The Fist

By Debbie Moore-Black, RN

I thought it would be easier than ICU nursing. After 33 years as an ICU nurse, I had to leave. I just couldn’t take the pounding on the chests of little old men and women. Hearing and feeling their ribs crack while CPR was performed. I just couldn’t handle these poor patients that should have had a peaceful death when the inevitable was near.
Family members with expectations of miracles. Denial. Rationalization.
And I had to take a break from my favorite dedication to ICU nursing.

Morally, I could not assist in keeping an end stage multi-organ failure patient alive artificially anymore.
So I chose Behavioral Health as my last “swan dance”. Thinking it would be an easier qpassageway to retirement.

But ICU nursing and Behavioral Health Nursing… they are apples and oranges. Both with incredible complexities.

He came to us from jail. He knew the tricks to get out of jail…. Temporarily. He smeared his feces on the walls in his jail cell. He started to talk about the FBI being a chip in his brain and suicidal ideations. And they knew they would have to admit him to our Hospital: Intensive Management Behavioral Health.
He had a long record: Domestic abuse/violence. Rape. Assaults with a deadly weapon.

Upon entrance to our unit, compared to his jail cell, we were nicknamed “The Hilton hotel”. Your own bedroom, with a bathroom and shower. 3 meals a day with interval snacks/refreshments. Medications to calm you down, to help you sleep, to help stop the voices in your head. To help you to relax. Loads of group therapy and gym time. Anything would be better than being in jail.

I always said my “anti-assault prayers” before entering this Behavioral Health unit. Sometimes they worked well for me, for us. But these patients were so random. Anything could be a trigger.

On this particular night, Sam started to act out. He was already very intimidating. He’d stare at the nurses. A fixed glare. He’d have verbal fights with fellow patients…. And then came the chair throwing, and tossing over tables in our community room.
We immediately called our Public Safety Officers (PSO’s) to assist the staff and to protect us and protect the other patients.
I readied my syringe, haldol, Ativan, Benadryl.
The trifecta.
We could not verbally redirect Sam to go quietly into his room.
So the PSO’s held onto him and guided him to his room.
He physically fought his way into his room, attempting to fight off the PSO’s while shouting out obscenities.
And then a calm came over his face.
I had to give him an injection.
He stood perfectly still. Rolled his sleeve up and said “ok, I’m ready”.
A PSO stood on each side of him.
Sam stood perfectly still and stoic.

For a brief moment, we chose to trust Sam. That he was willing to take this injection in his arm.
With my alcohol swab ready, I wiped his arm and then began to aim the needle.
Out of no where, the perfectly still and calm Sam, got his fist and aimed at my jaw.
I saw his fist coming toward me and I remember saying “Oh no”.
The strength in his fist made my entire body crash to the floor. My eyeglasses flew out in the hallway.
A PSO on each side of him, and we didn’t see him coming at me until it was too late.

Our biggest mistake was that we trusted him.

He then began to physically fight the PSO’s. And he was steadied, another nurse gave him the injection and the patient went off to the seclusion room.

I was immediately wheeled down to the Emergency Department. I was uncontrollably crying and shaking. I couldn’t talk. The physician thought the patient had fractured my jaw, I had contusions on the right side of my face. And I couldn’t move my mouth.
They wheeled me in for a stat CAT scan of my head.
Beyond the contusions, the Cat scan was negative. I was lucky.
I took 2 days off of PTO.
And I was back.

But things were different. I was fearful. Of any of these patients. I realized he could have done so much more damage physically.

But mentally, I was now damaged.
Dead bolting my doors at night at my house.
Waking up at 0300 seeing that fist come at me repeatedly. Dreams of unidentifiable men breaking into my home.

Obviously, I was experiencing PTSD.
And I have sought some long-term therapy.
I pressed charges against this man, but then that became a fear also. He could find me. He could look up my address.

My one comfort is knowing that my male
rat terrier dog protects me.
And though he is small, he would go at someone’s jugular for my protection.

It’s not an easy job.
Another real reason that within one more month I will retire from being a nurse.
If the lay people only knew the physical and mental abuse we take 24/7.

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