swallowflight

back to work yesterday. kept  busy with a couple of emergent patients. one, an older man who came by ambulance from a nursing home with respiratory distress, turned around nicely – was opening his eyes and looking much more comfortable (according to his family much more like his norm) by the time we sent him to a regular medical floor. it’s kind of amazing to see that process when it happens – when someone comes in really sick and gets better by the time he leaves. the other one was a middle aged man who was sent by a clinic where he was having an outpatient treatment. he’d had a sudden change in his mental status. he was pretty out of it by the time he got to us, and deteriorated over the several hours that i was taking care of him. i watched his neurological status change almost before my eyes – from being confused and disoriented to being very lethargic and only responding to pain/discomfort. i found myself feeling worried and helpless as i watched him decline, even while the diagnostic process was going on – CT scan, blood work, etc. – just wondering what it actually was that he needed and whether we would be able to get it done in time to help him.

initially he was quite aggressive, probably because of the fact that he wasn’t understanding what was going on, and because what was going on was decidedly uncomfortable. his condition was such that we needed to do a number of invasive procedures over the course of the time he was there – from taking a rectal temperature to putting in a foley catheter and a nasogastric tube. we started with the IV – one of the techs had to hold him down while i put it in and drew blood. then – i don’t even remember what it was that we were doing, maybe something as benign as repositioning him, but all of a sudden, he lurched up in bed and landed a heavy punch to my chest. i wouldn’t have liked to have been on the receiving end of his full force had he been less debilitated.

i’ve often had to fend off swats and scratches and general resistance, but never something as direct (or as powerful). the funny thing was that although i was surprised, i almost didn’t register it – i remember thinking, am i hurt? i don’t think so. and then just going back to whatever it was we were trying to do. the resident next to me asked if i was ok and i said yes and that was it. i was almost surprised that she asked somehow.

except for fights with my siblings when we were kids, and the odd spanking from my parents, i’ve never been hit. i know that nurses (along with other health workers) frequently face violence in the clinical setting (some of which is not a byproduct of confusing/mental changes) and i don’t think it’s particularly uncommon in the ED. it’s something i haven’t spent much time thinking about. do i feel vulnerable? not really. but i think that’s because my tendency is to assume that people are not going to attack me, not necessarily because that’s an accurate assumption. perhaps i need to tune up my alertness to danger. not what i expected to get out of this new undertaking! but not a bad thing.