The Sound of a System Learning to Flinch

His eyes still haunt me. Not the vacant stare of psychosis, but the knowing—a man trapped inside a body turning to stone, screaming without sound. I was a rookie nurse, fresh off orientation, working a unit labeled “psychiatry” in the same way a back-alley knife fight might be called “minor surgery.” Our patients? Collateral damage of medicine’s shrug: altered mental status of unknown origin. Translation: We don’t know, you figure it out.

The man arrived confused, weak, a medical riddle. By day two, his muscles hardened into concrete. Blood pressure cuffs slid off arms rigid as rebar. When I pressed my stethoscope to his chest, I didn’t hear a heartbeat—I heard a countdown.

The Hospitalist: “Anxiety. Give Ativan.”

The Psychiatrist: “Medical. Not my service.”

The Patient: Clawing at my scrubs, leaving bruises in the shape of question marks on my wrists, eyes screaming I’M STILL HERE.

By day three, he was a statue gasping for air. Seizures wracked his body like faulty wiring. Every rapid response call dissolved into the same bureaucratic ballet: Medicine pointed to Psych. Psych pointed to Medicine. And the man? He became a ghost in their charting—“psychosomatic,” “noncompliant,” “needs time.”

I spent my night off elbow-deep in UpToDate articles, chasing the thread between his locked jaw and the missing “why.” Extrapyramidal symptoms. Neuroleptic malignant syndrome. Death by neglect. The puzzle pieces fit—all except one: No antipsychotics on his med list.

Then I found it.

Buried in page 47 of his chart, a single line: “Haldol decanoate 100mg IM administered 14 days prior.” A slow-release antipsychotic—a time bomb in muscle tissue. No fever? His jaw was clenched too tight for oral temps. No resources? Our unit didn’t stock rectal probes.

The Hospitalist (sipping coffee): “No fever, no NMS. Escalate to Psych.”

The Psychiatrist (rubbing his temples): “I’ll order Cogentin. But transfer, needs Medicine.”

Me (white-knuckling the chart): “He’ll be dead by shift change.”