The Dewey Cocktail

In most places of work, including my psychiatric hospital, certain unique phrases become part of the daily parlance. Phrases like “The Dewey Cocktail “. Twenty nine year old Chuck Dewey was a manipulative fellow with little regard for others. For Chuck, people were simply pawns for him to use. But now he found himself behind the walls of the locked psychiatric ward and therefore he was not in control. It didn’t take long for Chuck to start slamming doors and threatening other patients half his size. He stood 6 feet 5 inches and with his muscular frame, he was one scary fellow. “Get me out of this hell hole”, he screamed, and when the staff attempted to defuse his posturings, he started flailing his arms and punching fiercely at everyone. It took eleven staff members, two of whom were now bleeding, to finally pull Chuck down to the ground….. ….“Haldol 15 milligrams”, I yelled to the nurse; “and Benadryl 50 milligrams and also Ativan 2 milligrams; give them all IM (intramuscularly) right now!” Within moments, this trio of meds - an antipsychotic, an antihistamine, and a benzodiazepine - were shot into the upper arm of Chuck, and in short order he had calmed down and was well on his way to sleep. The staff loved the quick effects of this confluence of medications - and so named it, “The Dewey Cocktail.” But I didn’t feel so good about all this. I wanted to reach Chuck, not just knock him out. I tried and tried, but couldn’t get anywhere. Chuck persisted in seeing the world as his playground and he was incapable of expressing any apology or remorse. Anger and narcissism blinded him. More violent outbursts followed and unfortunately, the newly coined Dewey Cocktail had to be delivered twice more, both times again with quick success. The sages say that the strongest of persons are those who can control themselves. When we respond with rage, when we allow our limbic system to take over, we have then become slaves to our passions and lose our chance to learn from the situation. If this rage turns to physical violence, there is no time to waste, and a band-aid cure becomes necessary, a band-aid like the Dewey Cocktail. When Chuck finally was discharged from the hospital, he turned to me and said: “f… you, Guterson, you’re a good guy, but f… you.” I thanked him actually and said that I learned a few things from him. And I told him that I hope he will look in the mirror someday. …..two days later, a fresh patient got totally out of control. Every effort was made to soften the patient by verbally trying to calm him down, but to no avail. As his violence escalated and fears of others getting hurt intensified, the nurse turned to me and whispered, “Dr. Guterson, time for ‘The Dewey Cocktail’?” Indeed it was, as it has been many a time in our little psychiatric universe, but it still remains a mere band-aid at best.