Thursday, February 28, 2013

Violence In The ER

Maybe it's just me. Perhaps I've only worked in terrible places with terrible people. But I don't think so.
Maybe it's just that I'm a big, bad former Marine, and when one's only tool is a hammer, all their problems look like nails. Except I'm average sized, with a middle-aged donut (despite my brain's insistence that I'm still young), thus not really physically intimidating to anyone except perhaps Warwick Davis, a hobbit, or my cat. So in looking back at my anything-but-extraordinary career in the ER, I'm frankly rather astounded at what a throw-down knockdown hog-wrassling time it's been.

I've been spit on and at, punched, kicked, slapped, choked, hit in the head, clawed, gouged, bitten, urinated on, pelted with any number of objects and body fluids, dog-piled, injured to the point of temporary disability twice, one of which was potentially permanent and career-ending (and thankfully fully recovered from), assaulted, battered, and of course verbally abused, cursed at and threatened almost daily.

I've broken up fights, disarmed lunatics, and made at least as many tackles in my career lifetime as Dick Butkus did in any one year he played, and no disrespect to Mr. Butkus, but I did mine while wearing less pads and no helmet.

I've seen co-workers stalked, threatened with death, punched in the eyes, nose, mouth, and throat, had their heads yanked back by the hair, bitten so hard they had teeth marks a week later, had faces scratched, legs and knees twisted, need ice packs, Ace wraps, and stitches, been kicked in the groin, and had IV poles, power cords, chairs, instrument trays, canes, shoes, full and empty urinals and bedpans, and just about anything else you could imagine wielded, swung, or thrown at them, time after dozens of times.

Total number of patients or visitors arrested for assault or battery, let alone actually charged with violence against us, or prosecuted for same, in all that time: zero.

Is it just me, or is there something more than a little f*****d up with that ratio?

Police have bullet-resistant vests, pepper spray, tasers, batons, and guns. And numerous other cops one radio call away.

If we're really, really lucky, the hospital, one time in a thousand, might file a restraining order against somebody, once they've gone apeshit enough to get charged and booked into jail anywhere else in society. And hand to God, had anything like this happened to me at home, I'd have been well within commonsense rights and responses to have blown a few heads off.

So Houston, WTF?
Saying this is a problem is like saying the explosion of Mt. St. Helens was unsettling. It's telling the astronauts on the last Challenger ride that things would be a little bumpy.

Whose fault is this?

Society in general, for thinking that walking into the ER is carte blanche for doing what the jacktards with Ph.Ds, and too many with Nursing Ph.Ds, call "acting out".
What the police call it when it happens anywhere else is aggravated assault and mayhem, so let's quite pussyfooting around and using psychobabble happytalk instead of precise clinical language. Five year olds "act out". Adults are being criminally violent.

Hospital management, from relief charge nurses to CEOs and every worthless waste of skin and oxygen thief in between, for collectively and reflexively shrugging, and adopting the "Tough Shit, You Knew The Job Was Tough When You Took It" philosophy, which is a remarkably callous, spineless, gutless, and self-serving crock of a well-known substance when employee safety (not to mention the safety of everyone else in the hospital) is what's at stake. Coal miners in Appalachia get more respect from management than staff workers do in hospitals. In the words of one former military commander, "F*** You. Strong message follows." Those penny-pinching short-sighted bastards have never had anyone's backs except their own buttcheeks, mainly because that's where they store their heads on this issue, 365 days a year, plus an extra day during leap years. I'm remarkably well-read, and I've got pretty comprehensive recollection of my nursing school days, and I can't seem to recall reading in either the state penal code nor any textbook of nursing that the job of healthcare workers is to get the shit kicked out of them, literally, day in and day out until they either quit, retire, or die, yet I've seen and experienced that is the reality.

The police, for taking a "So what do you want US to do?" attitude, as if suddenly the laws of the city and state magically don't apply inside a hospital like they do at Fred's Bar & Grill.
(For the record, Officer, I want you to do to them what you would if it had been a "brother officer" they'd kicked, punched, spit on, or tried to choke out. Because if you don't, Hear Me God, I'm going to treat you like them, every time you and your brethren in blue enter my ER. Think about that long and hard when you just can't feel me about cuffing Mister Douchebag and filling out those nasty reports.) 
And a lot of that is because of the city and district attorneys who are too gutless and chickenshit to prosecute, in their entire careers, one case of violence against health care workers anywhere I've lived, worked, driven by or flown over since I Australian rappelled out of the womb on the end of an umbilical cord. As Casey Stengel said time after time, "You could look it up."

And lastly - not mostly, not substantially, not firstly, but certainly lastly - us.
Those of us who put up with being treated like punching bags, as though getting jacked up is some mark of special blessing, machismo, or street cred. Or because we didn't know any better, or because supposedly older and wiser colleagues told us, explicitly or implicitly "That's just the way it is." As Bruce Hornsby's song should have taught you, "Aw, but don't you believe it."

