Fight Club

Lately, I’m finding that I’ve been spacing out a lot. During my last shift, I forgot to hook up the IV into the patient after programming everything perfectly! After that, I forgot to do my 1700 meds for two of my patients. Maybe its exhaustion, or maybe its boredom but I find that I’m not focusing as well on my day to day routines. But boy oh boy did my attention span ever increase when I had to deal with David, an 87 year old with mild dementia.

He has had an operation on his knee and a pressure ulcer on his foot, so walking is extremely difficult for him. Yet, he insists on walking. So what are we to do? We bring him on over to the nurses’ station in a geri-chair to keep a close eye on him. Usually he just talks to himself, but on this day, he was particularly agitated. He tore apart his pillow so he was surrounded by polyester fluff for a while and then he tried to undo his gown by any means possible, including chewing on it.

While my teacher and I were busy with other patients and transcribing doctors’ orders, David soiled himself and was trying to remove his clothes to try to clean himself up. Now, before I go any further into this story, I should mention that David is MRSA positive and he is suspected to be positive for C. diff. Naturally, we do not want him to try to clean himself up in front of everyone and then touch other surfaces with dirty hands. I should also mention that the smell around the nursing station was so pungent and palpable that it felt like a physical blow to our olfaction.

He needed to be taken back into his room as quickly as possible to prevent any further olfactory trauma. When I started to wheel him back into his room, David started to whip at the air with his gown and a flat sheet yelling, “YEE HAW” and “Giddy up horsey”. Being the professional I am, I started to laugh until my sides hurt and tears started to flow freely! Truly, it was quite funny. However, the laughter stopped when we got to his room because his mood immediately changed. He saw his neighbor’s family visiting and thought that there were intruders in his room. David started yelling incoherently and held on for dear life to the doorway frame so I couldn’t push him into his room. Slowly, but surely, patients and their families started to peek out their doors to witness the spectacle that was about to unfold.

David is a big man. He weighs at least 200 lbs and he is about 6’2. The brakes on his chair weren’t working too well. This meant that I had to hold onto the chair with all of my strength as David tried to get away. For once in my life, I was extremely happy that I am not built like a frail sprite! Nonetheless, I managed to calm him down enough that he stopped struggling – which is when I quickly wheeled him into his room. I know that’s very deceptive but at the time I thought that this was the best way to prevent him from trying to get away and to stop the other patients gawking at us. I drew the curtain around his bed and reassured him that he was in his own room and that the ‘intruders’ were in their part of the room. I learned something then – placing your hand on a patient’s chest while kneeling down to be at their eye level and saying “stop” gently usually works for a little while.

My teacher then came into the room and wheeled over a commode chair for him. Like I said, he is a big man and extremely unsteady on his feet. As a result, he was very difficult to transfer, but we managed to wheel him over to the toilet. He finished his business and but when he stood up to go wash his hands, he nearly fell over and that would have been BAD… calamitous bad. I panicked and called the emergency alarm and yelled out for anyone else to come and help me. I think the alarm and my cries for help frightened David so he took a swing at me – and got me in the stomach. That literally knocked the wind out of me. I now have an angry looking purple bruise right in the middle of my stomach. Luckily my teacher was got there to hold down his wrists and managed to get him into the chair. Not so luckily, he swung his fist again and socked her one in the jaw. Now we were both momentarily incapacitated and David tried to walk. This is where professional nursing practice falls apart. I knew that if he stood he would fall and split his head open. I got up and almost tackled him back down into his chair and tied a restraint around him, which of course infuriated him. David started to swing his fists again and despite my best intentions, he got me in the ribs this time. “David! Don’t you dare hit us! You’re hurting us”, I told him. “You guys are trying to kill me” was his emphatic response along with another attempt to punch me. ‘That’s enough of this bullshit’, I thought. I went out of the room and drew up 3 ml of Haldol while my teacher called a code white. I knew that it was a prn med for him, but I wasn’t sure of the dosage. Nonetheless, I stuck that needle in good. Coincidently, that was the first time I’ve ever given an IM injection. What a way to start! A third nurse and two security guards finally arrived to help us get him dressed and back into his chair. 3 ml of Haldol and he still didn’t calm down for 20 minutes! When we finally managed to wheel him back to the nursing station, he was sleeping every so gently. He actually looked quite sweet.

Despite getting a good story out of this incident, I don’t think we handled it well at all. Here was a man who has dementia and felt extremely threatened by strangers descending down on him so he tried to defend himself. We became equally defensive and our response was to chemically restrain him and then call more strangers down to help us out. When I rechecked his MAR, his Haldol dosage was only 1 ml – I gave him three times the ordered dose. Of course we had to fill out an incident report, but I did not feel particularly proud at the thought of having to explain this to his family. Hopefully, the next time I see David, he’ll be feeling a lot better and I won’t have to be a part of a code white. For now though I will be nursing my own bruises.