Worried I was aggressive in hospital?

[rhythmisadancer3]

Hi, really embarrassed about this and I know nobody on here can fix that directly but I guess I’m just hoping that by posting it might get it off my chest a bit!

basically I got a bit of a telling off from a doctor and whilst I think it was probably more to keep me calm than to actually give me in trouble, I feel so embarrassed in case maybe I was behaving out of order or badly and that’s why they were annoyed at me?

for context I had an emergency cardioversion because of an unstable arythmia. They had started to sedate me but I think they said I became really unwell quickly (I think maybe really low blood pressure) and so they had to do the cardioversion immediately or something along those lines. I was really unwell but was still awake and had very minimal sedation. When I say I felt the whole thing that’s an understatement- it was horrific. I’ve never been electrocuted but I think I probably know what it feels like now! I actually remember the shock in my entire body from my neck to my toes and my body sort of jolted up with it like something from a horror movie. Needless to say I screamed the place down. I remember wailing to the doctors and nurses that it hurt so much and I was completely hysterical, like inconsolable. I wasn’t screaming (after the initial shock!) but was wailing and sobbing. Really embarrassing but I think I had such got such a fright.

the doctors and nurses were amazing with me, and they were reassuring me and calming me down but then I remember they became really serious and strict and were basically saying ‘(my name) stop it now. stop it NOW. Stop this behaviour now.’ And were being really firm as if I was in trouble. I think realistically it was more to stop me freaking out because they knew we would have to do it again because it hadn’t fixed the arrhythmia. But part of me is like, was I behaving really badly? Or was I being loud and out of order or aggressive and that’s why they were annoyed? That bit is a a bit of a blur so whilst I want to believe they were just being firm to keep me calm, part of me is like was I cursing or flailing about or behaving out of order? Obviously I’ll never know now either way but I’m a worrier and I’m like oh god was I behaving aggressively or something and that’s why they were annoyed at me?

they were brilliant- really helpful, had an entire team of people working to help me and they were amazing. I guess I just hate the thought that I was possibly behaving aggressively or agitated or something to have caused them annoyance or upset when they were so kind to me

haha sorry long rant. I know nobody can tell for sure and I’ll never know either way so I’m just going to move on. Just thought I’d post on here in case anyone has had similar and can reassure me that it was probably just them trying to calm me down!

@writing123

A temporary impairment of the mind and capacity to make a rational decision can occur in times of severe pain. There is a two stage test that must be completed if there is a suspicion that the patient lacks the capacity necessary to make a decision at the time it needs to be made. Severe emotional distress can be a cause of a temporary lack of capacity. In which case medical professionals will act in the patients best interest.
Please do not quote things you do not understand. It sends incorrect messages and scaremongers unnecessarily.

"This case sounds like an emergency to me. The heart could have stopped. No time for a calm discussion about risks and benefits and getting a signature."
100%. Also, if they took her at OP at her word and stopped because, in a haze of pain and confusion, she screamed stop, that would be like taking at face value a confession that had been extracted under torture.

I am really sorry that happened to you. We are at our most vulnerable then. Women are not taken seriously. I has a smear test about 20y ago that I am still v angry about due to a violation of consent.

She had already received some light sedation and has said that her blood pressure went into the 50s/60s which is not compatible with life. We don't know whether she would have refused the procedure resulting in her death but the Dr's clearly didn't think she had mental capacity to make that decision. Just because somebody is conscious and talking doesn't mean that they have capacity to make a decision. Giving sedation lowers blood pressure which would have been life threatening for OP and could have sent her into cardiac arrest before the arrhythmia did.
By all means I understand what you are saying and it is clear you have not been listened to by health professionals but in this circumstance it doesn't sound as there was another option.

Would an advance directive cover this ?

Can you have it written to state that if you decline treatment even if it appears you may not capacity - they are not to continue ?

A bit like a DNR ?

