Wednesday, April 24, 2013

Aggressive Patients

Two evenings ago, I was going to write about Monday, but I decided to wait a little bit because I didn't want to push Jodi's post down too soon. Especially considering her house is being devoured by vicious wood-eating beasts.

SO...Monday. I was running a Training & Education group ("D" group, our lowest functioning patients), and Otis was there. He was decompensating badly. Of course the eye brow plucking, breath holding, and intense staring were present, but this was FAR worse. Otis was staring at me with his fists clenched so tightly, they were trembling. His face was turning bright red, and he was seething. He was shaking, saying over and over, "I forgive you I forgive you I forgive you I forgive you....." Then he got up and stood right by me, trembling and posturing himself as if he were going to hit me. But he appeared as if he were trying to stop himself. His muscles were tense and he appeared SO tortured...I have never seen anything like it. I am thinking, Holy shit, he wants to take me DOWN.

This is probably the first time in my job that I actually felt in danger of physical harm. I knew, without any doubt, that Otis could physically attack me at any moment. And much to my dismay, the two patients that I am certain would instantly defend me against such an attack were not present that day in the group (one of them is Mr. Scorpion, who was still on the inpatient side). I gazed around, in an attempt to quickly identify my allies. To my right was Thelma*, cradling her rag doll. Next to her was Lucy, mumbling to herself and applying her lipstick all over her face. Straight ahead was Polly, sitting there calmly with a serene smile on her face, one hand casually draped over her walker. And next to HER was Andrew, who was rambling non-stop about how "the fertilized female wasp enters the fig through the SCION" blah blah blah...This wasn't looking so good.

My mind was racing, but I kept my voice calm, and I said, "Otis,are you okay?" He didn't answer, except to murmur rapidly under his breath. I said, "I can tell you are really struggling with something right now, and I'm so sorry you are going through this....I want you to go out on the patio and try to relax for a little bit." He glared at me, then appeared to be experiencing some internal battle. He flung open the group room door, charged out the room, slammed the door so violently the wall shook, and yelled some curse words.

The moment he left the room, I felt a surge of relief, and I left too (now that I had access to the exit), so I could let my supervisor know what was going on. I was hoping he could be walked over to A&R and assessed for inpatient hospitalization (since he so obviously wasn't taking his meds). I grabbed my cellphone on the way back to the group room, because I had decided to completely blow off my training & ed exercise, and just play some music. My nerves were a little rattled, and the D group loves listening to Oldies (Thelma's favorite song in the world is "I Only Have Eyes for You", which reminds her of her deceased husband).

This is when things got even more bizarre. While I am in group, I happen to see my coworker through the window out in the parking lot looking distressed. I see Otis out there, but he is minding his own business now. There is an ambulance worker with my coworker. Then I see our outpatient RN running out there. What is going on?

It turns out, while my supervisor, the O/P clerk and RN were trying to figure out what to do with Otis, my coworker (I'll call her "C") was physically attacked by a different patient. Apparently, this patient stormed out of C's group, and C followed her to the parking lot to make sure she was okay (we have to check on the safety of all of our patients before they go). When C got to the parking lot, the patient charged her like a bull, and kicked her several times. For no reason. What is so strange is we all know this patient well, and she is typically friendly, cooperative, and cheerful. I was stunned.

What followed was a freakin' fiasco. The patient flew into a rage, and nobody could even approach her. The cops were called, and much of the staff was out there. Meanwhile, all the groups had let out, and the vans had shown up to take the patients home, but we couldn't let the patients out of the building because the patient was freaking out right outside the patio door, so they were all crowding the halls. Even the patients who had driven their own vehicles could not be let out, because of the safety risks. During all this, my job was to guard the back door, to make sure none of the patients slipped out into the parking lot. Otis, who I had temporarily forgotten about, suddenly reappears, trying to push his way out. GREAT. Now I have to tell the guy who wanted to kill me ten minutes ago that he can't leave the building. When I told him though, he surprised me. He grinned and gave me two thumbs up. Umm...okay.

The vans had to be relocated, and the patients had to be escorted out past the gym, through a side door, and filed out by the swimming pool. After the outpatient wing was cleared out, I banged on the bathroom doors, shouting, "Anyone else still in here?" A voice pipes up,"I'm in here!" It was Margo, our CLUMSY, toothless patient who wears a Santa Claus shirt all months of the year. As I walk her out past the pool, I tell her, "I swear Margo, if you fall in this pool, you will never hear the end of it from me." She just laughed.

Eventually, the assaultive patient went inpatient (Unit 3). As far as Otis, he got discharged from our program.We found out that he has not taken his meds for a while now. He needs to be moved to a board and care, where his meds will be administered by staff. I guess he will be moving soon. Once he is med-compliant, he will be able to readmit into our program.

I am really bummed about this. I want Otis to come back soon. I know that sounds strange, but...I feel his actions on Monday were admirable. I had a flashback of a worksheet Otis filled out his first couple days here.The question was, "What bothers you the most?" Otis wrote down, "men who hit women." Now I feel like I understand why he wrote that. On Monday, there was a dark part of him that REALLY wanted to hurt me...but he fought that side of himself with all the strength he could muster. I admire Otis because on Monday, in his own way, he did what he could to protect me from himself.

*All names have been changed