A Morning From My Past
I am a firm believer in learning a job from the ground up. That is how I learned the psychiatric hospital business. Since 1986 I have had a number of titles and job responsibilities. At one hospital, I was in charge of transportation - I was the only person in the hospital who could not drive. Some of my most memorable experiences came while I was a clinical associate in New Orleans. A clinical associate is a part of the nursing staff. CA's as they were called were flunkies - the bottom of the totem pole. We were the canon fodder who got to restrain a patient if he/she went out of control. We got to help the patients go to the bathroom or take a shower if they needed help. The CA's cleaned up the messes. It was one of the best learning experiences I ever had. Anyone going into psych who does not log time as a CA is missing out.
A typical shift started with report. The idea is to hip the oncoming staff to the current status of each patient. I liked report because it was a treasure trove of straight lines. Here is an example of what I am talking about: Nurse reading from clip board in monotone fashion, "Mr. Bates is still sexually inappropriate . . .he required redirecting for masturbating on the unit." Then I would say something like, "yeah, even as a young man he was referred to as Master Bates." On another occasion: Nurse reading from a clip board in monotone fashion, "Mrs. Smith was admitted last night from the ER. She threw hot water on her husband, then continued throwing objects like coffee cups and lamps. Mr. Smith ran out the door and she gave chase in the station wagon. In her attempt to run down Mr. Smith, she ran into a tree sustaining minor cuts and abrasions." Then I said, "huh, he must have used the 'C' word."
Report would conclude with the head nurse passing out the patient assignments. Depending on a few variables, a CA would work with 3 to 6 patients. One of my patients this particular day was in the seclusion room. This room was for patients who needed to be watched more closely or for patients who could not control their behavior. My patient was in for the latter reason.
Julius was a long shoreman. He was admitted because he was off of his medication and was acting bizarre. He was an African American about 5' 9" tall and weighed more than 200 lbs. He was stalky and muscular. There are a lot of things to do at the beginning of the shift. There is paperwork to get started, vital signs to check, sharps to pass out or put away, phone calls to make for patients, and lots of questions to answer. I was taking care of those duties when the unit secretary told me that Julius wanted to talk to me.
The unit was a big open area. A door from the unit led to a large inner staff room where we charted or had meetings away from the patients. The seclusion rooms abutted this area and the patients were visible through a large window on each room. There was only visual access from the charting area. To get into the seclusion one had to go out to the unit and in another door that was the hallway to access the seclusion rooms.
I went to see what Julius wanted and since I had not met him yet, I opened the door and introduced myself. He was sitting on his bed and did not acknowledge my introduction. He stared at me and said in a flat voice, "I want some orange juice." Responding to him I said, "OK Julius, I have to take care of a few things, but I will get it in about 5 minutes." With that, I locked the door and went to take care of those few things.
Julius had a different timetable in mind. Before I could do the next thing, the unit clerk opened the door from the staff area and yelled for me to come quick. I ran to the door to see what she was so excited about. Now here is what I saw. I had just opened the door from the unit and was looking down a hallway. The seclusion rooms were on the right and the staff area was on the left. Then I heard a loud crash and saw what turned out to be the bed suddenly protrude through the window. Broken glass was everywhere and the mini blinds clanked as they flew out from the impact. There was now access to the seclusion room without having to go around.
A million thoughts were going through my mind. Julius was walking around in his room trying to get the bed out of the window frame to, I figured crawl out and look for the orange juice himself. The crash got everyone's attention and the staff area was filled with CA's and nurses thinking out loud. "He's going to get out of there." "I thought those were shatter proof windows." "Oooooo what are we going to do." I do not remember how many of us went around to the access hallway, but we decided to take a mattress and hold it up to buffer us from this patient with an obvious OJ monkey on his back. Why a mattress? Someone heard that was the way to do it.
So here we are in the hallway. One guy was at the door with his key ready to turn. Me and about three others were holding a twin sized mattress sideways ready to rush the long shoreman. It had occurred to me that the mattress was covering me from the waste down and my hands were not free to protect me should Julius decide to hit me. Other staff were giving advice, "watch the glass." I had not been doing this sort of thing that long so I was pretty nervous. Something about the threat of physical harm makes me uneasy.
The word was given and the key was turned. The door was pulled open and what followed resembled a rodeo. If you have ever seen a bucking bronco burst out of the gate or a running back break through a line you have an idea of what Julius did. He charged right at me and we all converged in a mass of flailing and falling humanity. When the dust settled, I was on top of Julius. I have no idea how that happened, but we got him controlled and put in another room and I am sure gave him all the OJ he wanted.
After an incident like that everyone is relieved. The players relive the incident with a blow by blow account. When I walked into the staff room, the unit secretary who had seen the whole thing from the broken out window said, "John is a hero, he got on top of Julius and held him down." I stopped her right there, "Shoot, I was trying to get out of his way, but he ran straight for me. I fell on him by accident." We all laughed and slowly calmed down. it was only 8:30 AM and we had a whole day to work.
Most of my mornings are uneventful - and that is fine with me. Here's to routine mornings, they sure beat mixing it up with Orange Julius.
Until the next time
John Strain
Wednesday, November 19, 2003 at 5:15AM 