Saturday, 30 July 2011

A and E : Compare and Contrast

This is a slightly different style of post. I know that for friends it will be a reminder of a difficult time, and that medics may find themselves acutely aware of the other side of these events. This is my perspective on two A and E visits, one a few years ago and the other a few days ago. This post may be triggering or difficult - please feel free to skip it, or come back later.

I walk into A & E. The waiting room is dark and intimidating. There are several loud, drunk men and I am frightened. Sophie goes to talk to the receptionist because I am too far away to find the words. She barks at her to speak up, and I am dimly aware of the room falling silent when Sophie says that I'm suicidal and not safe at home. Sophie asks if there is somewhere quiet where I can wait, and she is told that I can stay in the waiting room "like everyone else". We sit, and wait for over an hour.

This time I am going alone to a department that I've never been to before. I've been putting it off, because of all the times before, but the pain is too much. The receptionist asks lots of questions, and won't bring me a chair while we talk even though I ask her, I can't lift one myself. Again, my name, address, DOB and telephone number have to be shouted through a screen in a room full of strangers. I sit and wait for 15 minutes.

The triage nurse calls me through and tells Sophie she must wait outside. I freeze. I can't talk, I need my friend to be my voice. Sophie insists, and is eventually allowed in. I'm pretty sure the nurse assumes we've both been drinking. We haven't.

The triage nurse calls me in and smiles at me. When I tell her my diagnosis she writes it down and asks me to explain it to her. She tells me what will happen next. I am called up twice more - for ECG and chest Xray. Getting up and down is painful as is undressing. Both technicians are lovely, and help me to change into the best designed hospital gown I've seen. I return to the waiting room and wait another hour.

The triage nurse is aggressive, and brisk. I am under the "care" of crisis team, I should have called them. Sophie explains that after 2 hours of trying to get through, their advice was to do some washing up. Still, it is not her problem to deal with - "we're not going to admit you, we're not going to give you anything, you could wait to see the medic on call, but they're busy treating people who are actually sick". Apparently if I was really suicidal I wouldn't be seeking help. I can't find the words to tell her that depression this deep feels like and end-stage illness. Death hangs over my head, and I have no control. I'm frightened.

The doctor calls me in and takes a brief history. He knows about my condition, and agrees with my interpretation of the symptoms. He listens to my lungs, and tells me the rib is dislocating with every breath.

Before I know it, the nurse has pulled me to my feet, propelled me back to the waiting room and told me that "if I choose to stay" I'm in for a long night. I want to leave, and when Sophie doesn't try to stop me, I know it must have been as bad as it seemed. I feel small and helpless, and incredibly guilty for "wasting time" and upsetting Sophie. She stays at mine. My friends don't leave me alone for the next 2 weeks as service after service failed me. I am lucky to have friends like these - 20 year olds doing what the grown-ups can't seem to manage.

I get shown my Xray, and talked through the findings. They check my pain meds and I am given lidocaine patches, and told to come back if they don't work.

I have been on both sides of A and E. I know that people get frustrated, and I know it is difficult to feel helpless because you can't "fix" people. I also know that people feel frustrated by the thought of wasting time spent helping "sick people" on people who have "done something to themselves". If only life was that simple.

The difference was in the small things - being smiled at, being believed, receiving treatment. Not being told that as a medical student I should know better than to break a rib...

And if you think that feeling suicidal doesn't count as an accident or emergency, you might want the NHS online symptom checker to change their advice. Because according to them I should have phoned 999. Think how well that would have gone down.

Please also look at my friend Ali's blog here at her posts about A and E, especially this one called 'Getting it Right'

You are welcome to leave your comments, no matter your opinion. I would ask that you bear in mind both that this post leaves me feeling pretty vulnerable, and that I have other readers who have also had similar experiences.


  1. I've had some really shit experiences in A&E for mental illness. Today I'm going to talk about a good one.
    I had a weird ?allergic? reaction to my usual meds, and had to stop taking everything all at once. My meds happen to be known for brutal discontinuation reactions. I probably should have been inpatient, but I was too mad to be in a general ward, and too physically ill to be in the psych hospital.

    A few days in, I was more and more confused, experiencing my usual off-meds hallucinations plus some more specific to meds withdrawal, and convinced that if I didn't [probably fatal SH] then [much doom]. Fortunately, being a well-trained nutter, I managed to reason with myself that if I explained [much doom] to the hospital, they'd be able to do a better job of [probably fatal SH] than I would. So off I wandered to A&E, and tried to explain what was going on to the receptionist. This is difficult when your arms and legs keep changing shape, gravity doesn't seem to be working properly, and you don't need to talk because everyone can hear what you are thinking.

