Diary of an FY1 - February 2012
Junaid Fukuta on dealing with the agitated patient
Seven months have flown by and before you know it I am settling into the routine of the hospital and if I may say so myself, I am becoming rather efficient. Increasingly I find the whole set up of medicine is based on one key word immortalised by Spock: logic. Patient presents with symptom A, do tests X,Y and Z, diagnose disease D, briefly check latest guidelines and carry out said proposed treatment. Don’t get me wrong the whole process is great fun and it is what we have trained to do, but the key is logic. The problem is that it tends to fall apart when you are confronted with something illogical, and it is that very illogical thing that happened to me during one on-call shift.
It was a typical Saturday night so whilst all my friends were getting bladdered in the local bar I was scurrying around the hospital like a blue-arsed fly seeing referrals like chest pain, shortness of breath and my favourite 'doctor, they just don’t look right!'. When you are a really busy often the bleeps stack up whilst you are doing something. However, the nurses have one final trick up their sleeve too get your attention: the fast bleep. This is when your bleep does something unusual - rather than making an annoying noise that makes your blood boil, it actually talks to you and thus making you literally crap yourself.
"On arrival I see a bin being thrown across the ward and my heart sinks"
So I get my first fast bleep - 'F1 doctor please go to ward X', and just like that I am summoned like a naughty school boy to receive my flogging. Four flights of stairs stand between me and my intended destination and my heart starts thumping, I am thinking what the hell could this be, my mind starts visualising a mass rectal bleed or a blue patient, but when I arrive I am confronted by something much worse - the agitated patient. Now, the reason why this is so bad is because all logic goes out of the window. With a rectal bleed just do ABC and call the relevant people but with the agitated patient there is no reasoning with them, and there is often no easy fix.
On arrival I see a bin being thrown across the ward and my heart sinks. I am confronted by a rather large burly man with more tattoos than Glasgow who could give Chuck Norris a go for his money in a round house kick competition. He is shouting and screaming in the corner so I quickly seek the nurse in charge and keeping calm introduce myself 'Hi I am the F1, what seems to be the matter?' She looks at me, laughs and then with the reflexes of a cat, ducks down as a drip stand goes hurling across the room. 'Seriously, do I need to explain?' she says sarcastically and to be fair she has a point. So I turn and cautiously approach said burly man, seeing the notorious yellow bag of Pabrinex on the floor I assume (correctly I may add!) that this is an alcoholic who is withdrawing. I put on my most polite accent and introduce myself to which he replies 'come near me and I will rip your f***ing head off'. I quickly dispel the image of him fighting Chuck Norris that comes to mind, and think 'hell I need back up'. So I call for security and to their credit they send two even larger men and they quickly calm him down. One of the security guards turns to me and says 'what are you going to do doc?' and I think 'why me? They’re the ones built like tanks and I am supposed to do something!' A memory of a ward round as a medical student flashes past my mind where the consultant grilled the SHO for not taking enough time to reason with the agitated patient. I always thought it would never work but knew I had to give it a go before jabbing needles into him.
The conversation starts much how I thought it would; polite comment from me gets profanity from him with hint of violence to one of my body parts. But guess what, after speaking to him for 30 minutes he starts to calm down, objects stop being hurled and the room takes on a different air from being tense to almost jovial as the security guards start cracking jokes with him. One word springs to my mind - illogical: how can it change from a scene of complete carnage to one of serenity with the use of just words. Before I can ponder on it for too long I get another fast bleep! As I run off to the next ward I just hope it is to something more straight forward.
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