Friday, April 04, 2008


Midnight, and the night is heavy and black and tasting of rain. The elderly woman is sitting as described in the message: on a bench in the middle of the courtyard of the C-shaped block of flats. Beside the bench is a scrawny tree, and under the tree is a cat’s scratching post, some scattered cat toys, and a box of other pet junk. A black cat races from the bench across the courtyard and into some bushes. I give the woman a wave as I come in through the gate. With her bucket-shaped suede hat pulled down to the bridge of her nose, and with the collar of her quilted jacket zipped up under her chin, when she turns to look at me it’s like the turret of a tank swivelling round to meet the enemy.
‘Hello. My name’s Spence, and this is Rae. We’re with the ambulance.’
No reaction.
‘Can I ask your name?’
A firm whisper: ‘Mary.’
‘Mary - someone overlooking the courtyard has rung 999 because they were worried about you. They said you’d been sitting here for hours.’
Mary draws her arms in.
‘Do you mind if I sit down and have a chat? Just to make sure you’re okay?’
She shrugs, so I sit down. Rae hugs the clipboard to her and stands in front. The wind swings the empty bird-feeder in the tree from side to side. Tiers of windows rise up on the three sides of our curious little group. It feels as if we’ve arrived at the dark centre of a community of lights and curtains. Some people out on a balcony, watching us. Are they the ones who rang?
‘I’m not going back in my flat.’
‘Why not, Mary? What’s wrong?’
‘It’s infected. It’s got a virus. I’m not going in.’
‘Are you well in yourself, though?’
‘Apart from what the virus has done to my arm.’ She pulls up the sleeve of her quilted jacket and shows me what looks like a couple of flea bites. ‘The doctor gave me betnovate cream for those, but he doesn’t understand what’s really going on. It’s not safe.’
‘So what’s the story with the virus?’
She looks straight at me, and her eyes seem small and afraid.
‘I’ve been taking samples. I found traces. I took it all in a jam jar to the Town Hall, and now I’m waiting for them to get back to me.’
‘Traces of what?’
‘Stuff. A worm. All white and pointy. Stuff. It’s in everything. The walls, the carpets. The water.’ She turns back to face front again, gives herself a determined hug. ‘I’ve had enough. I saw the council this morning, but they didn’t seem to care all that much. I need a new flat. I’m not going back in there. I’m spending the night out here. My son will tell you.’
‘Where’s your son now?’
‘In the flat.’
‘Mary – it’s more than likely going to rain. You can’t stay out all night.’
‘I’m all right. I’ve got my thermals on. These boots.’ She kicks a leg forward to show us.
‘If we drove off now and left you sitting on this bench – well – we’d worry.’
‘I can’t help that.’
‘How about you come on to the ambulance, we can give you a little check up, then maybe go to the hospital? It’s nice and warm there. They can look into this virus thing, maybe do a blood test, make sure you’re okay. And in the morning things will be clearer, and someone can advise you the best way to proceed.’
‘No. Thank you. I’ll just stop here, if that’s okay.’
‘Do you mind if we go and have a quick word with your son?’
‘Be my guest.’
We walk across the courtyard to one of the entrance doors, and buzz her number. We are let in to a harshly-lit hallway, then over in one corner a door opens and a thin, middle-aged man with a scrubby beard steps out. His eyes seem edged with red, as if he hasn’t slept in a long while.
‘Come in,’ he says, attempting a smile.
The flat is dark and seems quite empty. It is papered with a heavy pattern of giant poppies on a dark blue background. Two toy lovebirds hang on a perch in front of the kitchen curtains. The son talks to us in the narrow hallway.
‘She’s bad tonight. She’s been going around putting these up.’
He hands us a cluster of handwritten signs, a shaky scrawl in thick red pen:
Quarantine. Keep out. Serious virus inside. Government informed.
Rae asks: ‘Is she having any psychiatric help?’
‘She has been to the doctor’s, when she started hearing voices, and he did offer to put her on some medication. But she didn’t want to take it as she said it would interfere with her osteo-arthritis. The trouble is, whenever she does go to see anybody, she seems absolutely fine and reasonable. It’s when she gets back here she flips. The other day she threw a load of stuff out - the microwave, the kettle, mugs and shit - because she said it was all infected. It’s mad. The thing is, I’m not here all that often. I work on the fair, and I’m away travelling a lot. I’ve only just got back from a few months off working a new ride up. And then I get all this.’
He gives us a tight-lipped smile. ‘It’s absolutely crazy and it is getting worse. My girl friend doesn’t want to stay here, that’s for sure.’
When we ask him if he thinks Mary is a danger to herself or to anyone else, he shakes his head. ‘I don’t think so. Maybe. She was throwing stuff around yesterday. I don’t know.’
We tell him that we’ll try to persuade Mary to come to hospital with us. He follows us back out to the bench.
Mary refuses to come on to the ambulance or to go to hospital. I try another tack.
‘Cal was telling us about the time you went to the doctor’s about the voices you were hearing, Mary.’
‘What about them?’
‘Well – I was just wondering – do you think this business with the virus might be something like that? Something that seems very real, but is maybe just happening more in your head?’

