9. Specialling the Wrestler.

Anecdotes from working in a psychiatric hospital..

(or Wrestling the specialler..)

Fact: It's very hard to stop someone from killing themselves if they're really determined enough. However on this occasion, this was my primary objective.

In psych nursing circles, protecting someone from harming themselves in hospital is called 'specialling'. It is total one-to-one care. It's a huge responsibility and a great drain on one's nervous system (not to mention staffing resources). It's also not really great for the patient, who has to forego all privacy and personal space privileges, including having escorted toilet trips.

The person is usually kept in a safe room away from the main ward area, where they may spend up to several weeks eating and sleeping and passing the time with the special nurses and perhaps the occasional visitor, until the depression lifts. Not ideal, but certainly better than ending your life prematurely and often violently. With the right care and treatment, most actively suicidal people eventually decide to carry on living once they start feeling better within themselves.

Big Kev had been admitted to the Acute Psych Unit after slashing both his wrists with a razor blade. He was extremely depressed and had made quite a mess of his arms in the process of cutting them, as you do. Both arms were heavily sutured (stitched) and bandaged up to the elbows. Big Kev looked like he'd got a long pair of sweatbands on his huge, chunky forearms - a bit like you see those all-in wrestlers wearing in the ring. Which is quite fitting really, because Big Kev was an all-in wrestler.

It was Kev's second major episode of depression and he'd been started on the usual course of antidepressants and mild sedatives to make his days a bit more bearable. He'd been on the ward for about two weeks and because of his admitted suicidality (not everyone owns up), was being specialled in a side room. His arms were in such a mess that a plastics consult had been sought and Kev needed to be transferred temporarily to one of the general hospitals for some surgery.

This is where I first met Big Kev in person. He wasn't originally an inpatient from my own unit's catchment area, but as one of the nurses in the department with a fair bit of specialling experience, I'd agreed to help out. I'd read up on his case file and been briefed about the situation, which was a slightly unusual one - specialling someone away from the comfort zone of the specialist psychiatric units. But I like a challenge and a challenge is just what I got.

After taking the handover from the departing nurse as they went off duty, there I was. Just me and this big bloke, closed up in a small side room together for the next 8 hours. Physically he was about as big as I'd expected (5'11'' - about an inch taller than me; 260 pounds - over 100lbs heavier than me!) and he had a bit of a fierce look about him, sitting there with his wild hair, stubbly chin and hospital issue dressing gown and I remember thinking:

a)  I'm glad I'm not standing in a ring on the opposite side from this bloke right now
b)  No. I'm just shut up all alone in a room with him
c)  Ah, but he's the one he wants to hurt..

Not that the two of us would be sitting here like this if there'd been any question of psychosis or any risk of danger to others. He'd been here a day already, surgery was scheduled for tomorrow morning and he'd be back on the unit again soon enough. Although not soon enough for Kev.

We talked for a while and during this time I performed an MSE (mental state examination) to assess, amongst other things, Kev's state of suicidality. What he said caused me some concern, because he said he was feeling a bit more energetic and denied any suicidal feelings or intentions. I knew from the nursing report that the day before, he'd still been pretty low and on the edge.

Either Kev was lying to me and he actually did have a plan (people can 'perk up' when they know it's all going to be over soon) or he was indeed feeling a bit better (in psychiatry a recognised danger zone: a depressed and amotivational person, too low to even kill themselves, may actually act on suicidal impulses once they start to get their energy back). Either way, I wasn't happy and Kev was starting to pace.

You know, the way a lion does, up and down its cage.

Now, after a couple of hours I'd had a little time to build up some rapport with Kev but as time passed, both his patience and my conversational repertoire were starting to get a bit stretched. The extra medication I'd given him to promote relaxation didn't seem to be doing much good, probably in large part to his Neanderthal constitution. He requested a walk to help him burn off some energy and, after a moment contemplating the consequences of a refusal (Headline: "Nurse's body found stuffed in laundry bag")(again) agreed, on the proviso that we keep strictly within the hospital grounds.

