Potty Brain

We got some strange looks from people walking by one of the rooms in the ED yesterday. In the room was a security guard sitting in a chair watching a 9 year old child … who was in 4 point restraints tied to a bed. No typo. The kid was nine years old.

He was brought by ambulance after the school called his parents. He was threatening to kill his classmates with the sharp end of a soup spoon and asked everyone in the class “are there any volunteers?” That was enough to get him a ride to the ED.

Why the restraints?

He tried to run out of the ED when he arrived and the paramedic had to grab him. They put him in the psych room and he began throwing the chair at the wall. They took the chair out of the room, then he tried to tip over the bed. They took the bed out of the room. Then he started screaming obscenities and kicking the wall. He flipped people off when they watched him through the window.

I walked out of another patient’s room, heard the screaming, and already knew I had had enough.

“You need to stop yelling and put that gown on NOW,” I told him.
“No,” he said defiantly. Then he stuck his tongue out at me.
“There is a pair of scissors in my desk drawer. If you aren’t undressed and in the gown by the time I get back here with them, I’m cutting your clothes off.”
“F*ck you, you gay f*cking a**hole.”
Inside I was thinking “Whoa.” On the outside I kept the poker face.
I walked to the drawer, got the trauma shears, and came back in the room. The kid screams “Fine! I’ll take my clothes off, but you’re not going to be in the room when I do it.”
I left and a short time later, the security guard came out with his clothing.
He started screaming and pounding the walls again.

I went back into the room. “Now you need to sit on the bed and be quiet.”
He refused. I walked toward him to lift him up and put him on the bed. He punched me the arm twice. The security guard went to grab him and he punched the security guard in the chest.
That earned him two matching sets of velcro bracelets.
It took three of us, but we got him restrained.
Oh, I should probably mention that first we asked him nicely to sit on the bed pretty please with sugar on top, then we asked him if he’d rather read Teen Beat magazine or play some pinochle instead of being restrained, then we frowned at him, shook our fingers, and sternly asked him to stop being so irascible because that’s what CMS requires us to do. When these “less restrictive” alternatives failed, then we restrained him.

While we were applying the restraints, this kid’s actions reminded me of a scene from The Exorcist. About the only thing missing was his head spinning around in circles. He had the Seven Dirty Words out in about the first 30 seconds. The stuff that came out of this kid’s mouth would have made CrankyProf blush. The most memorable moment in this special encounter was when he looked me straight in the eyes and sneered “Go f*ck your mother and then go f*ck some other pig while you’re at it.” I laughed at him because that’s all I could do. I just kept telling myself that this kid was nine years old.

He actually calmed down with a little Ativan and was able to be transferred to the children’s psych hospital without restraints.

Later in the day a 13 year old sexually active girl came in with “severe” abdominal pain and clean urine. I told her that I would need to do a pelvic exam on her and went to get the nurse. She stormed out of the ED saying “Ain’t no one looking at my sh*t — especially you.”

When my kids swear or say anything derogatory about anyone, we wash their mouths out with soap. After a while the soap stopped bothering them. We changed to Tabasco sauce. Potty mouth syndrome in the WhiteCoat household has decreased substantially.

Some kids think it’s business as usual spewing toxic waste out of their mouths and don’t bat an eye about it. People around them seem to accept it as an “exacerbation” of their ADHD. This type of stuff didn’t happen 20 years ago. It isn’t potty mouth any more, it’s “potty brain.”

What is going on in this world?