One night I found myself on the other side of the stretcher, as a patient waiting for a psychiatric assessment in an emergency department (ED). After drinking a couple of beers and texting a friend about my depression and marital issues, my friend was respectfully concerned about me. I had said that sometimes I would rather be dead than feeling this sad, so my friend convinced the police to place me under a mental hygiene arrest.

My interview by the male emergency physician was painfully brief, but I was forthright about being from the same specialty, explained in detail the preceding events, and said that I understood that he wanted to rely on a formal psychiatric evaluation before deciding if I was safe to be discharged to home. Being stubborn, however, and nervous about a positive blood alcohol level on my record, I shared my opinion about “medical clearance labs” that we emergency physicians usually order to appease the minds of our psychiatry consultants; we should not have to wait for labs to speak with our mental health consultants.

After he left, and while I waited alone in the room for what felt like forever, I heard my husband and my three-year-old son talking in the waiting room. All I wanted was to talk to my husband and my baby boy and tell them I loved them and that I was okay. I knew it would not be until morning before I was “medically cleared” for my psychiatric evaluation, and I wanted to let them know they could head home. So I popped my head out, and, because there was no one-on-one attendant nearby, I walked out of the room to find my family. Unsurprisingly, several nurses and a sauntering security guard followed me before I could even reach the waiting room door, refusing to let me talk to my husband. After they threatened to have me dragged back by security, I walked back to my room and sat on my bed.

Several minutes later, a group of nurses and a security guard stood next to me. I knew immediately what was about to happen as they all grabbed hold of my limbs, despite my passively lying down without a hint of resistance. I knew there was no use in fighting, but I did plead, though, blabbering about giving in to the blood tests and asking why they were doing this when I had agreed to come back to the room voluntarily. But the begging and tears did not stop them from stabbing me with three intramuscular injections, later confirmed to be the notorious B-52 combo of lorazepam, haloperidol, and diphenhydramine. All I could do was submit to their power as I lost my freedom to control my body.

From my experience as an emergency physician, I know there are often pressures influencing the decision to chemically restrain patients, one that I have felt guilty for even entertaining, such as lacking staff to spend the time verbally redirecting patients back to their room or situations like the one I experienced recently when a first responder flippantly asked if I would just give a verbally belligerent guy some ketamine and make “everyone’s life easier.” It should be obvious that using any form of restraints should be a last resort, used only after attempts to deescalate have failed, not just because there are physical risks like extrapyramidal and cardiovascular side effects, but also because restraints limit some fundamental human rights and risk the individual’s long-term mental well-being. One study found that up to 47 percent of people end up with post-traumatic stress disorder as a result of this traumatizing practice.¹

Having now been the victim of this coercive procedure, when it appeared that chemical restraint was used “punitively, for convenience, or as an alternative to reasonable staffing” and without exhausting alternative options, I can now speak from the perspective of the patient on what it feels like to have liberties stripped away, to feel that forced treatment was completely unjustified, to think perhaps it was a means of punishment or an “unnecessary exercise of power,” and to feel utterly helpless and vulnerable.^2–5 Although carrying a diagnosis of depression caused me fear of being discredited and suffering professional fallout, unlike most mental health patients who have no chance of obtaining justice, as it is their word versus the almighty physician’s, I am in a position where I can use my story to promote awareness and change within our medical community.⁶

When I finally had the courage to request and read through my medical records, I was appalled to learn that it was a second female doctor, one I had never met that night, who had the audacity to write in a note that she was medicating me because I was agitated; she wrote that she was doing it for safety reasons. Perhaps she was receiving sign-out at shift change and made a very inaccurate presumption, but this is only my own speculation; there is no other evidence in the chart of her having any form of interaction with me. My story is not meant to demonstrate a rare “bad apple” doctor getting away with malpractice but to call attention to a much more likely scenario: Emergency physicians frequently jump to chemical sedation without exhausting other options or contemplating the ethical and moral consequences of this practice. Further, and perhaps more importantly, when we witness any form of practice that we may find questionable or even outright wrong, we may not speak up because we have learned to be silent. The “hidden curriculum” of our training teaches us not to challenge the hierarchy.^7,8 Meanwhile, patients are losing trust in our health care system; I am losing trust as well. Every day I think about leaving medicine, even though that would only add to the statistics of burnout and the abysmal attrition rate, especially of women, in our specialty.⁹ By speaking out, I hope to once again find my calling in medicine.

Dr. Vargo, a loving mother of two beautiful boys, completed medical school in Rochester, N.Y., and her emergency medicine residency in Syracuse, N.Y., and is working full-time as a nights-only emergency physician in community hospitals in western New York.

References

1. Chieze M, Hurst S, Kaiser S, et al. Effects of seclusion and restraint in adult psychiatry: a systematic review. Front Psychiatry. 2019;10:491.
2. American Medical Association. Use of restraints. Accessed May 19, 2024.
3. American College of Emergency Physicians. Use of patient restraints. Updated February 2020. Accessed May 19, 2024.
4. Crutchfield P, Redinger M. The conditions for ethical chemical restraints. AJOB Neurosci. 2024;15(1):3-16.
5. Muir-Cochrane E, Oster C. Chemical restraint: a qualitative synthesis review of adult service user and staff experiences in mental health settings. Nurs Health Sci. 2021;23(2):325-336.
6. Gold KJ, Andrew LB, Goldman EB, et al. “I would never want to have a mental health diagnosis on my record”: a survey of female physicians on mental health diagnosis, treatment, and reporting. Gen Hosp Psychiatry. 2016;43:51-57.
7. Wong AMF. Beyond burnout: looking deeply into physician distress. Can J Ophthalmol. 2020;55(3 Suppl 1):7-16.
8. Osuch JR. Legacy of abuse in a sacred profession: another call for change. Virtual Mentor. 2009;11(2):161-166.
9. Cook TP. Why are women leaving EM?: Female EPs who left the specialty were more than 12 years younger than male EPs who left. Emerg Med News. 2024;46(1):1,21.