Next thing I knew, the fire alarm was ringing. It seems the boy escaped and decided pulling the alarm was a good idea. Only the swiftness of security, and a timely message over the PA system that evacuation was not necessary avoided a complete disaster, but despite everything, we know these patients can’t help who they are. We aren’t saving the world, but we try to treat these people — as irrational and obnoxious as they sometimes can be — with compassion.

Today, I’m hurrying down the corridor when I spot a man whose eyes twitch like the boy who pulled the fire alarm. He’s dark and muscular, sitting on one of the beds in the hallway. He’s so tall that even sitting I feel like he’s looming over me. I watch him eye the approaching security guard intently. There are two guards in our ER: one at the front door, and another who walks around to ensure things are under control. That guard is getting closer to the man on the bed, and it’s like one of those nightmares in slow motion as I watch the patient’s shoulder muscles bunching, his right arm swinging… and the loud crack of a fist smashing into bone.

The guard does a graceful pirouette, half-turning from the force of the blow, and then he crashes onto the white-tiled floor, unconscious. The patient rips a decorative Monet knockoff from the wall, and races down the hallway, the gold picture frame glinting under the fluorescent lights as he swings and barely misses a tech stepping out of the next room. With a shocked scream, she ducks and flees.

It’s like a game of bowling, and the menacing, picture-toting juggernaut is the ball. Residents, doctors, nurses, techs — I hear stunned cries and feet pounding as the regular hospital foot traffic disperses. A shocked nurse drops a tray of food, and a nearby doctor just misses a heavy blow. Overhead, the PA system is blaring, and in the midst of the chaos, a resident is checking the security guard to make sure he isn’t seriously injured.

With a dull thud, the door at the end of the corridor is flung open, and my stomach tightens. That’s the door into the ER waiting room, and now the danger is real. Through the haze of horror, I find myself racing forward, just in time to see the man hurdling over the five-foot desk in the center of the room in true Olympic high-jumper style as he bears down on the waiting patients.

And then Alex, still clutching his trademark thermos filled with coffee, sprints past me. Alex is one of the attendings, and he really cares about helping the residents. He’s also a solid six-footer with the build of a linebacker. He makes a spectacular dive at the patient’s knees, a classic tackle, hot cup flying through the air. There is a shower of coffee, and a heavy thud echoes through the room. The man is on the floor, Alex pinning him down, and the remaining security guard puts him in restraints before there’s even time for a reaction.

There’s a moment of stunned silence.

“Taylor, I was hoping not to see you back here,” Alex says gently to the prone figure on the floor. “Bring a dose of Haldol, stat,” he whispers to a nurse standing nearby. The antipsychotic medication is nothing if not effective. Taylor is tranquilized and attached to a bed within a few minutes, and the rodeo is over.

Somewhat shaken, we all try to return to our regular routines.

Yet even two days later, there are still coffee stains on the wall. Maybe the maintenance crew doesn’t scrub the walls, or maybe coffee stains are too stubborn to remove. I don’t know.

But they remind me of the kindness in Alex’s voice, even as he held Taylor to the floor, and how sometimes we need to do tough things to help others.

“The ER is the closest thing to a three-ring circus you’ll find in medicine,” one professor told us in med school. It does sometimes feel like a circus, all action, motion, split-second decisions, and, sometimes, danger. But one thing is missing: the glamour. The work we do with our deeply damaged psychiatric patients is not glittery and exciting. It doesn’t even seem to bring any concrete results. The boy who pulled the fire alarm? I’ve treated him numerous times since that day. And if he comes tomorrow, I’ll treat him again.

It can feel so futile, treating a problem that isn’t going away. Trying to help patients that aren’t going to get better — ever. Who sometimes don’t even appreciate our efforts. But we’ll do it again and again, as long as our patients return. Because here in the ER, every person is worth treating, no matter what it takes.

And we’ve got the coffee stains to prove it.

The characters in this series are composites; all the stories are true.

(Originally featured in Family First, Issue 902)