Invisible Wounds

"Female u/k age, tired, mental health problems"

"What's been going on?"

"About a year or so ago I witnessed something horrible. The death of a young man. I suppose, in the days / weeks that followed I expected to see his face in my thoughts. On the night itself I think the adrenaline kept me going until I got home. I just laid there on my bed and absorbed it all. I'd just watched someone die in the most horrific of circumstances and was helpless to stop it. Could I have done more? It was a helpless feeling that I just couldn't shift. His face. It was there all night. As the days past I thought about him less and less. I don't remember when his blood stained face stopped appearing in my dreams but within a month I'd say he was gone."

"So what's changed?"

"I found out his name. I was shown an online article about his death. I suddenly felt I knew who he was, what he was meant to be, what he had lost. His blood stained face came back. I'm plagued by flashbacks on an almost daily basis. I can't get his face to stop invading my dreams. It's weird though, now I almost take comfort in his presence. I can't imagine a day where he isn't present."

"And have you talked about this to anyone?"

"Sure, I've spoken to the people that were there and others. I feel like I'm the only one bothered by this. It's an overwhelming isolation which is eating away. Maybe it's just sleep I need. I can't remember the last good nights sleep I had. I've always had a problem sleeping but now it seems worse. After hours of trying I eventually get to sleep but once drifted off I'm awake again with an alarmingly predictability and the circle starts again. And again. Sometimes I just wake. Sometimes it's a nightmare. I picture his last moments again and again. Not from where I was though. It is as if I was watching it on TV. And I'm not looking at him really. I'm looking at me. It always ends the same though. His bloodied face, distorted, mutilated and swollen, lifeless. It's just......there."

I was clear just from looking at her eyes that this was taking it's toll. She looked drained.

"I have seen things that should upset me since but they don't. Maybe I'm hardened to it. I just feel numb. I try and keep busy to take my mind off it. The more tired I am the more I try and avoid thinking about how tired I am. I know if I think about sleep I'll think about him."

"What about your friends and family? Do they know?"

They do and they don't. They say they do yet I feel vilified for being irritable. Despite how I'm feeling they always have something trivial which is much much worse. Either that or I'm given happy clappy cliche advise about 'staying strong' etc. My mood swings back and forth and I try to only interact with them when I in a good place. It's just easier that way. I'll be fine, I'll get over it, I'm just tired."

"There is help available." 

A smile appeared on her face. Clearly I wasn't in on the joke.

"Yes I know, therapy, drugs, a sick note etc. No thanks. Can't be dealing with a disciplinary and P45 too! Work is a good distraction but they don't take kindly to mental frailties! Honestly, I'll be fine! Just venting!"

*          *          *          *          *

The 'patient' was me. The 'guy' was patient from '3am' (read). Post Traumatic Stress Disorder (PTSD) is very very real. It's often associated with the military due to the sights they see and the environment they are in. However, it is becoming more and more common, or more and more freely admitted in the Police and the Ambulance services. I have it, or had it, I'm not really sure. I'm also not really sure if it is ever something that goes. Maybe it is and it just hasn't gone yet. Maybe it is gone and what is left will stay. I don't really know. I wrote this post because of one I read on the One Police UK Facebook Page. It really hits hope what PTSD is all about. 

Despite what the PR department will say, there really is no provision within the emergency services for dealing with it. I tried accessing the 'free counselling' service that is offered and if anything just trying to make an appointment made me worse. Actually saying  'I have PTSD' was of huge importance, as cliche as it is. Not in the sense of standing in a circle and saying 'My name is....... and I have.....' but to admit that your mental health is affected is quite a big thing. Especially when until that point, you only ever had to deal with other people's mental health. In the ambulance service, the closest you come to your employers knowing something is wrong is going off sick with stress. And lets be honest, that only stands to give you a reputation for 'someone who goes off sick with stress'. i.e. chancer, faker, pulling a fast one, playing the game, abusing the system. It's true. That is how you will viewed by management. 

Admitting weaknesses isn't something that is done much in an environment full of black humour and bravado. Mess room banter probably wouldn't cope with someone saying 'actually no, I see his face in my sleep every night'. You just play the game. Put on the brave face and only confide in the ones you think won't judge your weakness. Let's be honest, it doesn't give much confidence in a new crew mate when a simple head injury causes you a panic attack. There a triggers everywhere, it's about learning to spot them and avoid them. Sadly, this job doesn't let you avoid seeing words like 'fall from height'. These are the invisible wounds that PTSD leaves behind.

