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Had a patient. Poly-drug abuse, mental disorder, was in an accident and broke some bones.  In a non-pysch unit, these terms raise alarm bells. Meaning, no ones wants to take these patients. Read: Violent tendencies. Read: unpredicability. Read: psychic vampire. I volunteered, because no one else would. I volunteered because this patient is sick and still needs care. But damn, the costs are high.

Patient was okay most of the shift. Okay meaning I was constantly on guard, constantly negotiating, constantly watching out for signs of trouble, constantly seeking help from peers, constantly trying to ensure patient autonomy without sacrificing his or my safety. Would it have been easier to keep in the restraints I found him in at the beginning of my shift? Heck, yes! Without question! But keeping him like this, like a prisoner in a hospital bed, just because he has mental issues is no way to treat the marginalized folks in our society. And so I negotiate. De-escalate. Encourage.

But it all turned to crap towards the end of my shift. He tried to get out of bed for the upteenth time. With a broken leg. This time, no negotiation was working, and I could see it was spiraling out of control. I told a colleague to call the code which brings security and psych while I held on to my patient who was screaming obscenities, who was trying to inflict pain — both emotional and physical — to anyone around him.

My patient was again restrained, but that didn’t stop his yelling, screaming and hostilities. Only drugs did that. Medications to try to keep him and me and my colleagues safe. What a total sh*t show, in the end. For him. For me. We both ended my shift completely emotionally and physically exhausted. But he was, at least, safe from himself.

The hardest part of all this is that I want to be angry at him. No. I am angry at him.  All of my work, all of my negotiations, all of my fear of possible being clobbered upside the head  to keep him safe while relatively free ended when he wound up restrained. I wanted to scream at him at the end of my shift. I wanted to yell at the top of my voice “Do you have any f-ing idea the amount of energy you took during this shift? Do you have any idea the emotional toll? I could have taken the easy route. Left you restrained the whole night. Given you your medications on nurse auto-pilot, and monitored your vitals without changing your leads for the thousandth time. I could have made my job easy. And now it has turned to sh*t.”

But you can’t yell at a ‘crazy person.’You can’t rationally (or irrationally) argue with someone who is mentally incapable of acting normally. You really can’t blame them. And that is the bitch of it. All you can do it protect yourself and them as best you can. Limit exposure. Take a mental break. Space your time with these patients out. Or try to avoid them completely, like many of my co-workers do. I get it. I understand. I want to do it too.

I probably will do it, too. Self-care in nursing is a thing. Poorly practiced by many. Poorly supported by many institutions beyond HR buzz words. But I do realize it is important. So, I will like my co-workers remain silent for a time when these patients come up, and management asks for volunteers. Let others deal with them. Let others share in the additional burden that these patients inevitably require.  For a time, at least.