The Green Green Fields of Home

The phone beside me rings in the middle of the night.  It is half past midnight; I had fallen into an uneasy sleep; it takes me several attempts to find the answer button in the dark.

It is a psychiatrist on the other end of the line and she wants to talk about Julie.  She sounds disconcertingly bright and alert for the time of night.  Julie is in hospital, not the mental hospital, but the main hospital in town, where she is being treated for a paracetamol overdose.  She has been on a drip.  I visited her earlier in the evening and had some dispiriting conversations with a psychiatrist.  After she finished the drip they wanted to check to see if the treatment had worked, make sure there was no sign of liver damage.   Assuming she was physically sound, nobody knew what to do with her after that.  She is in crisis again.  She spent last weekend in the mental hospital and there doesn’t seem much point sending her back there: they can only babysit her, they don't offer any therapy, and it seems to make her worse.  But she is very reluctant to come home without more support: she is feeling suicidal, scared and anxious.  And there is absolutely no additional support to be found: her regular care coordinator is on holiday; the crisis team are overworked and can't take her on.  "The whole system is in meltdown!" wailed the psychiatrist.  She seemed more upset by the situation than I was.  I only have one patient to worry about; she has many.

Eventually the psychiatrist I spoke to in the evening had come up with a solution: Julie might be able to stay overnight in the general ward where she had been on the drip.  She could stay put, catch up on sleep and everyone would get together in the morning to decide what to do next.  She might be feeling better and the prospect of coming home seem more cheerful.  It seemed a good idea to me; I kissed Julie goodnight, drove home and went to bed.

But I was unaware, driving home, that other forces were at work.  By the time I was climbing in under the duvet, and the psychiatrist I spoke to was safely home at the end of her long shift – this was about 10 in the evening - the main hospital experienced its own crisis, having run out of all available beds.  The A&E department shut its doors, non urgent care was suspended, staff were called in to send patients home, freeing up the beds for urgent cases.  By midnight, the night shift psychiatric staff reached Julie and assessed her: and decided to discharge her at once.

It takes me about 10 minutes of that conversation in the middle of the night to cotton on that they are sending Julie home immediately.  I don't appreciate the significance of the hospital going into emergency mode. I am groggy from being woken up, but the night psychiatrist is also reluctant to state the facts baldly.  What she is trying to do is assess over the phone whether I have the resources to care for my daughter in her current suicidal state.  She is trying to reassure herself that the decision she is making is in the best interests of the patient, not just the best interests of the hospital.

It is easy for me to give her the reassurance she needs: I do want Julie home with me, and I don't doubt that home is the best place for her.  Julie does calm down eventually if she is here for long enough, and it is the only way to draw the crisis to a conclusion.  But I also know Julie will not agree with this at all.  While she is in crisis, she does not feel safe here - she has done too much self harm at home, and she knows where things are that she can use.  I know she will be angry and upset to be sent home, and there is high risk of yet more self harm, bouncing her straight back into A&E.

So I answer all the doctor's questions in the middle of the night, and I agree to take yet more time off work to watch Julie during the day, and an hour later she turns up in a taxi.  She is furious as only a tired sick teenager who has been woken up in the middle of the night, quizzed by doctors and packed off home in a taxi can be furious.  She probably feels – and who can blame her – that the doctors don’t care about her.  I tuck her up in bed, hand her some sleeping pills, and sleep next door with the door ajar.

This was written a few days ago.  A few days of hell have passed since then, but she is slowly emerging from the crisis.