He was delirious and taking swings at the nurses

Late one night in Sydney’s Sutherland hospital I was the doctor on the wards.

There were about 150 patients under my care.

And it was a good night

A quiet night.

Just after 3am I was sitting in the doctor’s room doing some work, because sleeping when I’m on nights doesn’t work for me.

I got a page, and called the number in the message.

The nurse said, “Can you please come down here. There’s a patient who needs to be sedated.”

And I was like,

“You can’t just sedate a patient like that. What else can you do for him?”

It’s like putting physical restraints on someone, tying them down to the bed. You don’t do that unless absolutely necessary. Chemical restraints are the same thing.

So I asked them to call me back if they needed me and went back to my work.

Not long after, I got another call.

Different nurse, same patient: can I please come down sooner. He won’t stay in his bed.

“Ok”, I said and started to make my way down, a bit unimpressed because it’s still not a good enough reason to chemically restrain a human being.

In the meantime another page about a different patient came through – things were getting busier now. So I thought I’d stop there first.

As I’m attending to them, the original nurse messages: things have escalated.

He’s now taking swings at the nurses.

Uh oh, I think.

This is urgent.

“Call security. I’ll be there in a sec.”

When I got there, I took one look at the guy and said, “We need to sedate this man.”

The nurse agreed.

He was about 75 years old with a slender build. He would look like any other sweet old man under normal circumstances but at that point he had disheveled hair, his hospital gown was barely on, he’d pulled out his cannula, there was blood dripping down his arm, he was gritting his teeth with wide eyes and a look of fury on his face.

He was trying to get out of bed while the nurses attempted to hold and talk him down. He wasn’t going to cooperate.

This wasn’t going to end well if we left things as they were. Something had to be done, fast.

Problem was,

I’d never sedated a patient like this before, and didn’t know what to do…

***

The story goes, this gentleman had just been brought up to the wards from ED only an hour or two earlier after overdosing on his Parkinson’s medications. He was ‘safe’ in the sense that his body wasn’t going to self-destruct from the overdose, however he was delirious from it. Which means he wasn’t thinking straight, essentially wasn’t himself because the medications were affecting his cognition. He should have stayed in ED for longer where they could have monitored him more closely.

***

But it was too late for that now. He was my patient to look after.

So I got on the phone and called the Registrar in the hospital, who’s a more senior doctor, and asked them to come down urgently because we need to sedate this guy.

He heard what I said and was like,

“You can’t just sedate a person like that!” I rolled my eyes. “It’s like using physical restraints, but a chemical version, don’t you know!” He was far more direct than I was with the nurses.

I listened patiently and respectfully and asked him to kindly hurry.

In the meantime,

The patient had broken free of the nurses and was running up and down the hallway, going for the windows. Luckily, they don’t open.

I called the Reg again, updated him.

He said he’d hurry now.

Next, the patient grabbed an IV pole and started swinging it at me and the staff.

We backed off.

He slipped, fell and lost the pole.

I went for it.

We both got a hold of it.

I tried to peel his hands off the pole but even though on a normal day I would be far stronger than him, I couldn’t get his hand off it. His grip was too firm because of the delirium.

I backed off again and hoped he wouldn’t hurt the other patients, staff, or himself before everyone else arrived.

It was a moment I will never forget.

Could it have been prevented if I’d responded sooner? Was this inevitable because he was brought up from ED too early? Was my response, just like the Reg’s, the right one? How could I have questioned the nurse more effectively to judge the urgency of the situation?

Luckily,

Security got there at about the same time as the Registrar did.

The Reg took one look at the patient and said,

“We need to sedate this guy!”

I agreed.

The physical presence of the guards caused the man to calm down a little.

The Reg drew up the medication while explaining what he was doing so I learnt what to do. Security restrained the man, and we administered the sedative.

The result was almost immediate.

The gentleman calmed down, we put him into a bed, wheeled him in front of the nurses station and he slept.

I carefully examined him for injuries.

Satisfied he was ok, I left to continue my other jobs which had backed up over that period. There wasn’t much time to reflect.

Until the next morning, off course…

***

So what’s the GAMSAT lesson in this?

Not sure if there is one, really.

There might be more than one.

But it sure pays to get a head start on the ‘warning signs’.

If there are people whose job it is to have eyes on a situation that you don’t, and they’re telling you to move and start acting, it’s probably a good idea to do so. Otherwise, there may be a very dangerous and sad situation to deal with.

With that said,

I’m running a live online training session about how to study for section 1 of the GAMSAT.

It will show you how to understand the long complex passages quickly and effectively,

What to read and study in your preparation,

And how to systematically work out the right answer every time,

Even if you hate literature or English is your second language.

It’s one of my best.

Here’s the link to reserve your spot.

****

The next morning,

Before the day staff arrived and I had to hand over to them,

I did my rounds to finish off any tasks or paperwork for the night.

When I saw the gentlemen from the night before, still in the same spot in front of the nurses station, looking around slightly concerned by all the activity around him, I couldn’t help but feel compassion towards him. He wasn’t in control that night. He was someone’s grandfather, father, golf buddy.

It was a difficult situation for everyone, least of all for him.

“Hello, my friend,” I said to him, “Do you remember me from last night?”

He looked up at me, concerned, and just nodded, yes.

I smiled and told him he’d be ok. That the team will look after him and make sure everything goes well.

I wished him all the best and never saw him again.

Cheers,

Dr “time to act now” Tom

P.S. In Section 1 it can take time for some people to develop the right skills.

Spots for the training are limited and always fill up.

You can reserve yours here.