An Unfortunate Sexual Incident At Work

I have three fears in this Psych Unit business that I’m in and I’ve touched on this in a post a few months ago: first, death of a patient by suicide, second - sexual behavior between patients, and third - being out of a job. That is why I walk a straight and narrow path and have always remained as vigilant as possible in the 30 plus years I've worked in my position as a mental health worker. I have never relaxed and that's the reason why I don't do overtime work - because working just two days in a row, I give 100 percent all that time. However, in my opinion, you can’t catch them all because things can happen in an instant with just a brief turn of the head or being in a partially blind corner. As much as we attempt to be omnipresent, which is an impossibility, we still miss things. Case in point: on December 6^th just before 7 a.m. I was assisting a phlebotomist by escorting her to the patients’ room so she can draw blood and give TB tests. Neither I nor my other coworkers noticed that a male patient had slipped into another male patients’ room. See, we don’t allow patients to visit in each other’s rooms even though they are of the same sex. Just before 7 o’clock, I excused myself from the phlebotomist to do my second to the last rounds of the day before the end of my shift. When I checked one particular patients’ room, I didn’t see him there, which was not unusual because they come and go all the time. I proceeded to check on the other rooms that I was assigned to and when I opened one of the rooms, I saw one male patient lying on his bed in the knee-chest position while another male patient was facing him with his genital area directly positioned towards the lying patients’ buttocks. If that was too graphic for you, I apologize. Well, in a psych unit setting, sexual behavior is a no-no, regardless of whether it’s heterosexual sex or gay sex. All I could do was ask the male in the dominant position to get up and leave the room. He arose and pulled his pants up and left the room while I asked another staff member to call the charge nurse. To complicate matters, we were aware that the dominant male was infected with something I shall not disclose. I described what I saw to the charge nurse and she wrote a report about it.

This is the kind of patient incident that can get someone fired because you may be blamed that you had not done your job well for something like that to happen. I went home agonizing over the incident even though I thought that I had done the best that I could in checking on my assigned patients. I ruminated about how it could have been prevented, so much so that I did not sleep well. Upon waking from my restless sleep, I had three voice mails awaiting me, all saying to call my supervisor so I could give my input on what happened. I composed an email explaining what happened, sent it to my supervisors, then called them. Both calls went to voicemail so I left a message telling them I sent them an email. While waiting to return to work in the evening, I kept on checking my email for a response, but didn’t get any.

If there is anything that would probably support my telling of the event, it would be the omnipresent cameras recording our every move on the unit. The video would show that I was indeed with the phlebotomist and at the time I said I caught the two patients in the act, I was also indeed doing my rounds then. I don’t know what else I can do to prove that I was doing the job I was supposed to be doing. Regardless, I lament that we were not able to prevent it from happening and assigning blame is fruitless because it was a collective failure. I’m awaiting the fallout with trepidation.

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An Assault With No Visible Triggers

I've been working in Psych Units since 1981 and as psychiatric workers (nurses and mental health workers) we are trained how to manage assaultive behaviors (MAB). We are taught to watch for signs of an impending assault so it can be nipped in the bud, so to speak, before an assault happens, and the cycle that follows. When we see a patient starting to get agitated, we could intervene verbally and/or with medications to calm him/her down so that a full blown assault doesn't happen. Basically these are the steps to an assault: Baseline behavior where a patient is acting normally, a trigger which gets a patient agitated, the assault itself if the patient perceives that his/her needs are not met and attacks somebody, the recovery phase when the agitation declines, then back to baseline when the patient is acting normally again.

So what can you do when the usual signs of an assault cycle do not exist like it happened to me? There did not appear to be any triggers when the patient jumped off the bed twice nor when he tried to punch the respiratory therapist. Certainly none when he punched me at least three times on the head and face, since I was only helping him go to the bathroom. Whatever triggers all appeared to be hidden in the patient's mind. How does one defend from that especially when the patient exhibits baseline behavior right before and immediately after the assault? It was like turning a light on and off.

