Mental Health

Ah mental health, those two words that make health professionals cringe. Although, I really enjoy the effect you can have on people during these types of calls. Throughout my placements my interest in mental health has become greater and greater. I kinda enjoy the challenge. There isn’t just one answer to mental health and you have to use your brain. Mental Health services unfortunately in the area i work (and from what i hear across the country) during out of hours (when the majority of calls occur) is practically inexistent. This makes the situation somewhat frustrating as our only choice is to take the patient to hospital.

With my interest in mental health growing, i decided to write one of university essays on the subject. What i found was shocking, and led me to want to keep as many mental health patients away from Accident and Emergency rather keep them at home with the correct pathways and support in their own environment.

On placement recently, in the early hours of Saturday night I attended a young lady who was feeling suicidal. I was “excited” to treat this patient as the previous day we were informed of some new pathways for mental health patients, and i wanted to try them out.

I spent about 2 hours on scene with this patient, asking her all the relevant questions so i could assess her suicide risk and gain a comprehensive history. The patient scored a relatively low risk on the scale, meaning with the correct pathways, we could have left this patient. Fantastic i thought, perfect opportunity to try out these new services. I get out the list. Based on the time and day we had very limited choice. I telephoned the one which was meant to running that evening.

Engaged.
Tried again.
Engaged.
Tried Again
Engaged.

15 attempts later, i gave up.

This frustrated me to no end. Yes they are probably very busy, but they weren’t there when i needed them. So unfortunately I had to take this patient into hospital. On the way to hospital, we chatted about films, music. She was my age, and we had a lot in common which actually made it more difficult to comprehend.

Now you may be thinking this is fine, she will be treated there. However, as the patient is not sectioned, she would be able to leave at any point, with a standardly long wait at hospital there was the potential for her to leave.

I felt I had failed this patient. I felt the system failed her, I felt helpless as i wheeled her into the waiting room and left her there. Now of course I did the best for her, i tried everything that i could. But this didn’t change my impression of what i had done.

Getting home was not easy, I was tired, hungry, and pissed off. This led to some admittedly self-destructive thoughts to creep into my head

1. “She is going to leave and jump off a cliff”
2. “All mental health leads to this and people who I love are going to end up doing that”
3. “I have failed in my duty of care”

I had to tackle each individual one in my own mind before i was going to get to sleep that night.

1. I told myself that this wasn’t going to happen. Why would she, I reached out to her. When i left her she was happier and she would get seen and all would be fine.
2. This one struck a cord. Some of the people i truly love had/are suffering with mental health problems, and this led me to imagine their faces on hers. Will all those people end up like that went through my head.
3. This is an interesting one, and is in my view completely subjective. Legally, no. I had done everything in my scope of practice to assist this patient and had left them in a place of relative safety (a whole other debate). But in my eyes, I had. What more could i have done though, it annoyed me more that i didn’t have an answer to that question. Why wasn’t there more that i could have done for that patient.

Eventually I got to sleep realising that it was late and actually I couldn’t deal with the situation at the time and now all i needed to do was sleep. In the morning I rang, texted everyone who i knew would be able to help me. Essentially convincing myself that she and me would be fine.

And I truly hope she will be…

Making “that” decision

Yesterday, I “ran” my first resuscitation as a student paramedic. A relatively normal situation for a paramedic to be in, a daily occurrence if you like. It was however my first time. I had a patient awake and responding to me, before then going into cardiac arrest. “Good afternoon, I said to the patient, how you feeling” the normal pleasantries were exchanged and within a minute of meeting this gentleman, I was jumping up and down on his chest and began the administering the life saving protocol i had drilled into me since day 1. 57 mins later, this gentleman was intubated, cannulated, had 9 rounds of adrenaline, and had certainly had his ribs broken in the process of CPR.

I was running the show though, it felt good to know that after three years i was getting somewhere, somewhere with my confidence levels, my ability to delegate and my ability stay calm. However, as i gave the order to switch the person performing CPR and to give the ninth dose of adrenaline. It struck a cord with me. 57 mins of jumping up and down on this patients chest, for what reason anymore. There had been no output throughout, no ounce of response from this patient. For the first time since beginning my training i began the process of “stopping CPR”. For me this didn’t sit comfortably during the process of resuscitation you just sort of run on auto pilot. But having time to reflect you realise the enormity of the decision you are making. I’m 22 and I am about to make the decision that this patient is no longer going to receive the resuscitation treatment that is keeping him alive. A patient that i had a connection to, a person that an hour a go was alive and talking to me. I felt myself becoming angry that he wasn’t going to survive.

On paper, he had such a good chance of survival, good chest compressions the moment he went down, intubated (tube down his throat to assist with his breathing) and cannulated (needle in his hand to administer drugs) within mins of this, but patients aren’t like textbooks, and now i had to make the decision to stop. I called for a review of what we had been doing. Going head to toe on the patient, in a way convincing myself that this was the right thing to do. I gave the order to stop CPR and have a final pulse and rhythm check, of which still nothing.

That was it…

The patient was life extinct, we all agreed to stop resuscitating the patient. I began performing my own little post-life routine, that i have created. Trying to make the patient look “presentable” for the family, however also to take my mind off what has just happened. Keeping myself busy. It wasn’t until after, while filling out the paperwork, that it suddenly hit me, what had happened, I had just made the decision to stop resuscitation, to stop attempting to save this man’s life. It was something that i have been contemplating since it happened, something that i am assured will become easier with experience. But now it reminds me how short life is, and how we have to live every day to the fullest, and treat everyone you meet as if you won’t meet them again. After I completed the paperwork, everyone congratulated me on how well i and performed.

But this did not have the same effect it usually does on me. I felt i had failed, failed this patient and his family, it didn’t quite hit me until i arrived back home that evening, where the anger set in. Why didn’t he survive i asked myself, self-destructive thoughts of could i have done anything better. Did i make the right decision to halt CPR. Of course the answer was that I did everything i could, he died because he died, nothing to do with my actions. But it took a long time to discover this. My mentor always used to say take home something from every patient, initially for me this was a sense of anger and dread towards my actions and the outcome, however this turned to a lease of life, wanting to live my life to the fullest, and to treat everyone I meet as if its the last time.