putting restraints on a patient is not that easy.

once you decide to do it, it is the last resort. by last resort, i mean you probably have replaced the NG tube three times, replaced the IV access three times, replaced the foley catheter twice, and, a lot of times, you have been scared to your guts seeing your patient halfway off the bed, at the brink of falling.

maybe you have given the “sure to knock them out combination” of Haldol, Benadryl, and Ativan, but the patient is still all over the place, risking his safety, and frankly, terrifying you with the possibilities of falling. when they are so confused beyond description that the only way to make sure they are kept safe is to tie them down, you have to do it. i know that sounds barbaric, but that is literally what restraining a patient looks like.

for me, the reason why it is not easy to put a restraint is because it is not easy to watch a patient in restraints. then, there is the nagging fact that i never want to be in restraints. that makes it more difficult because you are doing something that you never want done on you.

so, if an extremely confused patient needs restraints to maintain safety, do you put restraints on a patient who is not confused but is jeopardizing her safety? do you tie up a patient who knows exactly what she is doing and knows exactly why she’s doing it?

unfortunately, you do.
so last night, i did. it was ugly, but i had to do it. it was one of those moments.

she’s been in our unit for a few weeks now, after being in an ICU for awhile. with failing kidneys that demand dialysis every other day, she has a lot of issues. complication after complication forced her to stay in the hospital in misery. she is fed through a tube, has a tracheostomy, has multiple wounds on her feet and sacrum. she is just tired.

she would have moments. times when she just thinks or believes that  none of what we are doing mattered. she would take out her trach, her central line, her feeding tube, whatever it is she can grab, just so she can go. she was completely aware of everything. she wanted to go. honestly, i do not blame her. she has not changed her advanced directives, and is a full code, so i guess there is still the overall desire to live, but she will have those moments when she just wants to give up because she’s tired.

she thought we will just watch her gasp for air and eventually die when her trach is out, so she keeps pulling it out. as i placed the restraint, i felt terrible. she had that begging look (”leave me alone, i’ don’t want this anymore…”) and i would have the same begging look (”don’t do this L…..”).

it is not easy to watch a patient like that. totally aware of what’s going on, determined to do something harmful to end it all, but unable to completely execute her plans. it is a sight that can break even a calloused heart.

sometimes, because you know it is right, you wish you can help her get better and live. sometimes, because you know it is her right, you wish you can help her rest and die. you wish you know what she really wants for sure. and you wish you know exactly what you want to do for sure.

confusing.
draining.
unsettling.

that’s why i’m still awake.