Читать книгу In Stitches - Nick Edwards, Dr. Nick Edwards - Страница 18

For some unknown reason, I am on an eco-drive. I have spent a fortune on energy efficiency lights, become keen on recycling and started to come to work by train. I feel like an eco-warrior (a middle class one who is scared of climbing trees let alone living in one with a bloke called ‘Swampy’, but still in my eyes an ‘eco-warrior’). I feel good about myself. These feelings vanish, however, as I get off the 8.42 train …

When I walked off the platform, there was a group of inspectors standing round a lady who was carrying a ridiculous number of bags. At first I thought she was shouting down a mobile phone. Then I realised that wasn’t the problem.

‘WHY DON’T YOU GET RID OF YOUR KNIVES?’ She screamed in the general direction of the ticket inspectors.

‘I KNOW WHY YOU WANT ME DEAD. BUT I DIDN’T CAUSE THE TRAIN CRASH.’

I approached and was told to stand back as she was apparently dangerous. She was very unwell, but, no, she wasn’t dangerous. I recognised her straight away. She was in her 40s and was a known regular at A&E. She had mild learning difficulties and psychotic paranoia and depression; a diagnosis of schizophrenia had been made in the past. She had a problem with alcohol (i.e. she drank more than her doctor) and her coping mechanism for whenever she got stressed was to self-harm. For years she had been in and out of psychiatric hospitals, and was now receiving ‘care in the community’.

In the past, patients like this may have been institutionalised, but they now are more likely to be cared for at home by community psychiatric nurses. However, these services are often under-funded and patients can slip through the ‘care’ bit of the ‘care in the community’ programmes. Instead, their ‘care’ is often provided by homeless shelters, police stations and A&E departments. This lady was one of these patients. She didn’t cooperate with any of the programmes they had tried to involve her with. She was getting sicker living in the community, but there was little anyone seemed to be able to do for her. As a result she had been to A&E 78 times in the last four years.

I approached the ticket inspector who seemed to be in charge.

‘What’s going on?’ I asked.

‘Stand back. She is dangerous,’ he told me, then started shouting at her: ‘Lie on the floor with your hands on your head’.

‘Bloody hell, she is clearly unwell but she’s not a terrorist suspect,’ I thought. She started screaming in fright and was scratching and biting herself to the point of bleeding. I intervened and called the police. I explained to the 999 control that this lady needed sectioning under 136 powers (i.e. the police could take her to a place of safety). When I explained that I was a doctor and not someone who needed sectioning themselves, they sent round two burly looking officers.

They were absolutely brilliant. They calmed her down and put her in the car while I unfolded my new bike and cycled to work – I really was on an eco-drive.

On arrival I explained why I had been late and that I had brought some work with me. This didn’t go down well. As ‘punishment’, my task was to go and see the patient that I had just arranged to come in with the help of the boys in blue. As I went in to see her, I nodded in appreciation of their work earlier and started to speak to the patient.

‘Hello. My name is Nick. I am one of the doctors here. What happened today?’

I said it in my most reassuring of voices, but it hadn’t seemed to calm her down or helped with her paranoia at all.

‘You aren’t a doctor. You’re a ticket inspector. I DIDN’T CAUSE THE CRASH. NOW GET OUT.’

Later that day, she was readmitted to a psychiatry ward. I saw her two weeks later, after another episode of self harm. It is a situation that we see all too often. In our current world of political correctness and not offering institutionalised care, there seems little we can do. As always, when there is a crisis, A&E is the point of call, but we cannot offer the long-term solutions that they need.