Tuesday, August 21, 2007

My Three Shrinks Podcast 31: Biteproof Gloves

[30] . . . [31] . . . [32] . . . [All]

Here is the little "podette" I mentioned last time. The next podcast, which will come out in the next day or so, features a special guest, Doctor Anonymous.

August 20, 2007: #31 Biteproof Gloves

Topics include:
  • Q&A: from Midwife with a Knife: Short version: How would you manage an agitated, aggressive patient in your OB/GYN office?

    [Okay, here's the long version: Let's say I have this patient who's clearly distressed and obviously psychotic (if I can tell, it's pretty obvious) who's caretaker reports that they're seriously considering hurting themselves or others, clearly the patient needs to be sent to the psych ed/crisis center/whatever hospital equivalent for evaluation by an actual mental health provider... So, after the caretaker says to us, "I'm worried about taking her back to the group home, I'm think she's planning to hurt someone there.", and I talk with the patient who says something to the effect of, "I know that woman's planning to take my baby, and I'm going to hurt her before she gets the chance." I make the decision that she needs to be emergently evaluated. I try to talk her into going voluntarily (mostly by saying things like, "You seem pretty upset, I think it might help if you went and talked with the doctors downstairs", she refuses, and security is called to escort her down to the psych ed. Eventually, (I think triggered by the stress of that situation and the chaos of a busy clinic and the security officer's arrival), and in an attempt to leave the room (I happened to be sitting between her and the door), she kind of half tackled/half grabbed/half pushed me (Maybe to push me out of the way? I think she was just trying to leave. I don't think she was really trying to hurt me), the security officer grabbed her, she bit him (although he was wearing biteproof gloves) and she eventually was taken to psych. My question for you guys is, how do you psychiatrists recommend those sorts of situations be handled?

    So, we answer the question in the podcast. We also speculate about "bite-proof gloves."
Oh, and if you want to see a funny but very strange rendition of Zappa's Peaches and Regalia -- with a man using his ungloved but cupped hands as a musical instrument -- then do check out this YouTube video (turn down your volume first). I could not stop laughing.

Find show notes with links at: http://mythreeshrinks.com/. The address to send us your Q&A's is there, as well.

This podcast is available on iTunes (feel free to post a review) or as an RSS feed. You can also listen to or download the .mp3 or the MPEG-4 file from mythreeshrinks.com.
Thank you for listening.


Midwife with a Knife said...

Woo Hoo! I got my own podette! Now I feel special. ;)

Thanks for answering my question. I don't know for sure that the gloves were biteproof, but they went over his latex gloves (the purple ones are nitrile, btw) and reminded me of the gloves that we used to handle mice in a lab I worked in. Those gloves were bite-proof, and so I assume that the security guy's gloves were too. Our patient population is pretty rough. Our security staff carries those special gloves and actual guns and stuff. It sometimes makes me a little nervous that our security guards need guns.

For the record, nobody was harmed in the making of this situation. The patient ended up admitted to psych, and everybody else was fine.

Anyway, thanks again for the input.

DrivingMissMolly said...

I really enjoyed this podette. It made me really think about how I think when I walk into the office of a psychiatrist or therapist.

Although I have never become as agitated & have never been psychotic as MWAK's patient was, I am always wary. I prefer to sit as far as possible from my psychiatrist. Shortly after I started seeing him he rearranged his furniture. That threw me off and I ended up sitting right next to him at the end of a couch that his armchair was close to.

I used to think that the purpose of his chair being where it was, pretty close to and in line with the door, was so he could grab me if I wanted to leave and hold me against my will. Now I've learned that it is HIS escape route.

Now that he has kept his new arrangement I sit on the opposite end of his couch. I have tried to calculate the odds of my running away without him stopping me. I still look around at each visit for changes and obstacles to possible escape.

I also glance at the top of his desk for scissors. Not sure why.

I thought unruly patients just got tackled and injected with thorazine or haldol.

Does that never happen anymore or does it still happen and it is a secret?

I was "tackled" once in a psych hospital and "placed" in seclusion. Would that still happen today? That was 18 years ago.

