Why is it always the big ones?
If you’ve ever worked in a psych unit, from time to time there is a patient that becomes unmanageable and requires some medication to calm down. In my long career there have been many. Most are forgettable, but some you never forget.
I was working a day shift at a state facility and my shift was over, but I had admitted one of the biggest guys I’ve ever come across. He was around 6’8” and somewhere in the neighborhood of 300lbs. His father had been a professional football player and I’m sure this guy had played some college somewhere. He was psychotic as hell, but manageable during the admission. The fear in the oncoming shift was palpable.
Come as you are.
I had just gotten home and was eating dinner when I get a call from the hospital. The “Big Guy” was going off and needed some medication. They were asking me to come back and assist in giving him something to calm him. I told them I would be there in 10 minutes because I needed to change. They told me to come as I was because it couldn’t wait. When I arrived I was met in the lobby with the other instructor of PMAB (Prevention and Management of Aggressive Behavior). We took inventory of who we had to help in the take-down if it came to that. There were 4 guys and a janitor. Two of us were pretty big guys, but the other two were older and the janitor was about 100lbs soaking wet and was already shaking in his boots.
We entered the unit to find the “Big Guy” pacing the hallway. He was wearing only a pair of boxers, (as a do-rag on his head). He had a cigarette in his mouth and was screaming to have a smoke break. It was around 2300 (11pm) and the next smoke break was not until 7am. The staff was all locked tight in the nursing station and the patients were all in their rooms with their doors shut tight too, occasionally one would peek their heads out. We headed to the nursing station to re-group and finalize our plan. They were talking to the Doctor and I mentioned that this guy might need a larger dose than most. The Doctor ordered Haldol 10mg and Ativan 4mg. (twice the normal dose) This guy was so big that normal take procedures were out the door. We assigned one person per limb. Each of us knew that we would have to hold on for dear life because if one of the limbs got loose someone was going to get hurt.
First in battle, first to the ER.
We stepped into the hallway, because I had admitted him, I would be the “front man”. I asked why he was upset. He told me that he wanted to go smoke. I told him that as much as I would like to let him, the next smoke break was not until morning. I promised that he would be the first one out but that he would have to go to his room now. He went off screaming and paced down the hallway. We decided to take him down on his next lap. The two of us that had some size were to take the arms and the older guys would work on getting the legs pinned together. The janitor, if he hadn’t wet his pants by now would help out if anything got loose. The moment came and I gave the signal. We quickly got his arms and pushed him against the wall, his legs were together and we went to the ground hard. The older guy was stuck under him but had his legs pinned and we had his arms. It took everything we had to hold him there. He was faced up with the older guy underneath, and the two of us holding arms that were as big as most guys legs. The nurse approached and gave him a shot. We figured that we would stay here for about 20 minutes to let the medication take effect and then move him to his room or the seclusion room. Our 20 came and went and this guy would not let up. We waited about 15 more minutes without any relief and the Doctor was called again. He said to give the double dose again and he was on his way to the Hospital. The second dose was given and we waited. In about 20 minutes the guy was calmer and I asked if he would go to his room. He agreed and off we went.
Father knows best.
He sat down on his bed, still sporting only the “do-rag” boxers. I talked with him and promised that if he could maintain that I would personally take him for his smoke break in the morning. He agreed and we eventually left. The next morning I arrived on the unit. When it was time to go smoke I went to his room and he was still sitting on his bed as I had left him. Now, that amount of medication should have knocked him out for a day, but he didn’t appear too phased by it. We went to smoke and then were off to breakfast. On the way there, we met his father, who had been called during the night as a protocol. He was even bigger than his son and asked to have a private talk with his son. We ushered them into a conference room and he immediately went to a tirade. He told his son that he beat the crap out of him if he gave us any trouble again. (There were a few more cuss words than I care to write, so I am paraphrasing) When they came out the father thanked me and left. The patient never said a word.
On the job training.
We had that patient for about 3 weeks and from that morning on he was calm, in control, and would say, “Yes sir, no sir, please and thank you”. He never gave us any trouble. Actually, he was a big help. We had a transfer of an aggressive patient to our unit. One day that guy was going off and tearing up the place. He was a pretty big dude too. When he got into the day room with everyone watching TV, he picked up a chair and threw it at the window. As he moved towards the TV to do the same thing, “Big Guy” grabbed him by the shirt and pinned him against the wall. We went up to get the guy from him and he told us he had him so we could get everyone else out of the room. “Big Guy” was already learning our protocols. He held him there until we could get meds and clear the room. I told him if he needed a job or a reference I would be glad to help him out.
While we always try everything to keep from taking someone down or forcing them to have take meds, there are times when you have to make that call. I never take it lightly. I’d rather talk for an hour if it’s going to keep someone from hurting themselves or someone else, but then there are times when talking is out the door and force becomes your only option. I have thought many times about that night. “Big Guy” could have easily flicked up off like ragdolls, but he didn’t. No one was hurt and he got the meds that he surely needed. Another crisis averted!
