Chaos in the Mental Health Center
It was 1978. I was a medical student doing a rotation in “Mental Health”.
I use the term “Mental Health” because, back then, Behavioral Health meant behavior modification using techniques like relaxation exercises, meditation, etc. Mental Health was what we call Behavioral Health today. They changed the name to reduce the stigma of having a Psychiatric or Psychological diagnosis and where you were being seen by your doctor or therapist. I was assigned to the Mental Health Center. The Behavioral Health Department was clear across the campus and was led by an Internist, not a Psychiatrist.
Anyway, I was on call for the night with the Psychiatrist on call. She was a tiny woman, not taller than 5 feet and probably weighing not more than 100 pounds. I was hanging out in the resident’s quarters when I got a page to meet her in the Emergency Department (ED). When I got there, she was seated in the corner behind the nurse’s station holding the ED chart. “This is going to be very interesting for you”, she said.
The patient was a 30-something year old man who was exhibiting very bizarre behavior. He was seeing and hearing things and had unusual body language. He had a history of Bipolar Illness but was on no medications.
We went into the exam room where the nursing staff had admitted him. He was sitting cross-legged on the exam table which was up against the wall. He was a big muscular guy. He was somewhat agitated. He kept flexing his body and his arms. He claimed to hear several voices and saw birds and bats coming out of the corner of the wall near the ceiling. He said he was uncomfortable with this and wanted some help.
The Psychiatrist asked him a series of questions as I just sat there and watched. She then told the patient that she recommended that he be admitted to our Mental Health Inpatient Facility. He agreed to this. We left the room.
The Psychiatrist told me she was fairly certain that the patient was having a Bipolar Psychotic Manic episode and he needed to be admitted and treated as soon as possible. She wanted me to do his admission history and physical (H&P) exam.
We completed the ED paperwork and accompanied the patient, along with a Security Guard, to the Mental Health Inpatient Facility. I went directly to the patient’s room with the patient and a nurse. The nurse was in her late 20’s. The nurse gave the patient a quick review of the room and what was in it and left. I performed the usual medical student comprehensive admission H&P including a very complete Psych review of symptoms and queries. During that time the patient continued with his posturing and flexing, but he was relatively pleasant.
I completed the exam, shook the patient’s hand and excused myself from the room, letting him know that the nurse would be coming in to do her required “intake”.
The Inpatient Unit was an unlocked unit. Dangerous psych patients were not supposed to be admitted there. The on-call Psychiatrist said the patient was somewhat bizarre but she didn’t consider him dangerous. Another thing about the unit was, the place where we all did our charting and had patient care coordination and discharge meetings was right behind the nurse’s station and was enclosed with safety glass with chicken wire running through it. This included the door, which could be locked. We called this the “Charting Room”.
I was in the Charting Room writing up the H&P when I suddenly heard a woman screaming “Open the door!” I looked up and saw the nurse who was assigned to the patient I had just admitted running full tilt towards the door. I opened the door, she ran in screaming, “Close the door and lock it!” I closed the door and switched the lock on it as fast as I could. When I looked up I saw the Bipolar patient also running full tilt at the door! The nurse screamed, “Don’t let him in!!”
Now, I’m standing at the door which is a glass door with my hand held tightly on the door knob to back up the lock. The patient came running at the door, leapt up in the air so his left side was facing the door and hurdled himself into the door as hard as he could. All the while I’m facing the door watching all of this and hoping I don’t get glass and a patient slamming into me!
The patient hit the door and fell to the ground. The glass didn’t even crack! But the man got up and tried to turn the door knob to get in. He tried this for about 15 seconds, then gave up. He then turned to the nurse’s station which had fortunately been vacated by the staff (who had run down the hall opposite the patient’s room and locked themselves in a conference room). The patient then started destroying everything in the immediate area. He banged on the Charting Room windows several times.
As soon as the patient had hit the Charting Room door, the on-call Psychiatrist had called security. Two of them arrived relatively quickly but they were no match for this totally out of control psychotic man. They retreated. The man continued to tear away at the nurse’s station. Interestingly, he didn’t run into the other patient rooms, which all had their doors closed by the staff. He would leap over the counter of the nurses station and bang on the Charting Room windows.
About 15 minutes went by when the two security guards came back with four police officers. They jumped on the man and eventually got him to the floor. The on-call Psychiatrist and the nurse who had run into the Charting Room went out to where the patient was. The Psychiatrist ordered Intramuscular Haldol, large doses. The nurse administered the drug until the man was unconscious. The police officers lifted the man up and carried him out to a police car. They headed down to the State Inpatient Facility about 60 miles away.
The nurse who had run in screaming came back into the Charting Room and thanked me for “saving her”. She said when she went into the patient’s room to do her intake, the patient was crouched on the bed and leapt at her like a tiger. She dropped everything she had in her hands and ran as fast as she could down the hall, hoping someone could hear her screams so she could get herself behind that glass door.
I was so glad that glass door was strong!!