I just can't believe how nice you guys are. Roy souns so non-judgmental. It is hard for me to accept and believe but I know you wouldn't lie.

God it must suck to get stoopid comments from mental patients. Sorry.

My Dad used to chase me around the house before a spanking/beating. There was no hiding or escape. The first time I beat him upstairs to the bathroom and locked the door, I was elated, but he waited outside....there really is no escape. It stays in your mind forever and ever and ever.


DrivingMissMolly said...

I have to admit that I liked sitting near Psychiatrist. It made me feel good, like we were talking and he was nice to me.

That scares me just as much.

Feeling good about a person is bad because they are unpredictable.

Even if they would be predictable, I don't deserve it.

This is why I will NEVER be well.


NeoNurseChic said...

Hmmm - like Lily, listening to this podcast made me reflect on the various seating arrangements I've had at mental health providers over the years. At the psychologist's who I saw in high school, she sat in a chair at a desk (but with the chair turned, facing me), and I sat on a couch - the door was just to my right. I could have gotten up and walked out it without her stopping me or having to move out of the way.

Then, I tried to find a pattern that would fit some sort of rationale for my current psychiatrist's offices at various locations, but I didn't really find one. At office #1, I sat in a regular desk chair right next to the door, and he sat at a desk chair turned towards me - the door was between us on my left/his right. There was another regular desk chair just like the one I was sitting in just to the right of me where I piled all my stuff I always carry with me, and then he had a couch over against the far wall that I never sat on. Not sure what other people did. Then, at office #2, when you walked in the door, his desk was against the right hand wall, and he would turn his chair - I sat in a chair in the far left corner, next to the window. He had a clock there that he could see, but he also had a clock on his desk that I could see - he had put tissues on the window ledge next to the chair, which I thought was nice.

Current office? Anything goes. I have seen him half a dozen times (at least?) since he has become an attending at a behavioral health center in NJ, and I've seen him in probably 4 different offices. I get a little unnerved by how loud some of the other coworkers get in the hallway during our sessions - I realize this is because it's the end of the day most of the time and they all seem to be talking about their after-work plans without regard to how loud this is inside the office with the closed door, but still - sometimes I just stop talking because I can't compete with their volume. It's so loud, I can't even think. But besides that - in the office where I was today, I was in a desk chair by the door, and he was in a desk chair across the small room. I bring my own tissues now because I've been caught a few times where all he had to hand me was a napkin or paper towel. He puts his watch on the desk so that he can tell how much time we have left, but there are no clocks I can see in any of the rooms, and since I don't wear a watch, it sometimes catches me by surprise when the appts are over! Of all the offices I've met with him at the new place, it seems that I am always closer to the door and he's on the other side of the room. I can't really remember all of the places we've met in, though really! It changes almost every time...!

So anyway - I guess what I'm getting down to is that sometimes I've been by the door, sometimes he has, and sometimes we both have. Sometimes I wonder how other people sit in the offices where there are multiple chairs. Except for in the very first office, I've always sat in the farthest chair away from him - but not because I'm afraid of him or anything, although I do tend to be unnaturally anxious when going to appts.

The purple nitrile gloves - I think somebody could easily bite through those if they wanted to!! I'd definitely want something else on top of those in the case of running into a biting patient! Fortunately, my patients don't have teeth!! (Well, I have seen a baby with a tooth before - was there at birth). Their parents have teeth, but hopefully they won't be biting at us!! I have heard stories from the OB department, however!

Take care,
Carrie :)

Rach said...

Ahhh... the seating. I just found out the the shrink is moving... so I'll need to reassess this situation in a few weeks (what is it with shrinks moiving in august? I don' get it...)

Anyways... I had a spot. It was a corner, and I'd pull my legs underneath me and just shrink into the corner of the couch... And then the shrink moved the tv set in the office because he got a gaming system. So i was competing for the corner with the TV. the TV one. I found a new spot. In another corner... But I too, felt very out of place in that new corner. When I bitched about the position of the TV he invited me to play the gaming system while I talked... I said I'd rather talk than play (although... I wanted to play without having to talk!)...