Fitting

She’s lying on the floor, hands and feet in a crazy dance, head juddering from side to side, body jerking hard to keep up.  Tear trails snail down her cheeks. She’s wearing a jeans and a low-cut top; skyscraper heels lie to one side. Her friend kneels by her, trying not to cry, saying her name.

Female, 17, fitting. That’s the detail we had as we picked our way around the catshit on the stairs of the Plymouth flats.

My crewmate takes the friend to the kitchen to make tea and talk, while I place one hand on the girl’s upper arm and introduce myself. I exclaim at the beautifully-dressed baby, sat in her buggy, smiling at me. I mention how lovely the flat is, and how well the colours work. The girl sobs a little, wipes mascara-streaked eyes, then she tells me she decorated the flat herself. We move to the sofa. Aqua coloured cushions gleam with metallic thread. The edges are fraying.

I pick up the baby, who reaches for her mother, and pass her over. The baby smiles, plump-cheeked and crinkle eyed at me. Baby’s father, also 17, met someone else halfway through the pregnancy. The girl tells me how much she loved him. She was pregnant at 15, they were going to get married. Her mother is an alcoholic, so she wasn’t living at home much, mostly dossing with friends. She thought they could get a flat, the three of them.

The baby is four months old. Her father adores her, and comes to see her regularly in the day. He lives at home with his Mum, who also loves the baby. Tonight, the girls were going out to a party for the first time since the birth. Dad had agreed to babysit, but then decided to go out with his girlfriend instead.

Calling the ex and arranging for his Mum to babysit isn’t in the paramedic guidelines for managing fits. But that’s what I did.

I was thinking about that job when I woke today. It was years ago, and I think it comes not from the fear of becoming epileptic as a result of Hunt which is a possibility, but from a conversation with A who came to see me yesterday, about being fundamentally emotional, feeling emotions, yet not engaging on that level. My old, pre-Hunt self has always been calm in a crisis, well able to deal with traumatic and difficult situations which I actively enjoy; nonetheless I cry at the drop of a hat, at films, over books. Each of the 18 babies I’ve delivered caused a horizontal spurt of tears. Yet at the moment I’m dissociated. I had some deeply upsetting news unrelated to Hunt, a couple of days ago, and while it’s on my mind I haven’t even started to cry. That fear of not being able to stop again?

So fake fitters are on my mind. They’re everywhere, because it’s a simple way of getting a lot of attention. Commonly the faker is a young woman, in the centre of a vortex of friends and bystanders, and maybe a couple of street pastors.  Do something! Her drink’s been spiked! Caaaaaaaaarllllllyyyyy! Help her!

Usually they are also pretending to be unconscious. Anyone who works in the emergency system of the NHS is adept at waking unconscious patients. The primary survey involves a basic level of consciousness check; Alert, Voice, Pain, Unresponsive (AVPU).  It’s easy to slip across the line to Guantanamo Bay with the pain response when you know it’s a faker, so I’d do the basic test then use one of the more subtle ways of catching them out: Gently brushing the eyelashes elicits a giveaway eye twitch; explaining in detail the path of airway you’re about to insert up their nose and down into the pharynx quite often results in an Oh! Where am I?; and as a last resort I’d  insert an OP (the ones you see on TV with the ring of plastic outside the lips). This one slips gently into the mouth, and over the tongue. As it moves towards the pharynx, the gag reflex kicks in. Once you’ve broken the spell, you can find out the story. It always involves an upset, and it’s escalated way beyond the intent.

Beyond the consciously faked fits and unconsciousness is a fascinating area of psychology that again highlights this intersection between the physical self, the brain and its physiology, and the conscious and unconscious minds.

I researched this and wrote a case study entitled She’s Faking It when I met a teenager who had what are called (wrongly, I think) pseudo seizures. A more appropriate name is psychogenic seizures, because these are not under conscious control; there’s nothing deliberate about it. Often these can present in a very similar way to a seizure originating from an abnormality in the brain – and of course there are several types and combinations of those that manifest in a range of ways other than the classic tonic-clonic that the fakers always try and fail to emulate.

Psychogenic seizures are a type of conversion disorder; they convert extreme psychological distress into a physical form in order to get out of an unbearable situation. They do sometimes accompany epilepsy in one form or another, but usually not. They include such signs as dilated pupils, and normally end with a kind of absence, but they aren’t followed by the postictal period of many epileptic seizures, where confusion, dazedness and sometimes agitation can be present for 30 minutes to several hours.

In children and young people psychogenic seizures are a sign of psychological, physical and/or sexual abuse. The dreadful thing is that some of the adults I’ve been to have been having these seizures since childhood. All that pain.

