I once walked onto my shift seeing 5 security guards sitting on a patient. I heard his screams first. He was yelling, “I’m going to fucking kill you!” Over and over again. I know this might sound dramatic, I know it might sound absurd. But as I loaded my belongings into my locker to start the day at 7 a.m. I barely flinched. In fact, I think I might have sighed. It was a situation that I had seen too many times and it did not scare me anymore, it just made me downright tired. I came around the corner to see exactly what the commotion was about. There, I saw my coworker standing outside the room, face as white as a sheet. I overheard her say, “It was 4 a.m. and I told him breakfast did not come until 8 a.m.” Most of us would not threaten to kill someone out of hanger. But what about a man who had been shot in the head? A man who had a restraining order against him from his own family? I suppose that kind of man might. I sat down to receive report from an older colleague of mine. She gestured toward my coworker being screamed at and then muttered to me, “That nurse let her team down today.”

          The Neurosurgery team of residents insisted that the patient was not always violent. Apparently, the violence was secondary to being shot in the head. I wondered how someone this angry could have been any different before his affliction. Was it that he was an incredibly kind man who just happened to have many restraining orders against him? A gentle and caring man who was mixed up with some gang whose wife feared him? It was my first year out of nursing school, and I believed everything that anyone told me in the hospital. I would absorb every piece of information and cling to it for dear life. Neurosurgery telling me this patient was only violent after being shot in the head was the first time that I questioned whether doctors really did know everything.

          Amy told me what had happened that shift after a series of disparaging comments which had been directed at her regarding the incident had surfaced. She started her shift like any other night, at 7 p.m. At around 2 a.m. in the night, the patient had woken up and asked for food. Amy informed him that there was no food to be had and he begrudgingly went back to sleep. Then, at 4 a.m. the same thing happened again. He awoke and asked for some food. Amy, a little frustrated, responded more defiantly that he would have to wait. Unbeknownst to Amy, the night shift nurses had been satisfying his cravings by storing food in the mini fridge behind the nursing station. They had purposefully kept the fridge stocked to ensure that his behaviour did not escalate since he did, after all, have a violent past. I guess nobody had told Amy this vital piece of information and she did not want him developing bad habits in the hospital. Usually, if one nurse appeased his hunger at 4 a.m., then it would become an expectation and we don’t have food lying around on the unit. Unfortunately, Amy’s denial of his request sent him into a full-blown rage. She had no idea what kind of monster was about to be unleashed. He immediately attempted to stand but thankfully one wrist remained restrained to the bed after the other wrist had been freed. He ripped his IV out of his arm, grabbed the IV pole and threw it at Amy with all of his force. This man was over six feet tall and was pure muscle. Like the Hulk unleashed, he began trying to untie his other restraint. Amy dodged the IV pole and immediately called a Code White. The hospital has a series of codes, the white one means violence. Security arrived a few minutes later. 5 security guards, all under the age of 25 and unarmed by the way, tackled this man and attempted to pin him to the bed. Even though he was restrained on one side, he was flinging security off of him. Finally, security managed to pin each limb down to the bed while 2 officers sat on his torso. Just when they thought they had him under control, the patient spat right into the eyes of one of the officers. Patients who spit, not just dribble or drool, are called spitters. Spitters usually have an incredible ability to wield their saliva as a weapon, shooting it far and wide and hitting anyone in the way. This man was a true spitter. With 7 officers now on the man, he began screaming, “I’m going to fucking kill you!” at Amy. This is when I arrived to the unit at 6:45 a.m. Meaning this altercation lasted about 2 hours.

          My colleagues saw Amy as wrong. They said she should have just given him food, who cares if it is 4 a.m., the man is violent. They felt her actions jeopardized not only her but all of her coworkers including security who were working that night. I suppose on some level they were right, but I could not help but feel bad for Amy. Nobody had told her about the food supply in the mini fridge for that patient. In many ways, she was attempting to set boundaries so that he would stop asking for food overnight. So that he would not bother another nurse with the same question.

          Alas, that is how it is being a nurse. Sometimes your decisions pay off and sometimes they don’t. Making one false move in the hospital can be detrimental to both patients and health care staff. Want my opinion? That patient should never have been allowed on the unit without 24 hour security in the first place. But of course, we assume that nurses can handle everything. I was even more frustrated to learn that the Neurosurgery team had banned sedatives for that patient. It is difficult for them to do their assessments accurately when the patient is drowsy or sleeping. However, what is more important? The nurse or the patient? When he was unsedated he was violent and dangerous. Neurosurgery does not spend 24/7 with the patients, they visit for a few minutes and leave if the patient is aggressive. The nurses are forced to spend 12 hours at the patient’s bedside. Should it not be the nurses decision if the patient is sedated? After all, Neurosurgery used our assessments.