My first few days………
Just five minutes, a quick coffee and a ciggie then back to the ward where I was able to let myself in as I’d been given keys and a swipe card for the downstairs door. Derry had gone into Management Round which, I was informed, happens each Monday morning. Apparently, this is where the Doctors plan ward round allocation of patients, who are normally seen on a weekly basis.
The phone was ringing off the hook and there was no one else around to answer it so I gingerly picked it up, saying ‘Good morning, Lavender ….’ A female interrupted and spoke urgently “Why is my brother off the ward? He’s banging on my front door and all the bloody neighbours are out on their doorsteps. What’s going on?”
“Uumm, good morning. I’m a student nurse. Do you know who you want to speak to, which nurse?”
“Someone who knows what they’re fucking doing would be good.”
“Ok, what’s your name and your brother’s name …..”
“It’s Pauline Kennedy calling and my brother is John. He’s screaming through the letterbox now, can you hear him? Fucking arse”
“Pauline, hold on a second.”
“Not you, him, sorry.” I’m glad she clarified that cos I’ve been called some names in my time, but that was a new one. “Ok, Pauline, give me a second, would you like to hold on or shall I call you back?”
“No, I’ll hold…” she tutted. I dashed up the corridor, knocked the door to the meeting room and popped my head in to tell Derry and the Doctors. “For fuck sake.” Derry’s Irish brogue rang out and “Has she called the police?” enquired one Doctor, the elder out of two. But Derry was out the door, heading for the office and I followed.
“How’d he get out?” Derry muttered to no one in particular. “Hello Pauline, it’s Derry here. Is he still there? Have you called the police? Aye, I know but okay, I’ll do that. You just keep yourself safe and I’ll call you back in a wee minute.”
“Jesus, we’re in trouble now. This guy used to live with his sister and he’s paranoid about men wanting her, that they want to have sex with her. He’s already done time for smashing the electricity man in the face with a brick after the poor man went to check the meter. John’s on a Restriction Order (1) so he is.”
“Here, you call the police on this number and let them know what’s going on. Pauline’s address is there,” urged Derry, pointing out a page in John’s file. Alison had just come into the office and I could hear Derry filling her in while I spoke with the police. I was a bit nervous, having never been in a situation like this before, but I was able to give all the necessary details to the police.
Derry, bless him, winked and gave me the thumbs up while he was on the other line to Pauline, letting her know the police were on their way. At the same time, she’d told Derry that John was quietening down a bit. The two doctors; the Consultant Psychiatrist and an SHO (2) appeared at the office door. “Everything alright Derry, Nancy? Oh, hello Nancy. Sorry, I’m Doctor Shand and this is Doctor Wiles. Do we know what’s happening? Let me know when he’s back on the ward please.” he smiled and left.
“Good job there Nancy. Will you just write in his notes; what happened?” Derry asked.
It wasn’t long before the ward door opened and I could see John being led in by the police and half a dozen people who, it turns out, are part of the Hospital Rapid Response Team (RRT), called to assist in emergencies like this. John shuffled in, head down, looking shame-faced and went to the smoking-room while a police officer spent a moment with Derry then led his team away.
The RRT was a team made up of six-seven people, mainly men it seemed, one from each of the wards, who responded when a bleep and the radio sounded, telling them where to go. On this occasion, they’d been called to the hospital entrance when the police arrived with John to escort him back to the ward. The Team had now followed Derry into that tiny office and, being a bit nosey, I went to the smoking-room where I offered John a ciggie. I’d cottoned on that ciggies were the currency used if you wanted to engage a patient and this time was no exception.
However, sitting between John and another patient, who’d introduced himself, with a cut-glass English accent, as James and asked for a ciggie, I felt decidedly uncomfortable. John was muttering he wanted to kill someone and James was bouncing back and forth in his chair, fists balled tight. I was wondering how I could finish my freshly lit ciggie and make my exit back to the relative safety of the kitchen without bringing too much attention to myself. Just at that, the door opened and Derry said “Come on John, you need to take your meds.”
