Saturday, 12 June 2010

The Tree

He's only 10, and he's jumped out of the window. Only 10 years old, and he's jumped. This litany keeps running around in my head, as I kneel down to assess the young lad at my feet. I can't remember the last time I had to look after someone so young, someone who, even at that tender age, had decided to try and end his life. His parents stand by anxiously, as I take a look.

He doesn't look all that bad. He is lying on his right side, and his eyes are open. He tells me his name when I ask him, and he tells me that his right wrist hurts. I'm not surprised; he has clearly broken it. He says his back hurts a bit, but he can wiggle his toes without any problem.

The main issue we have is that he is in the front garden, and there isn't a whole lot of room for us to work in. Still, we manage to get a scoop stretcher next to his back, and then roll him on to it, with only a modicum of difficulty. And then it's a simple matter of lifting him over the wall and on to the waiting ambulance trolley.

I find out that he has been treated at the local hospital by the psychiatry team fora while. As he doesn't seem too bad, I decide that the local hospital is the best place for him; once the A&E has sorted out his wrist they can get the psychiatrists to look after him, and that's what he needs more than anything else.

I suggest this to the crew, and a look of horror comes over their faces. "But, what about the tree?" they ask. I panic, and look up in confusion, wondering if one is toppling over towards us.

But no. The crew are talking about the new Trauma Tree. Now, when you go to a trauma case, you call up a clinical coordinator in Central Ambulance Control, and they will tell you where to take the patient, based on a tree-like decision tool. And oh the trouble you get into if you don't do as suggested.

I tell the crew that I don't want to go anywhere else, and that I will make the decision, as the senior clinician on scene. They relent, but ask me to make the call, so that they don't get into trouble. Now I'm worried. Will I get into trouble? The crew tell me that all calls that are blue-lighted into hospital are scrutinised. I think quickly: the local hospital is only 3 minutes down the road, and he's not all that badly injured. We can just drive him to the local A&E without blue lights. They agree, sort of, with the proviso that I come with them, so that I can explain why they are bringing a 10 year old who has fallen two stories, without calling it in as a Trauma Call first.

Now, I am all for assistance to the crews when they need it, and wholeheartedly support the idea of a clinical coordinator desk, where crews can call in if the are having difficulties. But the idea of a clinical decision tool that is inflexible, and which has to be used on all trauma patients regardless of what the crews at scene feel, makes me worried. As this was a child, and as paediatric trauma is not well resourced in London, I can only imagine that we would have been directed to the closest hospital in London with paediatrics and trauma, and that would have been a journey of over 15 miles, and about 30 minutes or more. Worse than that, he would have been far away from his family and the support mechanisms he needed most.

33 comments:

  1. An interesting perspective on the new trauma system, which I wholeheartedly believe is a good idea. Why, exactly, are we taking this simple decision away from road crews? Surely they can assess on scene far better the needs of the patient than yet another coordinator at the end of a phone. If the decision is made based on a protocol, then why not give the crew the protocol, with the option to use their clinical judgement to over rule it if they see fit.

    As far as I can tell this is more top down micro-management that devalues and deskills our paramedics and EMTs. Why do we seem to be doing everything imaginable to return them to the oxygen wielding, scoop-and-run, stretcher monkeys of old?

    ReplyDelete
  2. I agree and disagree, all at the same time! I hate the idea of a rigid and inflexible triaging system, which makes no use of anything above the neck. However, mechanism of injury and missed injuries are important concepts. Not all injuries are immediately apparent on the side of the road and as a result trauma centres to function effectively do expect and need a degree of over triage to avoid any patients arriving at centres which are unable to provide the approptiate level of care. Overall, I think a bit of flexibility and dynamic triaging of such patients should be allowed for, and on the rare occassion patients needs exceed local resources, a more efficient secondary transport/transfer system must be in place and utilised.

    ReplyDelete
  3. Yes, I tend to agree. The issue I had with this case was the fear on the part of the crews when they heard that I was going to make a decision that was contrary to the coordinator's.

    ReplyDelete
  4. While on the topic of time critical secondary hospital transfers, do you feel this is something that should form part of physician based UK pre-hospital care, as seen in other countries? With the combination of primary responses and time critical secondary missions/retrieval, maybe the government would then give PHC the attention it deserves and formalise cover/funding. This could be achieved through uniting schemes such as BASICS and regional air ambulances.
    This is an area of the national trauma plan that I felt was not addressed adequately. Creating trauma centres is one thing, but the provision of doctors (needed only ocassionally I might add) for the management/transport of unstable patients the extra distance from the incident to definitive care is not always consistent.

