Working Through Confusion

The Code Green

Matt Heflin was making the rounds down the corridor, enjoying a quick chat with his co-worker when a large bearded man began screaming at the end of the hall.

“I’ve gotta hit somebody!” the man shouted, lunging down the hall towards Heflin. With a practiced calm, Heflin’s co-worker deftly side-stepped the charging giant, grabbed him into a head-lock, and threw him to the ground. After a brief struggle, the man calmed down and Heflin was able to fit him with a set of velcro restraints.

This is what Heflin and the rest of the PNAs up in 2JPW, the Thought Disorders unit at the University of Iowa Hospitals and Clinics, call a Code Green.

“Code Green’s are the biggest cluster fucks of all time,” Heflin said, “Fifteen chiefs and no Indian. Everyone wants to be in charge and no one wants to listen.” Heflin admits that this particular Code Green wasn’t exactly by the book. When a patient threatens physical harm, a PNA (psychiatric nursing assistant) is trained to neutralize the situation with several conflict defusing techniques. Headlocks and takedowns aren’t exactly part of the repertoire, but they happen all the time. Heflin demonstrated one of the techniques in the living room of his cousin Megan’s apartment. Heflin, tall and lanky, wearing grubby gray work pants and a green American Eagle polo, stood up straight with a grin on his face to show all in attendance how to handle a patient who has aimed a kick at your shin.

Keeping the Peace

“I could get in so much trouble for showing you this,” he said, standing with his back straight, his feet locked, hands balled into fists. The invisible attacker charged across the room and aimed an invisible kick toward Heflin’s right shin. Instead of blocking the insubstantial blow with a graceful chop of his forearm, Heflin shot his knee up to his chest, a jerky gesture reminiscent of the first move in some sort of goose-stepping parade. With a pivot, he pumped his foot back to the ground, turned, and marched straight out of the room, away from the invisible attacker. A successful dodge and disengage.

Heflin’s training is designed to minimize conflict and keep people safe in a potentially volatile environment. Every day he works in close proximity with a grab bag of patients who range from depressed to schizophrenic. Most of them have drug problems. At any given time, Heflin says, the unit has one or two star patients, patients whose neuroses are particularly severe. He recalled one patient who stuck out his own eye during Heflin’s shift. “Just took his finger and jammed it in,” Hefflin said. The PNAs had to restrain him so he wouldn’t stick out his other eye.

This is Heflin’s job, to intervene on the behalf of individuals who are unable to do so for themselves. He used to work in a shampoo factory, putting bottles into boxes. His current job required a weeklong training course in which he was taught CPR and made to watch sessions of electric shock therapy. Naturally, when he made the transition to working at the Thought Disorders unit during his junior year of college, he was a little nervous. “I have a lot more responsibility now,” Heflin said, “I mess up here, I break someone’s neck.”

Origin Story

Oddly enough, Heflin’s parents met in the same Thought Disorders unit that he works in today. His younger brother Travis also works with him, as do most of his aunts. When the family gets together for dinner, they spend the evening trying to outdo each other’s stories about their experiences on the unit, who did a one-on-one with the craziest patient, who got attacked by who and their best guesses as to why. It might seem insensitive, but in a family of PNAs it’s important to maintain a sense of humor about what can be a very stressful and emotionally taxing job.

Heflin and his mother, who transferred to the OR due to work related stress, share a story that’s hard to top. One day, one of the borderline personality patients approached Heflin’s mother and kicked her in the stomach. Heflin’s mother was pregnant with him at the time. To this day, the same borderline woman makes appearances in the unit, making her what Heflin and his co-workers call a frequent flier.  She is unaware that Heflin is the son of the PNA she kicked all those years ago. When he passes her in the hall, he can’t help but think that this woman could have ended his life before it even began.

Heflin walks among these emotionally disturbed individuals every day. His job requires him to be aware of changes in their medications and how that might change their behavior, try to empathize with them, remain a source of calm at their most violent. Not all of them interact with the world in conventional ways, so it’s important to remain alert, adaptable, and sensitive to their emotions. He doesn’t understand it all but Heflin says it’s important to remain respectful.

“You gotta learn to act like a kid,” Heflin said. Just listen, ask questions, nod, and try not be preachy. But it’s also important to be careful. “There’s definitely a professional distance you have to keep,” he said, waving his hand in front of his face, “You can’t bring it home with you.”

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