Risk of Violence in the Workplace

 Every now and then The HEADoc finds himself in an undesirable inescapable situation. . .

Last week The HEADoc was trying to forge an alliance with the most delicate of cases; a teenager facing the difficult reality of the first psychotic break of Paranoid Schizophrenia. Failing to make a trusting bond with such a patient could adversely affect his future treatment outcome in many ways. This is the type of case that can truly test the psychiatrist's clinical abilities. As the patient made an effort to let down his psychological walls of defense for the first time, a ruckus was undeniably overheard coming from the front. The situation seemed to be escalating. It was a drug seeker unable to obtain his drug of choice from the local ER after claiming to have unlikely side effects from what he had been prescribed by The HEADoc the previous week. Profanities shouted at the nurse and receptionist along with racial slurs and demands for something to be done immediately reached the point they could no longer be ignored or overlooked.  Thus, the limit was reached. In the words of Beyonce', "he must not know 'bout me." In the field of psychiatry, there are times when an emergency arises that cannot wait for reinforcements to arrive.

So The HEADoc finds himself in quite the predicament. He is in an important session with his most vulnerable case while being disturbed by his least desirable patient type. His staff is being verbally abused and threatened and his waiting room milieu has been disrupted in the most rude and disrespectful manner. In a previous entry where the HEADoc wrote of violent behavior becoming imminent in the office setting, a commenter criticized his angry confrontational manner of handling a 16 year old girl who was threatening violence. The commenter suggested offering her something to eat or drink to help calm the situation. In certain situations the textbook must go out the window. Risk management is crucial but mental health care is a risky business and shiggety inevitibly will happen. Statistically, over 80% of those who work in ER's or Mental Health clinics will personally encounter violence at some point during their career. One really doesn't know what their reaction will be until finding the situation arise for them. Restoring order with minimal harm becomes the ultimate objective.

So how did the HEADoc react? Hint: not with milk and cookies. This person had crossed the line clearly and the negotiation/compromise stage had expired into the enforcement stage. There does exist a legitimate career known as a bouncer who provides security to certain establishments. Most businesses just hope that situation where someone must be physically removed from the premises never arises. The police are not readily available and are a non factor in most of these situations. Without providing details, the violator was removed and threats to take out assault charges against The HEADoc were made. That is just a case that will have to be proven in court. The HEADoc describes the whole incident as regrettable and unfortunate for all involved but feels he did what he had to do and will do it again if the situation calls for such an interventive measure.

Feelings of guilt usually follow feelings of rage or anger, in normal people. How could The HEADoc return to his session with the young man he had to excuse himself from to try and restore the peace? Interestingly, the young man was not at all emotionally traumatized by the events. He in fact was able to see The HEADoc as a real human being with real emotions. The patient offered the doctor empathy and understanding and an avenue opened for him to discuss some of his own thought content in a therapeutic setting. Thus, a potential disaster turned into something positive.

HEADoc Concedes (Adventures of The HEADoc)

  The HEADoc has made the decision to concede. . . 

from his 4 month one on one campaign of taming nature which he referred to as a challenging but enlightening experience that had therapeutic benefits in all 3 spheres of mental, spiritual, and physical health. The most devastating blow to the campaign surprisingly was not the 2 fires or the constant myalgia but turned out to be the escalating effects of the imminently approaching scorching summer sun in conjunction with multiple chigger bites in uncomfortable places, poison ivy, poison oak, sumac, and finally a tiny deer tick found attached with the characteristic bulls eye rash that often precedes Lyme’s disease. The HEADoc did learn that all ticks don’t carry the pathogen but even when infection occurs it is usually completely curable if treated with a course of doxycycline or amoxicillin for 3 weeks.

Joe Thomas’ Land Clearing was contacted for relief and brought in the Bull Dozer and other heavy equipment. In 2 days time 2 acres were completely cleared, a task that would have required perhaps a year of Saturdays for the HEADoc to complete alone, were he to actually survive the ordeal. The HEADoc states that if he had it to do all over again, that except for a blunder or two, he would choose the same course of action. He found a certain sense of satisfaction in reconnecting physically with a place of so many cherished memories from a different time period. Talks with his mother, who is the last living member of her generation of the family are more special than if a contractor were just hired to have done the job from start to finish. So Operation Land Clear has been deemed a success.

 The cat is home, calm again and grounded for life. The HEADoc was scolded by a commenter for never having her spayed. The HEADoc will accept that responsibility and accountability. He understands that it is the right thing to do since this is his 6^th time adopting cats and all the previous pets were sterilized properly except one who got pregnant at 10 months of age. Maybe it’s a Freudian thing, and The HEADoc understands the word humane but the thought of cutting out reproductive organs can be quite repulsive. I suppose it must be viewed as a necessary evil.