    ReplyDelete
  5. ps as well as formalising cover and funding, I feel there would be a need for stand-alone subspecialty status(PHC) with ongoing formal training/assessment, accredition and clinical governance, as undertaken within hospitals.

    ReplyDelete
  6. I was that ten year old. I tied my school tie to a tree in the playground then around my neck and jumped. The knot didn't hold, I landed flat on my back.

    No-one came to save me. I am here and living a life-sentence. Every day I wish I was back in that playground so I could do it again and get it right.

    I hope he gets the help he needs. I hope he doesn't reach 30 and wish it had all been different.

    ReplyDelete
  7. Dear Jupiter. Your comment has left me speechless. My only hope is that you too manage to get the help you need, and soon.

    ReplyDelete
  8. A ten year old suicidal? That, is awful. Jupiter, if you are reading this, take the doctor's advice, and get some help soon. Depression is treatable. It is a lot of work, but definitely treatable.

    ReplyDelete
  9. I have been reading. I didn't want to say anything else because I didn't want to cause any more distress to RRD or any other readers.

    Over time I have tried to get help, I do take antidepressant medication, it masks my feelings. Drugs don't cure stuff they are just a plaster. I have begged the NHS to offer me some kind of talking help but I am always told that the waiting lists are very long and I am functioning well so don't really need it.

    I've stopped asking now. What's the point. Others are in much more need of help than me. Children like the little boy you've written about, RRD, it is people like him who need the help.

    Too late for me, the outcome is inevitable. I don't think it matters. I am nothing.

    That little lad has a whole future in front of him.

    ReplyDelete
  10. Jupiter, I really don't mean this to sound insensitive, but you're only 30! You too have a whole life ahead of you, and are just as worthy of being happy as anyone else on this planet. Don't write yourself off, ok?

    ReplyDelete
  11. Sorry, I should have just kept quiet.

    I know that 30 is still quite young and that there is the possibility of life ahead of me. I know that I should be grateful for what I do have and make the most of everyday. I know that there is potential for change and that I should keep asking for help. I know that maybe, just maybe, things could change in the future. I know that people think I should pull myself together and get over it because it's been going on so long they think it is just a habit. I know that cutting myself off, screening calls, avoiding texts and having auto-responders on my email accounts might be seen as me intentionally making things worse or seeking attention.

    I know that if the knot had held that day in the schoolyard the lives of people who have been forced into my company would have been so different, brighter, happier and very much more stress free.

    You say not to write myself off but I haven't written myself off. Someone else did that, long before I had the cognitive ability to try and do it to myself.

    ReplyDelete
  12. The beauty of the Internet in general, and blogs in particular, is the ability to speak your mind and yet still remain anonymous. You can, and should, say whatever it is you want, or need, to say.

    The more I write here, the more I realise how important it is for everyone to have a voice.

    Keep reading, keep writing: we are all there for you.

    ReplyDelete
  13. "Keep reading, keep writing: we are all there for you."

    Did you write that for me?

    I don't want to use your space for my issues. It isn't fair. This is your place for your writing. I have been reading along for ages and I respect your blog as being about your work but not part of your work.

    Somehow I thought that if I told you about me as a ten year old it would help that little boy feel less alone. But, I guess he'll never know.

    ReplyDelete
  14. No he probably will never know. But I still think sharing your experience is valuable. After all how many suicidal 10 year olds can articulate and explain how they are feeling and why they are feeling that, so for someone to share their viewpoint from when they were that 10 year old is in some small way giving a voice to people in that situation. I hope you manage to find some help or solution that works for you. And if it gives you hope I struggled with severe depression for around 10 years, but in this last 6 months it has lifted, I've reclaimed my life and I feel like a different person. Whilst it's incredibly difficult to hold out hope after such a long period of suffering try and remember that people can get better, even after many years.

    ReplyDelete
  15. Jupiter!! What a fantastic name!! If you can think up a name like that, you've got lots going for you. When you wake up tomorrow (or why not RIGHT NOW)do one tiny positive thing (wash your hands and see how clean they are and marvel at how your fingers move). Everyone who reads this blog and its comments is on your side and willing you to become a posiitve human being. AND you can. Keep writing; it's such a wonderful way a getting rid of those bad thoughts and swopping them for good ones instead.

