fixed on him. I fiddled nervously with my hands as I hesitated mentally over whether to touch him or not. I finally decided I needed to harness some bravery and continue with my work. I stepped over to the side of his bed, his eyes still closed and his breathing heavy. I glanced back at the heart monitor as the beats crossed the screen in a slightly irregular rhythm.
“Sir I’m going to check your IV lines now.” My voice shook but then I cleared my throat and tried again, hoping to sound more in control. “It will only take a minute.” I unclamped the tubing, cleaned the port and attached the saline flush. I started to push it in very slowly, expecting some kind of reaction from him. Still, he didn’t move.
Somewhat encouraged by his lack of response, I moved to the other side, doing the same with the IV line in his right arm. I pushed the saline flush faster this time, at the normal rate. I was almost done and he spoke suddenly.
“Don’t touch me.” The tone of his scratchy voice sent my hopes for a decent night to the pit of my stomach. His voice was cold and rough, marred by years of trials I couldn’t imagine. He said it calmly, without emotion, like a very real threat and a shiver passed over my entire body.
No movement, eyes closed, rise and fall of his chest in synchronized motion.
“I’m almost done if you’ll just give me a minute. Let me listen to your heart and lung sounds first.” I yanked my stethescope off my shoulders and quickly placed the earpieces into my ears. I picked up the end of the device and brought it near his chest, trying to get my assessment over as quickly as possible.
“I’m warning you, don’t touch me.” Since I couldn’t clearly hear him, I slipped one of the earpieces out slowly as dread filled my gut. He said it again, slowly, with precision over every word. “I’m warning you, don’t touch me.” My hand shook and I gripped the piece of equipment tighter.
“Ok well let me finish and I won’t bother you again.”
One of the slits of his eyes opened abruptly as he stared straight at me. Creepily, the other one remained shut. Shocked and scared, I took a step back immediately. “Did you not hear me?” he said, getting more irritated. “I said I don’t want to be touched.”
Since my gentle encouragements had yielded little progress, I gave it some force, all the force an innocent twenty two year old girl could manage. “Sir, you are in the hospital for a reason, because you’re not well, and I’m trying to take care of you. I’m just doing my job. Let me listen to your heart.”
The slit closed again. Up and down went his chest. No reaction.
I stood there for a long moment, trying to decide if his silence indicated agreement or dormant rage. Bolstering my bravery yet again, I placed the stethescope on his chest and leaned down towards him. I could smell the dirty stench that coated his skin. I barely let out a breath as my rising fear choked me. I felt like the lamb lying down with the lion.
In a split second, the entire situation changed.
His eyes snapped open, wild and full of wrath. He started to scream, a tortured wail that thrust me away from him. I scrambled backwards as he lifted his leathery arms into the air and pulled out one IV, then the other, splashing blood all over himself and the bed. He let out another scream and clenched his hands into desperate fists as if a lifetime of anger had finally spilled over in this instant. Seeing the sheer insanity in his eyes, I think I’ve hardly ever been that afraid. He barely looked human anymore.
“Help! I need some help down here!” I cried in desperation. My cohorts recognized the panic in my voice and came running to my abandoned end of the hallway. With his chest lifted, he looked like he was about to jump out of the bed, focused on me as his target. I couldn’t move, couldn’t breathe. I was frozen in fear as this crazy man pushed down on the side rails in order to boost himself up. He was about to lunge, aiming for me.
Suddenly, out of nowhere, I saw one of our male nurses throw his body on top of my patient, slamming him back into the bed and away from me. Another grasped the patient’s arms and held them to the bed. Someone else got his feet. Everyone was yelling and throwing equipment at each other as someone else called for the physician. Completely stunned, I couldn’t even react as I watched everyone in rapid motion.
It took six nurses, four of them strong male nurses, to simply keep the patient from catapulting out of the bed. He thrashed and howled, kicking vehemently against them, and they shielded their faces as he started to spit. Two hands rapidly and expertly placed restraints on the patient’s arms and then two more on his legs. Even with the restraints, the patient bucked and whipped his head back and forth, screaming and biting at the air in sheer rage as his spittle flung across the room. Someone got their hands around his neck long enough to put a paper mask over his face to protect the nurses from his bodily fluids.
Then, as if it couldn’t get worse, it did. The patient screamed again, mustering all of his strength, and thrust upward so hard that one of the restraints on his arm broke and his arm went flying into the air. The nurses grabbed the liberated appendage and clamped down on it with white-knuckled hands. They looked at the destroyed restraint and then at each other helplessly. That never happened.
“We need some IM Haldol now!” the doctor said as he ran up breathlessly. His eyes scanned the situation, instantly registering the severity of the circumstances. Without any remaining IV access, we couldn’t give the patient any of the intravenous medications we would normally try first. We would have to inject the medication into his deep tissue to absorb. Hopefully then we would be able to hold him down long enough to get another IV line.
A fellow nurse ran back from the medication station with the drug and threw it to another nurse with a syringe in hand, ready to draw it up. In only a few seconds the male nurse who had first jumped on him inserted the needle into his skin expertly. In his fury, the patient didn’t even register what had occurred. Still holding the patient down firmly, we waited for the medicine to take effect. I watched the male nurses with a new level of gratitude as beads of sweat collected on their foreheads. I thought maybe I wanted to cry.
The male nurses remained over the patient as one of them carefully pulled out a catheter needle and searched for an acceptable vein on his arms. With all of his scars from drug abuse, there wasn’t much to choose from and he searched for several minutes before finding one he could try. With the heightened precision that accompanies a true emergency, he slid the catheter in, the needle out, and hooked up the IV tubing. Per the doctor’s orders we gave another dose of medication into the line. It took several doses before he started to calm.
After a few minutes, the patient’s grunts diminished and his strength surrendered. Little by little, not trusting him in the least, the nurses lessened their grip on him as they placed a second set of restraints on the patient. We wouldn’t go through that again. Few words were spoken as everyone caught their breath, attempting to recover from the rush of adrenaline.
The patient lay there with eyes closed, his breathing starting to calm. I could still see his veins sticking out on his forehead from the exertion. I couldn’t get the image of his crazed face out of my mind, watching helplessly as he was about to pounce on me. With all the excitement, I could hardly process what had happened. Someone put a chair behind me and I sat down. The doctor ran his hands through his hair and exhaled deeply. A wave of relief washed over me. We were all glad that was over.
I related the events of the night to the doctor as he adjusted my orders. “Well he’s going to get what he wanted. Don’t touch him for the rest of the night. I’ll put in the order.”
So I sat at my patient’s bedside for the rest of night, simply scrutinizing the monitor and trying not to disturb him. I tried to imagine what thoughts ran through his brain, what voices were speaking to him, what instincts motivated him to attack us. We would probably never know, and despite his crazed outburst, we were there to help him. We wanted him to be set free from the terrors that haunted him. We tried our best to confine and contain him but there was little we could do to liberate him. With an unexplainable mix of compassion and sheer terror, I ruminated over my patient, keeping a close eye on his every movement.
And with the slits of his creepy eyes almost closed, lying limply in the bed, I knew he was watching me.