By Susie Branagan, BSN, RN
“I just want to use the bathroom like a real man.”
He was seventy-one years old and he had been in that bed for nine days, and nine days is long enough to stop being a man with a truck and a wife and forty-one years at the same company and start being a room number with a bag hanging off the side of the frame. Nobody sets out to do that to a person. It just happens to him a little more each day, while everybody around him is being very kind about it.
He was not cleared to be out of bed. He had a Foley and the bag was hooked to the frame, and when he stood up he took the bed with him for half a second before it tore out of him. Anybody who has seen that happen knows what it does. There was blood on the floor fast, and it always looks like more than it is, and it was still a lot.
Then he came at me. “I’m not going to hurt you. I just want to use the god damn bathroom like a real man. Now take me.”
I told him walking was not safe, and he had nothing left to argue with, so he put himself on the nearest available person instead. He got both hands on me and leaned. I am a small woman and he was going forward and he kept going, and the only thing between that man and the floor was my shoulder up under his chest and my shoes braced in his own blood.
I had already pressed the call bell, which is what you do, and nothing came back. So I pressed the duress alarm and I waited.
The alert went out in two seconds. That is in the log. It is a very good number and somebody was right to build a system that produces it.
We were the satellite hospital, out on the island, with the big house across the water. Two security officers covered the entire building that shift, and both of them were down in the emergency department on arrest watch with two prisoners handcuffed to two beds. You cannot walk away from a person in custody. Somebody had to go find two male aides, pull them off whatever they were doing, walk them down there, and hand off two prisoners one at a time before either officer could take a single step toward me. And I was at the far end of the unit, last room before the break room, which is the longest walk in that building from any direction.
Every one of those people did their job correctly. Nobody dragged their feet. It still took seven minutes to get a second body into that doorway, and seven minutes reads like nothing at all on a report.
Try it with a man on your shoulder.
I could not scream. A nurse screaming tells a patient that something has gone wrong, and the only thing keeping him on this side of it was that I was still acting like nothing had, so I talked to him instead. I asked about his family. He had a daughter down in Florida he did not see enough of and a son closer by who he saw more than he wanted to, and he told me both of those things while leaning on me hard enough that I could hear my own pulse in my ear. I asked what he did before he retired and he told me about the company, and I kept asking him things I did not need the answers to. He called me a name at one point and I let it go by. He told me to move and I told him I was working on it, which was true in a way he had no way to check.
Then I told him that if we were going down we were going down together and I hoped he had good insurance, and he laughed. This wet, worn-out sound with his chin somewhere near my collarbone, and for about two seconds he was a man having a conversation with somebody instead of a weight on her.
Then he went quiet and got heavier, and I understood he was not fighting me at all. He was leaving. Whatever had been holding that man upright was going out through the floor along with everything else, and every thirty seconds there was more weight and less of him, until he was folded over my shoulder at an angle gravity should not have permitted, and all I could think was that if he went down I was going with him and I was going underneath.
You do not count in a room like that. I could not tell you if I stood there two minutes or twenty. The log says seven and I believe the log. It is just not describing the same event I was in.
Somebody came, finally, and it ended the way these things usually end, which is that it stopped being an emergency and turned into a mess. Extra hands. A chair under him. Towels and then more towels. A new Foley later that evening that he did not want and that somebody had to explain to him twice.
Then he started apologizing. Sitting there in that chair with four people in the room and the floor cleaned up, he apologized for the language and he apologized for putting his hands on me, and he said he did not know what came over him, and he said it about six times. He could not look at me while he said it. He said it to the blanket. I told him there was nothing to be sorry for and I meant every word, and he nodded at that blanket and did not believe me, and I would rather have held him up another seven minutes than stood there watching a seventy-one-year-old man be ashamed of his own body in front of me.
The break room was eleven steps from that doorway. I know that because I had been staring down that hallway for seven minutes. I sat down in there and my hands started going, which they had not done once while I was in that room, and then I washed his blood off my shoes and went back out and finished my shift.
The technology did its job that night. The alert fired, it went where it was supposed to go, and it reached the right people in two seconds. Audit that system on notification time and it passes with room to spare.
Notification is one step out of about six. There is activation, then notification, then somebody working out where in the building you actually are, then somebody being free to leave what they are holding, then the distance, then the doors, and then finally a person standing next to you. We measure the two easy ones, call the result a response time, and put it on a slide.
What made those seven minutes was two officers for one building, an arrest watch nobody could walk away from, two handoffs, a corridor, and a room at the wrong end of a hall.
An alert is a message about help. A message about help is not a person in the doorway.
So buy the part that comes after the message. Ask how many people are actually free to respond at two in the morning, and where they are standing when the call goes out, and what they have to put down to come, and how long it takes to walk from the farthest room on that unit. Then run it at night, with the staffing you really have, and hold a stopwatch on it.
Somebody is going to be down at the end of that hallway holding a man up, and the only number that will ever matter to her is how long it took.