Photo with permission of Sharon Light
Some people reading this story might recognize the character Jack Solomon. “Jack” is based on a peer, mentor and a friend. Sadly, “Jack” passed away this week – a very profound loss to his family as well as the people he served and his colleagues and friends. Although all the stories in this story are made-up, clustered themes and impressions, based on the many, many people I have met in my work for over 35 years, “Jack” is true. I know that this is exactly how he would have handled the made up (but not uncommon) crisis situation in emerg. His compassion and skill were exceptional. His insights into behaviour and dynamics made him an invaluable advisor. He was humble about his practice and thought it was amusing that I wrote him into this story, although he was also tickled. If you knew “Jack” you will hear his voice – I hope.
That night I slept so hard I know I didn’t move. The temple chime roused me from pleasant slumber, like a dirty joke. I slid out from the covers, trying my best to leave Jody undisturbed and enjoy her rest. Moncrieff was begging for his chow and I had to get there quickly lest his wild cries wake everyone on the street. Last night I left my clothes for the day in the back room, so I wasn’t barging around getting ready for work. I skipped my daily yoga stretches, promising my right knee and my shoulders I would work them out later, after work.
I was running a bit late because I forgot that I needed to give at least a cursory shovel to the bank at the end of my driveway to get my jeep back on the road. I arrived just before report and had to hear Linda out in full Winter regalia, with Linda staring at my dripping boots. I had just uncoated and unbooted myself and dropped my belongings in the crisis office down the hall when I heard the distant shout: “Hey!” a split second before the crash. I knew to haul ass out onto the unit. Attention attention code white emergency department east wing; Attention attention code white emergency department east wing. Another crash. Everyone was in motion.
As I had learned in report, a young psychotic man had been waiting for transfer to the psychiatric hospital across town. It sounded as though he had lost his battle with being patient. I hadn’t spoken with him myself but Viv left info about him after she completed the assessment. Neither of us knew him but his record showed he had been treated on our mental health unit. Viv was also aware that early this morning he had accepted a second dose of medicine intended to clear his thinking, and calm his behaviour. As I turned the corner and saw he had in fact rocketed the side table across the hall, I concluded he likely needed a little more medicine.
In the immediate reality, what we needed was to keep him, all the other patients in the area, and all the nurses and physicians safe. At times like these, our hospital security runs to help out but they are reluctant to wrestle with people. Probably someone had already called the police. “What’s this guy’s name again?” I asked as I passed the care desk. “Dennis” came the reply from someone. “Call up to the unit and see if they can send somebody down here to help us out”. I suggested, although it probably came out more as an order.
“Hey, Dennis” I broke the hush with a firm but not too loud voice. “What’s going on? What can we help you with”.
Dennis was a slender man with shoulder length greying hair. He didn’t look that athletic but I was pretty sure he could take me. He turned and looked toward me, I saw everyone else freeze. “I can see something has pissed you off. How about we figure out what happened and find a way to deal with it, me and you, so nobody gets injured by flying chairs….”
“Let me out of here!” He screamed in a loud and desperate voice. His hands grabbed at the arms of the extra heavy chair and I was instantly grateful for the weight of those suckers.
My legs felt weak but I knew our best approach was to get him talking, so I took a fortifying deep breath. “Dennis, my name is Hattie. I’m a nurse here…”. He glared at me. I couldn’t tell at this point if his message was menace or fear. But he did stand straight and remove his hands from the chair.
“Dennis, listen. I understand you are angry and maybe scared. That’s not what we meant for you. I’m sorry. We want to try and help” From the corner of my eye I saw Jack from the mental health unit arrive. Jack Solomon was a tall, stout man with a ton of experience. His size was one thing that usually calmed a situation but more compelling was his gentle way of just being with a person. I’d seen him in action enough that I was glad to turn over the reins, especially since it didn’t look like anyone else was ready to step up. “Hey Jack.” I turned my head without taking my eyes fully away from Dennis and Jack pulled in beside me. “Do you remember Dennis? He told the nurses earlier that he had been up on the ward a while back.”
“I think I do remember you Dennis. My name is Jack” he said with a small smile and nod. Whether he did remember Dennis or not wasn’t the issue. Most importantly, now he had Dennis’s attention. And with little more ado, Jack walked toward Dennis and said softly “let’s figure this out Dennis. You know this has to turn around. There are some people here who are really sick, and really afraid. What’s been going on?”.
Dennis looked around the area warily. His eyes darted between Jack and me. He turned and saw the other nurses then turned toward the general care area where, as if on cue to prove Jacks point, a woman’s voice called out weakly from behind a curtained partition “What’s going on out there. Is everything alright?”
“C’mon with me” Jack said gently but with authority. “You want a juice?”
A plastic tub of hospital apple juice appeared by my hand like magic and I passed it to Jack. When Jack held it out, Dennis retrieved it. He turned and shuffled back into the specially designed safe room he had been waiting in before the kerfuffle. Okay, it was more than a kerfuffle, and it would require considerable reports and data entry, but it did appear to be winding down. Jack and I looked at each other. He side-nodded his head toward the safe room and I noted Jack’s intention to go into the room to talk with Dennis. A lot of nurses would not do this. Most would slam and lock the door shut and unleash whatever happened next. Jack was one of the nurses who understood the nature and importance of this kind of work and he knew not only his skills but his limits.
