Tuesday, May 10, 2005


A strange thought came to me last night.

It was about one am and I was watching Mr Cray leave the Emergency Department. He was smiling and looked relaxed and comfortable, and those with him were happy and laughing. A spirit of cameradery, of knowledge of a worhtwhile job done well, seemed to follow him as he proceeded towards the exit. He had come to us tormented by voices, angry, lashing out, paranoid, in crisis, dependent on drugs and alcohol, and modern psychiatry had done its mysterious work and now he was calm, more at peace than he had at any time in the last few months. The psychiatric treatment of mental health patients gets a lot of stick, but occasionally we do do things right.

"Look at that" I said to the intern and the security guard. "Out of the strong comes forth sweetness. A triumph of modern biopsychiatry."

And as the ambos and police wheeled the barouche bearing Mr Cray's bruised, restrained and heavily sedated body down to the lockup ward, from which he would be discharged back onto the streets, he seemed - or did I imagine it - to drool in agreement with me.

"We really can make a difference to people's lives" said the intern.

The security man pressed the icepack to his jaw, grimaced and nodded ruefully.

I have only partial recollecion of my time in the ED on the "other side"- as a patient. It wasn't the best of times. And like most memory what you interpret as an objective linear narrative, as data about what went on, is in reality a melange: distorted scraps, imaginings, images, things that never happened but you thought they did, things that happened but to other people, what you wanted to happen and what you feared would happen. Unmatching fragments of a puzzle that your brain has shoved together and distorted.

We forget decades and remember moments. Do a Google search for Charles Bonnet Syndrome. What we know is not so.

But from looking back and extrapolating from what happens daily to other people, I can work out what it must have been like.

I would have waited a while, with my increasingly concerned workmate trying to keep me calm as I gibbered, in the waiting room amongst fevered children and footballers with twisted ankles and women with abdominal pain.

I would have been seen by someone with, to be fair, minimal psychiatric training, possibly only a few lectures and some work experience in medical school.

That person (a young, caucasian man with dark hair, wearing a lab coat, I can't quite make out his face) would probably have been tired and possibly nervous - he was young and relatively junior and there may not have been consultant support because there were damn few emergency consultants around at the time.

He might have got the short end of the straw. In our ED the new patient's paperwork is put in a box in order of priority: a priority three (say abdominal pain and fever) is placed above a priority five (say rash on fingers for the last eighteen months). The quickest way to unpopularity in the ED is said to be "cherry-picking"*, going through the box and selecting the patient you feel like seeing rather than the one who the triage assessment says needs to be seen next.

Well, if anyone does cherrypick, and it's hard to stamp out, the following pateints are the ones who will miss out and have to wait even longer:

psychiatric assessment
requesting admission for detox/withdrawal/needs accomodation
anal pain
rectal bleed
old person from half-arsed nursing home, demented, had a "turn", no further history available.

As you can see, almost half of those are psych, and all of them could be if it was a truly unfortunate psychiatric patient.

I like psych (oddly enough) and people are only too willing to swap. On occasion (and more at Shipton, only once or twice at Florey) I have been deliberately sought out - "swap you something for a psych?". I have got rid of "scaly rash on scalp", "might have been bitten by insect, not sure", and any number of "generally unwell" for extra chances to see psychiatric patients. "When I started out I palmed off a lot of babies that way. Sick babies frightened me. Then I sortof worked out if I never saw any, they would always frighten me, so I saw lots of them and now they don't.

Anyway. I am going to have to try and psych myself up to attend a tutorial this afternoon, so on with it.

[Note to self: insert insightful, profound or witty closing line here]


*Eating someone's lunch isn't good either. Sorry, Danny.


Blogger Stoic Stranger said...

Glad there are docs who actually want to see the psych patients. It is frustrating to know one needs help, to take the next responsible step of seeking help, and then to be shot down by a doc who would rather deal with "anal leakage" than "psychotic but not violent". Kudos to Bronze John.

2:12 PM  

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