When patients attack
It figures. I was too arrogant with fate and I paid a heavy price.
Exhibit One: I was bragging about the ice bath and touting its healing properties. The day I posted that I caught a cold. Thankfully, it is pretty much gone already, but I felt pretty lousy Thursday and Friday. Barbara, of course says it is because of the ice that I caught the cold, but I am not ready to concede that just yet.
Exhibit Two: The last couple of months I have been thinking about the fact that although I have worked in psychiatric hospitals for 20 years, I have never been the victim of an assault or an attack.
Exhibit Three: Without knocking on wood, I wrote a post about how my life hasn't been very exciting. I implied that since there was no real excitement in my life, I had nothing much to write about.
At the confluence of these three exhibits was Friday. It was just another day. Isn't that how most stories begin? It seemed like just another day, because I could not read the future, but by the end of the day I would no longer be able to say I had never been attacked by a patient and I would not be able to say my life lacked excitement.
In 20 years I have participated in a lot of "codes." A code is when a patient is out of control and they must be physically restrained. In some cases, a patient is placed in restraints. In other situations, the patient is simply held down for a shot, and then released.
Codes are stressful for staff, the patient being restrained, and the other patients on the unit. Great care is taken to ensure everyone's safety and most of the time; a code ends with no injuries to anyone.
You get bumped around in codes and sometimes a glancing blow brushes you or a random fingernail leaves a mark, but I have emerged virtually unscathed over the years.
The other way a staff member might get hurt is if a patient throws a sucker punch or simply attacks you. This is what I had always feared. I didn't know if I would be able to react to defend myself in a case like this.
I am usually pretty good at calming people down who are angry by talking to them. With my poor vision, I know I am a sitting duck of sorts. I might not see a punch coming and I have always had this worry in the back of my mind.
Being a man, I didn't want to get bested by another man in a physical confrontation. The ego carries scars much longer than it takes for a nose to stop bleeding.
The population we service are seriously mentally ill individuals. Many have schizophrenia and are paranoid when they come to us. Many of these folks also abuse drugs. They often have no family support, because their families have disowned them.
The paragraph above describes someone who is more likely to assault staff in a hospital. One of the best predictors of violence with these folks is a history of violence. If they were violent once, they can be violent again.
On Friday, we had a new patient to us. There was nothing that made him stand out. He was like one of our typical patients. He was diagnosed with schizophrenia, he was paranoid, he was off of his medication, and he was angry.
I will call this man Sugar Ray for reasons that will be obvious later. Sugar Ray was outside my office and a bit upset. He was asking someone the usual questions. "How long do I have to stay? When can I get out? Who put me in here?"
This is often a good time to start working with a patient. I said to him, "Sugar Ray, I am John, your social worker, come on in my office and let me see if I can help you with these things."
Sugar Ray came in and sat down. He was trying to figure out how he was committed to the hospital. He wanted to know which doctor signed the papers.
Beyond his questions, he would make statements about women. They were so off the wall, I can't remember what he said exactly, but his words were paranoid and he believed women were responsible for some bad things in his life.
As he made a few of these comments, he got a bit more intense. He leaned forward in his chair and said something similar to this:
You're a man and I'm a man. I am talking to you face to face. I am telling you that the next man I talk to here is going to get the anger. Not you though, I am going to let you off of the hook, but the next man. . .
At that point, Sugar Ray balled up his right fist and came at me. He was only sitting about 4 feet from me, so it didn't take him long to arrive.
During the milisecond it took for him to cover the short distance between us, it was almost funny. I was thinking, "I'll be damned, this guy is attacking me."
He threw a right hook, but I cocked my head and put up my left arm to block a direct hit. I was sitting in a chair and he was on top of me driving me into the wall. I couldn't get any leverage at first, but I managed to stand up.
I had my left arm on his right shoulder trying to keep him from throwing another punch. Meanwhile, he was grabbing my neck and face with his left hand. Then he used his left to punch me in the nuts a few times then he started grabbing and squeezing.
I was still off balance, because the chair was behind me. We spun to another wall in my office making a huge crash and knocking a picture off of the wall. I had him tied up so he could not do any more damage to me. At this point, I was hoping someone would hear the commotion and come in and relieve me. I even yelled help, but it was like I was in Maxwell Smart's cone of silence.
I quickly realized that if I were going to get any help, it would have to come from me. I stepped in front of him and slightly to the side, and then I locked my left arm around his neck. Using my left hip for leverage, I flipped him over my hip onto the ground.
I got on top of him and he was on all fours. I pulled his shirt over his head like a hockey player and locked my arms around his chest. This was a good control position, but by then he was out of gas.
He outweighed me by 60 pounds, but I had 5" on him. It helps that he was out of shape and a smoker. I heard people outside the office, "Should we go in" someone said. I yelled, "GET IN HERE!"
When they opened the door, it must have been quite a sight. Chairs turned over, pictures off of the wall, and my carefully sorted stacks of paper were all over the floor. In the middle of the floor was me with my arms locked around Sugar Ray.
We walked him to a place where he could chill out and he received some medication. My shirt was untucked and wrinkled. I had a bump above my right eye that I don't know if it was from a punch or a head butt. I also have some scratches on the right side of my neck.
All in all, it was a good experience for me. I won. I defended myself. I was professional - in that I did not become angry and take revenge. I never hit him. It gives me a story to tell and a blog post to write.
The thing is though, the next guy could be some ripped 27 year old who beats the crap out of me. Maybe I am looking old and Darwin's Theory is at play; you know, being culled from the herd.
I still have to finish this guy's social history on Monday. That will be round 2 I suppose.
I suppose I should thank my childhood pals, Frank, Bruce, and Doug. We wrestled each other a million times. One against one, two against one, you name it. My confrontation with Sugar Ray felt like one of those matches – aside from the low blows.
I am glad I thought about this attack thing. My way of dealing with fear and anxiety is knowledge and information. I went through some scenarios and decided that if someone were to come at me, I would tie them up and wrestle them, hopefully to a position in which I could control them. It worked just like that – at least this time.
So there you have it. My life is exciting, the ice bath may have given me a cold, and I got attacked by a patient.
I think boring was just fine.
Until the next time
John Strain
Wednesday, November 15, 2006 at 7:41AM 