She stands up as if the bench is suddenly red hot, snatches up the blanket she was sitting on and kicks the basket of cat-things. A tin bowl and cat biscuits scatter around us.
‘I told you what I wanted but that’s not good enough for you, is it?’, she yells. ‘You simply won’t let me do what I need to do. You’re a bully and you won’t stop until you get your fucking little way and have me back inside that flat. Will you? God.’
‘Mary – I…’
‘Get out of my way!’ She turns to go, sees Cal, spits: ‘You! You traitor! You can fuck off, too! I’m not interested any more. Leave me alone!’
She strides through us all, slams open the front door, then we hear muted screams of frustration from the flat.

Cal follows her inside. We call the police. When they arrive five minutes later I tell them what happened and the concerns we have, but we realise now she has gone inside the flat there isn’t much they can do. Cal comes back outside to speak to us.

‘She’s gone into her room and it’s fairly quiet. I think she’ll be okay. Maybe tomorrow I’ll get her to come back to the doctor’s so we can see about getting her a psychiatrist or something.’

We leave him to have a chat to the two policemen, then go back to the ambulance. I get Control to phone me back on my mobile so I can tell them what happened in some detail. The Dispatcher is particularly taken with it all; she laughs quite a bit as she types pointy white worm into the notes.


BenefitScroungingScum said...

The joys of care in the community! BG

Anonymous said...

I'm so happy to see a new post up. I kept checking every day! Your writing is wonderful.

By the way, I'm the first anonymous from the last post's comments. I've decided to unlurk, because your blog is totally worth it.

Spence Kennedy said...

Hi BG. How are you?
It's another example of how thin emergency psych provision is at the moment. If the patient has hurt themselves we can take them to hospital, (although some refuse), but otherwise the hospitals don't really want to know. They don't consider themselves a place of safety, in that there's too much equipment and vulnerable people around (and they're hard pressed to cope with A&E stuff). So if it's a 'breakdown' with low risk to the patient or the public, they're pretty much left to it. It'd be nice if there were some kind of out of hours service, expert help like a CPN or ASW, who could come in and assess. Too much is left for the police to mop up (and they've been told to hold back on Sect 136s). I certainly didn't feel easy that Mary (and her son) were left to it for the night.

Tsitsi - Thanks for your lovely comments!

Judith said...

Oh dear, reading this makes me sad. There's so much need out there. Poor Mary.

Like Tsitsi I check every day and I am always glad to see a new post. Good stuff Spence, but look after yourself and don't burn out. JB

Anonymous said...

It's hard to know what to do for the best in cases like these. I understand that the dispatcher can't possibly allow herself to empathise with everybody's troubles, still, it seems a bit heartless to laugh about it. The lady's delusions are quite real to her, after all. She feels genuinely threatened and misunderstood.

I'm Belgian, by the way, so I don't really understand the intricacies of British mental health legalities (and I apologise for any mistakes I make with English grammar and word usage). It just seems odd to me that the police would have the authority to have her sectioned if she was on public property. That is, if I understood you correctly. How is it that non-medically trained police officers would be expected to be able to make that kind of assessment?

By the way, I love the way you put this question: ‘Are you well in yourself, though?’

I've never heard it put like that before.

Spence Kennedy said...

Although it might seem heartless for the Dispatcher to laugh about it, she's only doing what we all do at various times, which is to take the sting out of a situation by finding the humour. In fact, the ambulance service - and no doubt all the emergency services - is renowned for its grim sense of humour. Mostly this is never heard by the public (we're just sensitive enough to hold back in company), but sometimes I might touch on it in the blog. It's difficult to understand if you're not doing the job, I suppose. But it's all about finding ways of coping with the relentless pressures of sick, damaged and otherwise disadvantaged people.

The police will section someone in public who is a danger to themselves or others, but they have no jurisdiction once they're in their house (unless there's a breach of the peace - there are always ways round these things).

I've never really thought about the phrase 'How are you in yourself?' - quite a strange way of asking how someone is, when you look at it!

S :)

S1sterBl1ss said...

May I ask why you do not print these stories into a book. They are both endearing and amusing. It makes you realise that there are people like Mary out there who are not "nutters" but people who cannot help their situation. I admire peoople like you and your colleague for your ability to care and assure them. I would be in tears seeing someone so vulnerable. I look forward to reading more.

uphilldowndale said...

Oh it makes me so sad how poor we are as a country, at helping people with mental health problems.
judithb, if you subscribe to a free RSS feed, like Bloglines
It will gather together all your favourite blogs and tell you when they have published a new post, so you only have to check in one place, it saves a lot of time and you don't miss any thing :)

uphilldowndale said...

If you are intersted in mental health issues, have a read of Mr Mans Wifes blog

and the links in her blogroll

Spence Kennedy said...

Thanks for the blog tip, UHDD. I'll check it out.