Lessons from the World’s Smartest Horse
As Lukas’ trainer, much of my experience has come from many years as a psychiatric nurse on acute-care locked down units. Take-downs. Even the name conjures up the octagon fight ring. Only there are no referees here. Technically speaking, take-downs are only supposed to occur if there is eminent danger to patients or staff and all other options have failed. Profanity, refusing to comply with assignments or the schedule, declining medications, insulting the Dr., racial slurs, poor hygiene or even threats do not fall into this description, although they’ve all been used as justifications at one time or another.
Ideally, a take-down team consists of 5 staff members who form an arc around the patient with the leader being the person who has the best rapport with that particular client. Each position has an assigned responsibility and target – arms, legs and the head person who is also in charge of monitoring staff locations and positions. In reality, mayhem often ensued – elbows in throats, knees dug into chests, wrestling moves that would have opponents tapping out – a tangled mangled mess. Not planned or intended for the most part, a situation that happens to worsen with every blow. Verbal conflict would escalate and the most impulsive member of the code team would initiate physical “intervention” – and the rest of the squad would be obliged to follow suit. Of course, the first staff to reach the patient was almost always going to get hit – punches, kicks, fists and knees flying – which made for further reckless and hasty mistakes.
Timing and waiting – this is what is often best but the hardest to do. From an early age are conditioned to do – something, anything! If we don’t, it is thought that we are weak, confused, and inept. Not so – even animals appreciate being given time to make a dignified response, even if it’s to comply or retreat. Fear and anger cause the most damage resulting in loss of control and harm. “I want a cigarette now! Not later! Right now, bitch, and don’t try to tell me what to do!” Testing, I decide, furtive glances mean lack of commitment; I don’t budge but continue to gaze at her unflinchingly. “I shouldn’t be here anyway! Give me my cigarette!” Long pause. Shoulders dropping, fist unclenching. I nod, “Smoke break is in 15 minutes; let’s go see about a fresh gown for you.” “O.K., thanks, sorry.” Over, never to be repeated, x 1000 outbursts with different patients.
Prone (laying stomach down) patients were safer it was thought…for the staff at least. Spitting, nasal discharge, freed limbs – less chance of employees encountering them, however, it was found through many investigations that patients were dying nation-wide in such predicaments. Drowning in their own vomit, obese patients whose hearts were strained beyond capacity, the elderly whose crinkly skin was peeled off to the bone, pregnancies that wound up as miscarriages. And so it was decreed by the regulating agencies that restrained patients be placed on their backs. A rise in staff injuries and medical leaves, urination fiascoes, gagging incidents (using washcloths, towels and clothes to prevent spitting by restrained patients) and deaths due to smothering along with multiple accusations of improprieties followed this ruling and it continues to remain a dilemma for healthcare to this day.
Raised voices in the TV room. The charge nurse, Rita, is ordering a teen-aged boy to turn down the volume. Uh-oh, I think, it’s just me in the med room preparing the afternoon doses, and the charge nurse of the adjoining unit in the nurse’s station. Why doesn’t Rita wait until the lunch hour ends and we have adequate back-up? Or, better yet, just ask the kid politely, for crying out loud. No, she needs it done “Right now or else!” and so I lock the cart and expect trouble. “Call for assistance, please,” I call over my shoulder to the other nurse and I enter the group room where the boy has squared off and the charge nurse is standing way too close to him. His wide bent-legged stance and puffed chest relay his intentions without any guesswork. Before I can take 2 steps toward them, he has grabbed her by her long hair and is swinging her in circles around him in a wild outrage. Screaming and thudding against the walls and furniture she flies – and we pile on the both of them in a flailing heap. Most take-downs ended up with at least bruises and some black eyes; this time the nurse went to the E.R. and wore a neck brace for over a month.
Michelle, a new boarder at the barn, showed up one day with a cast on her leg. “What happened to you?” I asked her in surprise. “Homer kicked me, can you believe it? – he wouldn’t let me pick out his back hoof so I smacked him good!” “Hmmm” – this is the response I’ve picked to keep me from saying what’s really on my mind – You mean you hit your horse when his foot was in the air and aimed at you? Don’t be a Michelle or Rita – pick your time and approach.
