By Susie Branagan, BSN, RN
The report documented the assault accurately. Patient became physically aggressive. Security responded. Staff member received medical attention. Leadership notified. Statements collected, event reviewed, recommendations made. Everybody did their job, including the people who wrote it.
It covered four seconds out of a twelve hour shift.
The six hours that actually mattered are not in it, because there is no section of an incident report where you describe a waiting room, or a CT scanner, or a woman who stopped me in the hallway four times and never once raised her voice.
We had been over census since before I clocked in. Every admitted patient in the building was still holding a bed in my department, which meant the people arriving that night went to the waiting room and stayed there. By eight o’clock the waiting room had a woman crying in a wheelchair, a man who had been there since noon, and a family who had just been told something in the quiet room and were sitting very still.
I had six patients. I had not eaten. I had not gone to the bathroom since three. Every nurse reading this already knows both of those things without me writing them, which is its own commentary.
My charge nurse was carrying a full assignment of her own and rebuilding the board every hour as things changed. There was nobody standing around. There was nobody available. That is not a complaint about her. She was the busiest person in the department.
One of my six was a man in his fifties with abdominal pain. He came in at three. He was worked up by four, his labs were cooking, and he was waiting on a CT.
He waited on that CT for six hours.
It was not anybody’s fault, which is the part that makes it hard to write about. A trauma came in. Then a stroke alert. Then somebody crashed. Every time the scanner opened up, a person with a shorter clock got in front of him, and that is emergency medicine working correctly. Somebody always waits longer so that somebody else does not die. We just do not usually have to sit in the room with the person who is waiting.
His wife stopped me in the hallway four times. I was almost never at the desk that night, so she learned my route and caught me between rooms. She was never rude to me. Not once. She said excuse me, and she said I know you are busy, and she asked whether there was any update on the scan. The fourth time she stepped in front of me so that I had to stop walking. She put her hand on my forearm and she did not let go of it right away.
I have thought about that woman for years. I do not think she was asking about the CT anymore. I think she was asking whether anyone in the building understood what the last six hours had been like, and the only honest answer I had was that I did understand and I still could not fix it.
I went in around nine to tell him there would be another delay.
He was different. Not dangerous. Different. He interrupted me before I finished the first sentence. He threw his hands up, twice, and the second time he hit the IV pole and it rang. He was moving on the stretcher, shifting, sitting up and lying back down. His wife was on the far side of the bed with her hand on his shin saying his name in the tone people use on a dog that is about to bolt.
Nothing he was doing predicted violence. I want to be careful here, because I have taken care of hundreds of frightened, furious people who never laid a hand on anybody, and the behaviors are identical right up until they are not.
But I have been a nurse long enough to know the feeling I had, which was that I wanted one more person in the room. Not security. Not a code. Not anything that would have told that man and his wife that they had become a problem. One nurse, leaning on the wall, saying nothing.
I looked at the hallway on my way past the door and did the math. Six patients. A charge nurse with her own assignment. A department that was over census before any of us got there. There was nobody to ask and there was no way to ask.
So I did what we do. I decided I could handle it.
I told him I would get another set of vitals while we waited, because it was true and because it gave me a reason to stay in the room, and I leaned across the stretcher with the cuff in my hand.
He had gone quiet. I registered that as progress.
What I did not register, because I was reaching across a bed with four other patients running in my head, was that his face had emptied out. The frustration was gone. Nothing had come in to replace it. His jaw was loose and his mouth was slightly open and his eyebrows had dropped flat, and the whole thing had gone smooth in a way that a face does not go on its own.
He looked almost bored.
And he was not looking at my face. He was looking past it, a few inches to the right, at the side of my head where my hair was.
I got the cuff around his arm.
He took my ponytail in his fist and pulled down and toward him, and my head went to the level of his chest, and he hit me in the back of the neck. I do not know how many times. It is somewhere between three and six and I have never been able to make it settle on a number. I could not get my hands up because one of them was still on the cuff and the other one was on the rail, and every time I tried to lift my head he pulled again.
It was his wife who got me out. She came across the bed and got her fingers into his fist and pulled his hand open, and she was screaming, and she was screaming at him, and I have never forgotten that either.
I ran. That is the word. I did not walk out and calmly activate anything. I ran out of that room and down the hall and I did not stop until I was behind the desk.
Security came. My manager came in from home. The report was written, the event was reviewed, and my organization did everything it was supposed to do afterward. I am not writing this because anyone failed me after I was hurt.
I am writing it because everything that mattered happened before I was hurt, and none of it is anywhere.
The punch is not where the story started. The punch is only where it became visible. The story started six hours earlier with a scanner that was busy and a wife who kept catching me in the hallway and a department that had no slack in it anywhere, and it built the entire time while every single person involved behaved reasonably.
There was no villain in that room. He was not a violent man. He was a frightened man in pain who had been left in the dark for six hours and finally came apart, and I was the person standing closest to him when he did. His wife was the only reason I got out. She has to live with that night too.
Violence in healthcare almost never starts with violence. It starts with waiting, and fear, and a department stretched so thin that the one thing that would have changed the outcome, another nurse standing in the corner of that room doing nothing at all, was not available at any price.
The warning signs are the same things I see every shift. A family asking for another update. A man sitting up and lying back down. Somebody wanting to know why the test has not happened yet. Most of the time those are frightened people having the worst day of their lives, and treating every one of them like a threat would make me a worse nurse than I want to be.
But I knew. Standing in that doorway at nine o’clock, I knew I wanted somebody with me.
The question I have carried since is not what happened.
It is what happened in the six hours before, and whether anyone could have come if I had the right tools.