Monday, September 05, 2011

overdose

Barbara speaks on the intercom with a strangely conversational tone, as if it was the most natural thing in the world for an ambulance to be calling by at six in the morning.
‘Ye-es?’
‘Ambulance.’
‘I suppose you’d better come up. But please - be very careful not to slam the door.’
We trudge up a neatly carpeted flight of stairs to her front door, a single pane of security glass with a floor-length cream curtain hung behind it. Barbara meets us at the door, a pale and pouchy, middle-aged woman whose dark bob of hair seems to accentuate the bitter fall of her mouth. Despite her comfortable clothes and polite speech there is an edge to her that glimmers beneath the bright hall light.
‘Hello. Ambulance,’ I manage to say. It’s been a long night. My lips are fat and my boots dipped in concrete. Any vitality I had has been rolled flat by the relentless passage of the shift, but this must surely be our last patient. That happy thought gives me just enough power to say: ‘Can we come in and chat?’
‘Oh. Okay. If you think.’
She lets go of the door and we drift after her into the sitting room.
‘Please excuse the mess,’ she says. ‘Organised chaos. But at least I know where everything is.’
In fact, the flat is as tidy as you could want. There is a laptop on an antique pine blanket chest, a large art book on the sofa, a blue bowl of fruit as tastefully set as the charcoal and pastel study of the nude above it. From the polished brown leather sofa to the tie-backs on the floral curtains, everything has the brisk domestic sheen of a Sunday Supplement article – except it feels off, as if, despite all the care, someone had come along and spoiled the photo by writing a terrible sentence – a bad thought, a dreadful curse - in small print somewhere.
‘Please. Have a seat,’ she says, taking one herself, perching on the edge and folding her hands neatly in her lap. ‘Now. What’s all this about?’
‘I understand you’ve taken an overdose. Is that right?’
She pauses, and self-consciously moves a few strands of hair away from her face. When she does speak again, she speaks in a close, low whisper, a slightly fussy tone, like a stressed teacher counselling difficult parents. She does not look up, but addresses the carpet between us.
‘Now. This is how things are, as I see it,’ she says. ‘Please – bear with me. I’ve had an awful lot of experience in these matters, both as a patient and as a friend of mental health professionals.’
‘Okay.’
‘I – well – from the beginning, I suppose. Last night I decided, for reasons I won’t go into now, because you’ve got better things to do, and so have I, and these things are complicated enough – and I know you’ve got a job to do, and I don’t want to take up any more of your time than I already am. I am in good health. I only suffer with a couple of things, one of them being depression. As you could no doubt have guessed.’
‘That’s the information we were given.’
‘Really? Fine.’ Her mouth seems dry, and she forms her words with that overly precise articulation you get with alcohol or drugs.
‘Firstly, yes, it’s true. I have taken an overdose. I have taken a packet of anti-depressants. Yes – I told this to the people on the phone, presumably part of your – erm – network. But as I explained, there’s nothing I want from anyone. It’s a decision I have made, and I’m perfectly within my rights to make it. So I don’t know what papers you’ve been reading, or to what rule you think you might be operating. But this is my house, these are my rights, and I know exactly what I can or can’t do. Let’s be clear on this before we go any further, or I’ll have to ask you to leave.’
‘Barbara – I’ve not met you before, so I’m completely in the dark about what’s happened today.’
‘Are you? Completely? Well that’s not much use.’
‘No. So let’s start with the basics. We need to know exactly what you’ve taken, how much of it, and when.’
‘Hm. This is interesting. So you want me to tell you exactly what it is I’ve overdosed on? Is that correct?’
‘Yes.’
‘I see. And on what study have you based this – erm – conclusion?’
‘It’s not really based on any study, Barbara. It’s a basic fact we need to establish before we can carry on. We just need to know the nature of the overdose.’