    Being in the waiting room was difficult because everyone there wanted me to be dead because they were all ill because of me. I explained this to the first nurse who saw me, & she found me a spare room. (Incidentally, I hate having to go through triage with a nurse with no psych training then some poor junior doctor who thought A&E sounded excitingly full of major trauma and has no idea what to do with one of *them*. If I've asked to see a psychiatrist, in London I've been allowed to see a psychiatrist with no further questions, but not 'oop North. No crisis cards here either).

    For some indeterminate amount of time I was being left on my own in a room which kept changing shape, full of interesting sharp things, electricity and monsters, listening to everyone in the entire hospital wishing I'd hurry up and do [probably fatal thing] so they could all stop being ill, I'd built myself a sort of den under the desk, and was crying & telling the monsters to wait 'till the doctors got here to do [probably fatal thing].

  2. In came a nurse. She sat on the other side of the room to me, and asked me what my name was, and what was the matter. After I'd told her about the monsters and [much doom], she brought me a cup of tea. This seemed quite reassuringly normal. A&E is a bad place to be if you aren't sure what's going on, because it's full of things that aren't normal to most people, weird-looking bits of technology, people in strange clothes using unfamiliar words, other people who look very ill or scared, and no windows or obvious ways out. A cup of tea with lots of sugar in a Styrofoam mug looks, smells, and tastes reliable.
    The nurse asked me some more questions - not medical ones, about where I lived and who I lived with, and what my favourite cafe was, and why I'd come to live here, and told me some things like that about herself. This seemed OK. She didn't seem likely to try doing [probably fatal thing], and she was nicer to talk to than the monsters, and didn't mind when I got muddled up talking because of all the people thinking at me. She asked me questions about safe happy things, so after a while I stopped crying long enough to talk to her and to think about less scary things and to come out from under the desk. I asked the nurse if she'd had any psych training, and she said no. This surprised me.
    After a while the nurse had to go, but that was OK because she gave me some more tea, and told me to keep thinking about sitting in a cafe, and I put my headphones in and shut my eyes and tried to ignore the monsters.

    When the psychiatrist came, I was calm enough to be discharged with extra Zopiclone to knock me out for a bit. They said they were going to send the crisis team round, but they never turned up, so I ended up back in A&E a couple of days later. Still, I was really impressed by that nurse. Not an easy situation, since my weird allergic reactions would have made IM haloperidol higher risk than usual.

    - Tiredlegs

  3. Thank you both for sharing so openly and honestly. In my line of work just now and then I meet someone who needs an A&E or emergency admission psych help; plus I've phoned a few GPs in my time when people have come to me in serious need of help. Intuitively I do the tea and listen bit, but often feel useless/helpless. It is a great help to hear/read what actually does help in such moments. Thank you again.

  4. "Sophie"31 July 2011 at 15:31

    I remember that, and I remember being so, so angry. D and I had spent so long trying to make you go to A&E in the first place, and insisting that you needed to be there and you had to stay, and we basically forced you into going and then they were so deeply crap.

    I remember that when we left the triage room and you wanted to leave, I thought for about five seconds that maybe we should stay before I figured that they weren't going to do anything except make us both more distressed. You were so surprised when I agreed that we should leave, but there was sure as hell no point in staying. Like you, I'd just spent the past few years in med school learning how a patient like us should be treated and then they'd done everything we'd been told shouldn't be done and I honestly wanted to smack someone.

    Some A&E staff really need more education.

  5. @Robyn - sorry if this is inappropriate, since I don't know your background, but maybe you'd benefit from a Mental Health First Aid course?
    As with physical first aid, a lot of it isn't particularly difficult to 'get', but might give you more confidence.

  6. Thanks tiredlegs (should that have an @ sign? I'm, a dinosaur I don't now these things) I was not aware such things existed. Hmm... I shall have to give it some thought.

  7. (Robyn, the @ sign is just shorthand to indicate who you're talking to when there's several people chatting in the thread)

    Some people have wonderful intuition about dealing with people in crisis / distress. The number of hours friends spent coaxing me into the shower, persuading me to leave the flat even just for the front step, making me something to eat - all those simple things just help to cut through the fog and the fear a little bit.

    The first aid courses are a great idea. I think there's a lot of mystery surrounding mental health. I was placed with a GP this year who said "you know, I went to a training yesterday, and they said that asking someone if they're suicidal doesn't make them more likely to do it". That is not new information by any stretch of the imagination but he was genuinely shocked.

    Before this particular incident I had seen an endless series of health proffesionals, none of whom had asked if I was suicidal (I had gone because I was depressed, I'm not expecting them to be psychic...) It is really difficult to bring up if noone asks.

    The website for Scottish MHFA courses is :

    Everyone else will just have to google, they're easy to find =)