Employees 

"Content warning: Detailed depiction of abuse of psych patient, sexual violence

 

In early 2022, I was working as a janitor in the Sparrow emergency department. One day, I was paged to clean a room in E hall, the locked psychiatric unit. While in the hallway outside E hall, I saw a new patient being brought to E hall by a police officer. As the patient and the officer waited to be allowed in, I heard a portion of their conversation. I perceived the tone of their conversation to be amicable and respectful, and I perceived the officer as reassuring. I heard the officer say, “Just tell them that you’ve been here before and didn’t feel like you got the care you needed.”

 

I followed them into E hall and began cleaning. The officer handed the patient off to a nurse and left. As I cleaned, I could clearly hear the intake process. The initial steps seemed fine. The patient voluntarily gave up all her personal items without incident. The conflict began when the nurse was instructing her to remove all her clothes, including her bra, underwear, and socks. The patient appeared taken aback by this request and said, “I’m really not comfortable taking off my bra.” The nurse told her she had no choice, and that it was part of the rules. The patient said, “Why do I have to take off my bra? I’ve never had to take my underwear off before.” She stated that she has been a patient within E hall four times previously and has never been forced to remove her undergarments, nor had this been asked of her at other facilities she’s been to. The nurse told her that the other employees were not following the rules, and asked the patient for the names of the employees from her previous stays.

 

The patient was willing to change into the top and bottom provided and give her clothes to the nurses, but refused to remove her undergarments and socks.

 

The pattern of the above conversation (patient expressing discomfort, asking for a reason, a staff member saying that “it’s the rules”) repeated for several minutes, with some variations. At this point, the cyclical nature of the exchange made it so that I don’t have a clear chronological sense of when the following events occurred, or which staff member made which statement.

 

All staff members present (nurse, tech, and security officer) had at least one variation of this conversation with the patient:

 

• The patient began crying. She said she had traumatic experiences related to being without her bra and would not be able to handle it. Her face was bright red and her arms were crossed tightly across her body.

 

• The patient asked if she could have her phone back so she could call her mom. The staff refused to allow this. The patient begged repeatedly for them to let her talk to her mom. The patient said she had a right to a phone call. She said she had always been provided the opportunity to call someone. 

 

• During the rest of the event, the patient would periodically ask again to be allowed to talk to her mom.

 

As the conversational cycle continued, the staff members began utilizing threats. The first threat I heard was that if she did not comply, she would not be given her phone and personal belongings back, so she would not be able to access her contact information for phone calls. The patient said she had all her important contacts memorized.

 

Someone told her that if she did not comply, she would be pinned down and security would forcibly remove her clothes.

 

She was told that if she did not allow her underwear to be forcibly removed, they would be cut off of her, and then the garments would be destroyed and she would never have them again.

 

When one of the staff members was behind the glass at the nurses station, I heard her tell the security guard that “of course the first one they bring us is an argumentative one.”

 

I finished cleaning the room and was disposing of my rags just outside of E hall when I saw additional security arrive. I reentered the unit after them, and stayed close to the door, against the wall. I was observing passively. Three security guards were between me and the patient. I did not say anything nor make any attempt to intervene.

 

Both nurses and the three security guards were entirely surrounding the patient. The patient was facing the wall and shaking. She had become very silent. I could not see a clear view of her face.

 

One of the nurses addressed me for the first time since the incident began. She asked if I still needed anything. I said I just didn’t want to leave the patient alone. She told me I needed to leave.

 

I said, “I’m sorry, but this is fucked up.” The nurse told me I should leave to go talk to the charge nurse. I told her she could talk to the charge nurse if she had an issue with me. She told me she would call my supervisor. I told her she could call both the charge nurse and the supervisor, but I did not intend to leave. She told me that watching what was about to unfold wasn’t my place. I told her it was my place as a human being who cared about the wellbeing of another human being.

 

All three security guards turned to face me. I was told multiple times to leave. At first I stood my ground, but when the guards were pressing up against me I decided to leave to protect my own safety. As the guards were pushing me out of the room, I shouted back to the patient that I was sorry, I wasn’t leaving of my own choice, that she was valuable, and that there were people who cared about her.

