Wednesday, November 05, 2014

little zombie

I’ve met Sophie before. Her case is certainly unusual – subject to fugue states, she’s been known to wander out of the house at night, where she’ll be found by the police, standing motionless in the middle of swerving traffic, or at a supermarket checkout, surrounded by staff and security, or half frozen to death under a tree in the park. She’s tagged, so any unauthorised exiting of her flat will alert the various agencies, including the police, that are currently assigned to her care. Often these fugue states will be preceded by mini-absences; the guidance is that if Sophie reports any of these during her morning or afternoon safety calls, an ambulance will be sent to check her over and co-ordinate anything else that might need to be done.
This morning she seems perfectly rational, though
‘I’ve had two absences’ she says, smoking a tiny roll-up pinched between the tips of her thumb and first finger. ‘I don’t feel safe.’
We call her key worker and describe what we’ve found.
She needs to be in a place of safety. Can you take her to hospital? We’ll liaise there.
Sophie has no feelings either way.
‘I don’t care. Let me just finish smoking this.’

We walk out with her to the ambulance. A sharp, blue autumn morning.
‘This is such a waste of time,’ sighs Sophie, looking down at her feet crunching through the leaves like a bored driver looking down from the bridge of a walking machine. ‘Just ‘cos I have these absences, doesn’t mean anything’ll happen.’
I shrug and stand aside as she steps up onto the vehicle.
‘I know,’ I tell her. ‘But at least there’ll be someone to keep an eye on you and keep you safe the rest of the day.’
When she’s taken a seat I help her put the seatbelt on. She frowns as I click it into place.
‘Okay?’ I say to her, taking a seat opposite.
She doesn’t answer.
‘Ready when you are, Rae’ I shout back through the hatch. We move off.
‘Such a lovely day today,’ I say, settling back into my own seat.
Sophie is perfectly silent now, the frown still holding.
‘Shame we can’t see out all that much. But I could turn the blinds if you’d like’
‘I love all the artwork in your flat. Is some of it yours?’
No response.
‘It’s okay if you don’t want to talk,’ I say to her. ‘I don’t mind.’
I pick up the clipboard again and write some other stuff down – for something to do more than anything else.

Ten minutes into the journey we meet heavy traffic.
‘All these roadworks,’ I say to Sophie.
Suddenly she reaches down to her right, unsnaps the seatbelt and makes a lunge for the back door.
She’s flung it open by the time I have made the distance and grabbed her round the waist. Even though she’s small she’s quite a handful, and it’s all I can do to stop us both pitching out onto the road. For a moment the two of us hang there, half-in and half-out of the ambulance. I’m dimly aware of a couple of guys on a nearby pavement pointing and laughing. By this time Rae has put the hazards on and come to a stop. She jumps out, runs round, and together we manhandle Sophie back inside.
We manage to put her back in her seat and for the moment she stays there, breathing hard, her cheeks flushed, but otherwise unemotional.
‘Will you be all right back here on your own?’ says Rae. ‘We could always call for help.’
‘No. It should be fine. We’re pretty close to the hospital. Probably best if you lock the doors from the front, though.’
We set off again.
No sooner are we moving than Sophie tries another escape. She manages to unclip the seatbelt again, and I spend the rest of the journey corralling her in place with my body.
At the hospital the opposite becomes true. She puts herself on the floor of the ambulance and won’t come out. We have the back doors open and a trolley standing by as we try everything we can to tempt her out. Finally, though, after about twenty minutes, for no discernible reason, she sits up, walks out, and lies down on the trolley.
We wheel her into the department. 


Later that day Ella, the triage nurse, grabs me in the lobby.
‘Thanks for bringing Sophie in!’ she says. ‘Thanks a bunch!’
‘Why? What happened?’
‘She spent the whole morning causing absolute chaos. She kept wandering out of her cubicle and standing in front of the desk or other people’s trolleys just staring, without speaking. She put the willies up everyone, including the consultant. He wanted to know who brought the little zombie in and d’you know what? I was that ticked off I almost told him.’
‘It wasn’t our fault. I spoke to the mental health team and they said she had to come in.’
 ‘Yeah? Well next time call me. Give me a five minute warning or something. That way I’ll know to go sick and be on the next bus outta here.’


jacksofbuxton said...

What do you think causes these fugue states Spence?Is it treatable?

Spence Kennedy said...

I don't know's the short answer, Jack. It's a mental health problem with a PTSD component in some cases. I would have thought medication & therapy of one kind or another, maybe CBT. Not terribly common, thank goodness. It puts you at tremendous personal risk...

JuliesMum said...

Can't help feeling somewhere other than the hospital A&E department would have been a bit easier on everyone. Surely there's some quiet safe familiar place where someone could keep an eye on her?

Spence Kennedy said...

Completely agree, JM. I often feel that with mental health patients. If they haven't taken an overdose or hurt themselves in any way, a busy A&E department is the last place they should be. It's a shame that the local psych hospital doesn't have some kind of reception facility. Much safer & less distressing all round!

Simon said...

Do you feel that mental health patients are a waste of ambulance time and resources or are you just frustrated that there is nowhere better for them to go for the help they need?

Spence Kennedy said...

I don't think they're a waste of time, Simon. But it is frustrating that there's often nothing better we can do than take them to A&E. During office hours there's a phone no. we can ring, and sometimes we can leave at home or refer on, but often in a crisis & not safe to leave at home, it's a trip up the hospital. Sometimes it's worse though, and a police section ends up in custody - but that's increasingly rare.

It's amazing, the range of jobs we cover, when you think of it!

Cheers for the comment!

Simon said...

Thank you for taking the time to reply :)

Spence Kennedy said...

No worries, S.
I'll always try to get back to you. If there's a delay, it must mean one of three things: I'm working, I'm sleeping, I'm trapped under a heavy piece of furniture.. ;)

Cassandra said...

First of all, just how often do you spend time trapped under a heavy piece of furniture?! (Unless that's code for being dog piled by your kids or something…)

It may be fugue states, but without having any context of her mental health or anything, from this post alone it sounds deliberate. A conscious effort to be a pain in the ass and seem a little psycho. But clearly she has a diagnosis, and it's probably a good thing I'm not the one to give it to her! ;)

Spence Kennedy said...

I think her condition exists in that grey zone between deliberate and unconscious. A kind of learned behaviour that turns out to be extremely debilitating. She gets plenty of help, though - and hopefully CBT or other therapies will help her get better.

As for the furniture thing... funnily enough... I knew I shouldn't type on this wobbly table next to that Victorian tallboy... so as embarrassing as this is.... heeeeelp!