    ReplyDelete
  16. The name is just the title of a song I didn't invent it. The thing is I am quite a positive person, that sounds so weird but I don't tend to look on the dark side of anything. I have a totally inappropriate sense of humour and it has got me through a lot of things.

    The problem comes when, as you suggested RRD Snr, I do something that could be seen as being positive. I can't see the point in it. I can look at beautiful things but feel nothing other than "is that it?".

    People always describe as 'resilient' and 'strong' which in some ways is true.

    As that 10yr old I wanted to make everything stop. I knew very well that death was like a full-stop. All I wanted was freedom from the things that were happening and I remember the feeling of not even being able to die properly.

    I was seriously and dangerously brain-washed and manipulated as a child and adolescent. Thanks to genetics I am still in contact, albeit very unwanted contact, with one of the people who did that. I'm 30 and they still use the same tricks and mind games as they did when I was a child. The difference is that I am now able to see what they're doing. From the perspective of a young child, younger than ten, I thought that the things going on were 'normal' and that every boy and girl were exactly the same as me. It was around ten that I suddenly realised that I was different than other children and that the sexual, emotional, psychological and physical abuse and all the manipulation were not at all 'normal'.

    I never had any idea how to fix it. Suicide felt like the only option for me to escape what was happening.

    ReplyDelete
  17. I just wish it had worked.

    ReplyDelete
  18. I am so saddened by your story, your desperation and your desire to die. I am so pleased that your attempt to end your life didn't work.I am sorry you don't feel that way too.

    Life is precious and while you don't see that at the moment, maybe one day you will. You write well. You have, through your words, enabled so many people here to see life from your perspective, you have moved us all and given us an understanding we could never have had if it were not for you. You have a gift.
    Why not use that gift to help other abused children? You could take some counselling courses, the training programmes usually offer you counselling first, then you can help troubled children. The insight and understanding you could offer to them would be so incredible that I am sure, with support, you would find yourself healing, while healing others too.
    Please try and see the worth you have, leave those who have damaged you behind and move forward, make a difference.

    I believe you can.

    ReplyDelete
  19. Mrs RRD, you're too kind. I would never be able to help children who have been through the same kind of things as me, I wouldn't be able to lie to them and say that it'd be ok in the end.

    The thing is, I am nothing. I've screwed up, done the wrong things, disappointed constantly. Nothing I've done or ever do is right. Always a flaw of some sort.

    My 'mother' never wanted me. She wanted a child but not a child like me. From day zero I was a disappointment, curse if you like. I've tried to please her and make her proud of me but I never manage it. I've given up on that now.

    I remember one parents evening when I was in senior school. I got good reports from most of the teachers and *she* was getting all cocky and claiming she was so proud and all the rest of it. Then she had to meet with my RE teacher with whom I had a relationship akin to that of mortal enemies. She really disliked me and the feeling was mutual. Anyway, RE teacher described me as "the worst pupil she'd ever taught". Mother literally had a breakdown, I was mortified by her behaviour. She got home and told Dad then rang a friend of hers. The friend told her that his son had been described with those exact words two years previously.

    It goes back further than that. When I was around 4/5mths old she was breastfeeding me and I'd obviously just started to get teeth and accidentally bit her. She (literally) slapped me away and started yelling. Then she made a huge fuss when I thereafter refused the breast.

    There are 100's of anecdotes I could share about her treatment of me. It's not so much that I've tried to end my own life but she tried, at least twice, to end it for me. My Dad was virtually unaware of any of it due to our circumstances. I lied to cover it up.

    Sorry, I'm kinda down just now and I'm just writing with no real purpose. Growing up from babyhood knowing that I was immediately rejected by my mother seems to have left a bit of a scar. I'm just so lucky that my Dad is the kind and compassionate man that he is. If it wasn't for him, I would not have survived.

    ReplyDelete
  20. Jupiter, Good Morning to you. This Blog thing is amazing and I want to start my own. EXCEPT I'd like you to help me!! I told you I love your name. I want to call my blog "The Planets" Jupiter obviously inspired the name and I'll have to choose another planet name for myself.