The walk brought a much-needed reduction in Big Kev's level of arousal (and for a few precious moments, mine too) and we strolled like a couple of lifelong chums. And one of those lives was rapidly ticking towards an untimely end.

One of the principles of specialling is that you keep the person within arm's reach - so you can grab them if they do something desperate. I still think back now to what might have happened if I'd actually managed to keep hold of Big Kev's arm. One minute he was beside me, the next he was head down and running at full pelt. I was nearly pulled off my feet and, like in some surreal funny/terrifying scenario, I imagine I must have looked like some cartoon character flailing along horizontal-fashion behind some maddened bull, hurtling out of control towards the busy road.

What followed reminded me of that scene in the film 'An American Werewolf in London', where the werewolf breaks loose in the middle of the Metropolis and the incredible chaos which ensues. I still have the image of that scene burned into my mind.

As I ran after him, Kev reached the main street and kept running, straight into the busy lunchtime traffic, straight into the path of a double-decker bus. It hit him at full speed, square on. There was an incredible bang, Kev was flipped spreadeagled about 20ft up into the air and came crashing down on his back. The bus driver reacted quickly and as he brought the huge bus to a dead stop, the successive skids and crashes of the traffic stoving into the back of the bus could be heard. A car coming in the opposite direction slammed on the brakes, was smashed in the back by two other cars and came to a skidding stop with its wheels pinning down Kev's dressing gown. Women were screaming, a pedestrian fainted, nurses and staff came running out of the hospital. It was utter chaos.

As I reached Kev I could see he was still conscious and breathing. I told him not to move. As I covered him with a blanket he just looked up at me and said, "Sorry Andy..."

The ambulances seemed to take an eternity arrive (one for m'man, one for the pedestrian). Somebody started directing the traffic. I sat on the road with Kev. I looked at him lying there. I looked around at the carnage surrounding us. I yelled at a couple of unfortunate do-gooders who wanted to transfer Kev tidily onto the pavement so the traffic could get going again (good tension release there). The police arrived and started sorting out the mess. I got the hospital administrator to contact the ward and the psych unit to let them know what had happened. Then it was into the back of the ambulance with a still-conscious Kev and away, weaving thought the trail of smashed vehicles and astonished onlookers.

Kev was given an initial once over in casualty and seemed to be in not too bad a shape considering. You soon know when you're at the bottom of the triage food chain. The X-Rays took ages.

Explaining the administrative situation was interesting, "Yes well Kev is actually a registered inpatient in two hospitals in this Health Authority at the moment, three if you include here.." etc. I really thought I was gonna get my arse kicked over this one ("You let him do what!!?"), but my boss was actually quite fine about it and showed great concern over my own well-being.

The X-Rays showed no breakages. In fact, Kev had come through the whole experience without a scratch (I hear the pedestrian got a fairly severe concussion).

As we strolled out of Casualty that evening to take the ambulance transport back, Kev looked at me and said, "Never again." He was a man of few words.



Random House

Life in a Community rehabilitation facility..

I: Handover

You always know when you've arrived for duty at Random House. If the acrid stench of stale piss doesn't get you first..   [read]

II: Pulp Friction

Has she been helping herself to the residents' medication again..?   [read]

III: Student Nurses

They're not bad," Maudlin replied, "We've got one male and one female this time. Jeff, the male, is interesting..   [read]

IV: Initiation

The laundry bag creaked a bit at the seams as the rope tying it to a radiator inside gave a little, but it held strong..   [read]

V: Evening Shift

Andy looked up from his microwaved lasagne and carefully wiped his lips with a napkin, "I'll deal with this one."..   [read]

VI: Rehab & Reality

"Hey cheer up Nurse Andy!" said a bright apparition standing at the office door. "Wot you got to be so down in the dumps about..?"   [read]

VII: Body Fluids

Now, I truly tried hard to find a nicer term here, but nasal mucus doesn't really begin to describe..   [read]

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