The problem we and police have is it doesn't stop. There is always a new memory around the corner. '3am' has effected me. It was the last job of the shift, the last shift in a run and I had seven days off to dwell on it. Maybe PTSD in the emergency services is more about timing rather that the event. I have seen things that a more tragic and more disturbing since but they don't effect me. Part of me wishes that they did. 

Another traumatic death or a dead child. Maybe the one memory that stays is protecting us. If every traumatic sight we saw effected us in the same way we simply wouldn't function. There is very little time to process information. Very often I have written about seeing something which most people would see as probably the most traumatic event in their lifetime, only to go to another call five minutes later. Maybe this is why

PTSD isn't going away, it is a fact of life and although some efforts are being made to treat it and make it more accepted, until it is fully embraced and tolerated by employers little will change. Let's be honest though, the reason why it isn't widely tolerated as a genuine reason for sickness is money. We can't have our police officers and ambulance staff on long term sick can we! There are targets to be met.....

Don't forget to vote in the MAD Blog Awards 2013. I'm a finalist in the Best Writer category and all votes will be appreciated! VOTE NOW! Voting closes midnight tonight!

I'm just a Fire Starter

"25 year old female, mental breakdown, setting fire to her room"

This had all the ingredients to be 'one of those jobs'. By that, I mean a job needing diplomacy, co-operation from mental health services and patience. It may also need police and fire, the latter of which I could happily do without! Mental health jobs kind of excite me in a weird way. I know that it will be tough to deal with, I know I will end up getting frustrated and wound up by the lack of options available to me and ultimately I know I'll probably end up blogging about the shoddy mental health care that patients have access too! Then again my fascination with mental health and psychology makes me gluten for punishment!

We pulled up outside to see a police car parked up. As we got out Trumpton pulled into the road, sirens blaring, causing curtain twitches galore to appear in their windows. Bear in mind it was 2am. There was absolutely no need for sirens on residential streets, but that's 'pet rescue' for you. As we approached the front door one of the coppers came out. 

"Evening ladies, she's upstairs, I'll send Trumpton back to bed!"

It's as if he was reading my mind! I headed up the stairs and followed the noise that was coming from one of the rooms. It was a halfway house for people recently discharged from the local mental health unit and there was an office at the end of the landing with a rather fed-up looking woman sitting inside. She just pointed at the room where the noise was coming from with a shake of the head. 

The police explained that she had been discharged for the mental health unit about 6 hours previous and had been 'freaking out' ever since she arrived here. She had been setting fire to documents and her mediation and was doing so because the voices in her head were telling her to do so. I made various attempts to talk to her without success. I like to think I can talk to mental health patients, some can and some can't. Normally I am able to, but sometimes patients either won't engage at all or will only engage with people who have gained their trust. In this case, she wouldn't engage with anyone. Stupidly I turned my back to talk to my crew mate and a water bottle came flying across the room and got acquainted with the back of my head. No cut, no lump, no harm done, but still.....uncalled for!

The police were savvy enough to know that jumping on her for assaulting me would have been of little benefit so it was ignored. She was scared, unsettled to say the least and was surrounded by police and an ambulance crew. We were all there to help her but I imagine it didn't feel like that. She said she wanted her case worker and that he was back at the mental health unit. As far as we were concerned, that's where she should be and as she had only just been discharged the plan was to take her back. With that suggestion she frog marched herself out of the room and downstairs towards the ambulance. I simply followed! That was easy!

Once on board we convinced her that it was in her best interest to let us check her over medically so that the unit would have no qualms about accepting her. She was medially fit as far as I was concerned. No alcohol in her body, no unauthorised drugs, no injuries, nothing! Excellent! Off we went, police in toe! 

So, there we were, 1 x patient, 2 x ambulance staff, 5 x police officers and 1 x mental health worker from the half way house. All 9 of us bundled into the lobby of the mental health unit. Behind the security glass that would rival most banks was a collection of staff. We were ushered round to the door to hand over. I explained what had happened and why we were her. Her response:

"She's not coming in here."

"Why not?"

"She's been assessed and discharged. There is nothing wrong with her mentally. It's just behavioural problems and attention seeking."

"We are called to a young woman, discharged from a mental health unit hours previous who states she is hearing voices and is setting fire to her room. She has anti-depressants and anti-psychotic medication. She clearly does have some kind of mental health problem and that is why we are here."

