Tie me up, tie me down

As medical students, we had infinite discussions about dignity, the right to autonomy, respect and minimal interventions for our patients.

Nurse Bear (cousin extraordinaire) often mocked my naive perspective; "When you've got a patient trying to punch you, see how you feel about chemical restraints..."

Night shift has brought this all to a head. Obviously, nights are when patients "arc up" - delerium kicks in, less staff is available, doctors are hiding in the residents room watching "Dr 90210" (ahem).

We were taught that agitated and aggressive patients should be managed with minimal intervention.

Then came Thursday night. The patient kept getting out of bed, taking off his clothes and pulling out his lines. I suggested small interventions - leave the light on, lower the bed so he doesn't fall, give him a gown, wrap up his drip points. He began wandering the wards, trying to get into other patient's rooms. Close his door, keep an eye on him. He began shitting and pissing on the floor, fingerpainting with his own faeces.

Haloperidol. Stat.

He tried to pull the lines out of a patient in the next bed. More haloperidol.
He got up, shat, slipped in his faeces and had a fall.

I had him shackled. Top and bottom.

The next night I had a patient who is delusional. He believes that he's in a prison camp back in Italy, posssibly under the fascists. Mindful of this, I was sticking to chemical restraint, as I didn't want to traumatize him further.

He kicked me in the head. A crafty gentleman, he would wait until I tried to examine him, then lash out with a very bony knee. (He was also kicking at the "people" at the end of the bed. I was the only one there.)

Shackled.

Lord, I don't even blink any more. Goodbye theoretical medicine. Hello night shift.