It's bullshit, boys and girls.
For the love of Jesus, Buddha, or the Flying Spaghetti Monster, stop acting like the dumbass battered wives and girlfriends you diss and scream at, strap a 2x4 to your spines, and stop putting up with being whomped on like it was some freshman hazing or dumbass rite of passage.

It's assault, battery, mayhem, and attempted murder.
Swear out the complaints, press the charges, and if necessary make the citizen's arrests required, and don't take no for an answer, or tolerate getting undermined by higher-ups.
When you feed the pigeons, you get more pigeons, and more pigeon crap. When you appease the bullies, you encourage more bullying. (And yes, you worthless wankers, I mean every one of you in a supervisory position who doesn't kick abusive people out the door on their fat whining asses, in 100% of cases, with zero tolerance, with security and if necessary a police escort.)

Or someday when one or fourteen of your co-workers, God forbid, finally gets a window blown in them by somebody with a 'tude and a firearm, because of all the times you didn't stand up and scream "ENOUGH!", it's going to be too goddamned late to tell yourself, or their families and kids, that you're really sorry you couldn't find the will, the wisdom, or the sense given to the dumbest jackass on the planet, with any number of legs, to act to end things before they went that far.

I'm not expecting to speed-dial 9-1-1 for every insaniac. That's what Geodon, Ativan, Haldol, hard restraints, and big security guards are for. And I get that both those on booze, PCP, meth, and those stricken with Alzheimers' or otherwise altered may be a handful.
Those are patients, and we'll deal with them.

But the ones who are AOX4 and just aggressive, hostile @$$holes, including spouses, parents, family, and friends in about a 10:1 ratio to the actual patient seeking care, need to be confronted with a simple common-sense standard: you attack those trying to help, you leave in handcuffs, and you never get to come back to us again.

I want the law in 50 states and every U.S. territory to be blessedly simple, straightforward, and unconfusing:
any threatened assault or actual battery on anyone in healthcare, from an EMT at the side of the freeway to so much as a custodial person at a hospital or a clerk in the doctor's office, is a straight out-and-out non-negotiable felony, and with the same mandatory 24 hour no-bail no-release jail time as spousal abuse. From Bangor to Guam, from the Bering Sea to the Canal Zone. And yes, that goes for drunks and drugheads. If we can charge them for manslaughter behind the wheel, we can damn skippy charge them for felony battery in the hospital or ambulance, and the quickest way to take the fun out of things is for The Man to deliver the smackdown.
And any continued verbal abuse or threat of violence whatsoever gets you kicked out so fast it takes your clothes a minute to catch up to your sphincter when you get ejected, and you get a restraining order filed the next morning in perpetuity.
To hell with "Three Strikes", let's try the "One Strike" policy, and see how it works. And post it in big red letters on signs right next to the cutesy "Patients Rights" plaques, at every entrance to every hospital:
"Any assault, battery, or threat of same by anyone against any employee here, for any reason, will result in immediate arrest and prosecution. Any verbal abuse will result in immediate and permanent ejection from the premises. There will be no exceptions under any circumstances and no second chances."

It's ridiculous that flight attendants serving Diet Cokes are given more protection from obnoxious businessmen under the law than the doctor, nurse, or tech working to save a life in the ER or at an accident scene working with drunks, drug addicts, certified lunatics, and world-class violent jerks, but they are.

None of us should have to lift weights and work for a martial arts black belt, or seriously consider wearing shin guards and knee pads, a cup, and possibly even a bulletproof vest under our scrubs just to do our jobs. Or to soberly weigh whether we'd rather carry pepper spray, a taser, or even a pistol hidden on our persons, breaking ethics, hospital policy, and possibly even state law, in preference to being one of the half-dozen pictures in the paper when some sub-human ghoul decides hospitals are the new place to go on a shooting rampage with no one who can shoot back.

There's a way to reverse things before it goes that far. (And if we don't, it's going to go that far, mark my words and note the date.)

It's far past time to stop mollycoddling the f*cktards, and start applying a little tough love. Generally, by giving them steel bracelets, and a 24 hour time out at the Graybar Motel, until the day comes when you're more likely to see icebergs off Miami Beach than hear about a healthcare worker getting roughed up.

Can I get an "Amen"?
And how many of the yapping pointyheads constantly carping about "getting nursing the respect it deserves" will help make such a policy reality, and how many will instead stare blankly like you've just grown another head, cough, shrug, and move on to studying the latest JCAHO Happygas, rather than saddle up for this fight?
Watch closely, and look and see who your real friends are when your own safety is under discussion, ladies and gentlemen.


  1. AMEN! If I recall correctly, last semester we went over violence at work, and we were told it's never acceptable from ANYone, patient, family member, co-worker, whoever. So, progress?

  2. Amen from 20 years in the ED.

  3. Preach it brother preach it! Amen from the choir! I work in a hospital where we do put charges on violent patients. One patient in particular has 20+ aggravated assault charges on him, he has attacked staff and destroyed hospital property countless times. The judge's sentence for this asshole of a patient after the last nurse he attacked showed up in court to show off her new black eye? Time served in city/county lock up.