On a recent night shift, there must have been a full moon.  The ED was packed, to the hilt, and my colleague and I were frazzled by the sheer volume of sick patients.  Sitting at my desk to write notes, I was in full view of the two locked rooms we use for agitated psychiatric or intoxicated patients. Most nights, there is someone with fire in their eyes staring at me through the window; other nights, someone will stand there screaming obscenities.  On the wildest of nights, my heart will jump into my throat when suddenly a violent hand slams itself against the door, or a patient throws the entire bed at the wall.

The other night, even the police who brought my patient in were left stunned.

I could hear her screaming from long before she arrived in the room.  Her deep, loud, angry and psychotic voice boomed down the hallways, announcing a fearsome presence and a need for medication stat.  They brought her in shackles, hands and feet cuffed, a treatment reserved for the most dangerous of the bunch.  Two young male officers seemed way out of their skill set; they held her arms carefully and evidently trying not to hurt her but still not get hurt themselves.  I wondered if police academy prepared them for this? 

Flanked by our MIBs (“Men in Black” – our ED ex-military security team), I entered the room in gown, gloves, N95 mask and face shield.  The patient wore no mask, and screamed at the security team to take their masks off. Pandemic be damned – in her fiery mind certainly a mere virus was quite unimportant.  She demanded to see the President of the United States. Not having him on speed dial, I offered myself as someone she could talk to instead.  I can’t quite recall the names she called me. 

Ever the idealist, I tried to build rapport with this woman in psychosis; I complimented her long, thick, rope-like dreads.  “You have great hair!” – what a mistake.  In a heartbeat or less, she whipped her head around like a medusa; talons of hair went flying into the eyes and faces of the poor young officers. 

“That’s enough, four point restraints, Ativan 2, Haldol 5, Benadryl 50 stat.”

Within minutes she was laying on the bed, medications beginning to chase away the demons and force her into sleep.

Two shocked and frightened countenances greeted me as the officers joined me at my desk; they had never seen anything quite like the show tonight.  Thankfully their eyes and faces were no worse for being whipped with intensity, and they left, shaking their heads, to get some fresh air. 

They left, and left me with a pit of fear in my stomach.  Women and men just like my patient, suffer with mental illness in our society.  But those who are untreated, those who refuse to comply with treatment, pose a real risk.  A woman such as this, in the throes of distress, does not see the world as you or I do.  She sees random people as dangerous, villains, threats.  This is the kind of individual who could lash out at any moment, at any person in her line of vision.  She may not know what she is doing, but she would do it anyway – and an innocent person could get hurt or killed.  The way she looked at me and spat horrors in my face, sent me away with goosebumps.  The mind is a formidable foe when it’s connections are out of sync. 

I left that night feeling like I often do these days: helpless, hopeless, and devastated.  My heart felt like those dreads had whipped it apart, and tangles of dirty hair were strangling my optimism.  Emergency Medicine can do that to you, but it can also lift you higher than you ever thought possible.  I hope I find that elevation on the next shift.

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