Thursday, April 08, 2010

the afternoon of the third day

Danny’s boyfriend Ahmed meets us at the door and leads us through.

She sits crouched on the edge of the sofa, her arms folded over her stomach, jiggling her legs up and down, looking pale and distracted. The room itself is sparsely furnished, as sharp as the sunlight that cuts through the foliage of the plants on the window ledge.

‘What’s up, Danny?’
‘I’ve been bad.’
‘In what way, bad?’
‘Stomach cramps, throwing up.’
‘Any pain?’
‘Not really. Just cramps.’
‘Any diarrhoea?’
‘Since how long?’
‘Three days.’

I look over at Ahmed, a silhouette leaning up against the window, the light dissolving his outline. I give him a nod and a smile, but however he looks is lost in the glare. I turn back to Danny.

‘Any other symptoms?’
‘Any health problems?’
‘What do you mean?’
‘Heart, breathing problems, that kind of thing.’
‘Are you on any medication?’
‘For depression?’
‘Well. Let’s do a quick health screen, your blood pressure etcetera. Then we’ll have a think what’s best to do.’

But I already know what’s best to do. Danny has D&V. Danny has a bug. We can’t take Danny to hospital. She’ll pass the bug on, more wards will close. Why can’t people see this? Why aren’t they more - aware?

‘Everything’s fine so far, Danny. Just a few more questions. Any chance you might be pregnant?’
She looks up.
‘And these cramps come and go? And they’re not too bad?’
‘Okay. And is this your address?’
‘No. It’s Ahmed’s house.’
‘Where do you live?’
‘Nowhere. Mum threw me out yesterday. I’m getting back in touch with Dad, but it’s difficult. I haven’t seen him in a while.’
I finish writing the report form, then put the clipboard on my lap and fold my hands on top of it.

‘I think you have a stomach bug, Danny. It’s horrible, it’s a nuisance but it is what it is, and the only thing to be done is ride it out at home. If we take you to hospital you’ll end up passing it on to people there, and some of them are so ill already it’ll finish them off. Plus they’ll have to close the ward down to prevent it spreading through the rest of the hospital. So all in all they’re really reluctant for us to take a case of D&V into hospital unless there’s some other serious medical problem, or it’s been going on for ages and you’re dehydrated. So the only thing to be done is tough it out here. Drink plenty of fluids, then when it all dies down – which I think it will pretty soon for you – start eating again, plain and simple food in small amounts.’

Danny nods, and folds her arms more tightly around her stomach.

‘Still getting cramps?’
She nods.
‘Taken any pain killers?’
She nods again. ‘Some paracetamol.’
‘Good. When did you take them?’
‘Three days ago.’
‘And how many?’

The room seems to brake, and everything lurch forwards.
‘Maybe more.’
‘Why did you take forty paracetamol, Danny?’
She shrugs.
‘Do you know how dangerous that is?’
She nods.
‘Did you take them deliberately?’
She nods again.
‘Okay. Phone, keys, jacket – we’re off to hospital.’
She stands up and brushes her forehead lightly with the fingers of her right hand, as if she’d forgotten something important and was trying hard to remember what it was.

Ahmed steps over and takes her arm.

We leave the house. As we step beyond the porch the afternoon crashes down upon us, hard and bright and blue.


Anonymous said...

omg I nearly stopped breathing for a minute there, did she make it?
how very sad.
you show a very important lesson of how never to assume the obvious.
thankyou, and thankyou for caring and for writing so powerfully

Charles said...

Glad you asked those last questions! It seems like so much of the time you ask a patient a final question, simply attempting to comfort them or make conversation, only to find some vital bit of information that would otherwise have gone unmentioned.

Matt M said...

It is too late, isn't it? After three days her liver is going to have had as much damage from the poison as it is going to. Right?

So sad.

Thank you for writing.

Bennie said...

poor kid. The reality of Paracetamol overdose is not publicised enough IMHO. The effects and timing of the effects should be made much more widely known.
As a piece of writing - loved the last line Spence very punchy.

laputain said...

The second you described her, in the first paragraph, I knew.

I've been a bit close to the edge myself in the last week- more acutely aware of my own fragility than for years- and the picture of Danny you painted was ever so familiar. Hope things worked out okay for her.

Books of the World said...

The amazing importance of asking just one more question. Wow. Great post.

Spence Kennedy said...

Anon - I don't think I'll ever learn not to jump to conclusions! But I suppose to be fair you go to so many jobs it's almost inevitable you'll become a bit blase. The other thing is that I've been to countless D&V jobs, a lot of which were unnecessary - it's just that every now and then it turns out unexpectedly.

Thanks very much for the comment.

Charles - Absolutely! I wasn't expecting anything by the question / was just making conversation. I almost fell off my seat!

Matt M - If she actually has taken 40, 3 days ago, the prognosis is terrible. We could only hope that she'd overestimated the number and vomited the majority of what she did take quickly. I'm no expert on poisoning, but it's a grim dose.

Bennie - Thanks for that. I agree - they should make it clearer that paracetamol is deadly for the liver. Lots of over the counter stuff is harmful, of course, but para. is right up there.

Helen - sorry to hear you've been feeling down recently. It's a horrible thing. I hope you're getting the support you need - and I would include good medication in there. Hope you've got a good GP.

Sometimes it's a question of recognising the tough emotional weather and riding out the storm. Having coping strategies ready for when it all comes down. I do sympathise. Hope you feel better and stronger soon. x

mbab - (prize for the most unusual site name, btw!)
Thanks for that, Max. Like I said in an earlier comment - an off the cuff remark completely turned my ideas around. :)


Thanks everyone for your great comments! I really appreciate you taking the time.

Jo said...

Oh gawds :-( I really hope she was ok.

Spence Kennedy said...

Hi Jo
Me too.

The awful thing is, the damage can present quite long after the event (liver / kidneys), and getting treatment promptly is really key.

I'll see if I can get an update sometime soon... :/

Rach said...

Your not the only one who put the brakes on, gripping as ever Spence, hope she is ok? And was exaggerating all along..x

Spence Kennedy said...

Thanks Rach. I think exaggeration is def the best option! :/ x

lulu's missives said...

Hey Spence,
Gosh how awful...was she ok? The pills for depression were a good indicator that something might be wrong.
If she's ok, is it likely that she'll repeat?
x jo

Spence Kennedy said...

Hi Jo

The anti-depressants were an indicator - except that it seems the whole world is on citalopram atm. It's almost like fluoride - they'll be putting it in the water supply next!

I'm ashamed to say that I don't know how she fared. I tried to check the other day, but I couldn't remember her name, I never did get her registered address, and no-one was on duty who'd been there that day. Sorry!

:/ xx

uphilldowndale said...

OMG....... jaw droping

Spence Kennedy said...

I almost dropped my pen! :/

Robin said...

"except that it seems the whole world is on citalopram atm"

In Lewisham and the surrounds, Mirtazapine seems to be the anti-depressant of choice - I was offered it as a first line AD a few months ago, then I heard of a few other people, a mix of friends and acquaintances that were either switching meds to it, or had also been offered it as a first line AD.

Back on topic though, your post was startling - a reminder of how easy it can be when in a situation to forget to mention things that are of vital importance.

Spence Kennedy said...

Thanks Robin.
I just had a quick read up about mirtazapine. We do come across it now and again, but so far it doesn't seem to be as prevalent in this neck of the woods. Sounds good, though! And a low OD rating, too, so prob an excellent choice.
That question really was a fluke, though. Shooting the breeze whilst I did the paperwork. Just goes to show...

Thanks for the comment, R.