All This, And They Pay Us!

Some time back, on absolutely my second shift ever at Shoestring General.
I'm at the back end, getting the hang of yet another EMR, and doing pretty well with all my patients, but then again even though I'm new here, I have more ER time than everyone else on the shift combined, except the charge nurse.

So things are busy, but steady, except for Baby Huey*.
This particular Not My Patient Tonight is on a 72-hour psych hold, for being off his meds, and playing in traffic. Literally.
Boom: danger to self, on a hold per PD, instantly.
So he's goofy, but not violent, and not all there mentally. with his very own 95# sitter to tend to keeping an eye on him. Which is sort of a disparity right there.

Physically, he could play inside tackle anywhere from Oklahoma U. to the Cleveland Browns. Call it 6'5", and somewhere north of 275#. But he's pretty soft-spoken, and re-directable when he starts to mentally drift. So it's cool.

Until about 0445AM, when he's told for the nineteenth time that he cannot leave, because psych hold, and finally, through the voices in his head, the penny drops.

I'm standing behind the desk at main station when he wanders out into the hallway.

"Baby Huey, you need to stay in your room please" says his sitter. "You have to stay here tonight."

"No, no, no! Gotta go now!" (direct quote) saith Huey. Who then proceeds to take a running start at the lobby door, barefoot, in just a hospital gown.
BOOM!

He hits that thing like Dick Butkus hitting a slow QB, and that door swings through 180° so fast and hard it sounds like a cannon when it hits the outside wall. Thank a merciful god there's no one on the other side, or they'd have been launched like a high pop fly past center field, and generally towards Hawaii in low earth orbit.

Before we can even pursue, the waiting room confuses him, so instead of exiting, he heads down the main corridor to the rest of the hospital, where he encounters a series of locked - we're talking electronically and mechanically - double exit doors.

Slap-slap-slap-slap-slap-BOOM!

Slap-slap-slap-slap-slap-BOOM!

Slap-slap-slap-slap-slap-BOOM!

We're just getting to the lobby, and he's already three doors down, having crashed through them like the opening scene of Get Smart, but at warp speed.

Locked doors? No problem. He's hitting them so hard, the metal jambs are flying loose and taking chunks out of the drywall when the pieces coming off finally land. If any of the 90# Filipina nurses on the floors were walking by, they'd be little crumpled lumps embedded into the opposite wall, but amazingly, he hits no one. Or else they're diving behind counters like the running of the bulls in Pamplona.

We're rounding the corner  just in time to see him blow through three more doors, flying through med/surg, telemetry, and surgical wards, now under a full head of steam, and with his southern exposure flapping in the breeze as the gown parts. He even eats it a couple of times, taking a couple of big faceplant tumbles, but before anyone can complete the tackle, he's back on his feet, legs churning for the end zone. Our slower guys just follow the trail of staff with shell-shocked looks lining the halls after the parade's gone by.

Finally, he runs out of hospital, and he hits an emergency exit in similar fashion, booming through it as well, and bursts out into free oxygen of the pre-dawn air on the backside of the hospital building. And runs smack into a nine foot expanded metal fence he can't climb.

By the time we get to the exit, he's pivoted, found the locked exit gate, and can't figure out the latch, but no matter. Up the fence he goes, using the pushbar as a footing to climb up.

Four of us from the ER, joined by two more guys from the wards he blasted through, are all in hot pursuit, and his momentary vertical attempt allows us to catch up to him. Now we've got him for sure.

Before he can get over, two of us grab his gown, and start to pull him back inside, before he's out on the side streets.

So he shimmies out of the gown, and crashes, now butt naked, the eight feet to the sidewalk outside. We got the empty gown, and he's gotten to the street.

Not being crazy or confused, we open the gate, and hurriedly try to form a loose circle around him.

He takes tumbles, but gets up, and continues to head away from the hospital.
We circle him, but if anyone gets too close, he bolts. We're trying to herd him back towards home base, but he's not having it. Oh, and he's screaming and babbling incoherently as we pass through slumbering suburbia.

It's still dark, and early morning, but people are starting to hit their morning commute on the local streets, and we're trying to keep him (and us) from getting run over.

Cars approach, and we keep one eye on Baby Huey, while waving traffic to go a different way. Seeing six guys in scrubs chasing a huge naked screaming guy down the middle of residential streets at 5AM, they get the hint, and drive away in any other direction.

We keep trying to at least make Huey turn and head into the quiet residential side streets, but like a moth to a flame, he's headed for the bright lights of the main drag, a busy boulevard with morning traffic getting heavier by the minute in the pre-rush hour darkness.

Meanwhile, one of my compadres is keeping the ER advised of our progress on his cell phone, and they're relaying it to the local PD. We hope.

We keep trying to direct the one-man stampede towards safer paths, but he's just not going to go along.

We're about 50 yards from the boulevard, and traffic flying past in clots with each green light, and he looks like he's getting ready to bolt through traffic.

And finally, fortune smiles on us. As Baby Huey is half walking, half-trotting, he gets to a curb next to the corner lot, about twenty feet from multiple passing cars, and then Hallelujah! there's some sprinkler water runoff in the gutter. He hits it barefoot, slips, eats it hard, and he's down!

"Dogpile him! Now!" I yell, and four nurses and two techs all pile on Huey simultaneously, before he can manage to struggle up on his feet again. Everybody gets at least a limb, and I throw my ponderous bulk right on top of him, holding on, and laying there like a big human sandbag to keep him on the ground.

Now it's a stand-off. He can't get up, but we can't get off, or do anything more than throw our body weight on all his limbs. So we're just one big half-naked 14-legged mess on the pavement, looking like six guys at the rodeo, all trying to ride the same bull at the same time.