I'm sorry you had such a traumatic experience @rhythmisadancer3
As others have said, your reaction was not unreasonable or unusual and I can almost guarantee that the staff won't have given it a great deal of thought afterwards.
Lots of people behave out of character when they are frightened, very sick or under the influence of sedative drugs. You were all three and you got upset. That's OK.
Sometimes when that happens it's necessary to be very firm, to protect the patient or others but I doubt anyone will have thought badly of you. If I was me I'd have been upset about having hurt you. Sometimes we do have to do really unpleasant things to people in emergency situations but nobody I know enjoys it or sets out to cause distress to patients.
I had a 30 odd year career in anaesthesia and intensive care and honestly I couldn't tell you how many times I have encountered aggressive patients, ranging from being sworn at to having my nose broken. But I don't lose any sleep over it often. It's usually pretty easy to tell the difference between someone who is behaving out of character because of extreme stress or because their brain isn't functioning normally due to their illness, injury or medication and people who are just arseholes. It doesn't sound like you're one of the latter group and any experienced clinician will know that.
Focus on your recovery and don't worry. I hope you feel better very soon.

Yes it would but it has to outline the specific treatments you would decline in the event of you no longer having capacity so they are often written when somebody has received a life limiting diagnosis.

Any treatment you are refusing.

I would not wish to be “saved” but with further trauma.

@OliphantJones I understand that extreme pain can temporarily impair capacity/rationality, but I also know that sometimes people (and especially women) can have medical treatments imposed on them without consent despite being fully rational at the time. Because that's what happened to me.

OP fears that next time she might be believed when she screams at them to stop, I fear that next time I won't be believed when I scream for them to stop. It's two sides of the same coin, and the ethical implications intrigue me, especially within this context, of the OP having been sternly told to be quiet.

It would be reassuring for me, and probably also for her, to hear if there's a protocol or flow-chart or some policy that's being followed, re consent in this kind of scenario. What wasn't reassuring was a PP's claim that consent isn't relevant in a life saving situation. That just isn't true - I have the significant settlement to prove it. And in my opinion it's important for female patients, especially, to know that. So I quoted the NHS's patient guide to consent for treatment. If this isn't suitable for a layperson to understand, or will send incorrect messaging or scare-monger, then that's a problem with the guide, not the person quoting it.

It's here, for those interested.

An ADRT (advanced decision to refuse treatment) is only valid if it was written when the individual had capacity, is witnessed, signed and contains the phrase ‘even if my life is at risk’ if refusing life saving treatment.
It also needs to be specific if refusing life saving treatment, i.e. refusing fluid resuscitation, CPR, invasive procedures etc.
It only becomes valid when the individual has been assessed as not having capacity.
If medical professionals have reason to believe an ADRT is not valid or authentic, they are entitled to make a best interests decision. Other than that it is legally binding and must be followed.

A DNACPR form is not legally binding so can be over ridden by medical professionals if they believe another course of treatment would be in the patients best interest.

Additionally, next of kin have no legal powers to refuse or demand treatment for a loved one aged 16 or over unless they have a valid power of attorney for health and welfare (NOT finance).

So basically it’s worthless and they can do what they want to you.

Brilliant.

Never mind - sorry for derail.

@writing123
There is a clear two stage process for assessing mental capacity in a patient, which should be followed and documented.
You may find the Mental Capacity Code of Practice helpful to look through. Just google it and you should be able to find it. It is a guide to applying the mental capacity act and making best interests decision decisions.
There is a problem because the legislation and Code of Practice haven’t been updated for many years. It really does need review and reform, particularly for those of us working in pre hospital care.
I am sorry you have had a bad experience and glad you were compensated accordingly.

Don't worry OP, it's likely that they genuinely just needed you to calm down so they could help you.

I had an emergency c-section with DS after a traumatic labour attempt. I remember someone (not sure if dr nurse or whoever at that point) asking me if I could feel more of a spray here or here, and I couldn't feel anything.
I was incredibly sleepy and struggling to even care about what was happening, and suddenly she shouted at me that I needed to wake up NOW and tell her what I could feel.

It actually worked, and I became more conscious for a bit.
Afterwards, when I was on the ward, she came to see me and apologised for how she'd spoken to me, but explained that it was really serious at that moment and my 'sleepiness' was actually them losing me.

It’s not worthless at all. If it’s something you feel strongly about I would advise you to do it properly so to speak, with a solicitor, and after getting advice from an independent medical professional. Make sure your family know about it and where to find it. Carry a copy with you and consider wearing an alert bracelet.
It is quite rare to look at an ADRT and think it isn’t genuine. It is harder to decide it’s genuine if it’s written on a phone with no signature or independent witnesses for example.
There is also something called a RESPECT form, which you can also use to record your wishes and preferences. These are helpful when making best interest decisions for patients.

I will be making an ADRT when I am a bit older.