‘Yes. I can see what you’re getting at. But before we come to that, let me just go over a few things. Because as you know this is my house and I’m perfectly entitled to do or say whatever I want in my house without fear of you or anyone else telling me what I should or shouldn’t say. Is that clear? I didn’t want you here. I didn’t ask for you to come, I didn’t want you to come. I simply phoned the helpline for some information – information that I wasn’t managing to find myself. The person on the helpline offered to send me your good selves, acting as their representative, who might be able to help me understand a few things and if not make things better, at least move things forward to a more satisfactory outcome for all concerned. Now, if you’re telling me that you’re unable for whatever reason to keep your end of the bargain, I think I would have to apologise for calling you out like this, say good morning and draw this interview to a conclusion.’
‘Barbara. Let me be as clear as I can. We work for the ambulance service.’
‘Yes. I am aware of that.’
‘Our job is to make sure you’re okay. We were told you may have taken an overdose. If you have, we need to know what you’ve taken, when you took it, and how much.’
‘Yes. Go on. I follow.’
‘But the fact is, we can’t treat you here. It’ll invariably mean a trip up the hospital.’
‘I’m not going.’
‘We haven’t the equipment or the skills to treat you for any of the harmful side effects that you might suffer.’
‘I’m not going.’
‘Plus there’s the reason you took the overdose in the first place. Can I ask – was it to do yourself harm?’
‘No – it was to kill myself. I was looking up on-line at the thing to take, and that was why I phoned the helpline.’
‘Well you see, Barbara – the fact that you’re quite clear about wanting to kill yourself is another reason why we’d like to take you to hospital, quite apart from any tablets you may have taken.’
‘I am not going to hospital. I have wasted too many months of my life in awful places like that and I don’t intend to waste any more. If all you can do is threaten to cart me off to some unspeakable ward somewhere, you can forget it.’ She stands up and starts looking around for something. ‘If I’d thought that’s all you were going to do, I’d never have agreed to let you in. You’ve made me feel quite anxious and upset. I’d like you to leave, please.’
‘Of course. But Barbara – just let me say this before we go. If you were diabetic and your blood sugar was low, you’d be distressed and out of sorts, wouldn’t you? You might well struggle to stop us helping you.’
‘You’re making me extremely anxious now. What do you mean “struggle”? Just what are you planning?’
‘Nothing. I’m not planning anything, Barbara. I’m just trying to be clear and open with you. I’m trying to find an example that might help you see things from our point of view. The fact is, you suffer with depression. And depression is just as much an illness as diabetes. I don’t have a problem with you accepting or refusing help, but I do have a problem if I think you’re not making that decision rationally, because of your illness. We’re supposed to act as the advocate for your healthy self, Barbara. We’re supposed to look after your best interests. And if you’re so depressed that you’re thinking of killing yourself and taking an overdose, I’d have to say that doesn’t look like a rational decision.’
‘Please. I’d like you to go.’
‘Do you have a CPN, Barbara?’
She snorts derisively.
‘CPN! The last place I lived virtually all my friends were CPNs. And if you think I’m going to offer up my life for them to dissect and gossip about endlessly you have another thing coming. Please. I think it’s high time you were going. I’m sure you’ve got better things to do.’
‘We will go, Barbara, but I wish you’d come with us.’
‘No. Thank you.’
She flashes me a look and wets her lips.
‘What will you do now?’ she says.
‘I’ll contact the out of hours doctor, tell them what happened, and leave it up to them to decide what to do next.’
‘Fine. Let them. Good bye.’
She holds the door open as we go out, then comes to the top of the stairs as we descend.
‘And please don’t slam the door on the way out,’ she says.

