Friday, May 04, 2012

a big night out

The city changes as the night goes on. The seagulls have the best view, skimming like drones across the upper reaches of the street lights, restlessly scavenging the network. Beneath them, the crowds have thinned along the shopping thoroughfares, clotting and spilling around the usual spots, the late-night bars and clubs. Even as we approach we can see this crowd has an unusual focus, though - a figure lying in the road with an epic triangulation of figures around her, crouching, kneeling, standing with a mobile phone and waving. A guy suddenly wrenches my door open just as I’m hitting the At Scene button.
‘Just slow it down, mate,’ I say to him.
‘She’s fitting.’
‘Let’s have a look.’
But even from here I can tell it’s not an epileptic seizure. There’s an artful focus about the way she flops her arms and legs about, the way she arches and relaxes her spine to bang her head comfortably in the lap of the guy on his knees cradling her. The setting could hardly be more public, and the fact that her skirt and top have ridden up, the way her arms are scuffed and dirtied from the road, all these things give the scene a shocking plausibility.
I’m like a street performer claiming his patch. And if the girl is The patient, I must be The patient whisperer, the figure in green with TV-levels of ability to take control, to sort things out. I’ve played this part before and I know how it goes. I have to get her into the ambulance as soon as possible, with the minimum of fuss. I know that the more direct and authoritative I can be, the more chance I’ll have of success. Conversely, I know that the longer we’re on show like this, the more chance there is the trick will be revealed and the scene become unmanageable.
None of the people with her are related; I identify Isaac as the friend sober enough to help. He stands behind me as I squat down, put one hand at her wrist to feel her pulse and one on her shoulder. She stares up at me, and stops thrashing around to listen for her cue.
‘It’s the ambulance. My name’s Spence. Can I ask what your name is?’
‘Gillian – have you fallen down and hurt yourself?’
She shakes her head.
‘Good. Now. We need to get you on the ambulance where it’s warm and safe. Sit up for me.’
She does.
‘Now bend at the knees – good. That’s it. Hold my arm. And stand.’
She stands.
The crowd parts to give us room as we walk over to the ambulance where Frank waits with the door open and everything ready.
As Frank settles Gillian on the trolley, I tell Isaac to wait outside so we can chat in private. I tell him I’ll be out again in five minutes. He looks crestfallen when I slam the door shut.


 Inside, the down-lighters above the trolley are warming and good. Gillian lies covered in a white blanket. She picks strands of hair from her face. Her pupils are saucerous and dark, whilst above her the ECG monitor jumps along at a clip.
‘Have you had any recreational drugs tonight, Gillian? We don’t care – we’re not the police. But we need to know so we can get you the appropriate treatment.’
‘No. Just alcohol.’
It’s hardly worth telling her that a blood test will reveal everything, but I’ll let the nurses at the hospital deal with that.
‘Ever happen to you before?’ I ask, writing down the last of the results Frank calls out.
‘A few. I’ve been for scans and stuff but they still don’t know what causes it.’
‘And how old did you say you were?’
She nods. 
Psychology. Can Isaac come? I want him with me at the hospital.’
‘Okay. Let’s get him on board.’


Isaac seems excited at the prospect of a trip to hospital in an ambulance. He sits forward on his chair, jiggling his legs up and down, his jacket on his lap, mobile phone in one hand, Gillian’s hand in the other.
‘This is wild,’ he says, looking around, his eyes as wide as hers. ‘It’s just like Holby City. How are you feeling, hon?’
She squeezes his hand. ‘Oh – you know.’
‘Who shall I call? Jazzer and Stoofus know already. I’ve told The Arch Meister. Crick says he’ll meet you there later. Ellie says hi.’
Gillian is lit up as much by his attention as by the down-lighters.
‘I’m lucky I’ve got such good friends,’ she says, and smiles at me. ‘God, I need a drink.’
‘You greedy bitch,’ says Isaac, thumbing another text. ‘You nearly died on me and now all you care about is booze. Honestly, girlfriend – you!’
He sends the text then looks at me.
‘How long have you been doing this job, then?’ he says.
‘About seven years.’
‘Like it?’
‘Yeah. It’s interesting.’
‘I bet you see some things.’
‘Oh - you know.’
‘Us for example.’
He laughs, stuffs his phone in his jeans pocket, then holds up the jacket he had on his lap.
‘What do you think of that?’ he says to me.
‘I found it. Didn’t cost me a penny. It’s a Ben Sherman.’
‘Do you know, I haven’t actually bought a jacket in years. Every one of the last three have been found. Two by me, one by my sister.’
‘That’s lucky.’
‘That is lucky. Three jackets. And look. Not any old shit.’ He turns the jacket inside out and presses the label towards me. ‘Ben Sherman. That’s quality. Look at the lining. Feel it.’
The ambulance rolls as we turn up the hospital slope.
‘We’re here,’ I say.
Isaac puts the jacket on.
‘Come on, girlfriend,’ he says, standing up and slapping her leg through the blanket. ‘Not the big night out I was hoping for, but whatever.’