“Nope!” John had no sooner hurled back at him when the RRT burst in and launched at him, grabbing him by his elbows and wrists, pulling him up out of the chair and on an authoritative command “Down!” to the floor. John was yelling “Fucking bastards. You fucking wait.” and struggling among the fag butts and drink slops, battling against the five staff holding on to him; one on each arm, one on each leg and one at his head. The person at his head was talking to John, calmly telling him what was happening, that it was for his own good and that he was okay. “Keep still. You’re safe.”
Hell, this didn’t look okay to me. Alison came in with a small cardboard tray holding two half-filled syringes and waited while someone pulled John’s jeans and boxers down about six inches. My heart was pounding and my eyes felt like they were on sticks as Alison swabbed an area of John’s right buttock, then said “A sharp pinch John.” she calmly popped one needle in and squeezed followed by another.
I would later learn that the intramuscular injections they’d administered was what nurses called ten and two; ten mg of Haloperidol (3), and two mg of Lorazepam (4) which, together create sedation quickly. This combination of drugs is normally used in the management of acutely disturbed patients? However, a patient unknown to the hospital or a smaller person i.e. a female, would be given a reduced dose of 5 mg of Haloperidol and 1 mg of Lorazepam in the first instance.
RRT held onto John for a few minutes and he eventually stopped struggling. Derry said “You good John? Come on now. We’ll let you up. Easy now.” They helped him to his feet and one by one, limbs were let go and the team dispersed. “Into the office boys and girls,” Derry continued, as if nothing had happened.
There was a quick debrief, where I learned that no one was taking responsibility for letting John out. I’d only been given the keys prior to my ciggie break and he certainly didn’t leave with me, despite the knowing glances I was getting from the ward team. However, the team agreed that the Control and Restraint (C&R) had gone well and no one got hurt, so the RRT left the ward.
Derry and Alison were both busy documenting the incident in various forms, so when I heard that someone had to complete an incident form, I happily offered. They chatted away, telling me that John had missed his morning medication which included ten milligrams (mg) of Diazepam, known to have a sedative effect, hence the paranoia and visit to his sister’s.
Alison held her hands up as she’d done medication that morning and she’d missed this. She insisted I document this on the incident form but I showed them both my documentation where I’d written, “John was seen on the CCTV leaving the ward at 08.10, just as medication was being administered and therefore did not have his medication.”
“Well done Nancy. You checked that yourself, did ye?” I grinned from ear to ear when he half-joked “You’ve got the job.”
(1) A Restriction Order is when Criminal courts can use section 37 if they think you should be in hospital, instead of prison. Section 41 is a restriction order. The Crown Court can add this order to a section 37 if they think you are a risk to the public – Section 37/41
A section 41 Restriction Order can be added to a section 37. It is then called a section 37/41. Only a judge in a Crown Court can do this. They will do this if they think you are a risk to the public.6 The restriction order means that there are restrictions on both you and your Responsible Clinician (RC). One restriction is that your RC needs to get permission from the Secretary of State for Justice to discharge you.
(2) SHO – A senior house officer (SHO) is a non-consultant hospital doctor in the UK. SHO’s are supervised in their work by consultants and registrars. In training posts these registrars and consultants oversee training and are usually their designated clinical supervisors.
(3) Haloperidol helps you to think more clearly, feel less nervous, and take part in everyday life. It works in the brain to treat schizophrenia and has a sedative effect within ten minutes It can also help prevent suicide in people who are likely to harm themselves. It also reduces aggression and the desire to hurt others. It can decrease negative thoughts and hallucinations. https://www.webmd.com/
(4) This medication is used to treat anxiety. Lorazepam belongs to a class of drugs known as benzodiazepines which act on the brain and nerves (central nervous system) to produce a calming effect. This drug works by enhancing the effects of a certain natural chemical in the body (GABA). https://www.webmd.com/