Psych Ward Stories( II): "He's chained to the tree"
I am posting this and running. Off to Nicaragua on Wednesday (July 29) for a week to visit my 23 year old daughter who lives and works there. Peace out.
Psych Ward Stories (II): The Very Large Man and the Police
I was on the fourth night of a week of graveyard shifts (11:00pm -7:30am). It had been a quiet week, as it often was. The minimum night shift nursing staff was four: two females and two males to monitor 20-28 patients in fifteen rooms. During high activity periods, that number would be increased to “three and three” and occasionally more. This was the locked psychiatric ward. There were two additional unlocked psychiatry wards just a short walk through the adjoining renal unit. Those units each had about fifteen patients and were staffed at night with at least one male and female, and often more. We could summon help from them quickly if needed, and occasionally they would call us as well. In fact, about once a week one of the medical units would call us and ask us to come help them with a patient behavioral problem. The pediatric service did this a lot, and so did one of the geriatric units. We were always willing to oblige, and in turn they were always appreciative – especially if we ended up admitting the patient to psychiatry.
It was 11:10 pm and the four of us who had just come on duty were being briefed on each patient by the soon-to-be departing charge nurse. There had been two new admissions that evening and both patients seemed to be doing well. It was “lights out” at 11:00pm and the afternoon staff was checking rooms, cutting down lights, and generally straightening up. Every staff member was routinely assigned certain patients each shift, and it was imperative that one made a connection with them, checked in to see how they were doing, and if possible engaged them in some conversation. At the end of the shift we wrote an individual nursing note on each of our assigned patients. You could learn a lot by reading those nursing notes and we would always glance at them at the beginning of each shift.
This appeared to be shaping up as a routine evening. The afternoon staff departed right at 11:30pm and it was then the four of us, and our 24 patients. The way it worked was that one female and one male staff would sit at all times in the hallway while the other two attended to business. The ward was L-shaped and the nursing station was right in the middle and so we pulled out a few chairs and began our nightly vigil. Within ten minutes Alice came dancing out of her room almost ballet style, dressed (or undressed ) in her flimsy light blue negligee. She was in her 50’s, married, and a lifelong resident of the local community. Her husband visited twice a day and always brought her some candy and often flowers. Apparently she had been friends with the now retired county sheriff. Before any of us could jump up she danced her way to the main door (tossing tissues aside for dramatic effect) and slipped a letter underneath it, and then danced her way toward us. She was always dressed provocatively and coming on to the male staff (and patients too, and some of the older guys really liked that) pretty much all the time. She was completely harmless (well, as far as we knew). One of the female nurses jumped up and led her back into her room and admonished her to stay put for the night. It just wouldn’t have been right without her visit.
The renal nurses next door always saved our “mail” for us and we would pick it up later. As it turned out, it was another long letter to Sheriff Parsons explaining how we were holding her captive, and that she needed his help to escape, and occasionally she would even describe an alleged misbehavior by one of us (“The big tall guy would not allow me to have dessert tonight and tomorrow they are going to lock me in the dungeon. You must help me escape TONIGHT.”) Each letter had an elaborate hand-drawn map of the hospital so that she might be rescued. The envelope was sealed, properly addressed to the sheriff, and always had correct postage. Alice could be both amusing and annoying. Tonight it was amusing.
The first time I ever worked the night shift she accosted me in the hallway, put her arms around me as I gently pushed her away (annoying), started mumbling something about how cute I was (I still fall for this) as I tried to coax her to back off. I looked down the hall to see who was watching (this was now getting embarrassing because she wasn’t letting go) and all three of my shift buddies were convulsing with laughter. This was my “initiation”, and sad to say, I would later do this to a new unsuspecting attendant on his first graveyard shift. Barbara finally came to my rescue, and led Alice by the arm back to her room. The three of them laughed for fifteen minutes as they relived all the “Alice and new staff” encounters that they had witnessed. I would see the humor in it later.
Things were quiet for a few hours and then the phone rang. It was the ER and they had a patient to admit. The clerk asked if we could send some male attendants down to escort the new admission and advised that we bring a gurney as the patient was rather “debilitated.” Hank and I headed out the door wheeling our way through a quiet and darkened maze of hallways and wards. The gurney had two large wheels on one end and two tiny wheels on the other, collapsible railings on the side, and two safety straps so that our patients didn’t roll off when we cornered too fast. This narrow bed-on-wheels also served in a pinch as a nap station for staff, as it was stored in a very large and quiet closet at the end of our hall.
