Violence in the ER

I’ve been mulling over writing this post for quite a while because it has taken me some time to mentally process the events myself. As a new graduate to nursing and especially to the ER, I have been repeatedly told that unfortunately violence is a part of the ER. Just Google the topic and there will be a plethora of links to studies and personal stories. The sight of security guards rushing down a hallway to subdue a violent patient, or seeing several nurses using restraints on old people with dementia to protect themselves against random hits and kicks are now little more than mundane sights. I feel that I’ve also learned to deal with the verbal assault unleashed at me by the mentally ill and/or ignorant bigots. Angry patients who are denied their favourite medications or simply told to leave usually part by threatening to find me after work and giving me what I deserve – I don’t think twice about them any longer mainly because the security guards are amazing people who go above and beyond their duty and actually walk me to the subway station if I ask them. This changed abruptly when I saw one of my patients who previously threatened to find me after work sitting on a subway seat in front of me and looking at my direction though not seeing me. I felt a wave of nausea so intense that I ran out of the train at the next stop where I proceeded to throw up two days worth of gastric contents into a garbage can. I paced the stop wildly and let two trains pass by before I shakily stepped into the next one. Despite the fact that I’m tall and quite strong physically, the knowledge of my vulnerability to violence both inside and outside the ER struck me like a shard of glass. While I haven’t turned into a completely paranoid basket case (yet), I’m much more prone to walking a lot faster than I did before, scanning the subway car for faces that I might recognize and sudden bouts of fierce palpitations when I see a random person sharing an inconsequential detail with a previous patient of mine. Perhaps the toughest lesson that nursing has to offer is that of balance - abandoning myself to either paranoia or recklessness will serve no purpose other than destroying my sanity (which is prone to random lapses in presence). The question that I now struggle with is how do I maintain my vigilance while not caving into complete madness?