Sunday, November 17, 2013

body language

Jenny has taken an overdose of pain meds. Nothing immediately life-threatening, but serious enough to warrant a trip to A&E. Her partner Geoff doesn’t need to get anything ready. Jenny was only discharged from the psychiatric hospital yesterday, and they haven’t unpacked yet.
He kisses her goodbye at the door, tells her he’ll be up later. It’s difficult for him, what with the pets and everything. But he’s used to it. Jenny’s been overdosing like this for years. The only surprise each time is the ease with which she’s still able to get hold of pills, her own prescription tightly regulated.

She takes my arm. I lead her to the ambulance.
‘Cold tonight,’ I say.
She doesn’t answer.

* * *

At the hospital the charge nurse greets us wearily. It’s been another busy night, but the crowds are thinning now and he’s got time to think.
He grabs the clipboard and wheels the portable obs machine in our direction.
‘Hello,’ he says. ‘My name’s Jack. What brings you to A&E tonight?’
He starts copying down some information from my sheet whilst I tell him the story – the overdose, the reason she took it, what it was and when.
‘Ah-ha,’ he says, putting the clipboard aside and wrapping a cuff round her arm. ‘Have you done this kind of thing before, Jenny?’
She nods.
‘Yeah – I thought I recognised you. Weren’t you in last week?’
She nods again.
‘Oh-kay. So tell me what happened tonight. Your man here tells me you took all these tablets. Why’d you do that, Jenny? Was it deliberate?’
She nods.
‘And would you go so far as to say you intended to kill yourself? Is that what you wanted from all this?’
She nods.
‘Okay. That’s fine.’
He writes down the blood pressure, SATS and pulse, takes a quick temperature then unwraps the cuff from her arm.
‘I just need to have a quick word to see where we’re going. Back in a minute.’

Jenny shifts restlessly on the chair.

‘I don’t like him,’ she says after a while. ‘He thinks I’m a burden.’
‘Oh no, Jenny. I don’t think he does. It’s been really busy here tonight. He’s probably just exhausted.’
‘He thinks I shouldn’t be here. I can tell by the way he looks at me. He thinks I’m a waste of time.’
‘I don’t think he does, Jenny.’
She’s not convinced.
She sits in the chair, holding on to the suitcase, jigging her leg up and down.
We both watch as Jack hands over to the main desk. The cubicle board is full, closely written in black and red, hectic as the tote board at a racetrack. Jack is there a little while. At one point he hangs on to the counter and stretches his back. The charge nurse takes a cloth, makes a change to the board. When Jack straightens up, the charge nurse is biting the end of the pen, studying the board. Then he tosses the pen back into the clutter on the desk and says something to Jack. They both laugh.

Jenny’s leg stops jigging and she straightens in the chair like she’s just been slapped.
She draws her suitcase closer in.


tpals said...

I know this sounds harsh, but isn't she a burden? With all that practice she can't really be intent on death.

There could be a place where people like her could skip the ODing and sign in knowing they will be taken as seriously as if they had gone through A&E.

Laura Elizabeth said...

Her paranoia makes me sad. A few years ago, I was that woman - in A+E over and over due to mental health and attempts at my life. I was lucky enough that one time, I met a compassionate nurse who changed my life. I wasn't treated as a timewaster or an inconvenience. She got to the heart of the matter (better than the psych liason team did...) and that was my last OD. She was the catalyst for me turning my life around.

I understand it can be frustrating for staff, but people don't do this "just for fun"...on the most part anyway! And in their busy, time bound environment they still have such a chance to change a life :-)

Would imagine there's a lack of training though...

Cassandra said...

I've not overdosed on pain meds, but I can tell you that I frequently feel judged when people find out that I'm on them, or by my doctor when discussing my ever increasing pain levels and the need for stronger medication. I can understand Jenny's feelings... it's easy to feel like a burden or to assign less than savory motives to health care workers. Maybe it's a protection thing. If I assume they're judging me or thinking me a burden, then it won't hurt if they actually are... and I might end up pleasantly surprised!

It does really annoy me, though, when people abuse prescription pain killers. Here in the US, they're tightening up regulations and making them harder to get for the folks that use them legitimately. And really, if someone's using them against prescription, you think they're going to listen to the rules that the rest of us abide by? Not so much. We pay the price for people like Jenny. She's not doing it maliciously, I know. She just needs help. But it still ruffles my feathers.

Spence Kennedy said...

tpals - I have to say my views on this have changed. We had a patient who presented very frequently with either stripes on her arms or overdoses. None of it was particularly 'serious', and it was tempting to see it all as a 'cry for help'. Next thing I heard, she had actually killed herself.

I wish there were some other route they could follow. To the extent where they didn't feel obliged actually to take the OD etc. Gradually, gradually, things are getting better, I think. But still we take far too many Jennies into A&E, and I wish it were otherwise.

Laura - that's a very heartening story. I'm really glad you found someone who could help you so effectively - especially given the difficulties of A&E. I have to say the nursing staff there are amazing - despite the horrendous pressures, they still manage to effect these miracles now and again. I'm constantly in awe of their ability & their compassion 'in the line of fire'.

In Jack's case, it was just a question of unfortunate sight lines and exhaustion. I'm sure he would've been mortified had he known the effect he had on Jenny.

Cassandra - I completely understand that instinct to 'pre-empt' difficulty & unpleasantness. And I know that it has an element of truth. I've seen how some frequent OD patients are received at A&E. It's so much to do with the pressures on the department. The feeling is, if you don't have to be there, why would you? But it's a sign the system is overloaded that sometimes you get compassion fatigue, and not the case in itself.

I know what you mean about the effect Jenny might have on the wider prescribing community. But she's a case in point - despite all the safeguards, she still manages to get hold of these things and OD. So in many ways the horse has bolted.

* * *

Thanks for your comments! :)

jacksofbuxton said...

Tricky one Spence.Obviously Jenny needs help,yet she's forever taking up the time of A & E.No easy answers.

Spence Kennedy said...

Really tricky. It looks as if she has lots of things in place, including a supportive partner and the attention of the psych services, but she still has this persistent problem with ODs. I suppose a few years ago Jenny would've been a long-term patient in a psych hospital.

Anonymous said...

This is when you release how much A&E has become a clearing house a production line. I am fortunate where I live that the local unit is a M.I. not A&E (which is 30 minutes away on blues) and the atmosphere in the unit is so different. The thing that surprise's me is I think the NHS is missing a trick by not using them for minor ambulance cases, ones that should of gone to M.I. anyway.

Spence Kennedy said...

There is actually a Minor Injuries unit here (called an Urgent Care Centre), and some cases do get referred straight to it. In Jenny's case they would still needed to have run some blood tests to assess the OD, so she had to stay in Majors. You're right about the clearing house aspect, though. In the ambulance we head for the main hospital, and they decide which section the patient goes to. In some ways that makes sense, as it cuts down transfers at a later date, when something that seemed minor is found to be more serious. At least they only need go round the corner!

Every aspect of emergency medical care is under pressure. I'm not sure what the answer is (probably a combination of things, as is often the case).

Thanks for your comment, Anon. :)