(Editor’s Note: This is Part 1 Dr. Simonson’s reflection on workplace violence.  Her personal story sets the stage for her current academic research.)

On a warm April day during the Spring of my first year of residency, I was quite stressed — I had my Step 3 exam three days away. Nevertheless, I couldn’t have asked for a better rotation to be on. I was in the middle of my Psychiatric rotation, a rotation known to be more “low-key” than other rotations, with great hours, an eager-to-teach staff, and an overabundance of comical banter.

I had temporarily put down my study notes to see a new patient. He was in his mid-20’s with no prior psych or medical history. He came to the ED with vague medical complaints yet an odd affect, so after being medically cleared, he was sent to the Psych Unit for further evaluation.

The patient was calm, pleasant, and cooperative. We had been conversing effortlessly for some time when the patient decided to lightly punch my arm. It was not painful or overtly aggressive — it was the type of punch a male would do to another male friend when they were proud of the other. To me, however, it was unwanted physical contact. I flinched, and the patient seemed to find my reaction oddly amusing. With a sinister smile on his face, he proceeded to softly punch my arm once more. I stood immediately, warning the patient that if he touched me again, I would call security. At that point, I attempted to make a swift exit, briefly wondering how I should proceed if the patient attacked me. Do I attempt to fight? If I fight, would I be kicked out of residency?

My thoughts were quickly interrupted by a fist hitting the back of my head, forcing me into the wall. As I tried to escape, he proceeded to punch the right side of my face four more times. I managed to duck in between any further punches and ran out of the room. To this day, I still don’t know why I didn’t call for help. In fact, it was not until people saw me motionless on a chair and blood on the floor did anyone realize that I had just been assaulted.

While the patient was comfortably sleeping after a nice dose of Benadryl, Haldol, and Ativan, I found myself being wheeled into the ED, embarrassed from the commotion and desperately trying to avoid curious glances from co-workers.

Eventually, word got around about my incident. Upon hearing my story, many colleagues came to my room to commiserate with me, sharing their own personal stories of workplace violence (WPV). I remember a nurse confiding to me about how a patient had once slammed her head into a gurney after grabbing her hair. I also remember one of the social workers solemnly telling me this was bound to happen at some point – it comes with the job – after revealing all the different times she had been assaulted. At the time, I found it odd that most of these victims had never reported the violent episode(s), and some even discouraged me from pressing charges

As luck would have it, I would soon begin to understand why many neglect to report these incidents after overhearing two police officers talking outside my room: “Why does she want to press charges? He’s a psych patient, and the case will go nowhere. It’s not like she has a chair sticking out of her head.”

Although physically I had nothing as jarring as a chair sticking out of my head, I did have significant swelling and bruising to my face, back, and chest, a laceration that needed to be stitched, a subconjunctival hemorrhage, and an occasional bloody nose. On top of that, what the officer couldn’t see were several facial fractures resulting in permanent right infraorbital nerve damage and posterior displacement of my right eye (that would have needed corrective surgery if displaced 1 millimeter further).

Even if the event caused no obvious physical injuries, assault of a healthcare worker is a Class C Felony in the state this occurred.¹ To add insult to injury, despite insisting I wanted to press charges, the officers kept persisting for me to wait and to give it two weeks. Yet, their contact card had no number, and when I finally found the number, my calls were never returned.

The next few weeks were difficult, and the next year was even worse. The stress from being out of residency, coordinating care, dealing with a lackadaisical judicial system, trying to reschedule my Step exam (and finding the money to extend my 3-month time frame for taking the exam, registering for another exam, and reinstating my expensive study bank), on top of all the responsibilities that come with living by yourself, took its toll on me. Stress caused a GI illness to flare, causing me to loose weight and hair. It was not until these adverse effects were noted that any attention came to the event that occurred. Sadly, I couldn’t help but feel the attention was misplaced and the concern delayed.

I found myself taking solace from the wretchedness of my situation by spending my spare time researching the topic of WPV. The lack of having obvious institutional reporting guidelines, the lack of support and guidance from hospital administration and ED management, the perception that assaults are part of the job in both the medical field and judicial system – there was no way I could be the only one who has had this experience.

What I found was disturbing….

References:

1. https://www.ena.org/government/State/Documents/StateLawsWorkplaceViolenceSheet.pdf