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Stressor - i hurt a patient tonight.

Discussion in 'Military & Emergency Services' started by FragileGlass, Nov 2, 2017.

  1. FragileGlass

    FragileGlass Active Member

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    When I tell people I work in an Emergency Department, they gasp in astonishment 'oh wow can't imagine the things you see'. I'm not part of the medical team, however my involvement is always negative. Very few moments of walking away with a sense of accomplishment or gratification.

    The tragedies are hard, the sudden deaths are difficult to see, the violence is unforgettable. These are not my stressors. Although now that I have an established PTSD diagnosis, I'm sure all events take a piece of me now not just my actual stressor.

    My stressor are high risk patients, mental health crisis, suicidal ideation, dementia, adult protection orders. Some of these become frequent fliers, they're in my ER often. I'm there to watch, protect, observe, interact and keep the patient calm and safe.

    These interactions go from calm to violent with highly charged emotions. I go up and down with them. The suicidal patients hurt the most, unfortunately some eventually connect the dots and I am left to receive their body at the morgue. Their words and emotions never leave your head once you've learned they succeeded in their mission.

    Tonight, I'm on day number 10 of a patients 16 day stay in my ER, 72 year old male, close to my fathers age. He is a retired Corrections Officer with PTSD stemming from being held hostage. He now has dementia an explosive combination combined with PTSD. Thus requiring a secured lock room with only a mattress.

    His emotions are everywhere from reality to his fabricated sense of awareness, I go up and down with him because no matter where he is in his mind he seems to trust me mostly. However my response is baseline restrain and hold due to his violent outbursts. It's always a tackle and restraint scenario. To a point that he cowers when he sees me and gives up easily. It's not a good feeling to feel someone give in this way. It's a feeling of breaking human spirit. You always go in hoping for the best scenario. Sometimes it doesn't work that way.

    He was so agitated tonight, throwing himself to the door, floor, raging and yelling, that I had to rush in with height level of force to restrain his self harm. As soon as the door unlocked, I rushed in to restrain, but he gave up immediately, meaning I hit him with far more force than needed since he had no resistance.

    His head hit the floor as we fell, eyes rolled back into his head, he was non-responsive. It became a code response, the entire medical unit rushing in.

    I stayed on for another hour to see how he was, he's ok, resting off a bad concussion. Nurses waking him up periodically to check. I go back in tomorrow to make it Day number 11 of his 17 day stay.

    I needed to vent. Sorry!
     
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  3. Sighs

    Sighs Not a Fairytale Moderator Donated

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    No need to apologise.

    Mental health work is hard. The place of physical restraint in treatment is even harder. If only we somehow had a way of knowing exactly how much force was necessary each and every time and could exert that and not one ounce more.

    Seems likely he would have been chemically sedated after you restrained him. Maybe the head knock was kinder anyway?

    17 days seems like a long time in ER. What happens to him after that?
     
  4. Stephernovas

    Stephernovas Active Member

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    Well I'm glad you shared, but you have nothing to be sorry about. From everything you explained, it is clear you assessed the situation as best you could with the information you had, AND only had the intent to help this man. Things happen. I am positive that if he had his sound mind again he would be happy that you helped him avoid much worse self-injury.
     
    mumstheword and FragileGlass like this.
  5. NaeNae75

    NaeNae75 Well-Known Member Premium Member Donated

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    The like is only for support.
    I'm sure you know it isn't your fault, that your judgement was based on what your assessment was in the moment. I'm also sure that is probably little consolation right now.

    But you stayed and checked on him, and he'll be fine. He really will. Now you will just have to try to do your job as well as you would every other day. I think you have to look at how you would feel if you didn't go in aggressive enough and someone else got hurt. Lose lose... unfortunately. Not sure if that helps either.
    For what it's worth, I'm sorry this happened.
     
    mumstheword and FragileGlass like this.
  6. FragileGlass

    FragileGlass Active Member

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    @Sighs

    He is a very difficult case, he can't be placed in a home due to his violence, he doesn't quite meet the criteria for psychiatric care. Our hospital is the only one in the region with secured lock room to keep him safe. He can't be transferred to an inpatient unit because he has hurt others during his moments. His dementia reverts him back to his hostage crisis. It's a sad story that's tearing all of us apart. This is a rare scenario.
     
    mumstheword likes this.
  7. Sighs

    Sighs Not a Fairytale Moderator Donated

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    Dementia patients can be the hardest to manage, especially when there are comorbidities involved. I was (professionally) involved in a matter where a dementia patient with renal failure kept pulling his dialysis lines out. There would be blood everywhere and he couldn't understand it and the staff would spend ages settling him down and putting his lines back in only for him to tear them all out again ten minutes later. His wife wanted us to stop dialysis but his adult children from a previous marriage were determined it continue. Very difficult for staff to try and follow the "First, do no harm" approach. After all , which was doing him more harm?

