Sunday, November 11, 2007
Real Live Violence
My husband loves violent movies. As I've gotten older, though, I've become more and more bored and uncomfortable with them. As far as I'm concerned, there's too much violence in the world: I don't need to pay to watch it for entertainment, and I'm troubled by narratives that portray it as fun or cool.
Lest this make me sound like a prude, let me note that the blood, profanity, and occasional physical danger in the ED where I volunteer doesn't bother me. Partly this is because I feel safe there, between the presence of security guards and plenty of burly techs. But part of it is that in the ED, violence is a symptom, an unfortunate side-effect of various medical conditions or mental states. It's neither glorified nor encouraged: it's treated.
During a recent shift, we had a patient who did not want to be in the hospital and who proclaimed, loudly and often, his intention to leave. As is so often true in these cases, alcohol was involved, but when he wasn't raving, this patient was quite articulate. He also had a sense of humor. He was wearing a loud plaid shirt, and when he first threatened to leave, a tech called security and the ED doc, who marched up to him and said, "Okay, look, nobody here is going to hurt themselves chasing you. If you want to leave, leave. This is what will happen: we'll call the cops and tell them to look for a guy in a plaid shirt, and they'll find you and bring you back here, and then we'll tie you up. Okay? I promise you, those are your options."
The patient looked her in the eye, raised an eyebrow, and started unbuttoning his shirt. She said, "If you take your shirt off, we'll tell the cops to look for a guy without a shirt." He started laughing -- everyone else did, too -- relaxed, and let the security guards lead him to a gurney.
He swung back and forth between calm and tense for the next few minutes. I went over to talk to him, staying a few feet away. He had a lot to talk about, and real, heart-wrenching reasons for being as upset as he was. But something I said set him off: he became very loud very quickly, and lunged suddenly off the gurney (not towards me, necessarily, just to anyplace where he could work off his agitation).
I stepped back. Three security guards closed in on him. At one point, he was scrabbling at a wall and they were trying to pull him away from it; at another point, he was bent face-down over the gurney, with the three of them piled on top of him, trying to capture his flailing limbs. They must have been able to grab at least one limb, because he kept yelling, "You're breaking my f***ing wrist!" They kept saying soothing things, trying to calm him down: finally they succeeded in getting him in restraints. They did all this as politely as possible, and the nurse who came to give him a shot of Haldol explained patiently what the drug was, and asked the patient please to lift the sleeve of his gown to bare his shoulder. The patient complied.
I felt genuinely sorry for him. I think the medical staff did, too. As for the security guards -- especially the three who were there -- I've known for a long time that they're angels of God, superhumanly even-tempered and kind even with people who are behaving very badly.
All the commotion freaked out some of the other patients. One, around the corner, came up to me later and said, "Are you okay? Is everybody there okay?" Another, in a room very near the restrained patient, asked me if it was safe to walk in that part of the hallway.
Through all this, I paid detached attention to my own reactions. I'd been careful not to get too close to the patient at any point, and had security not been there, I might not have risked talking to him. But I was glad I'd talked to him, and when he became violent, I wasn't scared or startled or even particularly excited. I was just sad.
His fracas with the security guards wasn't fun. It wasn't cool. It wasn't a beautifully choreographed Kung Fu action sequence, or a thrilling military adventure with sexy weapons, or a tense stand-off between Good Guys and Bad Guys. It was an ugly, awkward, blessedly brief altercation between a very sad, angry person and a group of professionals who were doing their jobs as well and kindly as they knew how. There was no stirring soundtrack, no clever wrestling moves, no heart-stopping suspense. There was only a mass of moving limbs, the patient's hoarse yells, and the guards' sometimes clumsy efforts to keep him from hurting them, himself, or anyone else.
Whenever one of my writing students hands in a story with long combat or fight scenes -- all of it carefully choreographed and described in endless detail -- I say, "I'm not your target audience. Fight scenes bore me; they're just descriptions of physical mechanics. What I care about is the characters, what drove them into this and how they'll recover from it later."
Some of my students understand this. Many don't. I wish they could spend some lively evening in the ED (as protected bystanders, like I am), to see what real violence looks like, and how ultimately uninteresting it really is.