Nikhil Joshi, M.D.
Doctor, Author, Leader
Nikhil Joshi is a young physician, writer, and speaker. He is passionate about furthering his ability to touch the lives of people positively.

The experience of violence

The experience of violence

It’s Nurses week so I thought I’d share a memory.

I was the senior resident for ICU and was on call. The ICU is at once a comforting and intimidating place. It’s one where you can do so much, but the question you often have to ask is should you? I was happy. The night was unexpectedly light and I had gotten a power nap in before call. Ring the bell and let’s go.

But there was a transfer coming in. And this one was going to shatter my night and lay an imprint on my mind that was never going to leave.

The patient had taken a great deal of cocaine and was known to be in an ‘agitated delirium’ which was medical speak for too violent and medically unstable for jail. So he was coming to us. I was talking to the team about it. We were trying to make light of it but were also running over our game plan.

It didn’t matter though, because we had Hannibal Lecter making an appearance.

Handcuffed to the bed and frighteningly strong he strained against it with bloody wrists, screaming. First at the male nurse, ‘John’, who would be looking after him. ‘You fucking faggot I’m going to kill you’ he yelled. To his credit my co-worker didn’t outwardly show any emotion. But I knew he was frightened. I sure as hell would have been if I had to look after him alone all night. Little did I know what John and eight other nurses, four security guards and three other doctors had signed up for that night.

John’s cool. He kept doing his job as if he never heard this guy. I told the patient to calm down in my best dulcet tones. ‘You fucking Paki, once I get out of here I’m going to fucking murder you you brown motherfucker’ he spit at me. ‘Actually I was born here’ I joked, hoping that maybe what Charles Manson needs is a little comedy. A little Patch Adams and this man might not murder us all. But this not being my first day on the job I smile at the team and say pleasantly ‘Haldol please’.

5 mg, 10 mg, 15, 20, 30? Really doesn’t seem like Haldol has anything on crack cocaine and bath salts.

We call my staff person in. She’s the best physician I know. Intelligent and compassionate, she’s the one I’d want looking after my family in the ICU. But even she is blown away by the sheer violence of this man. Other medications are trialed. The screaming goes on and on and on. The hours feel like days. There are so many moments where it seems like he’s going to actually break out, and beat up 8-10 people. My staff person says ‘let’s get anesthesia’ and at that moment I know even she’s blown away by the magnitude of violence resonating from this man. Suddenly he does break free and grabs one of the nurses. Hands quickly wrestle the stray wrist down, but it’s only a matter of time. ‘Propofol’ my staff person says putting her hand out. John hands the syringe and finally, we have an end to the violence.

Anesthesia arrives while we are bagging, a tube is put in and the silence sinks in. The pulsing angry center is no more. All that’s left is the rawness of the experience, the weak legs and dry mouths. The anger, sadness and compassion that make the whole thing so complicated.

We all take a break after the sedation is administered and the ventilator is hooked up. I have to get out of there; it was just so fucked up. I’m shaking. I go upstairs to hang out with the floor nurses and they have one look at me and knew that I was there for the three code whites. They don’t ask me questions, they make me sit in a chair and bring me cupcakes and water. They make light conversation. They don’t pry and effortlessly give me compassion, because this is an everyday reality for them and they’re wonderful people.

I go to the fifth floor to find B. She holds my hand. She knows. She’s just so cool and understands me so well. She’s such a bad ass; she could save a life or heal a broken soul. And she did both that night. We share a cigarette to calm my nerves. Retrospectively probably shouldn’t have smoked as I ended up getting cancer, but at the time it was an intimate act of compassion that helped me get through the night.

I go back to the ICU. My staff graciously offers me the opportunity to go home. I smile but politely refuse. Weakness was something I couldn’t stomach. Besides I was afraid, and the things that you fear are the things you must do quickly before the fear builds. I sat with John and our patient for the rest of the night, listening to the beeps and whistles of the unit until the night became the day.

While this was a bad case it’s something horribly common for nurses. Nurses are often victims of workplace violence, with frightening regularity. This story probably doesn’t even scratch the amount that others can spin out to you. We don’t talk about it nearly enough. It should be unacceptable. We should celebrate Nurses week by increasing the safety of our hospitals and emergency rooms. And if you do nothing else this week, then maybe ask a nurse for their story.


9 Responses to “The experience of violence”

  1. Asem

    That is some amazing writing
    Thank you for sharing

  2. Lindsay BNRN

    Thank you Dr. Joshi, it was a pleasure to work with you the few times I was lucky enough to.

  3. Bernice Sutton

    Thanks, I worked 17 years in ICU, I definitely can relate to this story. I enjoyed ICU, great nurses and Drs for sure

  4. Jenn NP

    Unfortunately, an accurate depiction of nursing reality. Well said. Thank you Dr. Joshi

  5. Katherine

    You’re absolutely right – we don’t talk about this sort of stuff often enough nor the impact it has on people. Thank you for sharing your story.

  6. Sandy Snyder

    I was a CNA for years and know what its all about. I worked a long time in nursing homes it really gets crazy at night. You are right we dont talk about that part near enough in fact Ive never told anyone about being afraid to go into some rooms at night.

  7. Pat Rodgers

    Remember it well.

  8. Joanne Smyth

    When I was a new grad I was intruduced to the DT experiece. 1 minute all was calm the next Mr S was naked blood pouring from his dislodged lines .Roaring like a caveman and coming at me with his shattered glass iv bottle. I was rescued by more experienced hands but not before I took a punch to the mouth. I was now angry. All I have to do to remember this event is look at my wedding photos as I was married 1 week later.

  9. Mr & Mrs Smith

    Respect Dr. Just for being aware of this reality. As a social worker we have our share but with many friend psychiatric nurses Ive heard all their stories and we share many clients. There are so many ways they could be made safer and should be.

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