Steve'nLubbock said...

As an epilepsy patient, I thoroughly resent folks like her. Oh, well, my friends know, and don't need a seizure to focus on me!

Spence Kennedy said...

I can see why you would.

The whole thing def felt like one big exercise in attention. Incredible that someone would go that far, even with the qualification that maybe it's an unconscious thing and they don't have complete control of themselves. A complex problem, and v frustrating.

Cheers Steve

Hannah said...

Three jackets, wowee...

jacksofbuxton said...

I'm a little more concerned about meladdo and his amazing ability to "find" jackets.Hmmmm

As for the patient,it's not her fault her friends mistook drunk for epilepsy.

I don't think I was that bad at University,but it was a while ago.

Spence Kennedy said...

hannah - I know. That's what I thought. Maybe they'll have to call him Three Jackets Isaac from now on. Or maybe shorten it. To Jackattack. Or Ack-Ack-Ack. Or something. The point is, it's early and I haven't had any coffee yet.

jacks - I must admit when he showed me the jacket I had a look for the hole where he'd cut the little electronic security tag off...

It wasn't just drunkenness, though. For whatever reason she was faking a seizure (although it has to be said you can never be 100% sure you haven't come across a strange variant with these things). What struck me was the extent she was prepared to go - in the middle of the road in front of a massive crowd, with her clothes all riding up. I mean, wanting attention is one thing, but this was exhibitionism of a whole other order. :/

Cheers for the comments!

Anonymous said...

As you say Spence, sometimes there can be very strange looking variants of seizures, so it must be hard to be sure.

The first time I ever had a seizure, the paramedics were apparently rather rude to my friends and apparently refused to believe that I hadn't consumed any drugs or alcohol. From what I've been told, they left me at the scene and my parents turned up and took me to hospital instead. I think in this case the paramedics probably made the wrong call, but I don't blame them for this as I appreciate how difficult it must be.

Having sadly since become rather familiar with the whole seizure process, I now know that I have long confused post-ictal periods, during which I am definitely not in a position to make any decisions or look after myself and I later have no memory of this period. It must be very hard for paramedics to balance the need for patient consent to travel to hospital etc. with the lack of ability to give such consent when in a post-ictal state.

I hope the girl you picked up gets the help she needs, whether it is for a seizure condition or for a psychological issue.

Spence Kennedy said...

Anon - Sorry to hear about your experience. Sounds awful. I hope everything's good with you now.

We usually treat the post-ictal phase over time. If the patient doesn't come up to full orientation in half an hour max, we'll always convey, if not sooner. And if we think the patient lacks capacity for one reason or another, we'll always do whatever we can to make sure they're okay.

In Gillian's case she didn't appear to be post-ictal, though. She was well oriented, chatting happily to Three Jackets and making various social arrangements. I did think the whole thing was psychogenic - prob exacerbated by some drug taking, which could've freaked her out somewhat. Anyway, whatever the cause there were def issues to be addressed at the hospital. Anyone who puts themselves in extreme situations of that kind is deserving of assessment, in my book.

And of course, like you say, you can never be 100% sure of your diagnosis!

Thanks for the comment, Anon. Very much appreciated.

Anonymous said...

In cases like these, can you say on handover that you suspect the patient was faking ? or do you have to confine yourself to observations on scene. Would it be useful for the staff to know your impressions ? Just wondering how you handle it.

Great posts btw ! Admire your ability to retain your empathy :)

Spence Kennedy said...

Thx Anon - Once upon a time we were allowed to write ?pseudofit. But now we have to write ?psychogenic fit if we have suspicions, along with supporting evidence.

The empathy thing does get tested most shifts. And the tireder / hungrier you get, the more difficult it is to see the whole picture. I think the day you feel yourself significantly losing that empathy, it's prob time to move on.