I remember in medical school discussing sedating patients – not in a pre-op kind of way – and the ethical considerations of such an action. I remember clearly thinking that I would not be someone who just sedated someone, who always tried to counsel someone, understand their views, try and work around a problem. I was positively repulsed by the idea of giving someone a drug to just make them compliant. Ideals are all well and good, and as the good Helmuth said,  “No battle plan survives contact with the enemy.” It’s Sunday night: a woman, elderly, hysterical, is kicking and punching and scratching and biting the nurses trying to prevent her falling and cracking her head on the floor, hitting her husband (hard), screaming that she wants to die and that she is never going home. She already had a cannula in her arm and I barely hesitated. She was a risk to herself, to relatives, and to staff: she was not rational, would not talk to me, and just like that I stripped her of decision-making capacity and slugged her with intravenous lorazepam. Of course, it wasn’t quite that simple, even discounting the physical difficulties of accessing her cannula to administer the dose. I had substantial background knowledge of her story, having spoken to her at length that morning and diagnosed her with delirium secondary to a urinary tract infection, and started her on antibiotics. I had been on the ward numerous times throughout the day, seen her steadily deteriorate mentally and become increasingly agitated. I’d spoken to my registrar about developments and future courses of action as needed. None of that makes drugging someone up to the eyeballs to calm them down feel more normal. In the States they still use physical restraints. There is an argument to suggest that these, although more acutely distressing for the patient and staff, are often needed for less time and have fewer (or different) side-effects relative to pharmacological restraint. The discussion is not one I have become particularly involved with but it does raise the question – what would I want for myself if I needed to be restrained? What would you want? stabby stabby

The next day she was better and went home, completely rational. Delirium is strange.


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