Code Black

In my last placement on a neurosurgery ward, I had an encounter with a patient who was very anxious and impulsive. He suffered from a dense (R) hemiplegia due to a (L) parieto-temporal lesion in his brain that has been excised. Pre-operatively he did not have any deficits in his limbs, and was a carer for his wife who had a stroke last year. He came in for the surgery because of the increase in frequency and severity of his headaches.

This patient was very anxious from day 1 post-op. When we went to see him for the first time to assess his mobility, he said he was able to walk to the toilet on his own and wanted to jump out of the bed to show us. Naturally, he could not do so due to his (R) sided hemi. He struggled in bed and was kicking up a big fuss, hitting his (R) leg and asking it to move for him. We tried to calm him down and explained what happened to him. We told him that after the surgery, due to swelling in the brain, it might take some time and rehab before he could recover function in his limbs. He was angry and said that he was normal. We couldn’t continue to assess him that day but assisted the nursing staff to transfer him into the commode to go to the bathroom.

Over the next few days, his mood seemed to calm down a little and I was able to engage him to perform some bed mobility and transfer retraining by his bedside. I thought he was progressing well when he started to get impatient again.

When his wife came to visit, he asked her to push him in a W/C to the courtyard where he could get some fresh air. The nursing staff were informed and permission was granted. That afternoon when I went back to see him, I heard from the nursing staff that he tried to abscond from the hospital grounds! He threatened and abused his wife and asked her to push him down to the car and drive away from the hospital. He was quickly returned to the ward and brought back to his room. This made him even more furious and he started throwing objects at the nursing staff.

The doctors came around to speak to him and advised a Code Black (Personal Threat) if the patient continues to pose a danger to himself and the people around him. He was under 24-hour surveillance for the next few days and refused Physio treatment. There was no way I could get through to him. I was not able to follow-up with him anymore as I have already finished my placement.

Does anyone have any ideas for a patient like this? Is there a way in which I can get through to the patient to help him understand his condition better?