God how awful for you.
I wouldn’t worry about it, they’ve probably forgotten all about it and you should too.
Im a dental nurse and I’ve had a couple of patients be absolute arseholes to me, I never take it personally people are anxious when they come to us and nerves can make lovely people behave out of character.
I behaved reaaally badly on a plane once. We’d accidentally sat in the wrong seats. We offered to move straight away but the couple said don’t worry about it and sat somewhere else but I could hear the woman chunnering on about it. We offered to move again. They said no so I told her to either swap or shut the fuck up moaning!!!
So out of character for me but I’m absolutely terrified of flying and was totally stressed out! I felt terrible for the whole flight! I’ve decided never to fly again, it’s not worth the stress.

I think your behaviour was completely understandable OP, and they just did what they thought might help them be able to do what they needed to do.

You poor thing, what an ordeal!

As you can see from the responses in here, they'll have seen it all before and you have nothing to feel badly about. Horrible situation all round by the sounds of it!

But as it sounds like you thought the team was really good and are also the type to worry about what impression you've left, maybe it would help you to write them a thank you note? You can refer to what happened and how scared you were but how grateful you are for their care and how they handled your distress.

Who doesn't like receiving a thank you card? And it might make you feel like you've "cleared the air" and drawn a line under it iyswim!

I agree - can you have someone with you if this was ever to happen again in the future?

I'm the last person to stand up for medical professionals but even I can understand why they had to do this

I wonder how the OP feels about being ‘saved’ in this way.

OP I would encourage you to get a debrief. Just to understand what happened and why. This sounds really distressing indeed.

Don't worry about the behaviour, people get deliberately electrocuted as a torture technique so don't be embarassed that you weren't calm, compliant and rational immediately afterwards.

I imagine the decision making process is a well practised one not just something they made up on the spot. e.g.
Patient requires emergency cardioversion to save life-> assess if this can be done under sedation to maintain pt welfare-> pt not suitable for sedation, emergency lifesaving life trumps welfare-> proceed to conscious cardioversion (akin to torture technique)-> immediate post conversion pt in the large % of pts who start screaming and panicking, in severe pain and delirious , causing catecholamine release which increases oxygen demand, endangers heart rhythm etc, can't read ecgs etc due to thrashing, also mental distress deleterious to pt welfare; attempt to resolve situation without sedative drugs if blood pressure etc still not stable-> attempt to calm pt by talking soothingly-> pt non responsive to soothing-> proceed to administer verbal face slap-> pt delirium still non responsive -> proceed to physical restraint-> check ecg leads attached, IV access still in etc whilst attempting soothing again, sedate pt if risk:benefit assessment determines that sedation is less dangerous to heart than continued distress.

If they were feeling any emotions towards you it was probably "Ugh I hate doing conscious cardioversions, feels like torturing the poor buggers. Ugh, I hate having to verbal face slap the distressed ones, it's like kicking puppies".

I think they should automatically do a debrief with patients in this situation when patient is rested and fit for it: the pain itself plus the fact that they have to deliberately inflict it on you plus the verbal face slap plus the fact that they (correctly as it turns out in your case) ignored the screams of the delirious patient to stop treatment plus you weren't far off dying plus the knowledge that the whole schemozzle might happen again equals a pretty mentally harrowing experience.

Im an A&E nurse and sometimes its essential to be stern with patients, if the situation is spiralling quickly and the outcome is dependent on acting fast, you have to be stern. Both with patients and relatives. Ive witnessed CPR descend into utter chaos because of relatives and been the one to have to, quite forcefully, remove multiple relatives from the area. Ive also had to tell patients they need to to stop what they are doing and listen to us in order for us to help them. 99% of the time, afterwards, when its less time critical, the patient/relative is understanding of why that happened in the moment and i am able to go back in, and be the empathetic understanding caring person they need, but in the moment its not always possible. Rarely, people remember and hold it against you as being that nurse who told them to calm down when they were scared/anxious/in pain and refuse to allow you that conversation and time afterwards. Sometimes they are moved before you have chance to speak to them again. Emergency care is often quite frantic and chaotic, and most defintely scary as a patient or relative, but they always 100% of the time in my experience and the people i work alongside, have the patients best interests at the centre of these decisions - even if that isnt communicated in the best way in the moment. We also understand that how people act when scared, in pain or incredibly worried for a relative, that version we see of them isnt how they are all the time, and is no way held against them in future contact.

I would imagine better than if she hadn’t been …

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