LJ Idol Exhibit A Week 7 Honey Badger don't care!
Code 99, 2 East! Code 99, 2 East!
The urgent call blared over the intercom. Within seconds, staff from other floors keyed in to our locked unit to assist.
In a psychiatric hospital, the doctors, nurses, psychiatric technicians, therapists and counselors are fully trained during orientation to know the protocols and procedures necessary for assuring the safety of patients and themselves. Code 99 meant that there was a dangerous situation occurring on a particular unit and all available staff members were required to respond to that unit immediately. The safety of patients and staff was the number one priority. We learned to work in teams. We practiced how to talk a patient down and, if necessary, how to take a patient down.
On this particular day, Nell was in charge. She expertly assessed the situation and chose her team. She asked me to draw up the protocol medication, even though it might not be needed. We always try to do the least restrictive measures to empower the patient to regain their own control. I went to the medication room and prepared both the oral and the injectable medication, just in case.
Sometimes a show of force is all that’s needed for a disruptive patient to regain control.
However, Nedra was definitely not fazed by the team standing in the hallway.
A small woman about thirty years old, Nedra had been voluntarily admitted a week earlier, after her sister found her in her apartment with self-inflicted cuts and burns on her arms and legs. She was docile and cooperative within the community and seemed to be making progress in her individual treatment and group therapies.
When she met with her therapist, she learned that she was still considered a danger to herself and could effectively be ‘blue-papered’ to stay. A blue paper is when the patient’s physician signs a form to the effect that the patient is still a danger to herself or others. A judge reviews it and orders the patient to remain in the hospital. This changes the admission status from voluntary to involuntary and she could be held against her wishes.
Upon hearing this news, Nedra went ballistic. Earlier this same day, she reportedly had stormed out of an activity therapy hollering that she was “sick of this place.” She had signed herself in and she could sign herself out. She ran into the community room, screaming obscenities at other patients. Some taunted her which made things worse. She toppled a couple of chairs and threw books and jigsaw puzzle pieces all over the room. By the time the team stepped into the room she was crouched down in a corner by a sofa. The second line staff brought the few remaining patients out and off to their rooms.
When I arrived with the medicine tray, Nedra was still cowering in the corner of the room. Nell asked her to take the medication. Nedra’s eyes darted around the room but her body language was so tight. I could feel her struggling to hold herself together. I sensed her angst and rage as she must have felt so powerless and hopeless and afraid. She just looked like a caged animal that wanted out. Her eyes were just glaring at the med tray.
“Get the fuck away from me! I don’t want no crazy pills. I need to go home. You can’t make me stay here!”
“Nedra, you need to calm down. You are going to stay here. We are going to help you.” Nell said.
Nell then motioned for the team to step forward and, as they did, Nedra bolted and lunged at Ed, one of the psych-techs, spitting at him and grabbing for his keys. She was in attack mode and didn’t care who was in her way.
“FUCK YOU ALL!! Goddammit all to hell. I want out of this nut house. Lemme out! Noooow!”
In a split second six staff had a hold of her head, both arms, both legs and her feet. She was taken down to the floor on her belly, cussing and crying. They held her there for a few minutes while everyone’s adrenaline was still rising. Then on Nell’s count, keeping her fidgeting body restrained, they lifted her up and carried her into the Quiet Room laying her face down on the mattress.
She kept on struggling so they had to continue to hold her still so I could administer the shot. Still trying to get free, she called us all a number of uncouth names. It took about five minutes for the med to kick in. Once her muscles began to relax, she stopped fighting.
Nedra fell asleep and we rotated staying one on one with her for the remainder of the shift. She remained in the Quiet Room for the night on fifteen minute checks.
In the morning she was embarrassed and apologetic as often happens after patients have such an outburst. We helped her talk about her feelings and used her episode as a teaching tool to help her learn that she needed better, more appropriate ways to cope. Anger is a natural and healthy response that has evolved to enable us to deal with certain threats, but uncontrolled anger is dangerous.
She willingly stayed in the hospital working on her issues for another week. Once she began to like herself again, she was discharged to outpatient therapy with a good foundation for continuing her recovery efforts.