We dare not turn loose of him for a single moment, or we'll be doing this again somewhere else. If he makes it through traffic, now only a  bare couple of yards away from where we're all playing on the ground.

A couple of early risers and even homeless people at the kwikie mart across the street see the ruckus, and ask if we need help.

"Yes! Call 9-1-1! Now!!!" we shout, holding on to the bull for far longer than the eight seconds in a proper rodeo. We're too busy to do much but maintain the situation.



"This was *not* in the job description!"

Finally, after something between one and five minutes, which feels like an hour, a black-and-white pulls into the intersection across the street. One of us risks letting go with one hand and starts waving frantically. We're rewarded with flashing lights, and the growl of a Dodge Charger coming right towards our melee at full throttle.

A squeal of brakes, and Officer Tackleberry comes flying out and lands on top of the huddle.
It still isn't close to enough, but it helps. A bit.

"Hey, guys. How's it going?" he asks with a big grin.
"We've got to stop meeting like this." I wisecrack right back at him.
We all giggle a bit, and the wrestling match continues.

As Tackleberry calls on his radio for more back-up, we try to get better control of Baby Huey's arms, and start s-l-o-w-l-y moving them to where Ofcr. Tackleberry can get a handcuff on a wrist. It finally gets there, and the first cuff goes on with a satisfying cl-click. But we can't get Baby Huey's other ponderously large arm anywhere near close enough for the second half of that act. But we're still holding him down with all our might, and he's tiring, ever so slightly.

Tackleberry reaches for his second set of handcuffs, just as his sergeant rolls up, and joins the festivities. Finally, we manage to get a cuff on wrist #2, then click the empty cuffs in each set together for the win. While Tackleberry and Sgt. Dooright do cop stuff with the locking mechanisms, we concentrate on keeping Huey from kicking anyone, and keeping his head protected from the pavement, because he's now trying to beat his way through the asphalt, forehead first.

Finally, a fire engine and a paramedic ambulance arrive. They throw a blanket under Huey's head, and it takes six hospital workers, both cops, and four of six firefighters to roll, lift, and place Huey gently on the ambulance gurney, velcro his limbs to it, buckle him in, and lift the whole package up and into the ambulance for the return trip to our ER, several blocks away.

A couple of our guys ride in the ambulance with the paramedic, and everyone who came in a vehicle drives to the ER.

The other four of us hoof it on foot back home, exchanging high fives and fist bumps, amazed that we finally wrangled our wayward guy without anyone getting seriously hurt, including Huey.

We beat the medics and PD to the ER by a couple of minutes, and then do the whole thing in reverse to get him into the ER from the ambulance. Per doctor's orders, we've already got a sedative ready for injection, which is given to Huey on the stretcher.

Once it kicks in, and he's too groggy to resist, it once again takes ten+ people to detach him, lift, and move him to our hospital gurney, and secure him until he's fully out.

And tell the story you just read to those left behind to mind the store, while we were out and about on the Great Crazy Patient Hunt.

Once things calm down, we pull some extra labs on our psych guy. The doc's worried there might be some controlled substances on board, but we also do basic blood chemistry.

The reward is finding out that Baby Huey was probably wandering the streets for days, and not drinking enough water. And no drugs on board, just plain nuts, but he's in pretty severe rhabdomyolisis. Which means his body, without any food to eat, is eating itself, and overloading his kidneys with toxins from muscle breakdown to very near the point of organ failure.

Baby Huey's not just batshit crazy and off his meds; he's very, very sick. We get multiple IVs going and start blasting him with the fluids he hasn't bothered to drink for days. Instead of going to psych placement, he needs to go to ICU that morning. I catch up on all my other patients, and now I inherit care of Huey, who's waiting for the next ICU bed. We squeeze in a full debrief for the night house supervisor, and a multipage multi-person incident report, in between patient care. Huey spends a week in the ICU, calm as a lamb, getting his psych meds every day, along with the meals and water he'd skipped in the tsunami of crazy he was living running around on the streets for days. He gets everything else he needs, until he's medically cleared for a psych hospital to pick up the ball. (They don't do medical problems, and we don't do crazy, so he has to be in great health everywhere but between his ears before they'll take him.)

So in a group effort, police, fire, EMS, the ER, and ICU save his life so he can come back to planet earth.

He could easily have been hit by a car and injured or killed. He might have caused a crash that hurt additional people. The police, alone, even at 2 or 3 or 5 to 1 on him, wouldn't have been able to taze him or wrangle and wrestle him into submission. They might have ended up killing him given his strength and aggression. It would have made wide news release, and given them a black eye in ripples outward that would have lasted for months. And if we'd just let him go to catch another time, he probably would have had organ failure and died before he was found.

Instead, he was as fixed as we could make him before going to the psych hospital.
On my way out, I passed three guys from building engineering trying to put the Humpty Dumpty broken doors along all the main corridor back into operation.

We thanked the other wards whose people tagged along for the final victory.
I sent a personal letter of thanks to police and fire departments, and made sure they got to senior supervisory levels ("Dear Chief..."), not just a verbal attaboy from a shift supervisor, because they seldom hear the rest of the story, or get thanked by anyone for what they do every day.

They had our backs, and we had theirs, and instead of a tragedy, or multiple tragedies, we all saved a guy's life, and unknown other lives, in what turned into just another wild and funny story from an hour out of way too many years in the ER.

I could hardly wait to see what Night Three was going to be like.
But I'm pretty sure when I went home the next morning they liked my work so far.





*{Not his real name. Or hers. Or xe's. In fact, maybe none of this ever happened, and I just hallucinated it all. Duh. HIPPA, bitchez.}