“Check for prn’s…oral is better…then join me”. Jack directed me, looking distinctly un-nervous and almost bemused but focussed. A ‘prn’ is a medication someone can take when they need it, instead of at a regular time. When someone needs the medication in their blood stream immediately, prn’s are given by injection. I understood Jack’s wish to go with an oral medication because at this point we didn’t want to lay hands on Dennis unless absolutely required. Once you hold someone physically, you are pretty much assured of a struggle.
Jack headed to the safe room under the watchful eye of Security while I held up my end of the bargain. As I approached the care desk to ask about meds, I saw the police had arrived. I recognized Pete Hamilton, an officer with whom I had shared the stage in a couple of presentations about partnering with police in crisis work. His raised eyebrows asked all the questions. The nurses ceased their excited commentary when they saw me. I had a sense they were furious about the disruption but unraveling that knot was work for another moment of this increasingly interesting day. “Thanks for coming out”. I smiled at Pete. He introduced me to Kevin, the other officer.
“Everyone OK?” Pete asked, looking at me but moving his eyes to the nurses, who had now resumed their duties, clearly distancing themselves from this incident, and me.
“We have a young man in there who is psychotic. He is meant for transfer to the locked unit at North Carter but we haven’t gotten the go-ahead yet to send him. I’m not sure what sent him over the edge but it seems like he flipped over some furniture and was quite disruptive. Jack Solomon, a nurse from upstairs, is in there with him now.” Since I knew the nurses at the care desk were listening I turned and asked “Is that how it went down, Linda?” The only first name I was sure of.
“Yes. That’s about it”. Clipped, with a serious glare.
“Can you do me a favour, Linda?” I continued without waiting for her replay. “Can you see if there is an oral prn for him – something to settle his behaviour, when he gets to his next stop at The North, they can work on the thought disorder. If there isn’t a prn order, can you see if the duty doc can give us one? Jack is pretty clear on it being oral. Thanks a million Linda.” I closed with a smile and turned back to the business at hand.
I faced the police officers “Do you cats have a little time? We might be able to convince The North to accept the transfer immediately, then you can help us get him there?”
Pete smiled knowingly “You take care of our friend. We will be right here, out of sight unless you need us”. Using police in this kind of crisis was one of the situations we covered in our public presentations, so I was sure glad to have Pete here. He knew that sometimes police are seen as a comfort to folks in crisis but sometimes their presence can escalate a situation. Since we weren’t sure how Dennis might react, he was right to hedge his bets.
When I returned to the scene, Dennis was sitting at the side of his bed, which in this special room had been bolted to the floor. Jack had taken root at the other end of the bed. Juli Ward, the duty physician had arrived and she was leaning against the doorframe in an attempt to look casual, while actually on-guard. “I can’t go today” I heard Dennis mumble. “Today is the seventh day after the seventh week…I can’t do it today”.
“OK Dennis, I hear you. Let’s talk about any way we can work around the date”. Jack was a genius. There was no point arguing with a guy who was psychotic, especially one who flips furniture!
Dennis didn’t expect this response and looked up at Jack, pursing his lips. He was thinking, as crooked as that thinking might be right at this moment. He held Jack’s gaze for a long time, and time was ticking very slowly right now. Then Dennis began to sing the gospel hymn: When the Roll is called up Yonder. We three stood riveted while he worked his way through the first verse then repeated the chorus three times. He was nearly out of breath by the end.
“I know that song, Dennis” Jack interjected before he could start off again. As pleasant as Dennis’ voice was, it was a little loud for an emergency department. “Why do you like it so much?”
Dennis began to speak in a rambling bent about his lifelong connection to the gospel church. He mentioned other favourite hymns. I was grateful he didn’t burst into song again. He just kept talking to Jack, who leaned forward in his chair and kept him engaged. Jack was putting on a clinic this morning; his management of this situation was exceptional. Juli was taking note. She likely knew she could leave but she seemed drawn to watch. Finally, Linda drew in beside Juli and motioned to speak with her. “Dennis, I’m sorry to leave this conversation but one of the nurses needs me to see someone else. Remember, this is a busy emerg and we have a lot of folks here who we have to see. If there’s anything I can do to help you through this wait, let me know. Or let Hattie or …. Sorry, I didn’t catch your name…” she directed to Jack.
“I’m Jack. From upstairs” Jack smiled and stuck out his hand in greeting. Dennis watched the everyday civilities unfold.
Juli shook his hand in greeting. “Jack. Thanks, Jack. We appreciate your help. Then she reoriented herself to Dennis. “I’m sure Dennis appreciates your help too. Take care and shout if you need me…”well”… she chuckled at Dennis, “how about don’t shout. Just let me know.” Miraculously, Dennis’s worried face eased into a sheepish smile and Jack and I laughed out loud. This may actually have been a little too much for Linda, whose frown carved grooves down her jowls. Nevertheless, Juli and Linda departed without incident and Jack and I were left with Dennis. “I asked the nurses if there was some medicine they could give you to help you with the wait.” I turned to Dennis.