The doctor could have ordered a tranquilizer after the patient already tried to strike the respiratory therapist, but was concerned that it may impair his breathing if he fell asleep. But that was why I was assigned to watch him 1 to 1, so in case he had breathing problems, I could intervene by at least repositioning him or calling the nurse for assistance.

With the patient's history of assault, I believe he should have at least received a sedative. That may have prevented the attack on me and at the same time, I could have observed him all night to make sure he didn't go on respiratory arrest. Instead, I had to go to the emergency room at 4:15 a.m. to be checked out while leaving the patient alone with his breathing problems. I ended up not leaving the emergency room until close to 8 a.m.

So what happened to the patient after I left him? I don't know and I really don't care. What I care about is my own health because without it, I can't take care of the same kinds of patients who may or may not try to hurt me.

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Assaulted By A Patient On The Medical Floor

October 9, 2012. 03:50 a.m.

Twenty four hours ago, I became a victim of an assault at work. A patient I was watching on the medical floor punched me on the back of my head and face while I was assisting him in going to the bathroom. But first let me backtrack to the events that led to this assault. I reported for work in South Campus and saw that one of the mental health workers had to float to 1 South. I checked the log book  to see whose turn it was to do it and it was me. I drove to the main building and when I arrived in 1 South I was assigned to watch an elderly Filipino man who the staff reported created no problems during that day, although he had acted out the day before, becoming violent because he wanted to leave the hospital. After getting a snack and receiving his medications, he went to bed and I thought it was going to be a long but easy night for me. At about 10:30 p.m. a nurse discovered another patient having a seizure in his room and the Rapid Response Team was summoned to check him. This patient was just transferred earlier in the day from South Campus for assaulting another patient. He had a previous history of having an adverse reaction to medications causing him to become unconscious. In fact a few days before, he was in ICU because of that. The family also reported that this has happened while the patient was not in the hospital.

 After being evaluated by the doctor, the patient was ordered transferred to the medical floor (2 North). He had apnea and had to be hooked up to the Bi-pap machine. A staffmember was needed to watch him for breathing problems and in case he throws up while hooked up to the machine. Having no other options, the nursing supervisor pulled me from my duties of watching the elderly man and sent me to 2 North to watch what turned out to be a crazier version of Mike Tyson. At first there was no problem because the patient was very sedated from the medications he got earlier in the evening. He was even taken to the radiology department to have a CT scan of the head done, and a chest X-ray in his room to make sure he didn’t breathe anything solid in his lungs while he was having a seizure earlier. Well, after all those tests were done, the patient suddenly woke up and jumped over the siderails of his bed to the ground. He was convinced by the staff to return to bed. As the respiratory therapist was trying to hook him up to the Bi-pap machine, he kept taking the mask off. He was given a regular oxygen mask instead. Then out of the blue, he got up and tried to punch the respiratory therapist. A code gray was called requesting assistance to control an assaultive patient. It was the beginning of a long and difficult night for me.

Due to the recent reactions the patient had to medications, the doctor didn’t want to order anything to sedate the patient for fear that he would go into respiratory distress (I’m assuming). Just a second after the patient tried to punch the respiratory therapist, he looked calm as if nothing happened. He jumped off the bed a second time. A second code gray was called. Again, just as soon as the patient was agitated, he was quiet again. This was a dangerous sign because he was unpredictable and could strike at any time without provocation. Still, a sedative was not ordered. The rest of the staff went about their business after that and I was left alone with the patient. He was also hooked up to an IV and he kept punching numbers on the keypad of the IV machine. When I asked him what he was doing, he glared at me and told me to leave him alone. I checked with the nurse to see if what the patient was doing would affect the operation of the IV machine and he said it did not, so I let the patient do whatever he thought he was doing. He even got angry at a nurse when she told him to put his oxygen mask back on.

