By Susie Branagan, BSN, RN
I was working on a medical-surgical unit when a patient pressed the call bell and asked for help getting into the shower. I had walked a hundred patients into a hundred showers. Nothing about walking into that one felt unusual.
His room was private and far down the hall from the nurses’ station. Private rooms exist for many reasons. They also put distance between a nurse and help. I was not thinking about that distance. I was thinking about my patient.
I remember the smell before I remember anything else. Alcohol withdrawal has a smell. It is the smell of a body doing the hardest work it will ever do, and I knew what it meant before I reached the doorway. He was in a medical crisis that had taken hold of his body, his emotions, and his ability to regulate any of it.
He was unsteady as I got him out of the bed, (something I am used to with most patients) and every movement cost him more than it should have.
Then he started laughing.
It was a real laugh. His whole face opened with it, wide and delighted, the first easy thing his body had done since I walked into that room. He was looking past my shoulder at something behind me, and whatever he saw there made him happy.
I turned around. There was the door, and there was the mirror over the sink, and in the mirror, there was nothing but me.
When I turned back, he was still smiling. He had a face like a folded map, deep lines running everywhere, and the tears were coming down through them, catching and dropping and catching again, working their way to his jaw the way a ball works its way down a pinball machine. His eyes were wide, pale as ice and shining wet, and they were not looking at me. They were fixed on a point about a foot to the left of my head. And they were tracking. Whatever he was looking at was moving.
One of his hands came off of my arm and reached past my shoulder into the empty air, fingers open. He held it out there and he waited.
Then, out of the blue he asked me why I left him. His voice had changed. It had gone quiet and much younger, the voice a man uses with someone he has known for fifty years.
I told him I had not gone anywhere. I was standing right there.
He said, “Clara. I was supposed to go first. THIS WASN’T THE PLAN!!”
I understood then that he was not seeing me. He was seeing his wife. She was standing somewhere in that room that I could not get to, and he had been carrying that conversation with him longer than I could imagine.
I did not correct him. There was nothing in that moment a fact could have fixed.
I said, “I know. I’m so sorry.”
His hand came down out of the air and found my forearm and held on. For a few seconds the room went quiet, and it was the two of them in it, and I was only the pair of hands holding him up.
Then she was gone. I watched it happen. His eyes stopped tracking and went flat, and his grip on my arm changed, and the joy went out of his face and came back as rage. The swearing started there and it got louder.
The laughing I could work with. It was the anger underneath it that put the hair up on my arms.
My nursing brain went where it always goes.
He is sick.
He is not choosing this.
Stay calm.
Help him through it.
Those thoughts were not wrong. They were the reason I was in the room. But while I was working to understand what was happening to him, I also had to account for what was happening around me.
As we moved to the shower area suddenly the shower curtains came down as he grabbed at them. The sound of the plastic tearing filled the small space and made it feel smaller. What had started as a request for assistance had turned into something I could no longer predict.
I was doing math I did not want to be doing. Where the door was. How far the call bell was. Whether he was between me and either one.
He was still a patient. He was still someone who deserved compassion. And I was still by myself in a private room, far from support, in a situation escalating past what I could safely manage.
My first thought was not to call for help. My first thought was to fix it.
Nurses are trained to walk into hard rooms. We are expected to bring calm into chaos. We are who families look at when they are frightened. But somewhere along the way, many of us absorbed the idea that needing help means we could not handle something ourselves. So we pause. We question whether we are overreacting. We wonder if one more attempt would have worked.
I hesitated for about ten seconds, and I knew exactly what was in them. I had already decided the room was unsafe. I spent those ten seconds deciding whether I was about to embarrass myself.
Then I moved my hand to the discreet duress button on my badge and pressed it.
Another nurse peer was there at lightning speed. She did not run. She did not bring a crowd. She walked in, took one look, and stood on the opposite side of the bathroom doorway from me. My shoulders came down before I had time to decide to let them.
That was the whole intervention at first. One more licensed set of eyes in a room that had gotten too big for one person. The room was safer inside of ninety seconds. Two nurses do not double the capacity. They divide the crisis.
We split it out loud, in front of him, in plain language, because he had a right to hear it. She stayed at the door with a clear path out for both of us. I stayed with him and kept my hands where he could see them. Neither of us put ourselves between him and open space. Neither of us got boxed into the corner by the toilet. That decision took four seconds to make because there were two of us to make it, and it removed most of the physical risk in the room.
Then we could think.
She pulled in the shower chair and locked it while I got him seated. Sitting changed everything. He was no longer fighting gravity and losing, and a man who is not falling is a man with a great deal less to be furious about. She cleared the torn curtain and rod off the wet floor so we were not managing a fall risk on top of everything else. We eased him into the bed. I got a set of vitals.
His heart rate was 162.
That number ended the shower. The assessment we finally had room to perform told us he was in severe withdrawal and heading somewhere worse. This was undertreated withdrawal, and now we had the numbers to prove it. She stepped out and called the provider while I stayed with him. He was due for symptom-triggered dosing, his score had climbed, and nobody had reassessed him since the shift before.
That call does not happen if I am in that bathroom by myself. I could not have left him. I could not have stopped holding him up.
He had IV lorazepam, telemetry, and a provider at the bedside within twenty minutes. We made a safety plan that night.
Our plan was operational. Two staff in the room for all care until his score came down. The door stays open. Nobody positions themselves out of sight of the hallway. Both of us know where the other one is. The charge nurse knows the plan, and it stands for the rest of the shift.
He got his shower the next afternoon, sitting down, with two nurses and his dignity intact.
He did not remember much of the night before. He remembered being cold, and he remembered someone helping him. He apologized for language he could not recall using, and I told him there was nothing to apologize for, and I meant it.
The outcome for that patient was better because I asked for help. Not neutral. Better. He got faster treatment, a corrected medication plan, monitoring he should have already had, and a safer room. The second nurse was there so both of us could get what we needed.
Support brought in early is a clinical intervention.
What stays with me is not the button. It is the ten seconds before it, and what was in them.
I spent them weighing whether anyone would agree with me. Nurses are expected to be capable. We assess, we solve, we stay calm when nobody else can. Those are strengths. They become barriers the moment we convince ourselves that needing another person means that we fell short.
It does not. Recognizing that a situation has moved beyond what one person can safely manage is not a failure of nursing judgment. It is an example of nursing judgment.
The button did not make the decision for me. It gave me a way to act on a decision I had already made. Compassion requires us to see the person underneath the behavior. It should never require a nurse to ignore her own safety.
I have played the ghost wife more times than I would like to admit. I have been the mother, the brother who never visited, and a man named Dennis who I hope was somebody kind. You take whatever part the room casts you in and you say the line. I am not afraid of ghosts. I have worked alongside them for twenty-five years. They arrive at three in the morning when nobody else will, they never come for me, and they are usually kinder to my patients than the room is.
I was Clara for as long as he needed me to be. Then I was a nurse who needed help, and I spent ten seconds deciding whether I was allowed to say so.
That is what workplace violence prevention should look like. Help that arrives before a nurse has to prove she deserves it. An environment where she can trust her instincts and has the tools to act on them.