“Ya. OK”. He muttered, unconvinced. “How long will it take?” Breakthrough!
I decided to experiment with the card up my sleeve. “Well, would you be willing to go with the police if they were available? Sometimes we can get them faster than the transport service.”
Dennis looked at me long and hard. He seemed to be measuring my commitment to him, or maybe it just felt that way. “That’s true Dennis” Jack chimed in. “Police get to run the lights”. Jack added with a smile.
“Sure.” Was all Dennis replied but his attention had returned to Jack.
“I’ll tell you what” Jack began a proposal to Dennis. “I will stay here with you. Hattie will get you some medicine to help you with the wait. She’ll check to see if the police are handy. And we can get you over to Carter North as soon as we can. Once you get there you won’t be cooped up in this tiny room and there will be other nurses who can get you settled in….”. I took that for leave. As I nodded to Dennis and walked away I heard he and Jack talking a little more about The North and what to expect there. Security stayed nearby to keep a watch out.
At the care desk Pete Hamilton announced: “The North is ready! When can we go?”
“Give us about 15” I asked trying to keep the ‘plead’ out of my voice. Juli Ward had come and gone from the desk but she had written an order for Dennis’s medicine. It was a tablet that dissolved under the tongue and delivered its effect PDQ. As a crisis nurse, I am not really meant to prepare or administer meds in emerg. Therefore I needed a quick and ready volunteer. I saw Linda walking toward us. “Linda, thanks so much for getting the Loraz from Dr. Ward. Dennis will take it now and then our friends here…” head nod to the officers “…will scoot him over to The North. Jack Solomon will stay here with him for the duration. Can you get the prn in to him quick?” Despite her reservations about the situation, Linda knew this was a reasonable approach and agreed. “Thanks guys.” I directed to the police officers, who were gracious players in this dance.
The rest of the transfer went smoothly. Linda delivered the prn. Jack sat vigil. Pete and Kevin smiled and introduced themselves to Dennis as the “cab drivers” and Dennis, in a calmer state of mind, was cooperative. “I know you had some medicine Dennis” Pete said calmly and he and his partner moved in close and placed their hands on Dennis’s elbows “let Kevin and I walk with you so you don’t trip or fall”. Brilliant! I owed these guys a coffee!
Jack took a moment to call over to The North admitting unit and explain what had gone down here and what to expect. He reminded them about the prn’s and described how Dennis had responded to calming and distraction. “All I can do now is cross my fingers…and maybe cross my heart” Jack’s baritone laugh was absolutely comforting. The work spun on around us. Jack was clear he had to get back to his own unit pronto. I just wished there was a chance to touch base with the folks working to see if there were loose ends. I saw Linda exit a curtained partition just inside the triage area. When she missed my wave, I asked Jack to stay planted for a sec and walked over to ask if everything was OK before we left.
“Fine. Now” was her terse reply.
“Funny Linda, it doesn’t sound that way from your voice”. An awkward, fruitless pause was the only response. “Jack has to get back upstairs and I have to get moving too, so I just want to see if there’s anything else I can do…”
“You’ve done enough”. Was the quiet icy blast through pursed lips. Before I could ask more, she turned wordlessly and slipped down the hallway.
Even though a ‘thanks’ wasn’t really required, it might have been nice. Not so much for me, I kinda belonged here but for Jack, who didn’t actually have to short his unit and come here to manage this problem. More than that, I had the feeling something else was going on and I wasn’t sure if or how much it involved me. Maybe not at all: maybe a lot. I’d have to check it out.
“What was that about?” Jack wondered when I got back to him.
“She said to thank you for coming to their rescue” I pasted a smile on that fib.
“Nope. She did not”. Jack said bluntly.
“What are you, the all knowing, all seeing Oz?” I tried to lighten it up a bit.
“Do I look like a little wizard to you?” Jack burst out with an emphatic laugh and stood facing me with his hands out to his sides, obviating his full figure. “Sweet Jesus Hattie. We mighta sent the wrong crazy person off with the cops!” Discomfort averted.
“Well, I do remember, for a fact, that you can be a fetching elf…” I laughed as I recalled a scene this past Christmas on the ward. Jack was wearing his usual attire, which included shorts despite the howling December winds, and topped it off with a green felt elf-hat with pointy ears painted on the sides. He meandered among the patients spreading well needed cheer interspersed with the odd blast against organized religion to the rest of the nurses. He worried the hat made it look like he’s ‘gone soft’ but we all knew he’s soft to the core.
His raised eyebrows signaled a wish to change the conversation before I outted his inner elf beyond the walls of the ward. So, changing the course a bit, Jack and I talked about which us would document what and I agreed to have Rudy call his supervisor to explain why he was pulled away, and for how long. We knew the Risk Manager would do a review as well, so our notes would have to be complete and timely. Once Jack’s elevator light was green as his elf-hat and the box was ascending I returned to the crisis cubicle and jotted a few notes and times so I could finish off my part of the report as soon as I was finished my tour of the other folks waiting for crisis assessments this morning.