Saturday, November 06, 2004


Patient K spotted us entering her room and immediately began wriggling around in bed. Her wrists were placed in restraints to prevent her from pulling out her IV lines, drains, and endotracheal tube. As a secondary security measure, her hands were placed in medical mittens that prevent those Houdini-like patients with great manual dexterity from escaping out of their wrist restraints.

Patient K had suffered a lapse in mental status recently, becoming acutely disoriented and a danger to herself. We had no other choice than to restrain her until her mental status returned. The attending physician and I were returning back to her room after evaluating her x-rays to discuss her plan of care for the day.

We watched as she struggled to remove her hands from her restraints. Patient K was working up a sweat, grimacing and straining to free herself. Our curious monitoring quickly turned to horror as she successfully removed her right hand from her mittens and wrist restraints. Before we could act, her right hand shot up towards the endotracheal tube. She was going to self-extubate and most likely suffocate to death.

As we rushed forward into her room to stop her, she glared at us, raised her middle finger, and smiled through her endotracheal tube. We paused mid-step, dumbfounded.

Satisfied, she laid back down with a smug look on her face.