 The HEADoc received 8 hours of Continuing Medical Education on Saturday, May 17^th in the area of Buprenorphine treatment for opioid addiction. Not that The HEADoc needs any more chemically dependent patients, but he just needs to be prepared in the latest techniques for managing this condition. Two of three case discussions involved cocaine abusers, and The HEADoc made his strong felt disdain and negative counter-transference for many crack users known among some of the top experts in the country from Boston . There were some nice academic discussions and the naïve individuals present allowed their hearts to bleed a bit, but the ultimate answer was to define your limits of how far to go with patients who cannot comply with treatment agreements or with the law. The HEADoc draws the line at telling lies and smoking crack, although that is usually a package deal and the lying is actually worse than the crack.

  Basically no one has a solution for handling most of these refractory crack and crystal meth addicts who choose not to sincerely seek rehabilitation but thrive on manipulation and deception. Their brains have been so badly damaged that oblivious self destruction is hardwired into their behavior. The HEADoc’s policy will continue to be to identify and dismiss ASAP all crack users who won’t admit to having a problem with using crack for it is pure insanity for a doctor to try and treat such a person without effective extended support.

More Adventures of the HEADoc

 My cat has lost her mind . . .

and I have no training in feline psychology. She's 3 years old now. What's that in human years, 16? Erroneously I thought I could keep her locked indoors and avoid having her fixed. Not! As a kitten she once ventured outside and got lost for a couple of hours. A neighbor returned her and for the next couple of years she didn't try that again. The first time she went into heat I had no idea what the heck was happening. She also had worms at the time, so I thought her behavioral changes had something to do with that. The injection at the vet cleared up the worms and he told me not to worry about the estrace cycle. Having her spayed could take care of the problem. I procrastinated. No, I just didn't do it.

I got pretty accustomed to her running to the door to greet me upon my return home from work. Sometimes she could be quite annoying by clinging to my every action. This Spring she developed a habit of running past me when I open the door. Once outside there would be an obvious look of confusion as if she didn't really understand why she did what she just did. She would then sniff the rug a few times and run back inside the door just as fast as she ran out. After seeing an apparent stray calico tom cat hanging around outside, I started to become suspicious. He was probably communicating to her through the door while I was away. He was perhaps planning a not so secret rendezvous. Two weeks ago she ran toward me as I opened the door to come in. This time she didn't even look back as she ran off into the darkness. There was no response to my meow calls for the next 4 days. Just when I was about to give up on her, she presents to the door meowing as if nothing has happened. She has lost considerable weight and seems to be starving. I figured she had learned her lesson. I was wrong. She's been away for 2 days so far this time. Anybody want a kitten, or two?

The HEADoc has become pretty crafty with his Chainsaw. . . 

and Beaver Saw brush blade through his Saturdays land clearing project. He's learned quite a bit about felling trees over the past several Saturdays of practice. During the last episode of Adventures of The HEADoc the pyromania party was crashed by the Siler City Fire Department. The HEADoc felt this was unnecessary. Oh what a difference a month can make.

This Saturday, The HEADoc experienced an apparent slip in judgment as he attempted to defy the laws of gravity and balance. He seemed to forget how recent it had been when he knew nothing about operating a chainsaw or cutting down a tree. Today The HEADoc would attempt to make a professional cut that at some point becomes the mistake of most amateur lumber jacks. Today he would make the tree he planned to cut fall away from the power lines in a controlled cut. Half way into the cut The HEADoc became acutely aware that he was in over his head. The hinge cut caused the chainsaw to be pinched firmly into the tree as gravity and balance refused to cooperate with The HEADoc's plan. As a public service The HEADoc wishes to remind all amateur chainsaw operators that this is the point to call the power company and swallow your pride. Tell them you are in the process of screwing up and need them to bail you out. They have the equipment to right the situation.

That said, most readers can probably assume that the HEADoc probably did not follow this prudent advice. He did learn a valuable lesson that will power is no match for physics. Yes, you guessed it. The HEADoc used the other saw to finish the cut. The tree refused to fall in the direction planned. The tree fell directly onto the power lines. The 4th of July came on May 3 for The HEADoc. The sparks and explosions were spectacular. The display culminated in a real fire this time. The HEADoc was not calm and collected this time because the situation was not under control. A passer by and a neighbor lended a hand to help control the fire until the Fire Department arrived. The passer by offered the humiliated HEADoc some consolation by admitting that the same thing had happened to him before. The neighbor's father had once felled a tree onto their house. Maybe this behavior is encoded in the Y Chromosome.