Today, I was truly frightened
Ever wonder what you would really do if a patient attacked you? Sure, we all might have ideas on what we’d do, but -much in the same way that we thought we would know what we would do when we grew up- we really don’t know what we would do until we are faced with the situation. In Emergency Medicine, some part of me believes assault is an inevitable occurance. The vast amount of people we see, the vast amount of people to whom we refuse narcotics, the amount of crises we see, the amount of people we give soul crushing news to....it seems more than likely you will meet at least one person who will lash out at the most immediate person - and as the nurse, that person is more than likely you. Today, I got a glimpse into that piece of myself. Today, for the first time in my life, I was worried about my immediate safety. The story has a good outcome for me because I am typing this message. But this is a story of how fast things change in the Emergency Department.
My coworker who had the zone neighboring mine received a patient who was vomiting, drunk, and possibly defecating on himself. I could smell him far before I could see him and counted my lucky stars that he was hers and not mine, because after the week I’ve had, I had no will to deal with that drama. So, I go about my work and taking care of one of my critical patients.
I return to my patient’s room some time later to fix his IV pump alarm, answer his questions, counsel him on realistic expectations of his condition, and update him on his plan of care. It was a difficult conversation to have, dashing some hope of turning dead tissue to live tissue again; but it was a calm and caring conversation. Those patients always make me a little sad. The shock and realization of the seriousness of the issue is a bit difficult to see on their faces and to know you are the one to put it there. You want to offer something to take that look away but you can’t promise anything...because ultimately you do not know the outcome. So, I left the room with that on my mind, speaking some parting words before closing the curtain, and turning around...and there he was.
He stood there in the middle of the hall, covered in vomit, flat affect, and staring at me intensely. In that moment, he was all I could focus on. The way his eyes zeroed in on me, I couldn’t look away. It reminds me of how a murderer in a film would stand, covered in the blood of his or her victim, completely snapped from reality. His eyes revealed no recognition, no apparent thoughts that I was his nurse....simply that I was there. “Uh...” I started to say as he shuffled to me quickly. By the time I had finished that word, he was within 10 inches of me, looking down. I had raised my hands, ready to push him away, by instinct. Then, a stern - slightly worried - “no!” Escaped unbidden from my mouth. And while I can recall this second in excruciating detail, it was just that - one second that went unnoticed by everyone. Surrounded by people and yet very alone. One second that could have had a massive impact to me.
He stopped advancing and turned, shuffling back to his room. There was no look of recognition that he had scared me, just the same flat affect. My heart was racing and I immediately went to my coworker and told her what happened. Sitter was placed to watch patient. And my coworker actively took my concern seriously.
This incident was so different from what I thought a threatening encounter would be like. I had always pictured pure rage, maybe psychosis....and maybe that is why those situations didn’t truly frighten me the way this one did. The blows that scare you the most are the ones you never saw coming. I was also a bit saddened that in that moment, I was not the badass ER nurse that takes no shit, I was scared. Truly scared. And it happened in an instant.
