overdose

I got my first death threat from a patient last week.

To be honest, it wasn't quite as dramatic as it sounds.  The patient aimed it in general at the staff who were caring for him, but I include myself since I was standing there when he looked around and said, "I am looking at your faces!  I am going to come back here and kill you all, every one of you!"

* * * 

Some context: he had overdosed on a drug that was making his heart rate slow down significantly, so the staff were somewhat concerned.  My supervisor, the toxicology fellow, came over to look at the man, pulled open his mouth, and inspected the green froth.  "Is ___ [the drug] green?"

I looked it up on Epocrates, a medical app, and found the picture.  "Yes, " I told her.  She did a sternal rub (rubbing knuckles on his breastbone, one way to see if patient can be aroused to consciousness) - no real response.  The man was pretty out of it.  The nurses bustled about, trying to put in IV's.

"NO MORE NEEDLES!" the man roared, opening his eyes.  He looked the toxicology and swung at her.

She leaned back, avoiding his punch, and kept unconcernedly lecturing the rest of the staff.  "His heart rate won't drop below 40.  We just need to ride out the next twelve hours till the drug wears off."

The staff all backed away.  Security came.  We closed the curtains as they restrained him to the bed.  The nurses put in their IVs, unhindered except for periodic exclamations of "No more needles!"  The man would then return to his obtunded state.

This joyful process culminated in the rather surreal encounter where he threatened to kill everyone, and everyone ignored it.

Just another day in the emergency department.