A few years ago I worked at a hospital as a constant observer.  It was a transitional job as I tried to figure out the next step of my life. What exactly is a constant observer?  one might reasonably ask.  A constant observer is basically a nurse’s aide who stays in one room to be with patients who might be a harm to themselves or others. Hospitals try very hard not to tie people down on their beds anymore.  There are a lot of reasons I might be assigned to a patient: dementia, adverse reaction to medication, brain injury, detoxing, or suicide watch, to name some.  I saw people at their most vulnerable state.  This is the fifth in what I plan to be a series of vignettes on my experiences in the hospital.

It’s possible to drink so much you turn your mind to mush.  I’ve seen it.

He went by the name Buzz. One nurse kept referring to him as Buzz Lightyear, even directly to him.  It was disrespectful, even if he was in the hospital for self-inflicted reasons.  Sometimes staff want to take it out on patients.  I found this especially true for detoxing patients—they wouldn’t treat them the same as other patients.  The first time I sat with him, it was only for about two hours or so.  Buzz was asleep, but not for long.  He wanted to wriggle out of bed, so I helped keep him from falling out.  His food arrived for dinner, but he could barely keep his eyes open to take a bite.  He was a leaning tower on the bed, and his speech was slurred and incoherent.

The next day I had him again. Unluckily for me, he was much livelier and intent on walking somewhere.  The Neuro Acute unit was small, with only eight rooms, most of them empty that day. We walked up and down the short hallway.  Each time we reached an end, he’d inevitably lurch toward it, despite my attempts to steer him away and my explanations that he had to stay.  At one end of the hallway were the double doors to the ICU.  Stopping him at that end wasn’t so bad – he seemed to understand my rationale that we couldn’t disturb other patients. But there was also the fire exit at that end.  No way.  Opening that door would set off an alarm and a world of trouble for me.  At the other end of the hallway were the double doors to the hallway and sweet freedom.  It was impossible to keep them closed for long as people come in and out of the unit all the time.  It was a lot harder to keep him from leaving the unit.  He wanted to get out.  He thought he was fine.

But he could barely stand on two feet without precariously leaning. I put a gait belt around his torso, just under his armpits, so I could hang onto something as he careened this way and that.    Meanwhile, his pants couldn’t find any place to cling on his skinny waist.  Again and again I tied them tight, again and again they fell down.  I was struggling to keep him from getting into trouble.  He wanted to go into the clean, empty rooms or behind the nurses’ station.  And I could barely keep him from falling over, but I couldn’t really stop him either. I kept hoping he would tire out and take a nap.  But he continued his exploration of the hallway, and I followed every step of the way.  I turned him around at both ends of the hallway, sometimes with a gentle nudge or a quick distraction.  I didn’t want to use force, but he was so insistent.  The gait belt was handy for holding him back, too, when he tried to make an exit.

I was about to break down after hours of this. The nurse aide marveled that I didn’t seem frustrated.  I was amazed that I had hid it so well.  We were down by the fire exit again, and he nearly pushed the door open, when a nurse and the aide came to my rescue, sending me off for my 15 minute afternoon break.  I went to the locker room, something I never did on my break, because I wanted to be absolutely alone.  I called my wife and started crying.  I was so overwhelmed with the responsibility of trying to keep this man safe even as he wanted to leave.  There was no way to reason with him.  When my 15 minutes were up, I said goodbye, wiped my tears away, and went back for more.