Thursday, August 21, 2008

visitors

We are an extemporary group of five, rattling upwards in a bleachy lift – me, my partner, the chaplain third-manning with us and two police officers. The chaplain is carrying our dressings bag. He hugs it to him, emanating goodwill. Ellie is carrying her clipboard, I’m pulling on my gloves.
Ellie asks the policeman: ‘So what do we know?’
‘Called in by a friend. This is a twenty two year old male, history of self-harm, apparently sticking pins into himself tonight. Why, I don’t know. Maybe it’s some kind of voodoo ritual. God knows..’ he sneaks a look at the chaplain ‘… God knows I can think of better things to do with my time, but there you are. You probably know more about this sort of thing than we do.’
The chaplain, lean and quiet and dark as a Mafioso hit man, smiles and nods. The female police officer leans in to her colleague and whispers something to him. The lift careens upwards. It really does stink, and I’m glad we are not going all the way to the twentieth.
The lift crashes to a halt and the heavy metal doors slide open. The police lead on; as a joke, we push the chaplain out next.
But the door to the flat is right by the lift and the police are already banging on it, so we quickly draw on a professional mask of concern. A voice from the other side asks who is it.
‘The police. Could you open up please so we can have a word?’
‘Sure’
Bolts. Chains. It swings open to reveal a boyish man in a faded black rock and roll t-shirt, boxer shorts and bare feet - a washed out yawn of a man whose reactions seem as woolly as his tangled brown hair.
‘What’s all this about?’ he says, wanly, then takes another toke on his spitty cigarette. His forearms are as covered in horizontal scratches and scars as the bark of a wild cherry tree. ‘What do you want?’
‘Would you mind if we came in and had a chat? We’ve had a call from someone to say that they were worried about your safety tonight.’
‘Who was that, then?’
‘Can we come in and talk about it?’
He considers us all for a second or two, then seems to lose interest. He lets go of the door, turns and slouches back inside; we follow him through the sparsely furnished flat into the front room. He resumes his place on the battered leather sofa, fitting the deep indentation there perfectly. There is a laptop propped open on an upturned crate in front of him, playing David Gray’s version of Say Hello Wave Goodbye. The ash tray is so full it spills over onto the disks and detritus that surround it. There is a bamboo blind tilted downwards across the main window; from behind it on a ledge, a tiny black faced kitten peers out at us, her fierce yellow eyes electrified with interest.
The man does not so much stub his cigarette out as bury it.
‘Was it Abby?’
‘Abby’s your girlfriend?’
‘Well’
The kitten suddenly jumps down onto the floor between us all. For a moment it stops where it lands in an intensely spiky attitude, front legs splayed out, shoulders at forty five degrees, staring and twitching – then bowls out between us and off through the hall.
‘She was my girlfriend.’
‘So what’s been happening tonight?’
The man seems to notice the chaplain for the first time, and frowns.
‘Don’t worry. I’m just along with the ambulance crew as an observer’ he says, gripping the dressings bag as if he wished it were bigger. Despite our uniforms, belts, blue gloves and radios, the police officers’ panoply of cuffs, batons and sprays – never has a simple collar of starched white fabric marked someone out so profoundly before. He may as well be dressed as a giant rabbit.
‘Have you hurt yourself tonight?’ asks the female officer, bringing us back to business with a flip of her notebook and click of her pen.
‘No. No more than usual. It’s not a problem. I just like to let blood, that’s all.’
‘How do you do that, then?’
‘With one of these’
He produces a syringe.
‘I draw a load out. Most nights. It’s no big deal. It’s something I have to do’
It’s just a kitten’s leap between the man on the sofa and the five of us here on this side of the room, but it feels more like a chasm. He stares at us with the syringe extended before him like a sacrament, his eyes glittering dark against the pallor of his skin.
‘Don’t look so worried. It’s normal for me’ he says.

The police ask us to check the man over, something he submits to with a bemused, slightly martyred air. He tells us about his CPN, how they try to help, but can’t really, as he’s never agreed that he does need help. He’s been in to hospital before with various infections. He’s anaemic. Ellie asks him if he has anyone he can stay with tonight.
‘Just the cat. My girlfriend left me months ago. I don’t know why she’s calling you’ He watches the BP cuff expand around his arm. ‘I haven’t seen my little girl in ages.’
We ask him what he intends to do tonight.
‘Take things as they come. I don’t know – improvise. I have no plans’
His blood pressure is low to normal, but he’s otherwise okay. He refuses hospital. We leave him to finish his interview with the police and let ourselves out.
‘I hope that cat didn’t go out the front door,’ says the chaplain. But we agree that the man didn’t seem concerned about it, so we let it ride.

Instead of taking the lift I suddenly sprint off down the stairs, and the other two try to catch me. It’s fourteen floors up, and I’m breathing hard as their heavy steps gain on me. The chaplain is singing the theme from Starsky and Hutch. Ellie throws her gloves at his head. Our laughter echoes up and down the stairwell.

16 comments:

Louise said...

Its hard when people have to admit they have a problem before they will accept help. I leave jobs like this feeling slightly frustrated that there isn't anything we can do.

Spence Kennedy said...

Hi Louise

It can be really frustrating. Round here, out of hours psych provision is non-existent.

But it's also kind of interesting - the sliding scale of what's socially acceptable. In this case, he wasn't causing himself gross harm, and he was doing it fairly discretely. He had been to hospital with infections a few times, but then, so do smokers and drinkers with the fall-out from their habit.

He was a sad case, but ultimately it felt odd interfering in what was actually a private ritual for him. His domestic situation was quite awful, though. Poor guy.

Then we show up, mob handed!

;)

Sx

Anonymous said...

