“Call security. We need restraints.”
The nurse yelled out into the hallway while he gently held down the patient’s strong right arm that vigorously wrestled in all directions to escape. I, a relatively new Patient Care Associate on the floor, was on the other arm. His screams echoed throughout the room, bouncing off the walls and into the hallway, prompting glances from other staff members.
I had walked in a few minutes earlier with his breakfast, ready to feed him. Simultaneously, his nurse was administering his morning medications. It wasn’t long before the patient punched into the air, demanding that he wanted to leave. He didn’t want breakfast. He didn’t want medication.
He swung his legs over the bed, attempting to get up. We knew he wasn’t strong enough to walk on his own; he was a fall risk. Cautiously, we tried to help him back into bed. It only got worse. My head was reeling as he tried forcing himself out of our grasp. Tension heightened in my stomach and my brain scattered everywhere. What was I supposed to do?
How badly I wanted to squeeze his hand and tell him that everything would be okay. But I couldn’t. Nothing I said or did in the moment seemed to reach him. My presence in the room felt pointless. Why wasn’t he listening to me?
Police arrived and secured the patient to the bed. I was at a loss for words. The patient didn’t commit a crime, so why did we have to do this?
Shortly thereafter, I attended a training session about caring for agitated patients. I was tasked with listening to an example audio that represented what patients with an altered mental status may hear throughout the day. The instructor told us to order a coffee while playing the audio with earbuds. At first, it seemed silly. It would be just like listening to music, right? Easy peasy. No different.
Little did I know, I was so wrong. After asking the barista to repeat what she said three whole times, I was hit with a jolting realization. All sorts of tones barked into my ears telling me to look up or down and listen to them. I wanted to shut out all the voices. But I couldn’t.
It felt like somebody else was inside of my head, controlling every single thing I did.
Patients with an altered mental status present a difficult, yet intriguing, challenge. Upon starting my job as a Patient Care Associate, I never envisioned using restraints was part of the job description. When the patient got put in handcuffs, I felt like a bad caretaker. I felt like I wasn’t doing enough for the patient.
To be completely honest, I still don’t feel as though we did enough for the patient. Were there no other options? Did we really have to tether him to the bed rails, preventing even the slightest movement?
The moment the police entered; I exited. I could no longer be there for the patient. Not by choice, but by hospital protocol.
I will never know exactly what my patient’s internal experience of that hospital room was that day, but I do know that it was likely out of his control.
This patient introduced a lingering question to my understanding of hospital safety. How can we implement alternative measures to de-escalate similar emergencies?
At first, I figured restraints were the only option. They shouldn’t be.
Kimaya Gazula is an undergraduate student at Boston University, Class of 2028. She enjoys spending time with her dog Luna, writing narrative pieces, and performing Indian Classical Dance. In the future, she hopes to care for underserved communities as a physician.