The new Spanish stallion at the barn was magnificent – Bandolero was well over 17 hands (so tall that I couldn’t see over his back), gleaming and powerful, gifted with breathtaking floating gaits, his long mane and tail twirled around him with every move. “I got a great deal on him,” the proud owner Mary tells me, as I wait to hear the rest. There’s always more I’ve discovered, and no horse is a bargain. “There’s only one problem with him,” Mary broaches worriedly; “He tries to kill you if you go in the arena with him.” A prancing exhibition horse, he had been whipped mercilessly. His previous owners had become too afraid of him to keep him after he began to protect himself. “I love him, Karen, will you help me?” Mary pleaded. Watching as he romped by himself while the wind tossed his snow white tresses in every direction, how could I refuse?
Bandolero had claimed the arena for now, I conceded, so I would pick my own place. You guessed it – the stall. Docile and sweet in his house – they never attacked him in there, long whips wouldn’t snap or sting in such a small area and the pseudo-trainers would be too vulnerable to his wrath. I explained to Bandolero the benefits of relaxing and stretching his neck when tension arose, introduced the whip (as Mary felt that she may need it in the future), and combined the calming exercises with the perceived threat. Instituting incompatible responses – that of relaxation and aggression – fixed the problem…in the stall. Would it work in the arena too? ”Get out, Karen, run!!” It was Mary, yelling at the top of her lungs – I had turned Bandolero out in the arena and was approaching him with the whip. He had caught sight of me and was galloping full tilt in my direction – I stopped and waited for him to reach me. Mary and the group of onlookers held their collective breaths – a sweep of my left hand, and Bandolero slid to a statuesque halt and lowered his head as his mane swept the sand. When possible – choose your ground.
“Dr. Strong,” the code for staff back-up, was best paged by the PBX operators according to administration – cool smooth voices not affected by the chaos of the units. “Dr. Strong to unit 1, Dr. Strong to unit 1” – casual monotone announcements that wouldn’t rile up the facility. Also, running in the halls was discouraged – appear in control and on top of it at all times, we were told. So when a frantic page screaming “Help in the gym!! Help!!” came over the loudspeakers, every desk emptied – even the accountants were sprinting to the gymnasium. Arriving on the scene, the room before me resembled a battlefield – bodies lying across the floor, thrashing and struggling – panicked patients and bewildered staff scattered to every corner. A disagreement about phone privileges had escalated from an off-hand remark to a full-blown riot. Rather than wait for the proper place – no audience, on the contained unit with adequate staff on hand, the staff member had slipped onto treacherous area. A soundproof room, 3 staff and 17 kids is no spot for an argument – use the right space to your advantage.
And then there’s cutting your losses. Joshua, a young man in his mid-twenties had been brought in to the hospital by his father earlier in the day. Threatening neighbors, verbally abusing his mother and punching walls – Joshua had agreed to receive treatment in order to return home. As the day wore on, his agreement waned. “Get me out of this nuthouse!” he screamed into the phone repeatedly, slamming the receiver down so hard it bounced off the hook and a voice could be heard swinging back and forth, “Please calm down, Joshua.” Pacing the halls, glaring at anyone who looked at him, veins on his arms popping. Code gray, a show of force, was called. Not a clear case of subduing, according to the charge nurse Allison, an old hand with decades of solid experience. So, a half dozen or so burly men nonchalantly strolled around the unit and waited for the signal. “Get the other patients in their rooms, space yourselves down the hall and give him room,” Allison ordered. As I watch, a look like no other settles on Joshua’s face – unmistakable in its chilling intent. His gaze is no longer focused – his eyes are looking right through us as if we don’t exist! To Joshua, we are no longer there and all that matters are his twisted thoughts. Wham, Wham!! As if to prevent himself from exploding, Joshua slams his head into the (shatter proof) glass partition with enough force to rattle the frame. The signal is given – Allison knows there’s no other choice at this point – she has seen the look too.
Regal, so named because of a crown shaped blaze on his forehead, was a sight to behold. A prize winning jumper with a price tag of a house – he was the pride of his amateur owner, Sandra. A troubling habit had surfaced however – Regal had become a bit bored with his job and had started inserting little hops into his landings. Drilling and demanding schooling led to increased resentment and more rigorous objections. An experienced junior rider had come off of him the previous week after a bucking episode “He knows just how to bounce you right off his back, I’m not getting on him again – he’s dangerous.” In the distance I can hear the sirens approaching “Don’t close your eyes, Sandra, look at me!” I tell the amateur-owner as I wipe dirt from her face. I’m cradling her in the arena after Regal dumped her, “I’m so sleepy, Karen, are you there, I can’t see you…” Several weeks of recovery followed and when Sandra returned to the barn, Regal was not there. Shipped to a sale barn with instructions that he be sold as a “flat” mount – no jumping allowed.
Follow Lukas’ adventures on his web-site: http://www.playingwithlukas.com
By Karen Murdock