Code White, Code Flight!

I remember when I had planned my first solo trip on the whim in 2018. I was working an evening shift in an internal medicine unit, on my birthday. Yep. Like every nurse, I was hoping that the shift would go smoothly. And hoped I did, without success.

They say that when a patient makes inappropriate/derogatory remarks or acts, health care providers should not take it personally. After all, their vulnerable state or their health condition may explain their conduct. Although I agree with such statement, there are exceptional cases that overstep the boundaries of even the most resilient person. In those circumstances, ignoring the frustration brewing within is no longer possible, leading to an explosive outburst (which hopefully occurs out of sight of patients, or in the comfort of the break room, your car or your home). In my situation, the pent-up anger that increasingly grew throughout my shift led to a “YOLO” attitude. With the swift click of a button, I had booked myself a solo trip to Iceland after my shift. Two months later, I was in Reykjavik, bathing in waterfalls, natural pools and my own peace of mind.

I’ve had my share of patients with interesting characters. I’ve been insulted, thrown racial slurs at, physically hit and spat on. Strangely, looking back on the situation, what my patient had done on my birthday was not as intense as the previously stated types of attacks. However, this elderly frail-looking woman knew exactly which buttons to push to shake up my happy birthday vibes. Mrs. S. was a thin woman with a slightly hunched and petite stature. She had come in for an acute COPD (chronic obstructive pulmonary disorder) exacerbation. During my shift, Mrs. S wanted to go out for a smoke despite having a nicotine patch on. With no one available to accompany her, and after speaking to my charge nurse, I tell her that it would not be possible for her own safety. Evidently discontent, she raises her voice at me.

Mrs. S.: “It’s not fair, it’s my right!”

Me: “I know you’re upset but no one can bring you downstairs right now. I also need to insert a new IV line in you to give you a magnesium replacement. It’s going to last 5 hours. I can’t have you going outside with the IV pole by yourself in your state.”

Mrs. S. rolls her eyes at me and looks away. I step out to prepare her meds and gather the equipment necessary to perform my tasks. As I re-enter the room, her roommate (she was in a two-bedded room) is sitting at the edge of her own bed with a frightened look on her face. I look at Mrs. S. who appears as though nothing had happened; I must admit, she did have a stellar poker face.  A few seconds later, I notice the scent of smoke subtly but affirmatively activate the cilia of my nares (dramatic much?).

Me: “Did you smoke?”

Mrs. S.: “NOOoooo …”

I look at her roommate.

Me: “Did she smoke?”

Roommate: -nods yes with a scared I-don’t-want-to-be-involved-in-this-please expression-

Mrs. S.: “She’s lying!”

I make my way to the bathroom, open the door and get bamboozled with strong CO2 vapors. I confront Mrs. S. about it again. She continues to deny the allegations. I then ask to search her belongings, which brings about her defensive stance. She then admits that her son came by earlier during the day to drop off a pack of cigarettes for her. As I insist she hand over the cigarettes and lighter, Mrs. S. holds on to her small purse like her life depended on it. I explain to her that smoking is prohibited as there is oxygen all around, increasing the risk of fire. Additionally, I tentatively use reverse psychology by telling her that smoking in conjunction with her COPD worsens her condition, thus increasing her length of hospital stay. Having been a heavy smoker for several years, this tactic leaves her unfazed; she is adamant on keeping her purse. I then advise my charge nurse of the situation. She involves security who then, after multiple tries, finally got her to hand in the goods.

After the ordeal, it was time to insert the IV. My charge nurse had suggested I discreetly apply an alarm bracelet on her as Mrs. S. was a “flight risk” (to leave hospital grounds without authorization). I go back into the room and attempt to insert the IV line. With much grudge, Mrs. S. observes my every move with scrutiny. After my first failed attempt, Mrs. S. says “Which school did you go to? You clearly are not competent to do this”. On the outside I remained professional. On the inside, … not so much. Prior to getting help from another colleague, I apply the alarm bracelet quickly, using the presence of an error on the previous ID bracelet as an excuse to execute the deceitful act. Once my coworker installs the line successfully, Mrs. S. squeezes in a snarky remark that decreases my tolerance level towards her. “See, you’re competent. Why don’t you teach her how to do this?”. I walk away to the nursing station to catch up on my nursing notes for her and my five other patients, and to give myself a breather.

An hour passes by when suddenly the elevator alarms go off. “Gosh dang it!” I think to myself. My charge nurse and I get up and see Mrs. S. using her IV pole as a walker and corners herself in the elevator. “Come out now, Mrs. S. You’re not going downstairs.” says my charge nurse. “NO!”, Mrs. S. says furiously. The alarm bracelet she is wearing deactivates the elevators and sets off a loud noise, rendering an escape quasi-impossible (access to the staircase requires a pin that is only known by staff). Hence, with failed attempts at de-escalating the situation and changing Mrs. S.’s mind, she remains in the elevator with magnesium running through her veins.

“Code White, 8th floor at the elevators” is heard over the hospital’s intercom. Within a few minutes, the Code White team appears. A Code White is used to signal a violent or aggressive individual that poses a risk to others, or themselves. Once called, a “show of force” (essentially, intimidating-looking and strong personnel throughout the hospital) is summoned to aid in handling the individual in question. Three men and one woman show up in attempts of getting Mrs. S. to collaborate. The woman PAB (patient attendant) recognizes Mrs. S. from the psychiatric unit and manages to convince her to step out of the elevator. Finally, some calm … or so I thought.

When I am about to pass the bedtime medications to Mrs. S., with her magnesium infusion now completed and free from tubings, I see Mrs. S. lying on the floor beside her bed.

Me: “What are you doing there?”

Mrs. S.: “Leave me alone! Get out!”

At this point I do not fight anymore but rather walk away. As I am preparing medications, one of my coworkers sees my frustrated expression and asks if everything is okay. I briefly tell her about Mrs. S’s tantrums throughout the shift. She then offers to be the one to give her meds and manages to get her back in her bed.

So that’s it. Although it was a frustrating shift, I do not regret it one single bit. In fact, it is thanks to Mrs. S. that I have gathered the courage to go on solo trips since then.

Until next time,

Love from Aruba,

Cristine