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Excerpt from ‘Grady Medic – Tales of Atlanta’ - Keith Blaylock

Keith Blaylock surveyed the devastation within the room in a studied silence. Furniture had been shattered and splintered, mementos of a childhood and teenage youth lay sundered at his feet, glass fragments crunched beneath the soles of his heavy boots, and the walls were stained with small spatters of blood from where a wounded arm had flailed while losing blood from some unseen wound. To his experienced eye, the only seemingly intact item in the room was the man who had caused the wreckage; a man who glared at him with eyes filled with madness and fear.

The paramedic felt no trepidation about being alone in a closed room with a patient amid a psychotic episode. In fact, he’d quietly asked the two Atlanta police officers and his partner to leave him with the patient for a few minutes. At 6’ 1” and 250 pounds of solid muscle, the former Army Special forces medic found few things in life with a potential for violence to be personally intimidating.

Keith leaned back against the bedroom wall and waited for the man across from him to speak first while he mentally reviewed the information given by the man’s parents. The 24-year-old man had a lengthy history of paranoid schizophrenia that began as a child. The episodes or breaks from reality had once been controlled by medications taken daily. However, the man had recently shown a pattern of skipping doses and had finally stopped taking them altogether two weeks ago.

The descent into his current state had followed a gradual pathway spiraling steadily downward. He’d begun talking to himself and of himself with a steady intensity. The typical sounds of the city surrounding the family residence intensified the man’s fear. Conversations held with their son were punctuated with accusations and warnings that slowly intensified as he perceived himself being threatened. It was some unknown and probably inconsequential event that finally triggered this final break from the reality known by the rest of the world in an explosion of violence. It was fortunate that the schizophrenic patient had chosen to destroy his own bedroom, rather than visit the outburst on his family.

The man snarled, “What do you want, white man?”

In a soft tone belaying the disparity in his physical size, Kieth answered, “What can I do to help you?”

The man blinked before snapping, “Nothing. I don’t need nothing from you.”

Keith nodded as if in agreement before speaking. He followed this with, “Tell me about the voices.”

The much smaller man was stunned. “Do you hear them too.”

The Grady Medic pressed forward with the questions. “What are they saying to you?”

“I don’t know man.” The patient answered. “I hear them whispering. Can’t make it out. I know it’s about me. It’s a bunch of people that I can’t see just talking all the time. The cat… that damned cat knows what’s going on. Cars on the street slow down to watch me. I see people out of there that just disappear like magic. The darkness is there too. Just waiting for me.”

A schizophrenic break is often characterized with audible and visual hallucinations which gradually intensify over time. The thought processes become jumbled and disjointed without any thread of logic connecting one sentence to the next. The paranoia steadily increases to induce a deeply seated fear which drives the individual’s response to all stimuli as the mental degradation continues.

Keith held his position resting against the wall as he considered the patient’s state and his options. It would be all too simple to use the available manpower waiting outside to wrestle down and restrain the patient. However, the man did not appear to be agitated enough to require physical force. The medic wanted to end this stand-off in a manner that gave the patient some small degree of control to elicit his cooperation.

The paramedic asked quietly. “What do you need from me? I am here to help you.”

The man began pacing to and fro across the ravaged debris within the room. “Make them stop. Shut them up.”

“That’s a plan that I can help with.” Keith agreed. He paused as if in thought. “What happened with your medication? Did you quit taking it?”

The man pointed at his groin. “It ain’t working. Had me a girl and she laughed at it not working right. It ain’t fair. It’s that medicine and I know it. I gotta be a man.”

Keith nodded with understanding. “They might have another medication that can help with that and stop the voices for you. However, that requires a doctor examining you because I can’t write a prescription.” He paused. “So… What would you like to do?”

“Them police are outside. They will take me to jail.” He became slightly more agitated. “I ain’t going to jail!”

Keith stood silently for a moment before speaking. “Here’s your choice and it is your choice. I can let you ride down to the hospital with me where I’ll speak to the doctors about what’s going on. It will be a quiet ride and we can get you some help. The other choice is calling the police in here where it will get ugly.” He added emphasis to his next words. “Staying here is not an option. Your parents are frightened for you right now and need you to see a doctor. They have a legal document that let’s them make that decision. So staying here isn’t a choice that you can make.” He modulated his voice down. “You can ride with me or you can ride with the police. It’s your decision. Personally, I’d rather take you with me to get you the help that you want.”

Having control in a situation, no matter how small, is important to all people in a crisis. A good medic understands that sometimes the smallest of decisions made by a patient can serve to sway a situation toward a positive outcome for all the involved parties. You simply lay the straightforward choices out and allow the patient to choose their own direction for the medical care to follow.

The man stood still for a minute as he weighed the options before him. When he spoke, it was a rational question. “I ain’t got to go in handcuffs?”

“Nope.” Keith smiled. “I don’t use handcuffs. You get to sit on the seat and have a nice quiet ride while I do paperwork.”

The young man stepped forward. “Yeah, that sounds good. Can we go now?

“Sure thing. Let’s ride.”

Grady Medics have an arsenal of medications and restraints available to them for use in controlling a potentially dangerous patient. However, the best course of treatment is a simple understanding of people and their needs in any given situation. Cooperation and a sense of controlling their own destiny is a mental tool used to influence outcomes when the individual can make some form of a rational choice.

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