Yesterday was my 1 year anniversary at Dirty Old Hospital. A year ago yesterday, I started there as a nurse intern. Can’t believe it’s already been a year!

To celebrate my anniversary, I received a complimentary chest and sternum x-ray, as well as a police report. I don’t know how they celebrate anniversaries at your hospital, but this really the way to ring it in! Did I mention that my manager sent me home early? Thanks, Boss!

I had been taking care of a patient with a long, sordid history of  mental illness. I knew this going into it. However, he’d been great all day; perfectly well-behaved minus a few brief episodes of yelling, which we were taking as a sign that he was actually feeling better. When we extubated him, he thanked us profusely (and genuinely) which actually brought tears to my eyes. He told us repeatedly that we were “wonderful people.” He said “thank you” every chance he got. At one point, I had him singing “Sweet Caroline” to me.

And by the end of the day, after I told him I was going to get him his book and a glass of water, he had punched me in the sternum. Happy 1 year anniversary, indeed.

At the time, I was too stunned to do much of anything, except cry, in that really embarrasing, snorty kind of way; the kind of cry generally reserved for the car or the shower. One of the managers heard the “thud” down the hall, then heard me gasp, then heard me say (kind of flatly) “That is not appropriate.” My clearest memory is the voice in my head that said “set a boundary and get the hell out of the room.” I remember fumbling with my grown (thanks, contact precautions!), blindly struggling to wash my hands before my manager grabbed me into a hug and started moving me towards the break room. Snort, sniffle, sniffle, snort.

I sat there in the corner and tried to control my sobs. Meanwhile the staff filtered in and out, making sure I was okay. A really awesome med student (who we’d been working with all day) even came in and sat with me for a few minutes when everyone else had to gown up and go in the room. A psychiatrist came in to check on me after the code was called off and the guy was safetly nestled in his 4-point restraints. Even the police were great, to be honest (when he jokingly stated that he couldn’t spell “schizophrenia,” it actually helped calm my mind to spell it out for him. Is that a police office trick, to calm freaked-out-women?) I couldn’t have asked for a better experience. So fear not, young nurses. Being punched in the sternum can really show you the supportive side of the hospital you work in. (Or not…)

Paperwork, manager’s office, paperwork, crying, ER, xray, crying…that was the next hour. Down in the ER, I was greeted with open arms and triaged in front of all the other patients. All the ER nurses ((granted, we are a small ER with no trauma center) came to visit me and tell me how sorry they were that it happened. I was showered with hugs and candy, including gummy bears in a denture cup. My nurse wrote up my activity “restrictions” on hospital letterhead, including no housework, laundry, dishes, or litterbox scooping, and orders to “remain in a relaxing position of no stress.” The ER physician signed it. Meanwhile, my phone was buzzing with text messages from my co-workers. I got home about 2 hours early. My husband heated some cherry pie, of which I ate only the crust and demanded not to be chastised for my actions. We tried to watch a funny movie, but I fell asleep on the couch, kleenex crushed in my fist.

This morning, I am bruised and sore. A little to the left or the right and he could have punched me in the boob, instead. However, while that certainly would have resulted in more padding for both of us, I can’t say that I would have been a whole lot happier. In fact, he was probably better off avoid the Ladies. I’m also terribly emotional about the whole incident. I have a lot of mixed feelings, and I still feel like I’m in a little bit of shock. In no particular order,

• I feel like a loser for sobbing in front of the entire freaking unit, all the nurses, docs, med students, police, and managers.
• I feel like they shouldn’t have sent me home, that I was a wimp and I should have just sucked it up and finished my shift.
• I feel absolutely.freaking.horrible about what happened to that patient after I left the room, although logically it was the best thing for him and the rest of the stuff. I’m just lucky he punched me and not one of our pregnant nurses, instead. But the sight of that guy in 4 point restraints, still taking swings at people, will haunt me for awhile.
• I feel like I should have seen it coming, despite everyone telling me otherwise. I feel like I should have done something to prevent it. Maybe there was something huge that I missed, something that would have been very obvious to anyone else.
• I feel like a failure to my patient. Failure. That’s one of the worst feelings.
• I feel betrayed by that guy. He was perfectly well-behaved all day long. He just snapped without warning. I thought I had developed a good rapport with him.
• And my freaking sternum hurts.

It was a really, really bad day, preceded by a wonderful day that I had planned to blog about. To sum it up, I took a 1:1 stable ICU patient on a vent and did about 99% of the work myself. I felt very proud. A month ago, I couldn’t have handled that assignement. Then this happened, and my confidence is shot. I now question my neuro exams. He was answering all questions appropriately, all day long. Did I ask the wrong questions? Did I not ask him enough times? And I don’t know how long it will take for me to be able to trust my patients again, especially those that have known mental illnesses. That makes me really sad. My patients don’t deserve my preconceived notions, and I’ve always worked hard to keep that kind of thing at bay. I won’t have as much control over it now, at least for awhile.

I still don’t hate my job. I am trying to take consolation in the fact that I gave him great care for 11 hours, and maybe made his life just a little bit better, even if it was termporary. The whole thing just  seems very unfair. To me. To my patient from last night. To my patients tomorrow. It all just kind of sucks.

Happy Anniversary!

Tags: assault, icu nurse, schizophrenia, violence

This entry was posted on Wednesday, June 10th, 2009 at 7:58 am and is filed under first year, icu, nursing. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.