"Well she doesn't. I assessed her myself, we aren't here to sort out peoples behavioural problems."

"But you are here to help sort out voices in someones head."

"She doesn't have voices."

"She says she does."

At this point, one of the coppers took over.

"We believe she is suffering a manic episode, the employee at the mental health half-way house agrees. If she doesn't have any mental health problems why are you putting her in a building for people recovering from mental health problems?"

After a brief pause..... "She'll have to go to A & E first. We can't accept her until she has been cleared by A &E"

"A minute ago you said you couldn't accept her because he hadn't got anything wrong with her! We have brought her here to you, this is the most appropriate place for her and the fact you discharged her less than 5 hours ago, to me, makes it a failed discharge. I suggest you re-assess her because your initial lack of diagnosis has been found wanting."

Another brief pause...... "Bring her through."

HURRAH!!!! Oh the joys of a mental health unit! To be fair, I knew it was never going to be easy! With my blood pressure suitable raised and my mood suitable lowered we trundled off to the ambulance so I could have an expletive filled rant in private! Good times!

The Three Stooges

“43  year old female, chest pains”

This job set the tone for what would turn at to be a very familiar night shift. I exhaled in frustration when I saw the address. It was one of the many regulars on our patch. She was a wine-drinking alcoholic; she always called for chest pains, always went to hospital and was always rude and obnoxious. Tonight would prove to be no different to the norm. We stomped up the concrete stairwell, navigating our way past the vomit on the stairs. Lush! Her door was wide open like it always is. We walked down the landing to her bedroom like we always do and found her lying on her bed smoking a fag like we always do. Then followed a very familiar conversation.

“Hello again”

“Alright luv”

“What’s the problem tonight?”

“I got chest pain”

“Same as before?”

“Yeah”

“Can we do an ECG?”

“Yeah, go on then”

We do the ECG and all her obs. They are all normal like always. 

“Shall we pop you up to hospital?”

“Yeah, I need to see a doctor.”

"Still got the pain?"

"Nah, but it should be checked out."

So, without any fuss he all walked (she staggered) arm in arm to the ambulance. We drove to the same hospital as we always do, where I gave the same handover as I always do. On to the next!

“37 year old female, suicidal, taken an overdose, police on scene”

We all say that the first job sets the tone and shifts have a theme but they really really do and I don’t know why! This address was also well known to us. It was the residence of the most abusive drunk in our area. I say abusive, she abuses the police and most ambulance crews but for some unknown reason she loves me! We pulled up next to the police car, which seems to be a permanent fixture outside her flat. In the hallway outside was one of the coppers.

“Good luck, she kicks off every time I go inside”

Sitting there in her underwear and dressing gown, she swigged vodka while smoking a roll-up. Her face lit up as soon as she saw me.

“Heya babe, tell the pigs they can go and you don’t need them”

As much as calling the police 'pigs' wasn’t acceptable, in all honesty, their presence was only going to make things worse and I knew they’d be only to happy to leave.

“I’m happy to deal with this, I know her well, she’ll be fine with me”

They were only too happy to leave and were gone near enough before I'd finished the sentence! It was the same story, drinking vodka to excess, self harmed her forearms, refused hospital and then there was a 45-minute battle to convince her to go. Sometimes she wins and sometimes I win. Tonight I won. Hospital was the plan and all we had to do first was go through the charade of collection her ‘valuables’ (vodka) and hiding them so they can’t be stolen. After completing this ritual we headed off and handed her over to the less than enthusiastic nurse. 

We left the hospital to go and get fuel and hopefully a Wild Bean coffee and a pre-packed sandwich. It really is 'gourmet on the go'! Well actually it wasn't because we never made it. We were flagged down by a member of the public for what appeared to be an unconscious man in the street.

“u/k male, unconscious, running call”

We called it in and were sent down a CAD number. It shouldn’t have surprised me that he was well known to us. I had picked him up yesterday about 200 yards down the road. In fact, he was being picked up 3-4 times a day, each time by an ambulance and each time taken to hospital. The problem is, each time, the hospital sober him up enough to be able to walk and then either sit him in the waiting room until he walks out or discharges him. He walks up the hill to the shops, buys more booze, drinks said booze and passes out again. The hospital are not willing or able to invest time in fixing the problem & we have no ability to anything else with an unconscious drunk person other than take them to hospital. The cycle will continue until he stops drinking or dies. The latter seemed most likely. 

