Wednesday, February 20, 2013

access all areas

Jean is waiting for me on the landing.
‘I didn’t call you,’ she says, then turns and walks back into her room, closing the door behind her.
I knock. She doesn’t say anything. When I give it a gentle push, it opens. I peer round the edge.
‘Can I just come in and have a chat?’
‘Suit yourself. But it won’t do no good.’
The foot of the single bed allows just enough room for the door to open; the head of it is pushed into a shabby little alcove with a couple of empty shelves above. The room is a dingy, high-ceilinged affair, painted so many times and so hurriedly you’d have to break the windows to let in some air. The fireplace in the centre of the main wall has been boarded up, but the old mantelpiece is still there. Jean has propped up half a dozen family photos along its length  – two kids in school uniform, the same kids a little older hugging each other in Christmas hats, a blurry party photo.
‘My angels,’ she says, rolling a cigarette, scattering tobacco over the carpet as her hands shake. ‘I’d do anything for those kids.’
‘Jean – do you know why I’m here?’
‘No. Why?’
‘There was a call to say you might have taken an overdose tonight. Is that right?’
She shrugs, licks along the fag paper, puts the fag in her mouth and then pats around for a light.
‘What have you taken, Jean?’
‘Look – I’ve been having trouble sleeping. I only moved in yesterday and it’s noisy, okay? So I took a few extra Tramadol. All right? Is that such a crime? I didn’t ask you to come here. I only phoned the doctor ‘cos I wanted to talk to them about stuff. What’s happening with me n’all that. Because I can’t go on like this, that’s for damned sure.’
She cups a lighter in her hands and leans over it; the flame illuminates a wizened face so drawn into itself it’s hard to say if she’s forty or a hundred and two.
‘The thing is, Jean, Tramadol is quite a risky tablet to overdose on. So I’m duty bound to say you should come up to the hospital to get checked out.’
‘What? And sit up there for hours? No way. All I wanted was help with my drinking. That’s it. The hospital won’t be able to do that, will they?’
‘Well, no – that’s really something your GP needs to organise for you.’
‘Right. So what’s the point of going up the hospital? No one cares up there. They just take one look at you and think piss head. They couldn’t give a toss.’
‘I think they do care, Jean. I mean – I won’t pretend they’re not busy. And often when it gets busy and pressured, they don’t have the time to sit down and talk things out in the way they’d like.’
‘They don’t care.’
‘When was the last time you were up at the hospital?’
‘Last year.’
‘What was that for?’
‘I had a perforated duodenal ulcer. It was bad. I was rushed in for emergency surgery, spent a week on intensive care, six weeks on the ward and then a couple of weeks in that rehabilitation place. The surgeon saved my life. He was amazing. Another couple of hours and I’d have been dead.’
‘So you see – they do care. The surgeon. All those other doctors and nurses. They took care of you then, didn’t they?’
She takes a crackling drag on her cigarette, and then carefully picks a piece of tobacco from the tip of her tongue with the dirty thumb and finger of her other hand. She drops it over the side of the bed and says: ‘Nah mate. Ain’t no-one cares about me.’
‘Come on, Jean. Let’s go down the hospital.’
She shakes her head.
‘What are your daughters called?’
‘Lucy and Janine.’
‘What do you think Lucy and Janine would say if they were standing in this room now? They’d want you to come and get help, wouldn’t they?’
She glances over at the photos on the mantelpiece.
‘They’re my angels, they are. My babies.’
‘So what do you think Lucy and Janine would say if they were here now?’
‘Mate – don’t bother. I’m not going to no hospital.’
‘I can’t force you...’
‘I know you can’t force me.’
‘But if you stay it’s against advice. Look. I need to finish off the paperwork before I go. You don’t have to decide right now. Let’s get a few details down and then talk about it some more.’
‘You can talk about it till you’re blue in the face, I’m not going.’
‘Are these your tablets here?’
I pick up a carrier bag from the rickety little table over by the window. Underneath a greying bra are boxes of medication – anti-depressants, pain relief, sleeping tablets.
‘There’s quite a lot here.’
‘Tell me about it.’
Jean sits cross-legged on the bed, watching me. An aura of tragedy hangs around her head as palpable as the smoke.
‘I had a good job,’ she says. ‘I bet you’re thinking What? Her? But I did. A really good job. D’you wanna see my work pass?’
She puts the fag back in her mouth, hauls herself to her feet, then moves unsteadily over to a decrepit chest of drawers. From the heap of junk on the top of it she untangles a security pass on a lanyard. She tosses it over to me, then leans back against the chest of drawers and folds her arms.
It’s a rushed portrait, functional, slightly blurred, but it’s Jean all right – in a uniform, smiling confidently.
‘That’s me,’ she says. ‘Access all areas. That was a really good job, that was.’
I can’t think of anything particular to say about it, other than to agree it looked pretty responsible. I hand it back.
She weighs it in her hand a moment or two, then shrugs and drops it back amongst the trash. ‘Now can you just go, please? I’m tired and I wanna go to bed.’
‘Are you sure you won’t change your mind?’
‘Change my mind?’ she says, opening the door and then going back to sit on the bed. ‘I think it’s a little bit late for that, love. Don’t you?’


