(This event occurred a significant time ago and has been waiting in the "draft" folder until details of the event have become obsolete in context to protect the privacy of those involved.)
A paramedic may have saved my life. I wasn't sick. I didn't call 911. I'm a nurse in a rural hospital who was working an ER shift in the wrong place at the wrong time. A voluntary psych patient walked into our doors with police escort. The patient wasn't under arrest and didn't want to be seen. Legally, that patient has a right to walk out that door. A quick assessment of the situation told me that the patient was both a threat to self and others. Threatening statements, aggressive stance, diaphoresis, verbalizing ideas incongruent with reality; I needed to get this patient out of our packed lobby and away from the other patients. So I did my job. I used my limited psych nursing skills to lure and coax the patient back into our pseudo psych room.
I say pseudo because I work in a tiny emergency room and we don't have the space for an official psychiatric ER room. This room is our back up gyno room for pelvic exams, sutures and general emergency department patients as well. There are scalpels, stitch cutters, razors, wires, tubing, monitors, metal tray tables, IV and oxygen supplies, suction tubing, IV poles and other supplies that can all be used as weapons against us. Even the wire shelving can be ripped from the wall and used to hurt us. But like I said, the patient arrived in the waiting room without warning, so the room wasn't emptied prior to arrival.
The officer had no back up. He was a friend of the patient's family and really just wanted to get this patient some help. Let no good deed go unpunished. The situation escalated quickly to the point of out of control. An ambulance, by chance, had just dropped off a different patient. In 3 seconds time, all of the cording in the wall had been ripped out, an ER stretcher thrown, a cop and RN locked behind a glass door with the unstable patient loose in the middle of the ER. That fast. In a millisecond, I realized this psychotic patient was in control and the gravity of the situation took hold.
I'm not going to lie. It was the most terrifying moment of my nursing career. I never saw it coming, I thought I was following all of the safety guidelines. I was keeping the officer between me and the patient, I was aware of my space and exits, I was thinking ahead of what needed to be removed from the room. But it was THAT fast. The patient could have killed me. That patient could have killed everyone in that ER. All of the could haves, would haves and should haves went through my mind in an instant. I don't know who unlocked the door. I don't remember getting out. I remember calling the front desk and asking for police backup "NOW" and the paramedic grabbing his radio and saying, "I've got it," some arguing, a taser sound and the same paramedic lunging across the ER to help the officer take this patient down. Police back up walked through the door and it took 6 strong men to hold this patient down until the medications began to take effect 40 minutes later.
Yes, people. That is your mental healthcare system. FYI: there really isn't one. The system is overloaded. When we called facilities for a psych bed, we got put on a waiting list 48 hours out - which means this patient was going to be staying in the ER for 2 more days with 1:1 nursing at the bedside. It means the 7 bed ER is now down to 1 nurse and 6 beds with a very valid threat looming near. It means that the patient experiencing the first real psychotic break in their lifetime isn't receiving the ideal psych care or medical treatment. It means that everyone who walks into that ER is walking into harms way; patients, nurses, doctors, lab, radiology techs, respiratory therapists, visitors, housekeeping, kitchen staff, paramedics, etc.
This wasn't a drug induced psychosis that would wear off like with the "bath salts" being laced into meth. This was a real, textbook, schizophrenic psychotic break. Alert and oriented to some extent with grandiosity, delusions and violent threats escalating to violent behavior. There is no reasoning, bargaining or placating. This person is the most dangerous patient we see in the ER because they are unpredictable and have no limitations to the acts they are willing to commit for unknown reasons. Bargaining and rationalizing go out the window quickly when attempted with someone with limited comprehension of reality. They can be easy going and cracking jokes while strangling you with electrical cords.
But it's the ER. There's no time to stop. There's not time to think. We all stuff it into that bottomless pit of a place that allows us to keep going and we move on. There's no time to think about anything but your next patient, your next order. We were busy resetting a hip, orthoglassing a fracture, oxygenating an overdose, transferring a hemorrhage, ruling out a pulmonary embolism and triaging every patient that walked through our doors in 3-5 minutes or less while attending our psych patient and doing our best because each of us can imagine ourselves in the place of our patients, or their families, and we just want to do our best for them.
I'm writing this knowing very well that I won't be able to share it until the specifics of the event are blurred to protect the privacy of the patients. We aren't allowed to discuss events like this, even with fellow coworkers that weren't involved in the case. We can't tell our spouses. We can't discuss particulars or specifics. The patient that threatened to kill me, attacked a cop he knew on a friendly basis and destroyed an ER room has more rights than I do and I can't share any information about anything without a subpoena and even then, a lawyer needs to review with me what I can and can't say. So I mixed a few facts up here just to keep it legal.
I feel for the psych patient. I feel for the family. I can't even imagine how frightening an event like this must be. But mostly, I am grateful. I am grateful for the paramedic that literally jumped across the ER to save my ass before a cop could even unholster his weapon. I know how much worse it could have been. I can't tell you how many times the scene has played out in my mind with different endings and bigger headlines.
I'm hoping our psych patient gets the appropriate care. I'm hoping our administration understands the need for more security and a better intake system for these patients. I'm hoping that law enforcement takes a closer look at their "voluntary" transport and drop off protocols. I'm hoping to educate the general public about how messed up our system is and that some of you will get involved and make changes. Just because we aren't allowed to discuss these issues doesn't mean it isn't a huge problem. It is. HIPPA and privacy protection laws just prevent anyone from knowing about it.
I'm so thankful for our EMS crews that keep us safe. It could have been so much worse. If you want shorter wait times and an ER that has room to actually care for people with REAL emergencies, help us reform the mental health care system. Help us get drug users, dealers and meth heads out of our ER. Help us educate the public that an ER is not a place to get free bandaids, Tylenol, Sierra Mist or a note to get out of work. Help keep us healthcare workers safe so we can do our jobs because you or a loved one might just need us someday.