Tonight, he was lying at the bus stop next to his empty bottle of scotch. He was face down and had wet himself. I often wonder what he was like before this. What kind of life did he lead? What family does he have? What friends did he have? Now there appears to be no one. The only people around him are the members of the public who call 999, the ambulance crews that take him to hospital and the nurses that kick him out. What can we do?! We scooped him up off the floor and onto our bed. We did the usual obs and then drove the half-mile to hospital. We got the usual looks of distain from the nurse and rolled him onto the bed. To be fair to the nurse, we had just brought in three abusive alcoholics in as many hours, but still……not our fault!

Alcohol is something that the NHS does not do well, a bit like obesity. We only treat in the short term when it is too late. Very little is done when warning signs are there. Accessing services is far to difficult and it is a lot easier to just give a bag of fluids and let them go than find out the cause and refer to the appropriate places. It’s a shame, if they invested in prevention rather than cure, the long term saving could be huge. Shame no manager or politician is ever that long sighted.

Off we went for fuel, this time we made it. The sandwich was rank and the coffee was a poor substitute to Costa but beggars can’t be choosers! After the start to the shift we had had it was a necessity! We went off and did a few more jobs to a different hospital and at about 2am came back to our area. We handed over our drunken teen to the staff and booked them in. I walked through the busy waiting room and what did I see?! All my regulars sat in a line on the bench together! The Three Stooges! That image summed up how the NHS treats alcohol and mental health. A sad sight but one that amused me! 

“Evening all!”

Snap out of it

“27 year old female, feeling unwell, tired"

Just another day, another dollar. The usual routine; wake up, shower, get dressed, make lunch, drive to work, get crap out of locker, chuck it on a truck, check the bags, check the cupboards, drive off for 12 hours of the usual. Job to job to job; the same old patients, the same frustrations and no thanks for it. It really does get you down sometimes! As for the patient, man up springs to mind!

She lived in a nice area, her flat was a nice size, clean and tidy, nothing out of place and she was well dressed and well presented. She was well spoken and very polite. What could possibly be wrong? She didn’t seem in any pain, she had a smile on her face and cracked jokes. She couldn’t really explain what the problem was and knew it was nothing she needed an ambulance for, but she didn’t want to go back to the GP. The last time she did she was fobbed off with a prescription and told to diet and exercise.  She was just... feeling unwell. So here we are. What is the problem?!

She took a deep breath... “OK, from the beginning...

...I suppose it started during my teenage years to a point; broken family etc blah blah blah, always a brave face but I suppose it took its toll. Self esteem was low, confidence was low but I suppose you just cope don’t you? A marriage painted over the cracks, 6 years of happiness and distractions and a lovely child to add to the mix made everything seem OK. After the marriage ended there was a rebound relationship that painted over more cracks. I suppose that wasted year gradually chipped away at any remaining confidence there was and after being left a shell, rock bottom was reached. All the while though, a well painted exterior left no one the wiser. Even my closest allies were unaware. Panic attacks began, intrusive thoughts plagued me and sleep became an issue. 3 months of 2-3 hours sleep a night took its toll. Bags under eyes is not a good look on me!


Despite the self-inflicted isolation and a full box of prescribed anti-depressants that I refused to touch, I found a way out. I suppose being as low as can be makes improvement all the more possible. I climbed out of the swamp of self pity and changed my lifestyle. The fake smile was more sincere and I felt good again. This lasted for 6 months. I found ways to deal with my insecurities and achieved a lot of personal goals. I had a good relationship with my ex which my son benefited from, I was fit, active, had a close group of loyal friends, I got this lovely flat in a lovely area, my family is caring and supportive, I live comfortably, I eat well, I could do what I want when I want. What is there to be miserable about? Nothing!