The patient fell asleep for about an hour or so, but woke up suddenly at 3:50 a.m. wanting to use the bathroom. I lowered his siderails, unplugged the IV machine, then as I was ready to escort him to the bathroom, I felt a very hard punch land in the back of my head. I felt another one near the same area, then on my left cheek. I yelled for help as I was falling to the floor and a bunch of staff showed up at the door. Then just like a couple of hours earlier, the patient appeared calm right after he assaulted me. He even gave me a urine specimen that the nurse asked me to obtain from him earlier. He was finally placed on soft restraints which I wasn’t sure was going to hold him because he appeared to be too strong for them.

In the meantime, I had other concerns. My head was throbbing and I was dizzy from the punches. I felt a bump where the first punch connected in the back of my head and had some pain on my left cheek. I told the nursing supervisor that I needed to go to the employee injury clinic as soon as possible because I was afraid that I had a concussion. He asked me if it can wait until 7 a.m. because he didn’t have enough staff to cover the patient, and I said it couldn’t. He went to get the paperwork. When he came back, he asked me to fill them out while he contacted the clinic. He planned to have the hospital van take me there because I couldn’t drive myself due to the dizziness. I learned much later that the clinic was supposed to have a shuttle to pick people up but it wasn’t available and not only that, there was no doctor available at the clinic. The nursing supervisor managed to get authorization from the administrator on call to have me treated at our own emergency room. I was escorted there at about 4:15 a.m. and more paperwork had to be completed. Soon, I was evaluated by nurse Jack whom I knew from being floated to the ER once in a while. He obtained an order for a head, neck, and face CT scan. Funny to think about it now, but other than getting my vital signs, neuro checks were not even done on me, nor a doctor see me until was discharged several hours later.

So I was assigned a bed and while waiting to be taken for the CT scan, I just sat there and read a magazine. Pretty soon, I got a text message from Michelle, one of the nurses I work with at South Campus, asking how I was doing. Our charge nurse Jim was checking for possible admissions from the ER and saw my name as a patient there. They haven’t heard about what happened to me. I texted Michelle back saying I was waiting for the CT scan because a patient punched me on the head a few times.

After waiting for more than an hour, the radiology technician showed up and escorted me to the CT room where she took the three ordered tests for the head, neck, and face. She was the same technician who did the CT scan hours earlier, of the patient who assaulted me. After the scan I was back in my ER bed to await the results. My headache and dizziness were still present but felt lesser. Michelle asked me if I needed a ride home and I said I would let her know. Feeling less dizzy an hour later, I told her that I may be able to drive myself home and thanked her for her offer.

Change of shift came at 7 a.m. and I was still in the ER waiting for the CT scan results. This was the worst time to ask a nurse for it as hospital workers would agree, so I just waited until night shift to day shift report was done. I checked with Olga to ask her if radiology is going to call in the results or if they had to check the computer if it was already in. She said they just got the results and the doctor was reading it. Then Jim, my charge nurse and Paulette, the psychiatric emergency team nurse (she was working the ER that morning) showed up to check on me. I told them what happened and that I was just waiting to be cleared by the doctor. A few minutes later, a doctor came to ask me a few questions while I asked him a few as well about my condition and CT results. He said I might have suffered a mild concussion since I didn’t lose consciousness , I was not disoriented, I answered his questions without hesitation, and didn’t have nausea and vomiting. Those were all signs of a concussion by the way. He offered me Toradol for the headache, but I declined fearing it would impair me from driving. He said it wouldn’t but I said no anyway, saying I would just take a Motrin when I get home. After that, with Paulette facilitating the paperwork, I was discharged from the ER. I’m glad she didn’t put me on a 5150 – 72 hour hold J.

My long night wasn’t over yet because I still had to report to the nursing supervisor to find out what to do next with this workmen’s compensation issue. He gave me an authorization for treatment at the employee injury clinic and I was finally able to clock out from work close to 8 a.m. I called the clinic asking them if there was a time limit after the injury for me to show up and the lady said no. I’m planning on going there today for a follow up and see if I can be cleared to return to work tonight barring any complications the rest of the day.

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