    My idea is we should ALWAYS and FOREVER be anonymous. No photos, no email addresses, no telephone numbers. Just occasional musings or rantings to let off steam or beg for answers for our problems. As few personal details as possible. We could try to attract a few more 'planets' to join our blog. Slowly, and only other anonymous people. NOT friends, NOT enemies, NOT anyone who could possibly know who we were. I have no idea how to start things moving. If anyone reads this, perhaps they could point Jupiter and RRDs Dad in the right direction. PLEASE, nobody try to find out who we are and contact us. If you do, I for one, will disappear completely!! That gives me an idea for my new name, Pluto, its the furthest from the sun, so hopefully more difficult to find!!

    How about it, Jupiter ? ~Will you join The Planets ??

    ReplyDelete
  21. This comment has been removed by the author.

    ReplyDelete
  22. Jupiter, pleased you want to join. PLEASE edit your last comment immediately and get rid of your email address. That loses anonymity. I did say I'd disappear if anyone tried to find out who I am and I thought that was what you wanted to do too. Maymbe we will have interlocking blogs so that we only have our own passwords. I'll enquire. BUT, FIRST get rid of that email address before it's too late!

    ReplyDelete
  23. What a wonderful RRD Snr - best of luck to you both, hopefully you could advertise your blog on other forums or blogs as somewhere where people can be anonymous and just talk.

    "My identity is completely hidden and when I signed up for this account I put Jupiter as first name and Rock as surname."

    I do not think that that is Jupiter's real email address, so no worries!

    ReplyDelete
  24. I am *so* sorry, I thought that because that email address is just an alias and not my real one it'd be ok for me to share it with you. It doesn't identify me in any way at all.

    The email I shared is completely anonymous and is the one I use for things where I don't want anyone to know who I am. There is no way I can be identified by it.

    I take my anonymity and that of others VERY seriously which is why I'd never post my real address. We are thinking the same way and like you, I will just vanish if someone tries to find out who I am.


    Interlocking blogs sound interesting, I've got no idea how that might work so I shall wait for your advice. I am involved in a project where all of the people on the team have access to one blog so we share the password and can all write to it. There is trust involved in that but so far it's working out very well.

    ReplyDelete
  25. Guess I've lost a great opportunity here because of my utter stupidity in sharing that email address.

    No great surprise. Just the same as usual, I always do this.

    Sorry I let you down.

    ReplyDelete
  26. This comment has been removed by the author.

    ReplyDelete
  27. Re RRD Snr and Jupiter, have you considered using a forum as an alternative to a blog? This way, only one of you needs to put details in as a forum administrator, perhaps jupiter as, as you've said, you have an anonymous email address. Once this is done, if you enable anonymous posting, nobody need ever enter any more details.

    www.freeforums.org offers a very simple way of signing up for free forums. All you need to do to ensure anonymity is encourage all users to use a false information when registering.

    ReplyDelete
  28. No, Jupiter. You did exactly as I requested so quickly that I still believe we should continue. Everyone makes the odd indiscretion and as long as one tries to make amends why should everything stop. We two are going to be positive NOW and FOREVER!!
    It's just that I've had a ridiculously hectic few days including a (very insignificant) hospital visit!!
    Just give me a day or so and I'll get it all moving forward. Have a good weekend all who read this, especially you, Jupiter!!

    ReplyDelete
  29. Hi, Jupiter & RRD. Please have a look at my blog. The address is http://lostinthemidstofspaceandtime.blogspot.com/

    It is a simple set of ideas which are self-explanatary.

    RRD can you add a link on this blog to mine and eventually to all the Planets??

    ReplyDelete
  30. Ok, RRD Snr :) I've followed the instructions as best I can and set up my blog. Do you want me to become a follower of yours so we get linked?

    ReplyDelete
  31. Just wanted to say I'm still here, RRD Snr I've written some stuff now so you'll be able to see it if you want to take a look.

    Admittedly, I'm struggling right now, but I actually think that the totally anonymous writing is going to help.

    ReplyDelete
  32. Hey RRD, Mrs RRD and RRD Snr :)


    RRD I tried to send you a message via here but I have no idea if it got sent or anything, if you got it could you possibly let me know because if not I'll send it again.

    Thank you!! :)


    PS, I've been writing in my blog a bit and I'm finding it helpful. Especially because no-one knows who I am. In a way it's really quite liberating.

    ReplyDelete
  33. Hi Jupiter, no, I didn't get the message. But, keep writing your blog - it's good!

    ReplyDelete