Wednesday, 15 May 2013

A rant about A&E

OK, first off I want to say that I don't come close to understanding the high stress of working in an A&E department. I've never done it, I've only ever been there as a patient or with a patient. I recognise that it's a difficult and sometimes dangerous job and in general I have a lot of respect for the people who take it on. That said I have had some really distressing experiences in A&E departments and I doubt I'm alone. The one time I went it with a physical injury they were awesome, likewise when I've attended with somebody else for physical issues they've been pretty damn good. Not that I've never encountered issues on that front - I have, particularly waiting times - but my experiences have been better than when I've been in with mental health based issues.

I once went it because I was feeling suicidal, was genuinely scared I would act on that urge and was told by the out of hours service that it was the best place for me. When I got there I was told that I hadn't harmed myself so they had no idea what I thought they could do. Not reassuring.

I've been taken in via ambulance twice, post overdosing. On both occasions I was tutted at and told off. Once a nurse even told me that if I was really trying to kill myself I wouldn't have chosen those particular tablets as 'everyone' knows they don't kill you. There was also a running commentary on the scars and cuts on my arms, which included a doctor poking at one and asking if I could feel him doing so. Yes, I could feel it. It bloody hurt.

Here's the thing. Not every overdose is a suicide attempt. Overdosing can also be a form of self harm. Self harm is self harm, not a suicide attempt. They are, in fact, different.

In both cases, someone else phoned the ambulance. I didn't really want to go in but was persuaded to by lovely ambulance people who made me feel looked after. Only one of my hospital trips was post a suicide attempt. I was made to feel stupid that it hadn't worked/left me with permanent damage. Apparently that meant I wasn't trying hard enough and was thus wasting time. Not a good way for a suicidal person to feel.

I have been in with other people post suicide attempts and seen them treated in similarly appalling ways. It enrages me, it really does. In A&E your job is to treat people, not judge them. I think there are some simple rules people need to remember.

1) If someone is taken into hospital after harming themselves, whether in a bid to end their life or not, there is obviously something wrong. To find out what is wrong, talk to and listen to your patient with sympathy and understanding.

2) Alienating and upsetting your patient will make things harder both for them and you. It makes it harder for you to do your job and may lead to you missing something important and getting them the right help.

3) Nobody hurts them self with the intention of wasting your time, creating extra work for you or making it harder for you to treat other people. In fact, their actions before entering A&E had absolutely nothing to do with you and so shouldn't be taken personally.

4) Curtains are not walls and your voice will carry through them. If you really are annoyed with your patient and feel you must vent, do so out of earshot of both them and other patients.

5) There was a reason the person did this to them self, it may be a symptom of a mental illness. Blaming people for their symptoms is not on. Would you blame someone else for having an asthma attack or having a cough?

Every time I think about this subject I get choked up. I once wrote a very nasty letter to an A&E nurse, though I never sent it. This was after a friend of mine killed herself. It was the last of multiple attempts, on the previous attempt she was told by a nurse that if she really wanted to die she'd have done it by now and to stop wasting everyone's time. I've always wondered if the nurse knew that my friend did indeed stop wasting everyone's time. Forever.

To be fair and balance this out, I want to briefly talk about the time I went to A&E with a friend of mine who had taken a potentially fatal overdose. I went with her in the ambulance and stayed with her until she was admitted several hours later. The nurse who saw her was brilliant. She was calm and efficient, and constantly reassured my friend that they were doing everything they could to save her life and make her comfortable. After the doctor had seen my friend, she stopped by to make sure we'd understood what was said and what was being done. She popped in often to see how we were getting on. She held my friends hand and listened when she was off oxygen and talked about being angry that her life had been saved. She got her talking about why she was so determined to die and asked what would make my friend not want to die. She never once made her feel guilty for being there and in fact did quite the opposite, assuring her she had ever right to be treated.

So there are absolutely people out there doing it right and it's entirely possible I've just been unlucky. Only I've had a lot of people share similar experiences with me. Personally, I think there should be mandatory training aimed at raising awareness of mental health and giving staff the tools they need to handle it. Not only when they first train but on an annual basis.

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