Thanks to all of you for giving an answer. Each suggestion shows how many choices we make, every day, every minute, even every second in the way we treat our patients, and each other. One small change, one small difference, can have a huge effect.
Here is what I decided to do in part 2 of “Decaf, OK?”
I walked over, a brisk but controlled pace the ten steps to cross the room, not running, not giving a hint of urgency or a mote of exigency. I arrived to the side of Dan and the nurse where they both could see me.
“Hey Dan. Want a cup of coffee?”
The non sequitur made Dan pause. The nurse startled, a plea in her eye but without a voice. The other staff, ready to take control of the situation looked at me in astonishment as if to ask who was the crazy one here? This guy was about to beat the crap out of a nurse with a chair.
Dan looked toward me, the chair still poised high above his head, a feather of ferocity wielded by a very sick and angry man. But he was my patient so I went on.
A grin crossed his face, and he put down the chair. “Cream?”
“Sounds like a plan. Let’s go and talk.” As the nurse let down her protective arms, as the staff remained within a reasonable distance in case Dan’s mood changed again, my patient and I walked to the kitchen area for a cup of Decaf.
Dan was 35 and had been in a state hospital for sixteen years. He had not responded to a multitude of antipsychotic medications, remaining in a world of delusion and paranoia, fearful and feared as he was a big, a very big and very psychotic man. He had been moved out of the State Hospital as the first step towards a transition into the community. Not because he was particularly ready or better or more able to manage reality. Throughout the country the aid for the mentally ill was drying up, and who did these people crippled by mental illness have as their champion? How were these severely incapacitated people meant to organize and lobby for themselves? The societal fear of mental illness continues to place a moral overlay on behavior that was on occasion erratic and unpredictable, creating anxiety in a community, and a resulting ostracizing rather than understanding of the inner world of these most remarkable of individuals.
So Dan had become my patient in a University based hospital after surviving for two days post-discharge from his sixteen year sanctuary.
WHAT WOULD YOU DO NEXT? HOW DO YOU BEGIN TO TREAT DAN?
I’ll tell you what I did after the next twenty comments. Dr. Joe