A few weeks ago, I was called to the ER to see a man who had threatened to kill another man in a drunken rage. When I spoke to the ER doctor over the phone about the case before actually seeing the patient, my first question was, does he have any weapons on him? And if you haven't asked, could you go ask? He had a 3 inch knife on him (legal to carry in the hospital if it can't be opened with just one hand), but no guns.
Then, a few nights ago, I was called to evaluate another man in the ER. Halfway through the conversation, he started talking about a shooting at another hospital. I am not sure how he got onto the topic or what his point was (something about saving extra medicine at home in case of an emergency), but I became anxious. He sat with a large black bag on his lap, and I knew he had some other belongings out in the waiting room. What if he had a gun in that bag? I could not focus on what he was saying anymore. My rational mind told me that this man was at quite low risk for acting violently in the next few minutes. He had no history of violence, he was quite cooperative and friendly while I interviewed him, and he was not intoxicated. But I couldn't focus. What if something happened and I had ignored my feelings? My heart was racing. My patient's lips were moving, but all I could hear were thoughts in my own mind. I knew I needed to take a break before going any further. I abruptly stood up and excused myself from the room. I had to get out of there.
I ducked into the social worker's office across the hall and confessed to her why I had stopped the interview. I felt really silly. This person probably didn't have a gun, but my imagination, with recent current events for material, was running wild with possibilities.
I called the grounds security police to accompany me back into the room. I thought there might be a "safe" way to ask this question, but there really isn't. The police man looked at me, then looked back at my patient and literally said, "Sir, do you have any weapons on you?" I had been scared to ask that question on my own.
Like the patient I mentioned first, this man also had a small blade on him, but no guns. He was embarrassed; he thought that I had seen the knife he kept on his belt and then called the police in because of that. He quickly unbuckled his belt, on which the knife pouch was threaded, and reached behind his jacket to pull it through the loops. This motion made the policeman say, "Hey! Hey, what are you doing?" My patient immediately put his hands up in the air. "I'm sorry," he said. Now it was awkward, and we were all on edge for apparently no reason. I thanked the officer for his help, and then I was back with my patient, finally talking about what brought him to the ER in the first place.
Recently, I have felt extemely vulnerable when meeting patients for the first time in the emergency room. People come in from a number of different situations from the community. They are not initially screened for weapons, and though a sign at the hospital entrance prohibits weapons, I'm not sure what deterring power it has.
There has been extensive press about mentally ill people and guns in the context of horrific recent shootings. There has been a push to prevent mentally ill people from getting their hands on guns. In California, the law prohibits anyone who has been placed on a 5150 hold from owning or buying a gun for 5 years. However, enforcement is problematic, and as we have seen recently, people get access to guns from family members and friends.
To work under the knowledge that people can be carrying weapons freely and/or illegally is unsettling to say the least. At times, I am finding it makes it difficult to focus on my job and to treat people openly and without fear. The more I learn about people, the more I realize we can't control people. But we can control the weapons that are acquired by citizens and what ammunition is out there. Let me get back to my job. Let school teachers get back to their jobs. Let movie and mall goers enjoy themselves with peace of mind. Gun control is what our administration should focus on. Obviously there are a lot of nuances here, but in the clinical setting, my recent personal reactions have been quite strong and clear, however rational or irrational they may be.