"he wasn't causing himself gross harm, and he was doing it fairly discretely"

descrete may be but not gross harm? i blood let when i was self harming previously. it went too far, further than i meant it to. i thought it was just a little blood here and there. by the time i'd come round, called my GP in a state and been taken in (my BP low but not critical) to hospital - my HB was 4.8 (normal at least 12) and i was admitted for a blood tranfusion.

it's the damage inside that you can't see, like smokers and drinkers like you said spencer. but then you can't force them to have a blood test, unless a psych thought they had reason to section the person for it - which they did me when i refused the 2nd blood transfusion.....

and on call psych teams are worse than non-existent over this way!

Spence Kennedy said...

Hi Anon

I'm really sorry to hear about the traumas you've been through. I hope things are good for you now.

It's such a fraught subject. In this case, the guy was not in any immediate danger, he was not threatening suicide and not a threat to anyone else - and he was in his own home - so there was little we or the police could do. I think maybe I was a little flip in saying that he wasn't doing himself gross harm. I think he was, actually, by increments. It seemed to be his way of dealing with his life circumstance. Other people drink and / or take drugs. He lets blood.

I wish there was at least a number we could ring to get advice on these jobs. Someone from the Community Mental Health team with access to patient details. Most of the people we meet in these circumstances are already known to them - you'd think they'd be able to field someone on a 24/7 basis to offer direction.

Out of hours psych provision is basically: police to section if the patient is an obvious threat and in a public place (with some latitude if they think they can swing a 'public order' arrest to segue into a 136) or hospital if the patient is injured / unwell. This has always seemed pretty crude to me. But I suppose you learn to work with what you have.

Thanks for your comment, anon. It's great to have this kind of feedback.

Katharine said...

That last paragraph was so lovely. An expression of the need for release when feeling helpless?

Next time I feel the same way I'm going to run round singing the Starsky and Hutch theme.

I've a feeling it might help.

Thanks for another great post Spence.

Subz said...

The bit at the end made me giggle. Thanks x

Lovin' yer blog. My pal gave me the heads up about it :o)

Spence Kennedy said...

Thx for your comments, K & S - really appreciate them.

Anonymous said...

Just wanted to congratulate you on this blog as a whole, your writing is fanastically evocative and always makes me think. It's not only a peek into an interesting job but a great read in it's own right.

Spence Kennedy said...

Wow - thanks, Anon! Who do I make the cheque out to?
S :)

cogidubnus said...

fourteen floors? bugger...you're a better man than I am mate!

Spence Kennedy said...

I felt really sick when I got to the bottom. I was wearing a new pair of glasses and the prescription was different, so that, on top of running down in a big spiral, plus being a bit unfit these days - I needed an ambulance myself...

Anonymous said...

Hi Spence,

thank you for your reply to my comment. I'm pleased to say with regards to self harm and blood letting things have been much much better for a couple of years. however i guess in some ways you could say annorexia is not much better. but i'm fighting back against that one too.

"Someone from the Community Mental Health team with access to patient details." From personal experience (and i hope it's just my area that has such appauling MH services and not the whole country, i'd hate to think it's like this everywhere!) MH crisis teams are mainly full of agency staff, so even if a person is known to the services you are unlikely to get staff who know them specifically.

For example i live on the border of 2 counties. my village has a 2 part name, the first part is also the name of a town across the border. when the crisis team (agency staff) from my county came to assess me in A and E, they looked at my notes and asked me why i hadn't contacted my crisis team, i distraughtly replied that THEY were my team. they then told me they weren't because i lived in "B", i then had to tell them to read my notes properly and that i lived in "B B" which was an area they covered. Having to tell nurses which areas they are supposed to cover when you are already distressed is really not what you want.

I am so so grateful to paramedics and techs for helping me on many occassions and have the greatest respect for you all. i used to hope that one day i could train and join up but my health has been poor for too long now i feel. i did a few shifts observing before they changed the rules on observers, so have seen the "taxi service" you often have to run. But there were also calls that touched me, like the elderly lady with a suspected UTI, who was so confused which was apparently very out of character.

You have such a way with words Spence, it justs puts across the atmosphere and emotions of the situations so beautifully.

thank you for caring and taking the time to share your stories.

Spence Kennedy said...

Hi Anon
Glad to hear that things are getting better for you. I hope you're getting adequate help for the anorexia.

I really wish there was better crisis psych provision, especially out of hours, but I suppose it's just money. On the ambulance we're very much caught in the crossfire. We do try to do our best, but it's often impossible and always frustrating.
Considering the scale of the problem, it's surprising there isn't more clarity / provision.

Thanks for taking the time to write. I appreciate it.

Anonymous said...

Sadly the Facilities for eating disorders (which my psych refused to acknowledge, so i had to seek help via my superb GP) is as good as the general psych services round here.

well, the one nurse there actually is, is amazing but she covers a vast area (at least 2 counties, maybe 3) on her own.

not sure which is better, a nurse who is like gold dust and spreads herself so thinly (i didn't see her this week because she could get a room to meet me in - mum wasn't impressed!) or a load of agency psych staff who are useless. this i'd rather have my one rare gem than a load of agency filling in.

Spence Kennedy said...

Anon,
It's shocking that greater provision isn't made for sufferers of eating disorders, especially considering the high mortality rates - and also the success at helping sufferers.

I don't know what the answer is. A lobby group? How effective are charities like SANE, for example?
Sx

Anonymous said...

Sadly charities can only do so much and then end up fighting the system themselves.

I heard recently that a wonderful advocate and area manager for my local Rethink finally left after getting to the end of her tether with battling against health authorities.

charities with helplines, like Sane are a god send during crisis times, but as for long term i don't know what the answer is, and even if we did, i'm not sure it would happen due to the normal problems of lack of funds to pay staff, give training etc etc