For me at the moment, my conscious mind is engaging with the world of my friends and family. I spend a good part of each day with a visit from one or two friends; I talk on the phone maybe for a few minutes, maybe an hour; I exchange messages when I can manage to text; chat to my family. I’ve had some deep conversations over the past couple of weeks, and there has been a strand of conscious reminiscing, but still with that level of detachment from the core of my mind. Beneath that is a whole world of unconscious thought, where images and experiences are escaping and colliding with whatever else I’m thinking about. Is it a protective mechanism? A way of gradually coming to terms with this situation?

12440802_10153534924483251_1745207805062560935_oYesterday, I went with A to Powder Mills. As we followed a very short section of the Dartmoor Lych Way, I realised just how short of breath I am because I know A from the Dartmoor Search and Rescue Team Tavistock and I’m used to walking at full steam ahead when I see her. Here I am crawling up a gentle incline, feeling the air dry in my chest, surrounded by a tightness.  I’ve been increasingly aware of this for a couple of months, and most definitely in the past three or four weeks, but it’s been explainable by the I’m so unfit maybe it’s a virus excuse, and then by the fact of Hunt. So only the context with that particular friend brought home the magnitude of the change, quickly followed by the worry of my lung nodules which might or might not be mets; or am I unconsciously thinking about the ?mets and worrying about shortness of breath because of that? Either way it was quite a shock and it weighed heavily. I’ve had pain between my shoulder blades too, and a general ache in the chest. I’m an expert on the very many types and meanings of chest pains of course, but I can’t look at anything objectively till such time as I know what’s in my brain and my lungs.

So for now, I’m going to let my mind wander and machinate through its Heath Robinson pipework while I write about it from whichever perspective happens to present itself.

 

 

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Bottom blockers

I’ve been having a few issues in the bottom department, as I mentioned last week; I thought it was related to steroids, but there’s no listed side effect of constipation. I’ve tried senna tea, prunes, linseeds, the usual. I eat lots of veg and nuts. I’m mostly veggie, although I eat the occasional fish, and my core diet is pretty good if you discount the cakes biscuits.

I got some Macrogol from the GP because one of the points made in the Brain Tumours information booklet is that constipation and straining must be avoided after surgery. I know I’m going to be blocked for a week after the general anaesthetic so I’ve been taking the Macrogol twice a day. If you’ll excuse the detail, things are moving with the speed and consistency of a sleepy slug,  but I don’t feel at all comfortable and I’d kill for a good dump.

I don’t know what’s causing this bottom block, and why it’s so slow to resolve. I strongly suspect Hunt has a part to play.

 

 

Bed blockers?

I wanted to say more about bed blocking because it is the tabloid headline phrase, the shorthand used to conjure images of elderly people waiting for places in nursing homes.  But it’s a lazy stereotype, and it’s one of the means whereby the concept of value in public services can be so easily reduced to one of finance and ‘efficiency’, and the so-called ‘difficult choices’ in cutting funding to the point where they collapse.

There are many reasons why someone might be in a bed which is needed for someone else. By definition it is almost always the case that such a person is also not having their needs met in an acute setting, because so many of those needs are pastoral rather than treatment-based. Their best interests might be to take them home with support; to take them to residential or nursing care; to begin specialist rehabilitation; to access specialist care and treatment centre for those with a particular acquired condition; or perhaps a hospice or other end of life care. None of those decisions will be straightforward, all will involve a multi-disciplinary team of professionals to assess and coordinate what’s in the best interests of the individual.

These are not decisions to be rushed. Where it’s clear cut, there should be the provision in the social care system to action the decision of course, and that’s largely missing. The halfway houses (community hospital wards being one vital resource that’s been decimated) are at best overstretched. In the meantime, a purgatory exists between the two systems of acute medical services with the potential for a level of recovery, and the decision to move to palliative care.

Imagine the complexity, the medical ethics, the emotions, the fading hope. I want to say that today, because I fear I’m guilty of a lack of sensitivity towards the many human beings, families and friends in that position. I’ve chosen freely to publicise my own thoughts and worries and to highlight the wider political implications, to have a mission. But how easy it is to casually trample yet another diverse and vulnerable group of individuals into the mud of a tabloid headline. These individuals are equally deserving of proper, well-resourced and funded care, and very often they are not getting it. They are also deserving of the time they need to negotiate the inherent web of emotion and conflict.

Action

On 11 March there will be an attempt led by Caroline Lucas MP, with support from a cross-party group of MPs to introduce the NHS Reinstatement Bill.

I’ve given the link to 38Degrees‘ page which has a further link for your MP’s contact details. There is also a link explaining what the bill aims to do.

If you’d like to do something proactive, might I ask you to contact your MP and ask her or him to support the bill?

You might also ask questions about cancelled operations in your area, and about cuts to social care and community and general hospital beds.

My MP has yet to respond to my points, perhaps because he is too busy earning his £460,000 annual salary as a barrister. But maybe yours will.

Thank you.