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?
Yesterday, 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.