Friday, 24 January 2014

'Stop Being so Silly' Said the A&E Consultant

TRIGGER WARNING: This blog describes a distressing incident and discusses suicidal feelings and feelings of frustration and helplessness.If you are affected by discussion of these subjects, don't read on
It was early on a Sunday Morning during the Queen's Jubilee Bank Holiday weekend. I had implemented my Crisis Plan following a week of sleepless nights and five days of constant vomiting, which gave way to dry retching. I was not physically ill, but vomiting spasms were one of my most obvious symptoms, during periods of emotional distress.

I was feeling suicidal and needed help - desperately. I phoned the Crisis Team, as per my Plan and after ten minutes was instructed to attend the local A&E and ask to see a member of the Team as they were on site in my local hospital. So, I did as instructed and reported to the A&E reception, where the Receptionist was helpful and clear that I had already spoken to the team and had been told to report to them. So far so good. Thankfully, for a holiday weekend at 4.00 a.m. the unit was relatively quiet, just three others along with me in the waiting room.

The Triage Nurse, again was efficient and reassuring, I had continued to retch violently and had soiled and wet myself by this stage and so was in obvious distress. She was empathic and quickly ascertained that I was already open to the local CMHT and therefore was responding correctly to my Crisis Plan. Again, no regrets, relief that the plan was working. Then it went dramatically wrong.

Enter, the A&E Consultant. Opening gambit: 'Why have you come to the Emergency Department tonight?' I told him I was diagnosed recently with BPD and was experiencing a sustained period of emotional distress. Again, a long explanation about the building distress, finally admitting that I was feeling suicidal had contacted the Crisis Team and they had told me to report to them via A&E, could I please speak to them. 'No, you must speak to me' - cue frustrated banging of head against wall. 'You must stop being so silly and speak to me'. 'What is all this nonsense about suicide?''You are being very difficult and I'm not prepared to refer you on'. I decided to try pleading, 'Please, I don't want to explain anymore, I need to speak to the team, I have already spoken to them on the phone and they told me to come here immediately. That was two hours ago.' He again told me that talking about suicide was 'silly' at which point I exploded: 'Get this bastard away from me, I don't want to talk to him anymore'. Again, banging my head against the wall.

He continued to refuse to refer me on until I had 'stopped this nonsense and calmed down.' Then, a Staff Nurse and HCA appeared, alerted by my shouting, and quickly removed the Consultant. For the first time since speaking to the Triage Nurse, someone asked me if there was anything they could do to help me. It was the HCA. I was able to tell her about my soiled clothes. She quickly arranged some scrubs for me to change into and offered me a cup of tea. Then she and the nurse put me on a trolley and tried to get me to put my head down.

Within thirty minutes of their intervention, a member of the Crisis Team appeared and assessed me. She prescribed a sedative to stop the vomiting spasms and arranged a home visit from the Home Resolution Team the next day. Admission was never an aim of mine, as it is noted in my Crisis Plan that this is counter-productive unless there is an imminent risk of harm to myself. Having removed the Consultant and feeling listened to, my risk of harm had reduced significantly.I was allowed to go home at 6.00 a.m. and had a visit from the Team at home by 10.00 a.m.

The team responsible for my care had helped, but there seemed to be such a disconnect between their response and the response of the Consultant.

Given that the Receptionist and Triage Nurse had noted the involvement of the MH team, why did this man not recognise the fact that my case had a solution in place? Why did he feel that it was okay to belittle my response? Why did he not notice my physical discomfort and embarrassment? Given that I was dealing with BPD symptoms and risk of suicide attached to this condition, why did he not carry out a more thorough assessment of my suicidal ideation?

I guess there are no answers as to why, only he may know that. What worked in soothing my distress and stopping my self harming behaviour from escalating, was common sense responses to a human being in need. In a word, compassion.

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