16 comments:

Josh said...

Thats powerful writing Spence.

What a challenge to face when you were at your lowest ebb. Does the adrenalin come surging in still?

How did the situation end? You end up having to get the boys in blue out to get her to hospital?

Baglady said...

She sounds so compos mentis. Poor thing. I hope her doctor persuaded her to get some help (or is that wrong of me, to think she must be making the wrong decision?).

Steve'nLubbock said...

So, do you know what happened to her???

Alan @ It's not work, It's gardening! said...

This sort of thing must be so frustrating. Very sad too.

Spence said...

Josh - It was incredibly diff dealing with Barbara at that time of morning, after such a busy night. She was so volatile, we had to choose our words as carefully as lawyers - just when you struggle to make any sense at all!

It didn't seem as if she'd taken a life threatening dose, plus it appeared she may have done it before, so all in all we thought she was a low risk. We referred the job back to Control and to the GP - any forcible removal would've taken a formal section, and we'd still be there now!

Baglady - I hope her GP managed to get her some help, although I suspect she was a difficult patient all round.

She probably had taken a minor OD, but she said at one point that she 'expected something fluffier' from us ie a long chat. I think that's a measure of her dislocation, calling 999 at 0600 for a fluffy chat! (Round here, at least).

Steve - See above! I know it's a bit frustrating, reading this blog - you hardly ever get resolution! But then, that's what it's like doing the job... until sometimes maybe a month or so later when it comes out in conversation... So apologies for that. If I find out I'll let you know.

Alan - I do feel a lot of sympathy for Barbara, even though she was prickly as hell. It felt lonely in her flat. Half the time, I think pure isolation is a terrible and powerful factor in these things.

***

Thanks for all your comments!

jacksofbuxton said...

Very difficult position you were put in there Spence.I realise you have various hats that you need to wear,but Barbara needed a little psychological help,not an ambulance crew (absolutely no offence meant there Spence,I'm sure you know what I mean)

Even so,I think you did remarkably well in such a difficult position.One you seem to find yourselves in quite regularly unfortunately as well.

Beautifully written as ever Spence.

Spence said...

Thanks JoB. Incredibly diff position, for everyone. And yeah - we do seem to find ourselves in the same old jam. Quite a lot of our work has that psych / social component. I wish there were more we could do, but even the hospital struggles to act as a facilitator for appropriate services - because they're so snowed with cases.

A national shortage of magic wands, I'm afraid, esp. these days... :/

Deborah said...

She sounds like my mother. But with us, it's a control thing, so she can keep us guessing

Henry said...

Spence,

your writing style is wonderfully vivid and rich. You certainly have a natural talent there. Your ability to paint a picture of the story unfolding in the reader's mind really never ceases to amaze me. You capture the emotions of the environment perfectly.

Every time I get a little fed up of my uni course, placement etc, I come and read your blog and everything is better.

Well done!

Spence said...

Deborah - I have to say that rings true with Barbara. Obviously I don't know her, but there was a sense that - consciously or otherwise - she was carefully controlling what she told us, to maximise the effect.

Henry - Thanks v much! Hope your (para?) course is going well, and best of luck with any exams.

Susanne said...

I really like the way you said that you were the advocate for her healthy self. That is a very interesting way to view the situation. Her anti-depressants clearly weren't working and I'm sure taking all of them at once wasn't going to help anything.

Spence said...

Thanks Susanne. It's a struggle to know what to say, sometimes (esp. early in the morning!) Essentially I think it's true, though. On the one hand I respect anyone's right to self-determination, but only if I think they're being rational about it, and not unduly influenced by their condition. A difficult & grey area, though, no question.

Anonymous said...

Did she call 999 or had she called NHS direct for a chat and found they sent out an ambulance?

Spence said...

Hi Anon
As I understand it, she rang NHS Direct to ask questions about the overdose, and NHS Direct persuaded her to let a crew in to talk to her face to face and 'give her some more help'. It's fair to say that Barbara was difficult to be clear with - ostensibly rational, but actually quite confused, and liable to go off at a tangent. But anyway - she knew we were coming!

Baglady said...

Spence

I know that memes probably aren't your thing but.. I tagged you in one anyway. I won't be offended if you don't do it. Just wanted to say how much I love your writing.

Kelly

http://baghabit.blogspot.com/2011/09/meme-seven-links.html

Spence said...

Thanks v much, Kelly! That's so kind of you. You're right about the meme-thing (even though it makes me blush to say it). I haven't really done much with that kind of thing because I wanted to keep the blog pretty straightforward - unending ambulance misery, and nothing but!

I've put a link on the side bar as a thankyou. One day, if I ever manage to get a book out (prob not anything to do with the blog, though), I'll send you a copy. So watch out. (But don't hold your breath).

With thanks again for the mention, and for bearing with me all this time

SK :)