News of the shootings in Tulsa about the shooting deaths of an orthopedic surgeon, a sports medicine physician, a clinic receptionist, and family member of a patient visiting a Tulsa Orthopedic clinic are alarming and sad. The actions of the shooter represent changes in our society which may allow, if not prompt, repeated similar events. In fact, a doctor and two nurses were stabbed in a California hospital a number of weeks ago.
It may surprise that healthcare workers are four times more likely to be assaulted than those working in other fields. This is not news to nurses. Such assaults have not been highly likely to be fatal, but are common in hospital settings, particularly for those who provide direct patient care. The seriousness of these assaults may be changing such that they are becoming more dangerous and worrisome.
Some of my experience with trauma to healthcare workers will be described. The first episode involved my lab partner during the first year of medical school. She was shot in the chest and almost died during a robbery attempt. Someone stole her bicycle at gunpoint on Belle Isle in Detroit. Fortunately, she survived. It is impossible for me to know how this experience affected her physically and emotionally.
The first healthcare worker that I personally witnessed to be at risk of injury was my supervising intern when I was a medical student assigned to a general surgery rotation at Detroit Receiving Hospital (DRH). When I was writing a note at the nurses’ station, I watched a patient chasing the intern through the ward hallway. The scene was more comical than one might imagine. We did not see that the angered patient had a weapon. The hospital security staff was summoned, and the intern was not injured. I suspect a few medical students on his service were hoping the patient caught the intern. The intern was a jerk. He did not teach us anything. He was mean to us and was mean to the nurses. We did not consider the possibility that the intern could have been severely injured. Luckily for him, he escaped injury. He did remain a jerk, however.
There were other scary events at Detroit Receiving Hospital when I was a student. It is my recollection that a man came into the hospital and shot and killed an administrator. I could not verify this searching Detroit news history. It is a recollection shared by at least one other physician who worked there at the time. It did not make a splash in the news.
There were instances of patients who survived a shooting or stabbing who were attacked again in the DRH ER while being treated for these assault wounds. The attacks in the emergency room put doctors, nurses, and staff at risk of injury. The security guards in the hospital were pros and fortunately were successful in protecting the ER staff back then.
When I was an intern at the Ann Arbor VA, I helped care for a psychotic patient who had surgery for problems related to suicide attempt and required ongoing ICU care. This patient, though he had a tracheostomy and was on a ventilator, got a hold of a very sharp pencil with which he tried to stab me in the neck. I was shocked and caught off guard. I was barely able to stop him. This sounds like it would not be that dangerous. It could have been serious had he penetrated my carotid artery or punctured me in the eye. I learned a lesson that injury can result during patient care in unanticipated ways.
Later during my surgical residency, I rotated on the thoracic surgery service at Henry Ford Hospital. I experienced two situations that were unimaginable. One of the cardiac surgeons performed open heart surgery on the matriarch of a large family. The surgery did not go well. The patient was not expected to live, and the surgeon did not talk to the family and inform them of this unwelcome news. He left his residents (me) and the ICU nurses to deal with the family. We did the best we could. I had never witnessed such reprehensible behavior by a surgeon, and I have seen and experienced a great deal of such behavior as a student or resident. The patient’s family was angry and uninformed. There were scores of family members, some of whom were allegedly involved in the drug trade, in the ICU waiting area. The ICU staff and I were worried they were going to storm the ICU. We saw the doors bowing in, but they withstood the pushing and banging on the doors by the family members. Those of us in the ICU had little confidence in the ability of security to manage the situation. We did not know what might happen. Everyone in the ICU was petrified. I did everything I could to keep this woman alive. She died shortly after I ended my shift, so I did not have to provide the even sadder news to the family. I was scared to even go to my car in the hospital parking lot for fear of getting hurt by one of her family members. I waited until the late afternoon to get to my car and leave, many hours after I was able to leave. My disgust for the attending cardiac surgeon remains. He taught me a lesson in how not to behave as an attending surgeon. I have gone out of my way to talk to family members after each procedure I performed and let them hear the news, generally good, but sometimes bad. I think I have missed talking to a family member only a handful of times during my surgical career.
During that rotation I met and collaborated with Henry Ford surgery residents. One of these residents was genuinely nice and friendly. We worked together for two months. I learned that he was shot and killed by a patient he treated while moonlighting in a local clinic. After he informed a patient that the patient suffered from a venereal disease, the patient shot and killed him while in clinic.
Another doctor I knew and worked with was murdered. He was an Ear, Nose and Throat (ENT) resident at the University of Michigan and then had fellowship training. I was doing general surgery residency and vascular surgery fellowship during the time he was in training. He became an ENT attending surgeon at U of M and was one of few surgeons at the time who performed cochlear implants in kids to allow them to hear. One of his adult patients came to his clinic at the University Hospital in Ann Arbor and shot and killed him.
After I finished training, I became an attending vascular surgeon at the University of Washington and worked at the Seattle VA. During one of my clinic days the VA security officers informed me that they had disarmed a clinic patient with PTSD who was a double amputee. God knows why he needed a gun to come to clinic. The concern was that he wanted to get even with the guy that cut off his legs (not me). Fortunately, he never shot anyone, at least that day.
While my wife and I lived in Seattle, she was caring for patient at Pacific Medical Center who was dying in the ICU. The patient’s middle-aged son, who was dependent on her, came to the ICU and was waving his gun around in a threatening manner. At that time, he did not shoot anyone. After this, he was not allowed in the ICU without being frisked by a Seattle police officer. A consulting psychiatrist stated the son had the profile of serial killer. My wife was the attending physician. She was advised to get out of town and be unreachable around the time of this patient’s anticipated death. This was not a vacation. Mercifully, nothing came of this for us or the staff at the hospital.
The last incident in this essay is not an example of external assault on healthcare worker. One of my respected colleagues I worked with for years was a vascular lab technologist. He was great at what he did and was valued. He shot and killed himself without any clues that he was so inclined. This suicide was a horrible surprise. I am still sad. I did not realize that he needed help. I missed an opportunity to help him.
There have been countless other incidents where nurses, doctors, transporters, and other hospital staff have been attacked by patients. These events are so routine that they are not even memorable or remarkable. The loss of my colleagues by gunfire, however, whether from an irate patient or through suicide, will not be forgotten. This essay does not mention others in the healthcare industry I know or have worked with that have had unsuccessful as well as successful suicide attempts. Recent events in Tulsa reminded me particularly of a few healthcare providers I knew and worked with directly whose lives were cut short by gunfire.