Wednesday, January 19, 2005


Okay, we'll leave the sex and drugs for future entries and go straight to violence. In a way, emergency is all about violence. Someone in one cubicle is being stabbed with little needles, someone else is having precise doses of poisons infused into their vein, another is being told she cannot leave the hospital and must take the medication that makes her fat and slow.

I think sometimes that the most important characteristic a doctor or nurse must have is some kind of internal distance, some gap between the surface of their skin and their soul, something that enables them to do what they do (with scalpels and needles and questions and detention forms) and go on regardless. I sometimes think that distance is the only thing that has enabled me to survive. My patients express their pain, and I make the appropriate responses, and think that I feel the appropriate things, but it is all images projected onto a screeen - vivid and colourful and dramatic, but in no way affecting what lies beneath.

Anyway, violence. Most people I know who work in Emergency have been hit. I can think without effort of nurses who have been punched, security guards spat at, doctors kicked. Most nurses have been punched, kicked in the chest, spat on, arms twisted, hair pulled, scratched, threatened with bodily fluids in one way or another. A year or so back in Perth a psychiatric nurse was beaten almost to death. Before Christmas a man threatened to shoot me in the back of the head - "and I've got a gun, I know you, never see it coming, bang, all your fucking brains" - and then he punched a wall and broke his fist and it was me who had to check out his fractured metacarpal.

And the year before a blonde man, slim, with green eyes, told me he would dedicate the rest of his life to hunting down and killing me and my family. This in front of six police officers. The rest of his threats were a bit woozy as the intra-muscular clonazepam took effect, but even so, it happened.

And in first year I had to leap on a tall, lean man who smacked the senior consultant in the back of the head, and me and the security guard pinned him down. Any bragging rights I may have gained from this episode vanished when I saw a leg protruding from the melee and slapped on a pretty nasty leg-lock, nearly crippling the security guard.
What do you do about this?

It's difficult to even talk about. There are few acceptable male responses to violence - in fact, I can only think of one: more violence. Since that is impossible for about thirty or forty excellent reasons, what does that leave you with? Hospitals offer counselling, but I am not entirely sure counselling works. I think it sometimes makes things worse. The police came around once and asked me if I wanted to press charges, but the perosn who had threatened to kill me was distracted by clouds of invisible psychic sexual organs* and who knows what any of us would do under those circumstances.

Me, I go home and talk to my brother and then I smack the punching bag.

Note the gratifying masculine nature of those responses. I am a real man after all.


I don't know what the answer is. Violence remains a part of the job, and it shouldn't be. The offical stance is that it is unacceptable, but the same offical bodies that issue our mission statments about safe and secure workplaces also close the psychiatric wards, gut community mental health funding and let waiting times extend into the distance.

Maybe part of it's in the training. Nurses and doctors - and it's the nurses who get hit most often - get trained in how to manage chronic renal failure when maybe they should be trained in how to manage a right hook. A few less session on nebulisers and nephrotoxicity and a few more on nunchaku.

Not entirely serious there. But I am running a self defence course for some of the staff I work with: de-escalating, psychology, basic physical stuff - so that hopefully we can minimise the damage for everyone.

Bronze John

* I am not making this up - in fact, I have met three patients with similar beliefs in the last five years. The belief that one is being in some way persecuted by invisible penises/penii is almost common enough to qualify as a syndrome. I'll be damned if I want it named after me, though.


Post a Comment

<< Home