Not so. Despite my new found ‘happiness’ there was also an inherent loneliness. A void that was not being filled. A cloud I was unable to see through. A cloud that engulfed me. The unspoken D was looming again, threatening to rear its ugly head. No one could spot the signs as no one knew it had been there in the first place. For 4 months now I have not been sleeping. I don’t mean the odd night of broken sleep, I mean not sleeping. My job is demanding and exhausting; after an 84 hour week I should be tired enough to sleep but I can’t. I can’t switch off. I lie awake for hours on end. 1am, 2am, 3am, 4am, 5am, now it’s time for an hours kip, 6am, hours kip, 7am, wide awake. The next day I am back to work. The annoying thing is it was work that triggered my current demise. There was an incident in which I was hospitalised which caused a long spell on my sofa. A long time to think, take stock and over think. I couldn't exercise, I couldn't really socialise and it felt like all the positive changes I had made were being undone. It was like I was watching it happen but unable to stop it snowballing. It knocked my confidence and left me resentment about the job I loved. Once back to work the damage was done,and I was left feeling like I was existing, not living, yet all the while the smile is still there. 


I hear people talking of depression and saying ‘why don’t they just snap out of it’. I want to. I can’t. It isn’t a choice. If I had a choice between a physical illness or a mental one I’d choose the former. Instead I get both. Maybe that is the problem. If it's not one it's the other. I don’t know. Looking in from the outside I have nothing to stress about. I have more than most people. I have a lovely, happy, healthy son who lights up my world. Surely that is enough? I have a job that pays well compared to a lot of people. I am not isolated from friends or family even though I feel it and isolate myself. I have a roof over my head. Seriously, surely I can just snap out of it?


It’s a cycle. You lie awake not able to sleep. Because you are awake your mind is at work. 5 hours awake in the dark gives you time to over think everything. You confuse yourself. You upset yourself. You feel alone. You wake up exhausted. You feel like you have been hit by a bus. Every day it becomes more and more of a struggle to leave the house. Your motivation is completely gone. The simplest of tasks become a chore. You feel lazy but there is no willingness to be pro-active. You feel horrible about yourself because you are so tired you are snappish. You start to snap at the people who are close to you but they just think ‘someone woke up on the wrong side of the bed’. You feel guilty and obsess over everything you are doing or saying. Tired and weary you get back into bed. Now you are stressed about your behaviour and your relationships in your life and can’t sleep or switch of. 1am, 2am, 3am, 4am, 5am, now it’s time for an hours kip, 6am, hours kip, 7am wide awake. It eats away your confidence and your self esteem. You feel like a shell.

Work doesn't help. I see things every day that add to my problems. I do have forums to vent and talk it out but I would be lying if I said things don't get to me. They do. I'm haunted by a lot. I struggle to deal with what life throws at people. A lot of the time I am fed up with hearing everyone else's problems. What about mine?! I can't avoid my work, I have to drag myself in every single day knowing that there is a high chance I'll be lying in bed later thinking about it. 

When does it stop? I don’t want to be that medicated patient. I don’t want to list antidepressants to the ambulance crew. I don’t want the big D on my medical record. I don’t want to talk to my GP about it; I won’t talk to best friend about it so the GP doesn’t stand a chance! Maybe I’ll just carry on smiling. No one will know. I don’t know. I think I’ll just stay here.” 

She didn't need hospital and didn't go, she just needed to talk it out, but it does raise questions. It’s a very common job, a very common problem. It’s probably more common that the stats suggest. How many people are suffering in silence? It isn’t an emergency and doesn’t warrant an ambulance but it does need addressing. Like all mental health, there is a stigma around it, a perception of weakness and misery that is not true. The fact that it can go so well hidden is testament to that. You can't just snap out of it. There is help out there, it just takes the courage to admit and find it. Unfortunately, until it is accepted as a genuine illness people will hide from it, deny it and do nothing about it. Luckily, she isn't hiding from it, denying it and is doing something about it.

The she is me.

If you are struggling with any of the issues raised in this post I highly recommend The Blurt Foundation. They are great to talk to, in total confidence, anonymously and online. 

The Irony in Crisis

"29 year old female, suicidal, having a break down"

Not wishing to sound like a broken record, mental health is a huge part of what we deal with, yet in terms of training it's what we get least of. I suppose it draws a parallel to the cost mental health has on the NHS compared to the funding it receives. Being able to talk to patients suffering a wide range of disorders is something you either a) have b) get with time and experience or c) never have. I like to think I'm somewhere between A and B with still a lot to learn. My abilities aside, I still have to treat these people regardless of what I know about their condition or mental fragility. 

It was about 8pm when we got the job so traffic was an a minimum and we were on scene within a few minutes. As we entered the road we got a message sent from control.

