Haldol, IM

I hated working in the upper unit at the psych hospital.  Supposedly, this housed the more stable patients. But I was cross-trained in admissions and know better. When a patient with good insurance needs a bed, and the upper unit is the only place there's a free one, they'll get admitted anyway.

This unit is on the top of a hill. It has a beautiful view, but it’s a 5-minute jog from the other buildings, so in an emergency, you’re on your own. I prefer to work with the adolescents, but a nurse who's been there much longer than me picked that unit, so I'm out of luck. There is a travel nurse in the upper unit with me, which is not typical, but it's her last day and I'm grateful I won't be alone.

I have a patient in her late 60s which is very uncommon.  It can be hard to suss out psych vs dementia in geriatric patients. Dementia is progressive, not a temporary crisis to be stabilized, so typically people over 60 are not admitted unless they have an established psychiatric history, which is the case with this patient.

She is in a very bad way.  She is shaking, for one, which I don’t like, and completely nonsensical for another.  Given I don’t know her and her baseline, I can’t tell if this is how she presents when she's in a psychotic state or if something else is going on.

Typically, mental health workers will take morning vitals, but this patient has me on high alert so I go straight for the vitals care to get a thorough assessment.  As I’m taking her vitals, she asks if I am a nurse and I say, “Yes.”

She asks, “Where did you go to nursing school?” 

I am comforted that this conversation is making sense and am preparing to let my guard down as the blood pressure cuff inflates.

“Is that your name tag?” She asks, pointing at my name tag.

“Yes.” I say.

She shakes her head, and very suddenly grabs the cord from the blood pressure cuff which is hanging from her arm to the cart, and wraps it around my neck.

“You’re not a real nurse.” She says in a low voice.

I get my hands up in time to get them in between my neck and the cord. The end attached to the cuff pops off and I back up.

“Woah!” I say, “You don’t feel good, do you?” 

Although this is playing out exactly like what movies have taught me psych patients act like, this is not typical behavior.  I notice she’s become increasingly sweaty. She does not continue to come at me. She looks dazed, staring straight ahead, shaking, sweaty.

I offer her water, but she won't take it. I can’t get her to do anything. It's not exactly like she doesn't want to listen, it's more like she doesn't understand, she's zoned out.  I also can’t get her to sit still long enough to get her blood pressure. I can’t get a trustworthy answer on when she’s last eaten, or peed, or how long she's been sweaty and agitated.

At this point, I call for the other nurse and we go through her medical clearance paperwork. Her white blood count was on the higher end of normal upon admission. We determine she is likely septic, maybe from a UTI.  The travel nurse is kind and helpful and we both agree this patient should be sent to the ER for labs. I call for an ambulance phone the hospital to give a report.

Several hours later, the patient arrives back, literally dripping with sweat. It's a pleasant 70 degrees out. The sheets on the gurney are wet. Her gown is wet. 

I ask the EMTs for paperwork, and they tell me the hospital didn’t send any. 

I say, "I’m sorry, I don't know why they discharged her but she’s not safe to be here.  I’ll call the hospital. We have to send her back."

I worked for this ambulance before nursing school and know that as soon as the patient gets off the gurney, transfer of care is considered complete, so I make sure she stays on the wet gurney.

I call the hospital and ask what was done and they tell say, "We gave her Haldold, IM."

“You gave her haldol?” I ask.

“Yes, she’s a psych patient and she was agitated.”

“I know,” I say, “We can handle psych issues and psych meds. We wanted labs drawn. I think she is agitated because she's septic.”

“We couldn’t get labs, she was too agitated, couldn’t get near her with a needle. Couldn't even get a set of vitals.”

I don't understand why labs weren't drawn once she was shot up with sedatives. And how do you discharge a patient from the ER without vitals? I call my supervisor and tell her I’m not comfortable taking the patient and am sending her back.

My supervisor tells me it’s fine, we’ll just take her. I say, “I’m not comfortable. Not only has she not been properly assessed, but she's now been overdosed with antipsychotics. Look at her skin signs, they're getting worse, she's not safe.”

She says, “If you really need me to, I’ll stay up here too.”

I say, “Look, I don’t think it’s about extra hands. This is what a person's body looks like when it's fighting to survive. She needs a higher level of care than we can give her.”

My supervisor says, “That’s fine, I’ll stay.” and signs the EMT’s iPad for transfer of care and helps the patient off the gurney. She doesn’t have an attitude about it. She’s one of the most go-with-the-flow people I’ve ever met in my life. 

At the end of my shift, I relay the story to the oncoming nurse. I say, "I believe strongly she needs to be sent out." Without going to look at the patient she says, “You don’t need to tell me twice,” and calls the ambulance once we’re done with report.

My next shift, I ask about the patient and am told the ambulance came to pick her up, and she died in the back of the rig on the way to the ER.  They got pulses back, and she was moved to the critical care unit. No one could or would tell me if she ultimately survived. 

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Review

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This story is riveting, intensely visceral, and emotionally charged—a raw and unsettling exploration of how systemic failures, medical negligence, and sheer human vulnerability can lead to tragic outcomes. The slow, creeping sense of dread built throughout is palpable and lingers long after reading.

The central theme is how broken healthcare systems allow patients to fall through the cracks. From the ER’s failure to assess the patient properly to the psych hospital’s willingness to accept someone who was clearly physically deteriorating—this story is a searing indictment of how bureaucracy can kill. The screaming instincts and repeated dismissals highlight a terrifying reality in healthcare—when systemic red tape and apathy overpower a trained professional’s instincts.

The setting of the upper unit being physically isolated on a hill parallels the emotional and professional isolation experienced while trying to advocate for this patient. The determination to advocate for the patient, even with constant dismissals, adds depth and emotional gravity. It shows the quiet strength of standing your ground in the face of systemic indifference.

The heartbreaking reality is showcased that doing everything right—following protocols, trusting your instincts, advocating for patients—doesn’t always prevent tragedy. The patient becomes more than just a case study. She’s a symbol of those failed by the system—a reminder that neglect in healthcare isn’t just bureaucratic incompetence; it’s life-threatening.

This story subtly examines how medical professionals carry emotional scars from their failures, even when those failures weren’t their fault. The aftermath of knowing that the concerns were valid, and that the patient likely suffered (or died) as a result of negligence, speaks to the emotional toll that medical professionals endure. This story perfectly captures the devastating feeling of witnessing preventable suffering and being powerless to stop it.

This story is unflinching in its portrayal of the harsh realities faced by both patients and the healthcare workers who try to advocate for them within broken systems. It’s heart-wrenching, visceral, and painfully honest—a powerful testament to how compassion can be stifled by institutional failures, leaving tragedy in its wake.