Wednesday, 8 December 2010

The Paracetamol Girls.

"In bay 22 we have a 24-year-old female who came in with an OD. She took an unknown amount of paracetamol, another unknown prescription drug and alcohol. Your patient."

I sometimes wonder why paracetamol is available OTC, as it's a cheap but horrible suicide. 'The Silent Killer', they call it. I don't know of any other potentially lethal OTC drugs that are that cheap.

She was a skinny, unkept girl, lying there. Tox screens had already been taken and the nurse was kind enough to put in a cannula. No results yet. She had taken a large amount of pills because she wanted to end it all. Then she fell asleep, and when she woke up she thought about her children and changed her mind about wanting do die. So she phoned the ambulance. No, she doesn't know what the other pills were, they were pink and prescription and not hers.
This she told me just as I was reaching her abdomen in my examination. Stretch marks and lots of excess skin. I asked her how many children she had. Two, but they weren't living with her. The eldest is in school. 

She has a prior history of depression and self harm and multiple suicide attempts and substance abuse. She's on benefits at the moment. She has lots of worries, and it all became too much for her. She didn't want to tell me about it. Fair enough, I'm not the psych intern any more, but I'm on A&E. 
My physical revealed only mild cerebellar symptoms, congruent with alcohol intoxication. My quickie psych assessment revealed symptoms of depression, an impulsive suicidal act and no further intent. She was ambivalent and just wanted to go home. 
Luckily for her, paracetamol levels were fairly low. She was admitted for psych evaluation in the morning (only a few hours away really). 

It's so easy to see suicide as something dramatic, romantic even. But the thing is, it's not. Tragic, yes. Ugly? Yes. Though I do love Emilie Autumn, and I do love this song. It leaves out all the ugly. Stupid? I'm not so sure about that. Doctors often get a bit annoyed by suicide attempt or self harm patients. Or by psychiatric patients in general, it really depends on the personality and life experience of the doctor.

Paracetamol overdose happens so often they've got a flowchart for it. Nice and colourful, with boxes to tick to help you deal with this patient. And not get sued. Check the dose, weigh the patient, check levels, start or don't start NAC. You have some time, but not forever. Admit, monitor, discharge. Install appropriate treatment in case of coma or any other problems.

Do you see the contrast?

There are many many girls like this one. In my half a year as a psych (s) intern, I've seen her past and her future. Early pregnancies, abuse, personality disorders, rocky relationships, children taken away from her, drug abuse, alcohol abuse, self harm, unfinished education, poor chances of sustainable income, benefits... and the cycle continues. I've seen them as mothers, I've seen them as children, I've seen them as patients. I've even seen this in a few people I called friends. I find it one of life's conundrums: how come those who can't deal with 'life' land themselves in hard to deal with situations all the time? Is it the Chaos Theory/ Butterfly Effect?

And then, when the situations which I'm likely to avoid myself get too much for them, paracetamol is available. Impulsively they choose a drug which may kill them, without doing the research and planning seen in those who fully thought their suicide through.

'Deal with it' is a lot easier said than done.

1 comment:

  1. I'm bipolar and I've attempted suicide about 3 or 4 times (I lost count). It's ugly. Each time I ended up calling someone to take me to the hospital and save me, because I didn't want to die. The problem is, my disease made it difficult to live. Thankfully, with the support of my family and health care professionals, I got the medication I needed to help me get back to living a fulfilling life.

    In answer to your question on my blog, I am a student. I got my Bachelor's in Psychology, but decided I wanted to go into Neuroengineering. I was told that I needed an engineering background of that so I am back in school getting my associates in Electrical/Computer engineering. After that I will go for an MD and a PhD in Neurosurgery and Neuroengineering.