tpals said...

Such a sad state.

Spence Kennedy said...

Hi tpals

It's funny, but quite often people'll say I couldn't do your job, and most of the time what I think they mean is I couldn't cope with all the blood & trauma. But actually I think the hardest thing to cope with is a constant exposure to these social deprivation cases. I think overtime they're the things that wear you down the most.

It helps to write about them, I suppose, because it forces you to be objective about it. But still...

Thanks for the comment, tpals. Very much appreciated :)

Compostwoman said...

So did she come with, eventually?
or did she die?

I don't know how you can keep on and cope with knowing you can't make people like Jean come with you to get help. And know they will maybe die in a few days if they don't come with you.

I don't mean that it is your fault btw! Not at all - it is *their* choice - but even so it must be so hard for you to deal with, knowing what you know.

I am a first aider and the few things I have seen at emergencies have stayed with me always - and nothing like the things you have seen every day though -

you do not get paid enough or respected enough by society, that's for sure.

jacksofbuxton said...

Such a shame Spence,although I'd suggest it's not really your job to do the work of a carer.However,you never know what you're going to get when you turn up.

Must be like being a scout,be prepared.

Spence Kennedy said...

Hi Compostwoman

Nope - she stayed at home. This piece is a very truncated version of what happened, btw. But after trying every conceivable tactic she still refused. She'd taken 10 tramadol (so she says - I couldn't see any packet evidence), and at that time she was perfectly lucid and oriented, so in the end it was simply a case of reporting the incident to the Out of Hours GP, who'd then pass it on to her own GP. Because she was in her registered place of address, there was nothing the police could've done. I suppose at the end of the day if you think someone has 'capacity' - which she appeared to have - they're perfectly at liberty to do these things, distressing though they are. You can only really start to use a degree of force if the harm they've done to themselves makes them less able to prove capacity (or resist).

I suppose in the end you're supposed to accept these things, but like I said to tpals, I think it does have a cumulative effect. We seem to go so many where I work!

Hey Jacks

I was only ever in the Cubs, and I only did that because they played football and cooked sausages. But yes - Be Prepared - which is why I always carry chewing gum.

Thanks for the comments!

Anonymous said...


Firstly, great blog - excellent writing.

This reads like you responded alone, is this true?
There is NO way this type of incident should have a SOLO responder, there is no way to assure your safety.

Over here (I'm a paramedic in NJ, USA) there would be at least two EMS providers, as well as the police, but with such an admission of ingestion she would also not be allowed to refuse.

(The "Land of the Free" is only so free; you can own as many guns as you like but don't admit to taking too many pills!!)

Keep up the good work,

Pete W.

Spence Kennedy said...

Thanks Pete

Truth is, for this particular job there were two of us, but if you're working on the car you often do get called out to psych situations on your own. Control will try to judge on the phone if it's safe or not, but seeing as we work in a small city, chances are you're on scene before you get any updates to the contrary. They do say that 'the clock stops' once you're outside / standing off, so if you have safety concerns you can wait for back-up. It's a difficult judgement to make though, esp. if you think someone's in trouble. The responder just has to decide in each case whether they feel safe going in on their own.

Here in the UK if you think the patient has capacity, you can't force them to travel. Again, a difficult judgement call, and one that's influenced by how serious an OD you think it is, or how likely they are to take more once you've gone. I've been to other jobs where we haven't left, have called the police, and one way or another have stuck it out till we've managed to get them to travel. But the bottom line is, if someone has capacity, it takes a long legal process to forcibly take them out of their home.

Cheers Pete. Hope all's good with you in NJ.