Posted by: medicblog999 | May 27, 2010

Getting too attached?

Have you ever had one of those patients who really had an impact on you?

Not a big job, not a traumatic job, just someone struggling with their personal demons and not particularly winning?

A little while ago, I had the privilege of looking after a 19 year old lady who had collapsed at work and had a possible seizure. I go there along with my crew mate John, and immediately realised that in this case, it was not a seizure.

Kirsty was sitting in a chair, staring into space, looking a little pale and trembling in her arms and legs. She was not responding to her work mates, and they were propping her up on the chair to stop her slouching and sliding of the front of it.

No response to verbal stimuli, but a groan and a focusing of the eyes after a short bit of painful stimuli courtesy of the anesthetist’s handshake.

She came around and started talking to me in a mumbling fashion. She appeared to be really anxious and a little scared. I wanted to move her to the ambulance so that there was some privacy for her whilst I tried to get to the bottom of what was going on, and do some further tests (a quick feel of her radial pulse told me that she was tachy at approx 140 beats per minute, so I wanted to do an ECG anyway)

On the back of the ambulance, she was reluctant to tell me much about what was happening and what she remembered about what happened. She wasn’t being obstructive, just obviously had some things that she wasn’t happy in sharing with us.

As John brought her bags on to the back of the ambulance, he dropped one and a couple of bottles of tablets rolled on to the floor. Kirsty immediately jumped up and lunged for the tablets with a look of panic in her eyes.

“What are they Kirsty?”

“Nothing, nothing, ok? It’s just some tablets, nothing special, ok??”

Her eyes began darting to and from John and I, and for a second, I think that the tears are about to start, but she regains her composure and smiles sweetly.

“They are just a couple of diet pills, that’s all. Nothing bad, you can buy them over the counter. That’s ok isn’t it?”

Things start to click in to place, but as I look at Kirsty, all I see before me is a beautiful young lady who doesn’t look too thin and is certainly not over weight.

“How many of these have you taken today?”

“Quite a few, but its ok you know. I’ve done it before. It’s okay, just been a little bit of a tough day….Can I go know, I’m fine”

I inform her that we need to do some more tests before I can consider letting her leave and get on with her day, even though I have already decided on these tests being as much of a stalling factor as well as a diagnostic tool. I wasn’t happy, my spider sense was tingling.

As John took her blood pressure, BM and pulse, I started to delve a little more. When I got to her medical history I decided to ask her if she had any trouble with dieting and eating disorders.

“Oh God no, I’m just the same as any girl. We all want to lose a little bit of weight you know”

This went on and on, but gradually over the period of the next five minutes the truth started to come out.

She had struggled with anorexia and body dysmorphia from a very young age and had been sectioned under the Mental Health Act a few years before when her weight dropped to 4 stone.

John then made an innocent comment which resulted in a response from Kirsty that neither of us expected

“Don’t be daft, you look great!”

After hearing that Kirsty physically started shaking, became twitchy then started punching herself in her chest.

“Please don’t say that! Just don’t say that!!”

I was shocked by the way that comment affected her, but I also understood that it must have been like the biggest insult in the world to her. I don’t understand her thought processes that brought her to that response, but I now knew that that wasn’t the way to approach this.

Kirsty settled a little, and switched back to her smiley demeanor from before. She was complaining of palpitations, which along with her tachycardia meant that I needed to do an ECG. I explained all of this to her knowing that it was going to be tough for her to let me actually place the leads and do the tracing. I assured her that I would cover her up and would expose her as little as possible, but that it was important for us to do.

She accepted and seemed to be mentally preparing herself for the ordeal that lay ahead. She was okay with the limb leads, and even joked on about not shaving her legs, but as I asked permission to place her chest leads, she started to hyperventilate.

“Kirsty, if this is too much, I can leave it ok?”

“No, just do it. Do it now!”

As I started to raise her shirt she cried out

“No, No, No, No!!”

I actually flinched, I got such a shock.

“Its okay, I’m not going to do it okay. I’m not willing to put you through this, it’s ok….”

I sat back down in my seat and looked across at her.

“Right John, let’s just head off, I’m not going to do anything more here”

Kirsty forced a little smile and seemed to sink even further into the trolley, pulling the blanket up around her chin.

What was going on in her mind? What sort of hell must she be in? I wouldn’t dream of saying it to her, but all I could see was a physically beautiful woman, who seemed very sweet, and who most guys would be proud to have on their arm on a night out.

I know that wouldn’t matter to Kirsty. I know that that isn’t what she sees when she looks in the mirror.

I felt a connection to her, I wanted to help. I wanted to make things better, but again, all I could do was try to be kind, not make anything worse for her and take her to A&E, where I know they will do nothing for her eating disorder as it is a chronic mental health problem (unless she is showing any physical abnormalities from it in her blood work)

We spent the rest of the journey chatting, with Kirsty continuing to try and persuade me that all girls feel like her and me trying to persuade her that I understand that she is going through more than just a little momentary concern about her weight.

