Sunday, September 25, 2016

Morning Rounds – Part 2 – Psyched

The pleasant chat I had with our last patient on morning one of my phlebotomy rotation left me with my guard down. Maybe blood drawing wasn’t such a terrible job after all.

We took the elevator to the fifth floor. As the doors opened it was noticeably darker than other floors, and eerily quiet. Even my trainer spoke in hushed tones.

“We have to make sure we take OUT everything we bring IN. You know, tourniquets and stuff,” she said.

“Oh, and no bandaids. We can’t use bandaids.”

My puzzled look did the speaking for me.

“Sometimes they eat them.”

I didn’t know if she was serious, but nodded my head, and emotionally buckled up for a wild ride.

“Oh, and put your ID away once we clear security. If you need to use your name, it’s first name only,” she added.

We were granted admission to the psych ward through a set of locked doors at the end of the elevator banks, by a security guard who checked our IDs and nodded his approval. More silence. He never spoke.

The first requisition was for a woman in room 511, across from the nurse’s station. Some silent pleasantries were exchanged with the nurses on duty, almost as if to say, “I know where you are. I’ve got your back.” My stomach was in knots.

Jane Doe was sleeping. Seriously, this patient was a Jane Doe. She was young, in her twenties I would guess. Lying on her right side facing away from us, the room illuminated only by an upward facing fluorescent light at the head of her bed, she remained motionless when we repeatedly called her name. The scene was straight out of a Halloween movie. You know, the one where as soon as you get close a knife-wielding psychopath lunges from under the covers. My trainer resisted the urge to touch or shake the sleeping patient, and was about to get a nurse for assistance when the girl stirred, yawned and said, “Oh, good morning.”

The draw went extremely well, but the patient’s thin and fragile veins required a bit of extra time with a tourniquet applied to allow her blood pressure to swell them sufficiently to puncture. We wished her a nice day and then headed to the next patient.

“Oh shoot, we forgot the tourniquet!” said my partner. “Can you go get it?”

I reluctantly agreed, and sheepishly re-entered 511, spotting the flattened rubber band on Jane Doe’s dining tray.

“We forgot this,” I said in hushed tones, reaching out to grab the tourniquet. She just smiled and nodded, as if she knew I was afraid.

“That went well,” I said when I returned to the hall.

“Yeah, they’re usually ok. Ok, now 522.”

By now the sun was coming up on the east side of the building, streaming through open drapes on Patient 522, who sat up in bed, cheerfully chatting with two orderlies and a nurse. He was a scruffy little guy, hidden almost to his bearded chin under a white sheet, only his head uncovered. I wasn’t able to see the full leather restraints that shackled his arms and legs to the bedframe under the covers.

We introduced ourselves, told him why we’d come and made small talk about the weather. My partner approached the left side of the bed with her supplies and prepared the tubes and other materials for the draw, laying them out carefully on the movable bedside dining table. And then she raised the needle from its hidden position behind the carryall.

If you’ve never seen someone go berserk, it’s quite a stunning display.

522 exploded into screams and yelled, thrashing from head to toe and side to side. The sheet seemingly flew away, leaving him exposed in his hospital gown, straining against the restraints, spitting, eyes bulging and shouting that he was going to kill us. The muscles and ligaments in his forearms looked as if they might snap.

The presence of the orderlies now made sense. The nurse tried to talk him down, and my partner held up her hands to indicate there was no harm intended. The orderlies grabbed his shoulders and nodded for us to proceed.

I stood aside, stunned. My partner approached several times, but there was just no way to get a needle in his vein, even if you could ignore the string of profanities and the volume of his outrage. He was moving too much and would have been injured if a vein could even be located.

My partner backed off and shook her head at the nurse. She agreed.

“It’s okay,” my trainer said to 522, “We’re done with you.”

“WELL I’M NOT DONE WITH YOU!” he promised as we walked away.

“I…AM…NOT…DONE…WITH…YOU!!!” he screamed, over and over.

We met the nurse in the hall. She apologized, as if any of this was her fault.

“I’M NOT DONE WITH YOU…” his voice trailed off as the door to 522 was closed by an unseen hand.

The nurse looked back at the room and exhaled. “He has homicidal tendencies,” she confessed. “You tried, it’s ok.”

On day three of my rotation I called in sick.

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