    Hugs if you accept them.
     
    mumstheword and FragileGlass like this.
  8. FragileGlass

    FragileGlass Active Member

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    I have a strong sense of respect for the men and women who put on uniforms of duty and service, military, first responder, security, corrections. It's hard for me to treat anyone like this let alone someone whose health is compromised from tour of duty. His story is ripping at my heart strings.
     
    mumstheword likes this.
  9. FragileGlass

    FragileGlass Active Member

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    @Sighs

    Dementia is truly a challenging affliction, this is the first PTSD / Dementia patient I have encountered, it's mind numbing. Especially since we are triggering his PTSD by locking him up. As well, myself being a sufferer it makes it tenfold harder as I would never want this for myself.

    Thank you for the hugs I definitely appreciate it :)
     
    Buttercup, mumstheword and jael like this.
  10. jael

    jael Active Member

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    @FragileGlass
    I too have been in very similar situations at work. It is always difficult to restrain patients. Especially ones with a trauma history. I also have hurt patients unintentionally. I'm wondering why they aren't using chemical restraint in your ER. Maybe they are. Either way, the job is a hard one.
    My dad has dementia and I can see the writing on the wall. Please know that what you did was understandable. There are no easy answers in these cases.

    PM me if you ever want to discuss.
     
    mumstheword likes this.
  11. FragileGlass

    FragileGlass Active Member

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    @NaeNae75

    Thank you! This is why I can go back and forth searching through my experience as sufferer and being a resource to supporters because I flip hats often and under so many crisis scenarios. I try to be careful, much of what i have seen and experience would trigger many in this forum. It's why us uniforms are hard to deal with at times. We don't want to terrify everyone with our stories. While they are tragic, they're impersonal to us at times, it's specific stories and sheer volume of experiences that haunt us. Although, I still have to distance myself from the men and women of the military out of respect and appreciation for their service as I have not walked a mile in their boots.
     
    mumstheword likes this.
  12. NaeNae75

    NaeNae75 Well-Known Member Premium Member Donated

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    I understand more than you could realize. My father used to share his combat experiences with us when we were quite young... over-shared would be more appropriate. During a time that I was at the height of imagination.

    So specific and detailed that images my eyes never saw were seared into my memory and my nightmares. Honestly, it left me pretty numb to many atrocities I witnessed firsthand. One day I'll tell you, but on your post is not appropriate.

    You have a high level of respect for many people, and your desire to be off service is very apparent. That is as admirable quality.

    I know you will continue to do your best, and really that's all anyone can really expect, right? I'm glad you feel comfortable sharing your experiences. So you know, you have my respect and my friendship.
     
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  13. Freida

    Freida Been There, Done That, Lived to Tell the Story Premium Member

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    @FragileGlass Ok. So you know im from the emergency services world so I have a bit of a different mindset on this....that's my disclaimer..

    Yes. It is horrible that he has these extreme reactions and is so terribly afraid and confused. But it is also fantastic because it means he recognizes you and stops fighting! When you are dealing with someone this extreme it sometimes it takes tough love. This is what you are doing. You are descalating him so he doesn't hurt anyone. How you have to do it is messy and sad...but. It's what works to keep him and others safe. And you are the one willing to do it. It's the bigger picture...you may remind him of something terrible. But because you do you can keep him safe. It is completely awful logic...but...there ya go.

    and while today was a case of it going horribly wrong it wasn't intentional. You feel for this poor man and the role you play in his life.. That means you are someone who cares deeply for your patients. If my whack job of a brother was attacking people in his psychosis and someone had to take him down I would want it to be someone like you. Someone who cares enough to make the tough calls

    Yep and this is another one to add to your PTSD pile. Just today my T and I were working on calls I can't talk about to Jo Blow Public because it would freak them out to badly. It still amazes me how brave you are in your posts.....And how much support you receive!
     
    Ninja, mumstheword, NaeNae75 and 2 others like this.
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