Friday, February 16, 2007

A Close Call on the Job

Last night, I was doing a per diem shift in the health center for the evening session. These evening shifts are generally low-key: a vaccination here and there, faxing prescriptions to pharmacies, joking around with the docs and medical assistants. However, one never knows when one's circumstance will be altered from its usual trajectory, and just such a situation arose last evening.

Suffice it to say that the detailed circumstances of the initial situation catalyzing this event are superfluous to the story as a whole. The main thrust of the idea is that a father of a young child was not allowed into the pod where the exam rooms are because the mother of the child was sharing some concerns with the doctor which needed to be communicated without the presence of the father. Needing further inquiry, the social worker had been called into the exam room, and the father was left in the waiting room to fume and pace. Unfortunately, all of this occurred without my having a shred of knowledge of what was transpiring.

As I sat at my computer in the pod filling electronic prescriptions, an agitated man appeared on the other side of the nurses' station, cursing and demanding access to his child and wife. A wild-eyed medical assistant calmly asked him to remain where he was as she took me around a corner to explain the situation in detail. While we were talking and my grasp of the situation grew, her gaze fixed over my shoulder and I turned around to see the man in question making his way quickly towards us up the hallway. He had crossed the nurses' station, passing a medical resident who was utterly clueless as to what was occurring, the OB/GYN doc also oblivious, dictating her notes by phone as he stormed past her.

Sensing both the gentleman's agitated state and the medical assistant's anxiety, I put myself between the enraged man and the medical assistant and did my best to try to de-escalate his fury. As his demands grew more fierce, my voice naturally rose to counter his. Knowing that I was taking a chance---but keeping in my mind that security had just been called and were at least five minutes away and were not even in the building---I stood my ground, raised my voice louder, and pointed towards the door at the end of the hall, demanding that he exit the pod immediately and wait calmly in the waiting room. Whether it was luck or some other form of beneficence, he somehow sensed that he was fighting a losing battle and stalked towards the door, entering the waiting room just as the security guard returned to restore order.

The conversation that immediately resulted from this encounter was one centered around what we would have done had he become physically violent prior to the arrival of the security guard. If he had swung at me or pulled a knife, how would we have handled the situation, and what liability would I personally carry if I were to strike him in self defense? What legal protections are in place to ensure that I will not be prosecuted or held criminally liable if I were to act to protect myself or another person, resulting in harm to this threatening man? (Furthermore, what would we do if he stalked us in the parking lot later that evening, attempting to "get even" for being publicly humiliated?)

Many of us working in the inner city with vulnerable and disempowered populations face risks when engaging in such employment. Threats of harm have been visited upon several of our providers over the years, and we all know that our work does carry some level of risk. Poverty, disempowerment, discrimination, classism, racism---they all contribute to the feeling of emasculation and helpless rage that many people in such circumstances can naturally feel, and when we uphold policies and procedures that do not make sense to a potentially volatile person, the resulting reaction can be explosive. Evidence of sexual or physical abuse of children is one area where staff feel legally and morally compelled to act quickly and comprehensively. Poor communication---or the lack thereof---can put other employees at even greater risk when they are not apprised of the situation and are then suddenly faced with an angry patient and no context in which to place such an explosive situation.

I realize that I was lucky that last night's episode ended with little fanfare. The potential for violence or the threat of violence was quite real, although our laughter later in the evening quickly dispelled any remaining anxiety. In the course of my years as a community nurse in the city, I have skirted drug dealers on busy sidewalks, visited known gang members on city blocks known for their illegal activity, and shuffled past suspicious-looking young men as they loitered in dark stairwells, stuffing emptied cigars with marijuana to make the ubiquitous "blunts" which fill the air with their distinctively aromatic smell. I have also been to a home where my patient's daughter's boyfriend had apparently hidden guns used in a gang-related crime. Oh, the places we go!

Of course, risk is relative in any line of work, whether it be personal injury or any number of potential hazards. When one feels that a brush with danger has been averted, one of course will naturally take stock, second-guess one's prior actions, and hopefully learn from experience, planning and strategizing for possibly similar scenarios in the future. There is always much to learn, and we will always equally hope that we never have to learn the hard way.
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