Prisoners

I recently had a patient get admitted for a-fib, and I learned that he'd been in a correctional facility (aka prison) for the past five years. I don't know what he did to earn such a sentence (and who knows how many years he has left), but he was one of the nicest patients I'd ever had the pleasure of caring for. A few nurses and I wondered what crime he had committed in the past that landed him in prison, and in a way, I don't want to know. I'd rather keep the memory of him telling me, "God bless you" when I told him he could go home, rather than learning that he did something heinous like assault another person or commit murder. That reminded me of another patient I admitted one night, and the "what-if's" still haunt me once in a while.

Last month when I was working nights, I admitted a 29-year old male with asthma exacerbation. He said that he had become short of breath while walking on the street; I remembered he was pleasant to talk to. The following night  I heard a "Code Purple" (code for "Aggressive patient or family member") overhead pointing to his room, and I wondered what could possibly be going on because I remembered him being a nice guy and unlikely to cause trouble. Usually I stay away from Code Purples; security usually deals with all that, and I didn't think much of it later. I found out later that he had gotten into an argument with his ex-wife who had come to visit him.

Later on, I looked the patient up to see how he fared after he was admitted. Then I got a huge surprise: the patient's mother had called the hospital saying that he had told her that he had knives in his room and that he was going to hurt himself and some of the nurses who kept coming into his room and "bothering" him. In fact, he had used a fake ID to get into the hospital; in reality, he was wanted by the police for assault (apparently tried to choke his ex-wife prior to coming to the hospital) and has a strong history of violence. He'd had a bag in the room with him that he'd refused to let the nurses handle; when security searched him at the social worker's insistence, they found a machete and another knife in the bag. He then began making threats and ranting that there was a hitman out to get him. The police was then called to take him to jail.

I was speaking to one of the nurses about this today, and she commented that she and another nurse had "been chatting with him" most of that day, and no one knew that he had a knife in his bag. What if he'd chosen to act on his paranoia? What if he pulled out that machete in the ER while my back was turned and sliced off my head? What if he stabbed the nurses instead and then proceeded to attack other people in the hospital? I imagine something like that would have made national news and brought up the issue of safety in hospitals. How the hell did the patient get a MACHETE into the hospital? I know we don't have metal detectors, but usually personal belongings are well documented prior to the patient leaving the ER. I hate to think about what could have happened if the patient's mother didn't call the hospital, what kind of terror he could have unleashed if he became any more unstable in the mind. We were very lucky.