We exited the elevator at the back of the ER in the triage area. Things were quiet as we wheeled past mostly opened and vacant treatment stations. A few curtains were pulled and we could hear some muffled conversations, and in one a baby was crying fitfully. All in all it seemed calm and under control. In the last bed I did notice that a uniformed police officer was sitting on the bed, and someone was holding a compress on his forehead. He looked a little disheveled. We pushed through the swinging doors and were immediately met with several campus police officers standing together and talking rather animatedly. They all were sweating rather heavily. One had a torn shirt, all had that dirty look of cops who had been in a wrestling match, and one appeared to be holding his wrist in pain. We acknowledged them with a friendly ‘Hi guys” but didn’t get much back.
We wheeled up to the clerk’s station. She was on the phone but motioned us in the direction of the exit doors. I looked over and there were three or four city cops at the door, all looking pretty beat up. We wheeled toward the door and I could see lots of red flashing lights through the small windows. This was unusual because protocol required ambulances to silence sirens, and douse emergency lights for the final 200 yard drive up to the ER loading ramp. Hank said something like “What the hell is going on out there?” I took that as rhetorical since I had no clue. One of the besieged cops motioned us through the doors saying “He’s outside and he’s all yours.”
Through another set of doors and we were on the loading ramp. Red lights flashing everywhere – must have been eight or ten police cars and one ambulance. Several more officers were on the ramp, and they too were pretty beat up. I could someone yelling loudly in the parking area, and some other voices responding rather forcefully.“What’s going on guys?” I asked brilliantly. “Over there by that tree in the island is your patient.” All I could see was a small crowd of people surrounding a huge oak tree, and I could hear a very agitated sounding person screaming now at the top of his lungs. We walked over, leaving our gurney on the ramp.
I spotted what appeared to be several young medical residents and at that moment realized what was going on. Our patient was literally shackled to the tree with a makeshift tie of chain and handcuffs linked together. His was standing face forward as if hugging the tree, but of course he was chained to it and he was yelling and threatening everyone, and cussing and fussing. I identified myself to the resident that looked like he might be in charge. He looked at me and said, and I swear this is true, “Do you think you can walk him up or do you need a wheelchair?” I looked at my partner who was already working up one of his patented “You’re just kidding, right?” looks and we both started laughing.
The patient was known to our veteran psychiatric staff and went by the name “Big George.” He was about 6’9” and weighed over 300 lbs, and he was all muscle. He was also known to suffer from severe manic-depressive illness (aka bipolar) with psychotic manic phases. He would get violent at times and at other times would be docile and sweet. Tonight it was rage and violence night. As we were standing there taking in the scene, Hank mentioned that Big George had once torn a securely bolted sink off the wall of his bedroom during a previous stay, and calmly tossed it into the hallway. Something about being irritated at another patient who was also in a manic state. I asked the ER resident to call the psych resident and have her come down. We would need more Thorazine tonight, and the psych residents tended to listen to us a little more than the ER docs did when it came to dosage and safety.
So here we were, standing in the traffic circle in front of the ER in the middle of the night, with Big George foaming at the mouth and shackled to an oak tree. Completing the scene was a ring of bedraggled and “flat worn out” cops and a couple of docs. It was our job to admit him to psychiatry. Hank jokingly asked one of the docs to unchain him and walk him to the triage area, and for a moment I thought he actually was going to do just that. Within ten minutes our psych resident arrived, and Big George received what would be several stiff IV doses of our savior, Thorazine. Within an hour Big George began to calm down and “relax” a little. By now fresh police reinforcements had arrived and we had quite a crowd. The fresh faces were ribbing the first responders pretty hard when I asked them to remove the cuffs and chains. All of a sudden it was just one cop, two docs, and us standing near the tree. The others had all gathered together on the ramp to “watch.”
We began explaining in a calm voice to Big George that we were going to remove the handcuffs, and walk him to a stretcher, and take him to his room. He mumbled something that sounded like agreement, so we released the lock. He slumped a little as he turned to face us, the handcuffs dangling from both wrists. He didn’t realize it but we left the cuffs on for quick reuse in the event it became necessary. The big guy fell onto the gurney and basically passed out. We secured the straps and headed straight for the back elevators. No paperwork was needed tonight they said as we wheeled past the clerk’s station. Funny how that worked. We wheeled Big George right into the quiet room and got him cleaned up and settled in. Then we began the first of sixteen straight hours of watching him sleep off the medication. The task now was to taper his meds just enough to eventually have him regain alertness, and be calm and manageable. This would take several days.
Now, several months later, we got word that a female patient on the open unit was expecting a visit from her husband, and that he would likely be carrying a gun and planned to kill her. Her attending physician had asked for a meeting with us to plan a strategy in the event that he actually brought a gun. I kid you not. Major medical center. Early 1970’s. Unlocked psychiatry unit. Physician without a clue. Young psychiatric attendants who watch too much TV and are also clueless and heavily testosteronized. Bad combination to set a plan to prevent an angry and jealous husband from killing his wife while she is in the hospital. Oh yeah, campus cops who don’t even like to come near the psych unit because they have to check their weapons at the desk are offering to stand by if needed. To be continued…