The Case I Can’t Forget is a weekly series that hears from the people working at the coalface of public service about the cases they have carried with them throughout their careers.
This week, NHS psychiatrist Benji Waterstones explains how an extraordinary intervention by a security guard saved his patient during a psychotic episode.
If you have a story you’d like to tell, email lucy.pasha-robinson@huffpost.com
“He’s in on it too!” she hisses towards the security guard hovering outside the interview room. It’s Sunday afternoon in a busy A&E and I’m the psychiatrist on-call. “They want to kidnap me, drug me and harvest my organs up north. Why else do you think I see so many red cars passing my house?”
Miss Patel is a 65-year-old woman in traditional Indian dress with a diagnosis of paranoid schizophrenia. She stopped taking her medicine and now believes ‘they’ want to conduct human experiments on her up in Grimsby of all places. Delusions don’t come much grimmer than that.
She’s been waiting all weekend for a psychiatric bed to become available, but there are none in the country. At this stage I’d take anywhere. Anthony, the muscular, Ghanian, A&E security guard minding her, has now become enmeshed within her persecutory belief system. She’s punched, scratched and spat at him and screams abuse as he opens the door for the lunch trolley. She’s calmed, and Anthony leaves, offering me a kind smile.
I call her home phone hoping to catch a partner or relative with more information, but get a cheery, vaguely-familiar voicemail: “Hello, Miss Patel here. I’m available but probably just can’t find my phone. Leave a message and I’ll call you back when I find it!”
In the grip of psychosis, patients are not themselves. When well, Miss Patel is described in the notes as a pleasant, single lady who attends gardening and art groups. Behind Anthony’s smile was the knowledge her behaviour was driven by fear and hearing voices, in an unfamiliar environment with bright lights and locked doors.
Nadia, the mental health nurse accompanying me, passes over the tray of fish and chips, an apple and a foil sealed cup of orange juice like you get on aeroplanes. Despite being halal she sniffs it suspiciously, finally declares it’s ‘poisoned’ and throws it on the floor. She doesn’t even trust the juice. Is there anything else we can get her? ‘No’. What does she eat at home? ‘Rice and curry’. I look hopefully at lunch trolley woman who shakes her head.
Refusing to eat or drink isn’t uncommon in psychiatry, usually driven by paranoia that food has been tampered with or the nihilistic belief that the patient is already dead and therefore doesn’t require sustenance. It’s a psychiatric emergency sometimes requiring electroconvulsive therapy (ECT).
Keen to avoid this, we hurry to the staff room returning with our lunchboxes. I’m pretty hungry myself and somewhat reluctantly offer over my falafel salad. ‘No’. Would she prefer Nadia’s fish paste and mayonnaise sandwich? ‘No’. I don’t blame her.
My on-call phone rings. Leaving the room to answer it Anthony worriedly tells me ‘doc, she’s not eaten for three days now’. Shit. I vaguely remember from medical school the average human can survive four days without water. The call is another A&E requesting me urgently. I scribble “strictly monitor input/output and encourage food and fluids” in the notes to no one in particular, and rush off to section someone who tried to jump in front of a train.
Hours later I head in the direction of Miss Patel’s side-room, revising in my head the ethical and legal implications of force feeding someone via a nano-gastric tube. In the hospital corridor I bump into Anthony, now wearing off-duty clothes, who sheepishly tells me he’s finished his shift and just left Miss Patel with an Indian takeaway he went to buy. He’s apologetic and hopes it doesn’t break hospital protocol.
In that moment, a six foot five man trained in physical restraint, was my modern-day Florence Nightingale – albeit with tattoo sleeves and the ability to benchpress 150kg. Of course Miss Patel doesn’t touch the chicken biriyani, this isn’t about being a fussy eater, but it was worth a shot, and encouragingly she does drink the mango lassi. Crisis averted.
Some argue compassion has left the so-called ‘caring professions’. That human kindness has been squeezed out of the overworked, understaffed and burnt-out NHS workforce. This was just one of many random acts of kindness that occur every day; the social worker who gives a service user £10 on the quiet so they can pay their heating bill, the nurse who stays late to hold the hand of a dying patient or the Good Samaritan doctor who risks litigation by intervening on an aeroplane. There’s still some goodwill left in the tank.
I smile at the thought. Nadia bounds over “Good news, we’ve found a bed!”. My smile turns to a full beam. “Only problem is, it’s in Grimsby”.
Some details, including names, have been changed to preserve confidentially
The Case I Can’t Forget is a new series from HuffPost UK that hears from those on the frontline of public service about the cases they have carried with them throughout their careers. If you have a story you’d like to tell, email lucy.pasha-robinson@huffpost.com.