Never Dull

A few weeks ago a patient turned south without warning. We'd been doing pretty well together, I thought, with some ups and downs. He's a very powerfully-built guy, but I hadn't had particular concern about my safety around him. Then one morning he wanted to talk, and we (along with an older male nurse) went and sat down in a small room off the unit. Almost instantly I realized I'd made a mistake-- he was glaring, his jaw rippled with tension, and his knuckles were white while his figners drummed the edge of his chair. He demanded unsupervised time out of the hospital. He told me I needed to give him a specific medication. He wanted extra cigarettes. He told me my name was not Dr. Turbo, he'd found out, and I knew damn good and well what he was talking about. He told me I was purposefully trying to poison him with Medication A, and that his liver and kidney were rotting due to my deceit. Was I afraid of him, he wanted to know? Hmm? I talked, stalled, tried to compromise, reason, soothe, use non-threatening body language-- but everything I said and did seemed to have diabolical, hidden meaning that made him even angrier. He moved to the edge of his seat. Several times, I imagined the attack that seemed almost inevitable-- a leap across the tiny room, a fist towards my head, maybe I'd be fast enough to slide out of the chair and get my clipboard in front of my face. Maybe the nurse would be able to grab one arm. Would other staff be able to get through the locked doors into the little chamber before we got pulverized?

There seemed to be a moment where he was distracted by a movement in the hallway, and I jumped up to open the door, saying "Let's head back to the unit." He tried to get behind me at the next door, but by making an elaborate motion of gentlemanly-ness (which included a half-bow that served as preparation to duck) I got him through first. Then, a long decompression back in my office.

Later he was transferred to a different ward. I saw him today at the snack machine. He smiled and reached out a huge paw. I looked in his eyes, saw trust, and took his hand. "Thanks Dr. Turbo," he said, "I'm doing a lot better. I'm going home tomorrow." We bought sodas. He shook my hand again. "Thanks again." Off he went. Not sure what the moral of the story is.