Exposure to Dangerously Violent Patient
On Tuesday July 21 a new patient entered the unit. Up until then no one had exhibited any sign of violence or threat of violence. This patient known only as D*, was different. Large, weighing perhaps as much as 300 pounds, he breathed heavily and was clearly in great distress. I think that the team may have sedated him beforehand but did not seem to have a problem with allowing him to enter the day room, the common area in which all patients tended to gather.
Any sedation at that time turned out to be insufficient as not much later, he said something close to “that fucking window better be open because I am going to jump the fuck out.” This required a definite bout of sedation, after which he was allowed again access to the day room not much long after. I remember vividly that I was asked by the staff at some point to abandon my table in the day room where I was eating so he could have it.
Around this time, D* walked the halls of the unit freely and he went by the room I shared with another woman. He actually crossed the threshold into our room for a few moments before heading away.
At approximately 6:00 - 6:15 pm the same day, D* stood up and rushed towards the locked double doors that directly faced the day room and led to outside the unit. With astonishing power, he kicked them through and ran away.
We were ordered to our rooms. This order was one that had already took place several times that day as each round of sedation failed to be effective. You can imagine how terrified we felt each time we were told to go.
As we came to my room this time, I could see how my roommate was especially terrified because of his prior entrance and because he was so violent and strong. I took a chair and blocked the door at an angle that would best serve as a barricade and also added a trash can. Then I leaned my back to the door and lifted a leg to place a foot against the door. I then gave my roommate a very quick lesson in self-defense from my study of martial arts. As we wondered what was happening outside we looked through the cracks but could not see anything. I put my ear to the door and heard loud noises but was not sure what they meant.
Then we heard a knock on the door. It was a staff member. She had blond hair. The staff member said everything was under control. She reprimanded us for the barricade, claiming that closing the door (which is forbidden generally) was a very wrong thing to do as it might lead the staff to the false conclusion that we were in danger. We should trust the staff, she suggested. Although I do appreciate this genuine concern about our safety, it seemed that in the face of the staff’s failure to contain the patient in the past, a barricade was probably a good idea nonetheless.
What do you suppose happened the following morning?
a. We received an apology for the distress we experienced or at least some counseling.
b. The kitchen managed to provide us all with the nutritious breakfasts we needed.
c. D* was released again into the day room.
Sadly, the answer is in fact c. On 9 am that same morning he threatened to kick down the door again. I myself was dismissed later that day and do not know what happened next.
To recap, the staff of the ITU repeatedly exposed a violent patient to a population that can only be described as quite vulnerable both physically and emotionally The first time can be understood, but not the subsequent instances. To add insult to injury, a staff member condemned us for attempting to protect ourselves from being assaulted when it was clear that the staff was in no position to protect us themselves. No attempts were made to address the severe trauma we had experienced through apology or any kind of group therapy.
I do realize that the staff of the ITU were facing logistical challenges about which I do not have direct information. But it is a standard practice to keep a violent patient isolated from the other patients for much longer than was done in this instance. Of the two other inpatient units of which I have some experience, isolation was used much more extensively for patients who were not even violent and any patient who used violence was usually transferred. It may be very well the case, there was no place to send D* then and there. But none of these possible explanations can can override the fact that the staff put our lives in danger and caused severe trauma.