Psychiatric Restraint and its Discontents

A narrative medicine story about moral leadership

Note to readers: all the images were AI generated based on the unedited text of the story as a prompt.

By the time I passed through the locked door between the hospital proper and the children's comprehensive psychiatric emergency program, there were already upwards of 40 people standing around.  Doctors, nurses, security guards.  I counted later, and it was actually 38.  Your brain remembers these things wrong, reliably.

The security guards looked particularly unsettled.  There were four of them. At Bellevue, the guards are all hospital police.  So they’re dressed like police officers, they stand like police officers, and kids respond to them like they’re police officers.  None of the names you will read are real.  Details have been changed for privacy.

“Nooooooooooo!” The shriek from within room one hurt my ears, and I was 2 locked doors away.  It has a combination of anguish and adolescent tonal instability that is both heartbreaking and ear rending.  

I moved quickly, and gave my key a quick twist to the right, and then another jerk, because the door had a sticky handle.  

I didn’t open it more than strictly necessary, and essentially slid myself inside, pulling it closed behind me.

The click.  It was satisfying.  Now whatever happens happens— but the door at least isn’t open because of me.  My control of the situation, thus, was exhausted. I tried to simply be.  It only worked so well.

The boy was tall, somewhere between 14 and 16, and the kind of slender body habitus meant that, to my eye, he hadn’t been in the system very long. Nobody had given this kid years of antipsychotics, yet, with the associated weight gain.  He could pass for a private school kid.  He had straight hair.  It was unkempt, and puberty plus terror or rage made sure I could smell how much he was sweating.

I turned my head about 15° to the right, and I saw the Director of nursing.  He was a short man, and I say that as a short man.