 

After I was gone, I speed-walked towards the cafeteria with the intent to find a place to calm down. However, as I was walking through the hallway, I passed the E hall emergency exit and heard screaming that I would characterize as intense, guttural, and piercing. I stood there listening until the charge nurse approached me and told me to go to my supervisor’s office.

 

My supervisor allowed me to leave work early because I was very distressed after witnessing this incident. I was not reassigned back to the emergency department for months. My supervisor told me something along the lines of, “Some people just can’t handle the emergency department, and that’s okay.” They compared this situation to how some people can’t work in pediatrics because seeing sick children is distressing to them.

 

At no point during this incident did I see de-escalatory measures being used by any party involved. The number of officers, the position of staff in relation to the patient, and the level of the threats being used were all escalatory in nature. I did not personally witness any staff apologize to the patient, nor acknowledge that this was a difficult experience for them. The default path of these staff members was threats, coercion, and ultimately physical violence. 

 

I did not personally witness either the nurse or technician attempt to gain more information about the decision making processes in those past incidents referenced by the patient, nor seek more information about ways the intake process may have been adapted in the past to respect both the patient’s needs and the safety of the parties involved.

 

The only thing I can think of that could be considered a de-escalation attempt is that at one point, the security officer used a softer voice when talking to the patient, but even in that instance, the actual content of his words was threatening in nature.

 

During a follow up conversation with my supervisor and a nursing supervisor, I was repeatedly told that they and the staff members present that day were “just worried about my safety.” I strongly object to the characterization that the staff member’s actions were taken out of concern for my safety. Not a single one of my coworkers acknowledged me throughout the entire incident until the end, even though the situation was clearly volatile long before that.

 

The nursing supervisor described instances in their career in which weapons have been found in a patient’s underwear, including, in one instance, a loaded gun. I have three primary concerns about this framing.

 

First, if this is the reason for the rule, that should be explained to the patient. Explaining the reasons why certain rules exist, or why certain requests are made, is an important de-escalation tactic. Otherwise, it feels even more arbitrary, cruel, and as if the rule is purely about maintaining total control over the patient’s body. The patient repeatedly asked why she was being asked to do this, especially considering that she had never experienced it before at Sparrow nor other institutions, and the only response I ever heard given to her was “because it’s the rules.”

 

Understanding the reasons behind rules is crucial to my second concern, which is that if we have clarity about the reasons rules are in place, then we can tailor our processes to the root concern, rather than adhering to rules for the sake of rules, without regard to situational context. If staff understood that the primary concern motivating the rule about undergarments is smuggled weapons, then the process could be adapted. As one possibility (which of course could vary depending on the situation), an employee could have the patient remove their undergarments briefly for a security officer to check for weapons or other hazards, before having their clothes returned to them. This could suitably ensure safety while also avoiding trauma to the patient. Clarity is a crucial part of developing procedural adaptability. The lack of adaptability in this situation caused a minor situation to escalate wildly and cause significant psychological and possibly physical trauma to the patient.

 

Third, and most importantly, I am concerned about using a hypothetical safety concern to dismiss and deflect from the actual, real act of violence that played out in E hall that day. Although I was not allowed to bear witness to what was done to the patient, I know they were threatened with physical assault, subjected to psychological trauma, isolated, denied access to their loved ones, and stripped (literally) of everything that made them feel safe. If my interpretation of what happened after I was removed is correct, then the patient was also physically assaulted and restrained by three strange men much larger than them – men who grabbed their undergarments and exposed their genitalia.

 

I highly doubt that any of the staff members involved in the incident will perceive themselves as having committed or been complicit in an act of sexualized violence, but that is the reality of what they did. It may be legal, it may be something the staff can justify to themselves, it may be institutionally accepted, it may even be institutionally rewarded, but the harm done to the patient is the same. Our culture — both that of society as a whole and Sparrow as an institution — generally does not view psychiatric patients as human beings, and I felt that mindset was reflected in this incident."