The urgent call blared over the intercom. Within seconds, staff from other floors keyed in to our locked unit to assist.
In a psychiatric hospital, the doctors, nurses, psychiatric technicians, therapists and counselors are fully trained during orientation to know the protocols and procedures necessary for assuring the safety of patients and themselves. Code 99 meant that there was a dangerous situation occurring on a particular unit and all available staff members were required to respond to that unit immediately. The safety of patients and staff was the number one priority. We learned to work in teams. We practiced how to talk a patient down and, if necessary, how to take a patient down.
On this particular day, Nell was in charge. She expertly assessed the situation and chose her team. She asked me to draw up the protocol medication, even though it might not be needed. We always try to do the least restrictive measures to empower the patient to regain their own control. I went to the medication room and prepared both the oral and the injectable medication, just in case.
Sometimes a show of force is all that’s needed for a disruptive patient to regain control.
However, Nedra was definitely not fazed by the team standing in the hallway.
A small woman about thirty years old, Nedra had been voluntarily admitted a week earlier, after her sister found her in her apartment with self-inflicted cuts and burns on her arms and legs. She was docile and cooperative within the community and seemed to be making progress in her individual treatment and group therapies.
When she met with her therapist, she learned that she was still considered a danger to herself and could effectively be ‘blue-papered’ to stay. A blue paper is when the patient’s physician signs a form to the effect that the patient is still a danger to herself or others. A judge reviews it and orders the patient to remain in the hospital. This changes the admission status from voluntary to involuntary and she could be held against her wishes.
Upon hearing this news, Nedra went ballistic. Earlier this same day, she reportedly had stormed out of an activity therapy hollering that she was “sick of this place.” She had signed herself in and she could sign herself out. She ran into the community room, screaming obscenities at other patients. Some taunted her which made things worse. She toppled a couple of chairs and threw books and jigsaw puzzle pieces all over the room. By the time the team stepped into the room she was crouched down in a corner by a sofa. The second line staff brought the few remaining patients out and off to their rooms.
When I arrived with the medicine tray, Nedra was still cowering in the corner of the room. Nell asked her to take the medication. Nedra’s eyes darted around the room but her body language was so tight. I could feel her struggling to hold herself together. I sensed her angst and rage as she must have felt so powerless and hopeless and afraid. She just looked like a caged animal that wanted out. Her eyes were just glaring at the med tray.
“Get the fuck away from me! I don’t want no crazy pills. I need to go home. You can’t make me stay here!”
“Nedra, you need to calm down. You are going to stay here. We are going to help you.” Nell said.
Nell then motioned for the team to step forward and, as they did, Nedra bolted and lunged at Ed, one of the psych-techs, spitting at him and grabbing for his keys. She was in attack mode and didn’t care who was in her way.
“FUCK YOU ALL!! Goddammit all to hell. I want out of this nut house. Lemme out! Noooow!”
In a split second six staff had a hold of her head, both arms, both legs and her feet. She was taken down to the floor on her belly, cussing and crying. They held her there for a few minutes while everyone’s adrenaline was still rising. Then on Nell’s count, keeping her fidgeting body restrained, they lifted her up and carried her into the Quiet Room laying her face down on the mattress.
She kept on struggling so they had to continue to hold her still so I could administer the shot. Still trying to get free, she called us all a number of uncouth names. It took about five minutes for the med to kick in. Once her muscles began to relax, she stopped fighting.
Nedra fell asleep and we rotated staying one on one with her for the remainder of the shift. She remained in the Quiet Room for the night on fifteen minute checks.
In the morning she was embarrassed and apologetic as often happens after patients have such an outburst. We helped her talk about her feelings and used her episode as a teaching tool to help her learn that she needed better, more appropriate ways to cope. Anger is a natural and healthy response that has evolved to enable us to deal with certain threats, but uncontrolled anger is dangerous.
She willingly stayed in the hospital working on her issues for another week. Once she began to like herself again, she was discharged to outpatient therapy with a good foundation for continuing her recovery efforts.