The movie marquee announced, “The Devil Wears Prada.” My patient would disagree. He thinks the devil wears a hospital ID badge and works on a psych unit.

Alan glared at me from across the desk. “Oh wonderful,” I thought. “Another outstanding holiday weekend. ” The police brought Alan to our emergency room in handcuffs. His girlfriend had called the authorities after finding a stash of weapons under their bed. Alan told her he wanted to kill his parents because he wanted to rid the world of evil. It was Alan’s first psychotic break. I hoped Alan would stay calm during the admission process. As with every holiday, we were working short on the unit.

“You bitch,” Alan screamed. “You can’t keep me here against my will.” So much for staying calm,” I thought. I had asked Alan to sign his admission paperwork. “Alan, I’m your nurse and you are at the hospital. You are in a safe place,” I said. He balled up his fist and shook it in my face yelling, “Liar! I know who you really are.” I leaned back in my chair and pushed the panic button under the desk to summon security. I responded “Alan, if I’m not your nurse, who am I?” He scowled and said, “You are the devil and you are going to hell!”

People ask me what it’s like to work on a psychiatric unit. As the weekend charge nurse, I’m responsible for making sure that things run smoothly on my unit. While the Monday through Friday crew is out enjoying the weekend, I’m stuck working with a skeleton crew. And because I have little backup in case of an emergency, I keep a tight rein on the unit. If a drug addict starts threatening staff or the other patients because it’s not time for a dose of Methadone, I put them in the quiet room. If they become violent, I put them in restraints. No questions asked. If a patient’s visitor becomes disruptive and threatening, I have security escort them off the unit. And if all hell breaks loose, I’ve been known to call the police. My entire focus is on patient and unit safety.

I can’t remember all the names patients have called me throughout my long nursing career. Nurses take a lot of abuse. However, being called a devil is pretty common when you’re dealing with a paranoid patient with religious ideations. I felt sorry for Alan. He wasn’t a bad guy. He was a decent person living with a very bad disease. I knew that unless Alan stayed on medications, he would never get his life back. I was relieved when two security officers arrived to help me escort Alan to his room.

As Alan repeatedly screamed I was going to go to hell, I prepared to give him an injection of Haldol and Ativan. As I leaned over him with the filled syringe, I thought, “No Alan, no one is going to hell today. I can’t leave the unit because we don’t have enough staff.”