Academic journal article Advances in Mental Health

On Deliberate Self-Harm and Emergency Departments

Academic journal article Advances in Mental Health

On Deliberate Self-Harm and Emergency Departments

Article excerpt

In a previous issue of this journal (Martin, 2012), I wrote about help-seeking, suggesting that a critical barrier to future seeking help might arise if you went to an emergency department, and were criticised or stigmatised for selfinjury, told that you were wasting stafftime, leftalone until staffcould be bothered to see to you or even worse, punished by being sewn up without anaesthetic. What I didn't say at that time was that I remember, with some chagrin, an episode from my own early career. Many of you will have seen the television programme '24 hours' about King's College Hospital Emergency Department in Camberwell, London; a fascinating insight into emergency medicine, but also into human beings at their best and at their worst.

I qualified in Medicine in 1967 at King's, and my very first house officer job was in King's Emergency Department. So, it is kind of weird seeing the TV programme, and remembering... In my time, we had lengthy rosters which included 1 week of 96 hours on duty, during which on nights (if we were lucky) we got some sleep in a tiny bed at the back of the department. We saw up to 140 patients a day, everything from small abrasions through to the man who was dumped at the back door, and crawled up to the reception claiming he had been shot in the head; on X-ray he did indeed have two bullets visible, and after surgery, miraculously he survived. An immersion in acute medicine; certainly an education for a 23 newly qualified doctor who knew very little despite winning the medicine prize for his year. The people who did have the knowledge were the nurses, and this certainly shows up in episodes of '24 hours.' I admit to being 'rescued' frequently during those 6 months, but gained an immense respect for the nurses, and learned that very important lesson: 'If you don't know, ask!'

One case has come to the fore in my memory during the last 10 years; during which the focus of my clinical, teaching and research work has been self-injury. I have told this story many times during seminar and conference presentations. It was mid evening, and 'John' walked up to reception and showed his bleeding arms. There were 74 cuts of varying depth on his forearms, and he was steered rapidly to a cubicle. A nurse and I were assigned to clean up John's arms, and sew up cuts where necessary. The nurse collected a trolley with all the necessary equipment, and John lay on his back, arms akimbo with a nurse on one side and me on the other. The registrar poked his head round the curtain and said commandingly: 'Sew him up without anaesthetic!' I looked at him and asked: 'Are you serious?' to which the response was confirmed 'Yes!' 'But...' 'Look,' said the registrar 'He obviously likes pain, and won't mind a bit more.' 'But...' 'Do what you are told!' 'Or I will report you!'

The nurse and I looked at each other, disturbed and confused, and were just about to get to work when the registrar poked his head back through the curtains: 'OK, look, you can't put lignocaine into all those cuts. You will use so much he will end up with heart block.' 'Are you serious?' 'Yes, now get on with it!' And so we did. With each needle entering flesh, poor John let fly verbally: 'Oh, oh, oh... do it again doc! Do it again!' The nurse and I looked at each other repeatedly, totally bemused. But we completed the job, covered the arms in antiseptic non-stick dressings and bandages, made an appointment for John to return to have stitches removed, and moved on sheepishly to the next allocated job. We did not have one whit of empathy to ask John what he was experiencing, why he had done this to himself, what his life story was? We did find out he had wandered over unaccompanied from the Maudsley Hospital, one of the great mental hospitals in the world, quite literally over the road from King's. We assumed he wandered back. We assumed he would be followed psychiatrically back at the Maudsley. I never saw John again, but I regret we did not treat him like a human being, were not interested enough to enquire about him as a person. …

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