I handed her over to the nurse at the hospital, who was great with her and put her into a quiet room where she wouldn’t be disturbed. I said my goodbyes and went back to the vehicle but just couldn’t stop thinking about her.

Why had she affected me so much?

Is it because I saw a woman who had absolutely no outward weight problems that I could see, but still sees herself as overweight?

Is it because I know that after a 7 year history she seems no further forward in any sort of treatment or recovery than she ever has been?

Or is it because, yet again, like most patients that I care for with serious psychiatric problems, as pre-hospital health care professionals, we can do nothing other than transport them to a facility that is inappropriate for their needs?

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Responses

  1. And the reason is…?

  2. Terrible, you really do feel for people who are in these sorts of situations

  3. I think maybe the reason is because you know that you can't help. With most other patients you can do something for them (give them medication, bring them to the hospital), but this girl needs more help than you could have given. Sometimes the only thing you can do is be a friendly face.

  4. Psyche patients tear at my heart the most. Of all our patients they seem to fall through the cracks the most and have the fewest advocates. Whether its the girl with eating disorders or the man who is suicidal, the guy who thinks he is “Jesus”, or the gal who doesn't know you are there and won't answer your questions because she is so involved with the voices in her head, they don't seem to have the resources to get them out of where they are and we don't seem to have the ability to help them either. Heartbreaking.

  5. Psyche patients tear at my heart the most. Of all our patients they seem to fall through the cracks the most and have the fewest advocates. Whether its the girl with eating disorders or the man who is suicidal, the guy who thinks he is “Jesus”, or the gal who doesn't know you are there and won't answer your questions because she is so involved with the voices in her head, they don't seem to have the resources to get them out of where they are and we don't seem to have the ability to help them either. Heartbreaking.

  6. Thats the thing Mark, I just dont know.Maybe Im just too soft and let myself get too involved when I should keep a bit more of a distance?

  7. I completely agree! Ive wrote about it before in a post called 'Psyche ER'There needs to be more acute care available for these people. Frustratingly, in the UK even the limited help available sometimes is with held if the patient is intoxicated with alcohol.

  8. I know, but its just so damn frustrating…..

  9. Thats the thing Mark, I just dont know.Maybe Im just too soft and let myself get too involved when I should keep a bit more of a distance?

  10. I completely agree! Ive wrote about it before in a post called 'Psyche ER'There needs to be more acute care available for these people. Frustratingly, in the UK even the limited help available sometimes is with held if the patient is intoxicated with alcohol.

  11. I know, but its just so damn frustrating…..

  12. […] was whilst I was reading some of the comments left by the JEMS readers on my post ‘Getting too attached?’, I decided to chip in myself and ask if anyone wanted to share their stories, I would be happy to […]

  13. I, too, have this “problem” of getting too attached to my patients. Most people that know of me, before they have ever worked with me, think I am a raging bitch. Most of what they see is me trying to be a patient advocate and being a little bossy to get it done. I had one partner a couple of years ago, actually tell me she was afraid to work with me because of how outspoken I can be. And then we had the little old lady, no real complaint, but since it was Christmas eve, and she did have an extensive history, and no local family, called 911 for “general weakness”. Before we left the scene, a full diagnostic work-up was done, and no abnormalities were noted. The rest of the transport, I sat in the back talking to her. She told me all about her family, how long she was married to her now deceased husband; all the trips he used to take her on, just because he could. Those are the patients that I want to go visit on my off time, but deep down, it feels like I am intruding on their real life, and doesn't feel appropriate. But I totally feel the getting too attached thing – almost daily… oh and that partner – she is one of my closest friends now, because she saw the side that my patients always see – just not everyone else at times. (bad part about being female in a mans world and aggressive in my treatments. Double edged sword for me)

  14. I, too, have this “problem” of getting too attached to my patients. Most people that know of me, before they have ever worked with me, think I am a raging bitch. Most of what they see is me trying to be a patient advocate and being a little bossy to get it done. I had one partner a couple of years ago, actually tell me she was afraid to work with me because of how outspoken I can be. And then we had the little old lady, no real complaint, but since it was Christmas eve, and she did have an extensive history, and no local family, called 911 for “general weakness”. Before we left the scene, a full diagnostic work-up was done, and no abnormalities were noted. The rest of the transport, I sat in the back talking to her. She told me all about her family, how long she was married to her now deceased husband; all the trips he used to take her on, just because he could. Those are the patients that I want to go visit on my off time, but deep down, it feels like I am intruding on their real life, and doesn't feel appropriate. But I totally feel the getting too attached thing – almost daily… oh and that partner – she is one of my closest friends now, because she saw the side that my patients always see – just not everyone else at times. (bad part about being female in a mans world and aggressive in my treatments. Double edged sword for me)


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