Tuesday, November 14, 2006


I've posted about how some people find the most challenging aspect of the ED to be the smells. Hospital odors can indeed be intense, but there are sounds I find far worse.

Screamers come in several varieties: howling children who won't calm down, psych patients responding to some reality no one else can perceive -- or so enraged or terrified that all they can do is wail -- elderly patients suffering from dementia. In all of these cases, the patient is in a place no one else can reach. Screamers are walled off from both communication and comfort, isolated in their agony even when they're surrounded by family and staff trying to help them. These cases are heartbreaking.

And they're loud. If there's a screamer in the ED, you'll know it the minute you walk in the door. The sound carries through the entire department, piercing and inescapable. No one blames screamers for screaming -- everyone understands that they can't help it -- but the noise puts both staff and patients on edge. Screamers are the ED version of car alarms.

These patients become the center of concerted efforts by anyone in the vicinity: nurses, techs, volunteers, security guards. Driven both by compassion and by a frantic desire for the noise to stop, everybody tries to get them to quiet down.

But with a real screamer, by definition, very little will work. Screamer kids will only scream harder at the sight of a teddy bear, crayons, or anyone at all wearing scrubs. They want home. This isn't it. I once saw a screamer adult brought in on a backboard and in a cervical collar; because those contraptions are so uncomfortable, we thought he might stop screaming if he was unstrapped. It didn't work. He bolted out of bed and kept screaming, running laps around the department, until security tackled him and put him in four-point restraints.

For me, the hardest patients are the elderly, like the old woman alone in the critical-care room -- her children having fled -- who cried "Help me" over and over. I asked her what was wrong. Two nurses across two shifts asked her what was wrong. She couldn't or wouldn't answer us. "Help me. Help me. Help me!" I watched the first nurse struggle with anger at the patient's absent family, who may after all have felt as helpless as we did. I watched the second nurse put up walls, emotional barriers to shut out the noise and what it meant.

I started avoiding the room. It was too hard to hear her crying "Help me," to want to help, and not to know how.

When screamers finally stop screaming, muscles and jaws unclench around the department. Everyone can breathe again. The screaming toddler has finally fallen asleep. The screaming psych patient has finally succumbed to injections of Haldol and Ativan. I once had a few moments of success with an elderly dementia patient whose husband had brought her to the hospital and immediately left. Strapped to her bed, she kept keening, "Mama, Mama, Mama," sobbing for someone who wasn't there. I sang her a lullaby. She turned to me with a wondering expression, and for a little while, she didn't scream.

But sometimes no one on the staff can do anything, because they're staff.

One evening a screamer arrived halfway through my shift. The patient, accompanied by a frantic relative, was taking Methadone to kick a heroin habit, but the Methadone dose had been decreased too quickly. The patient was in withdrawal, writhing in agony -- and screaming. A staff member begged me to do something to help. "Junkies feel so horrible about themselves, and I'm scared this kid's going to go out and use again." But whenever I went into the room, the patient turned sharply away from me, and the relative gave me a helpless shrug. Because I was the chaplain, the patient expected to be shamed or lectured.

The second bed in that room held a burly fellow with prison tats, including swastikas. He'd been brought in by a woman, wife or girlfriend, who looked as if she'd had a hard life of her own.

The nurse assigned to the room was non-white, and understandably nervous about the patient with the tattoos. The noise from the other bed was close to unbearable. It wasn't a good room. I found myself avoiding it, and the nurse probably wanted to do the same thing.

And then I went by the room on my way to somewhere else, and heard -- nothing. Silence, sweet peace. I ducked inside to find out what had happened, and found the woman who'd brought in the tattooed patient leaning over the now-quiet screamer. She was giving the screamer a backrub. The patient had finally relaxed, and so had the exhausted relative.

"Thank you," I said, and the woman smiled at me.

"I'm a masseuse. Massage really does help people calm down."

I wondered if we should recruit a volunteer massage therapist for the ED, but I'm not sure the patient would have let that person close, either. The woman giving the backrub was a peer, an equal: someone else dealing with real or perceived staff judgments, someone with whom the patient didn't need to be ashamed.

I don't know if the patient knew any of that consciously, but I do know that I saw Christ in that room. Christ is a hardened woman leaning over a bed, giving a backrub to someone who's finally stopped screaming.


  1. Christ is in all and any of us when we show love to our fellow men and women wherever they are - especially when they aren't easy to love at that moment.

  2. Hi, Susan! I totally sympathize with the ED staff, you and the patients . While I don't recall ever having been in dire straits as some of those in your stories I vaguely remember screaming as a small child. I don't think anything would have comforted me at that moment. I don't even remember what I was screaming about. I just know that Mom was holding me and I was still not happy.

    Great post!

  3. I've seen Jesus in faces you would never expect, in people you wouldn't think to give the time of day.

    And almost every time, it's the difficult patient, the homeless, the drunk...

    Pardon my skills at biblical quotations but I believe the verse says something to the effect of "...what you do for the least of my brethren you do for Me".

    I never was good at verse memorization. Always got the gist but the actual words? Not good at memorizing.

    I also don't believe in co-incidence and I honestly believe those patients were placed together for a reason. A reason that had nothing to do with open beds. : )

    If you get my drift....


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