"Patient now on window ledge, husband thinks she will jump, police on route"

As we pulled up at the house a man came running towards us from the property. I guessed by his mannerism that he was the husband but he got so close to the door I couldn't open it to find out. I had to usher him back just to open the cab door! We grabbed our bags while he frantically spoke (I'm sure he was talking faster than his lips were moving). The gist of it, was his wife was a paranoid schizophrenic and a manic depressive and was suffering a crisis because she had forgotten her morning medication. She was now locked in a room and 'threatening to jump'. We have no training whatsoever in talking down people wanting to jump but I've seen The Negotiator, how hard can it be.....?! With much intrepidation we headed up the stairs. The door to the bedroom was indeed locked, so I knocked. 

"Hello, it's the ambulance service, can you let us in so we can talk?"

To my surprise the door swung open and we were invited inside. On top of her apparent suicidal thoughts she was having a panic attack, never helpful in any situation so that's what we dealt with first. Once she was calm and able to speak in full sentences we found the root of the problem. She was scared of being taken away again. That fear is very common in mental health patients and often due to bad experiences where forceful removal and restraint has been used previously. My thoughts on this and restraint are best left for another day, but they were our patients main worries and cause of crisis. It was clear she needed treatment, be it at home or in hospital. A & E was the last place I wanted to take her and last place she wanted to go. She denied being suicidal and said she was just very depressed and her missed medication had caused her to hear voices and freak out. She wanted to talk to someone. Obviously, I was there, but my knowledge of what to say is hugely limited. She needed a professional. She needed a Crisis Team.

As luck would have it she had the number for her old crisis team. I say old, because they had discharged her a week previous saying she didn't need ongoing treatment. Hmmmmm. Anyway, I phoned them expecting either a constant ringing or a patronising message followed by equally drab digitised music. I was wrong on both counts! The phone was answered within seconds! A lovely, helpful lady who was familiar with the patient gave me a full history about her. I asked if a crisis team could come out to see her. She said they only do home visits until 9pm and as it was now 8:45pm I didn't argue. I asked for advise, wanting to find out what options were open to us and whether she felt our patient would benefit from hospital. She told me that she should be seen, if not tonight, in the morning and suggested she spoke on the phone with an AMHP. Brilliant, this was going well! 

"Shall I pass her over then?"

"I'm just about to see a patient, if you call back in 10 minutes, we'll have a chat with her and see if we can find space to admit her here"

"OK, brilliant, thanks for your help, do I just ring this number again?"

"Yep"

"OK, speak to you soon"

I told my patient the plan, she was happy, I was happy! Maybe crisis teams are not all bad! I started doing my paper work while my crew mate did her OB's, just to make sure there was nothing untoward going on. There wasn't. After 10 minutes I phoned back.......no answer. I phoned again......no answer. I phoned a third time.......eventually a guy answered the phone. 

"Hi, it's Ella Shaw from the ambulance service, Jane told me ring back in 10 minutes so she could talk to my patient and arrange an admission"

"Janes gone home"

"Erm.....I spoke to her 10 minutes ago, she told me to call back"

"Yeah, she left 5 minutes ago"

"Well is there someone else my patient can talk to?"

"No"

"So what are we supposed to do?"

"I don't know, that's up to you"

I spent a few livid minutes demanding names etc and ranting away but it was pointless. On learning the news that no one was free to talk to her, our patient started having another panic attack. She uttered the words 'I might as well kill myself' and 'suicide' amongst others, which until now, she had convinced me that she wasn't. We had no choice but to take her to A & E. The prospect of this started a chain reaction we were powerless to stop. She refused, we said she had to, the police arrived, she freaked out about being taken away, she became violent, she was put in handcuffs, she was sectioned and taken to hospital, screaming and shouting the entire way. The very same person who I had spent 45 minutes with discussing her dream of becoming a midwife or a pathologists assistant. It was heartbreaking. Yet again, another mental health patient let down by the system. Let down by the services there to protect her. She didn't need sectioning, she didn't need handcuffs, she just needed to talk to someone. What will happen about this? Nothing. Why? Because ultimately no one cares enough to fix it. There is nothing more frustrating. Yet again, a patients welfare is dictated by a shift time and the misfortune of time of day. What's the bloody point? A crisis team should do just what it says on the tin. Be there wherever and whenever a patient is in crisis, come rain or shy, regardless of whether it is a convenient time of day. Until these 'crisis' teams (and crisis is not meant to be ironic) are accountable for their failings, nothing will change. They are not all bad, but like everything in the NHS, if it is well run and done properly, we as an ambulance service rarely get to see it. Instead we just end up hitting our heads against the wall passing the patient from pillar to post. Is that what the NHS is for?!

