“Get me out of these!” C screams as he shakes the bed to which he is shackled. His veins angrily protrude from his neck.
We stare at him through a glass window.
“He gets so agitated when men enter his room, it is like he has an inferiority complex because he was calm for you, right?” the nurses, huddled, say to me.
That was because I spoke to him like a human.
“I am not a prisoner! What did I do to be chained to this bed?”
The care team has already written him off as a drug user who was sent to the emergency room from a rehabilitation center for “agitation.” They catch him in this snapshot in time. A snapshot in which he is actively withdrawing and explaining that “everything hurts.” A snapshot in which he is a patient who is purposely not complying and making this shift difficult. The nurse’s approach matches his: yell.
“C! What are you doing?”
They do not know that he traveled almost 1,100 miles with the love of his life to enter this rehab center together just two days ago.
“I need to use the bathroom! Let me out of these restraints!”
They do not know that this morning, the love of his life chose to abandon him at the rehab center without saying goodbye. Leaving him 1,100 miles away from anyone he knows or loves, alone. Without a way and without money to return there.
“Please! I will not be rude, I will not hurt anyone!”
They do not know that he is withdrawing from the same drugs he quit nine months ago. From the drugs he found again when his younger brother killed himself just three months ago.
“I just want to call my kids…”
He is no longer yelling.
I wrote this piece while trying to process the poor treatment of individuals with substance use disorders which I have seen throughout my training. A prominent pattern that I have witnessed includes a tendency to resort to stereotypes instead of paying attention to personal stories and struggles. While this is problematic and dehumanizing, it can quickly result in equally dehumanizing treatment such as the use of restraints. In these scenarios, the patients have two forms of shackles: the physical ones on their bodies which make it almost impossible to feel safe and calm as well as the stereotyped lenses through which they are being viewed and treated.
This experience helped me understand that, even as a medical student, I can be a strong ally and advocate for patients. In this situation, I had entered the room multiple times to speak with C to attempt to reassure him and allow him to vent his feelings and frustrations. I brought him a pillow and took measures to try to get his nurse to communicate calmly with him. I advocated for him to my resident and asked to re-assess him as he was not feeling better, physically or emotionally, after an hour and half in the emergency room.
As a physician, this experience will strongly remind me to always take the time to get to know patients and their stories. Patients are not medical questions. They are humans with feelings who are vulnerable to the challenges in their own complex world. It will help me remember that I will often be seeing patients on some of their worst days and that they always deserve kindness, respect and the benefit of the doubt regardless of their behavior.