Left Behind

"34 year old male, ? Collapsed behind closed doors"

This job gives you a lot of strength in many ways. I suppose it's fair to say it's good for character building.  Over the years I have found myself in various situations, where when I look back, I think 'how did I hold it together?' I often feel that the job has desensitised me to a lot of things. It has to. Everyone has their own coping mechanism and ways to deal with different situations. The much vaunted 'gallows humour' is something that all emergency services use. Perhaps after seeing the same thing over and over again, it just doesn't matter any more. There are some jobs however, that don't come along every other day or even every other month. These are the jobs you remember. Everyone remembers their first cardiac arrest, their first dead body, their first baby delivered etc and today was no different. As far as a day goes, it didn't feel right. I was just on edge, no idea why. When the call came down I knew it would be a serious job. We get  'collapsed behind closed doors' ever week but this just felt different. We headed round to the address to find two women standing at the front door. 

We grabbed our stuff and headed over. It was the patients partner and mother. They hadn't been able to get through to him all morning, afternoon or evening. It was now 10pm. His car was outside the house and they could hear his phone ringing inside. The police had been requested but we had no ETA so we decided to try and get in ourselves. The door had been locked from inside so forced entry was our only option. My crew mate stepped up and gave the door a kick but she just bounced back off the door. I then had a go. After three kicks, the door swung open with a deafening bang as the brass door knob crashed into an iron radiator. The sound billowed through the hallway. The goal was to get in and we had achieved that but now a feeling I'll never forget engulfed me. I had a pitted knot in my stomach and was very apprehensive about going in any further. The hall was pitch black and the house felt cold and motionless. I shouted as I gingerly walked forward. All I heard back was silence. The light came on and lit up the downstairs. My crew mate entered the only closed door but the room was empty. Upstairs it was then.

I looked up and braced myself. I don't like exploring dark, empty houses at the best of times but today I was really nervous. It was a split staircase, and as I went up the first few steps I could feel my heart pounding. I pressed the light switch on the wall beside me and a single bulb illuminated the stair well. As I turned halfway up, I saw my crew mate and the two woman starring up at me with a look of expectation. I continued up, the stairs creaking with each movement, and as I got to the penultimate step my breath was taken away. I had looked to the right down the dark landing and six feet from me, poorly lit was a silhouette. It was the silhouette of our patient. I was the silhouette of him hanging, motionless from the loft hatch. I still see it like I do a photo. A moment locked in time that will stay with you, haunt you perhaps, forever. We cut him down, the tragic and gut-wrenching pain that his loved ones were experiencing was palpable. It's not a nice sight for someone who is used to seeing some pretty horrible sights. For someone who isn't, I can't to imagine what that feels like. We laid a blanket over his body and went downstairs to where his family had gone. 

For us we could immerse ourselves in protocols. The guy had been dead for hours so we called the police to confirm an unexpected death, we filled out our paperwork and our Recognition Of Life Extinct form for the coroner. It all seems very scientific but it's a way to remove yourself from what the natural human reaction is to do. Cry. Seeing a relative cry in mourning is enough to put the lump in my throat and make me well up. They are horrific situations and no amount of training would make a difference. What do you say? What can you say? There is no way to powder coat what had happened. The evidence was there for them to see. It wasn't just knowing their partner or their son was dead, it was knowing how desperate he felt before his death to do what he did. Those feelings are what will haunt them just as much as seeing him hanging there. Every suicide effects many more people than the ones you see. There are always the ones who are left behind. The ones who feel that pain every day. The ones who still have to live their lives. Alone. That is the tragedy of suicide. 

He had a 3 year old son. He will never know him, but will know how he died

He had a 1 year daughter. She will never know him, but will know how he died.

He had a sister. She will always hurt because her little brother didn't come to her for help.

He had a brother. He will always feel that he should have done something more.

He had a mum. She will always feel that she failed. 

He had a dad. He will always feel like he failed.

He had a partner. She will always blame herself and raise their children alone.

He had many friends. They will all ask themselves why they didn't notice. 

He had depression. He couldn't confront it, or if he did, he couldn't turn the corner

NB: My final bullet points were inspired and partly taken from @chocolatewig blog post Life After Suicide with her permission. Felt it highlights the tragedy well.