Have you ever felt completely out of control of a situation? Truely, have you ever been in a position where the weight of someone’s world rests upon your shoulders requiring you to lift and perform at a high level, but you just can’t pull yourself together? I have certainly been there before. Not often, but certainly a few situations in my career have left me with a brooding sense of disappointment in myself after the fact, descending into a sleepless night of pondering your own adequacy in your job.
I know for myself, these situations seem to be roughly a fifty-fifty split between those involving a patient teetering between life and death, and those involving someone who is really not that sick at all. It seems a bit counter intuitive right? You would think that after years of constantly being exposed to those who are dead or dying would lead you to develop an iron focus and infallible confidence when managing simple, non-emergent presentations. But in reality, it’s more than just the patient’s medical presentation that factors into the care that they receive. My own fatigue has an enormous impact, how well I have managed a similar issue in the past has an impact, and likely most of all the patient’s own demeanor has a monumental impact on how I manage their problem.
I recall a situation from a number of years ago in which I truly felt out of control. It was early in my career so I was still building confidence and experience, particularly around assisting those with mental health emergencies. Ambulances get called to assist people who have undertaken deliberate self-harm regularly. For me it seems to be at a bare minimum once a week I will meet someone with this behaviour pattern, often times more. These jobs are relatively straight forward. Much of the self-harm that we see is more of a coping mechanism than it is a deliberate attempt to take one’s life. So by virtue of this, most people are only seeking first aid for their wound instead of urgent psychological support that may be more appropriate if someone has active thoughts of suicide. But every now and again, the stars will align, and we will be thrust into a situation that isn’t so straight forward. Sometimes this will be the result of someone being drug or alcohol affected. Sometimes it will be complicated by the energy of other people at the scene. Sometimes it will be complicated by a lack of additional support. And always, the time will be terrible o’clock in the morning after you have had an awful sleep before coming to nightshift.
I had most of these complications bubbling away as we arrived at the group home we had been called to at quarter to two in the morning. A group home is a residence for children and young adults who have experienced significant trauma in their life leading to an inability for them to live with their families. The kids living under this sort of care have often been victims of some of the most awful things you don’t want to imagine. Understandably, they frequently have ongoing psychological trauma from the terrible things they were exposed to in their former life. The minor we were here to help had apparently procured a razor blade from somewhere, locked themselves in a walk-in wardrobe and then opened up a number of old wounds. The staff there were unable to get them out of the wardrobe and made calls to both the police and ambulance services for assistance.
I hate talking to people through a door, I’m not good at it in the slightest. I received very little training on how to manage those with mental health presentation as it is, let alone the sort of professional negotiator style talk that you see in movies. It is difficult, but do-able to establish a connection with someone that has zero interest in talking to you. Most people cave after you try a few different approaches. But this same task is almost impossible when you place a completely opaque barrier between the two of you, eliminating any capability of you seeing them and them seeing you. So as I walked into this group home, police noticeably absent (Saturday night nearing two in the morning, they apparently had better things to do), I am led by the staff down a hallway and leftward into a plainly decorated room with a single bed in the far corner, a standing wardrobe immediately to my left and the walk in wardrobe to my right. Looking around the room I can see some fresh blood on the handles and door of the wardrobe, as well as a small amount splattered onto the grey carpets. I knock on the door apparently concealing our patient and attempt an introduction.
“Hey mate, my name is David, you don’t need to open the door and come out. It would just be really great if we could have a chat about what’s going on through the door. Is that ok?”
“Alright, no stress. I can see some blood around your room here, do you need some help stopping the bleeding on any of those cuts?”
At this point it crosses my mind that there is a chance this person may have bled a significant amount and is now not responding because they are unconscious. I attempt to slowly push the door of the wardrobe inward but am met immediate opposing resistance.
“Just making sure you’re still awake in there mate, any chance you could let us know how you’re doing-”
Better than no response at all. It was at this point that I had reached a fork in the road of how this was going to be managed from this point onward. I could attempt to force the door open, or I could let this person who was probably still holding one or more razor blades settle and wait for police to help manage this situation. I wisely chose the latter.
And so we waited. Every five minutes or so I attempted some variant of the dialog I had already tried without any response. What happens psychologically at this point is you begin to feel like you have done or said something wrong and therefore the patient will not comply with what you are asking. You get frustrated because you have been here for so long and there are other people out there that need your help too. You can start to feel some contempt toward the patient because they are making things difficult for you and you aren't in control. The urge to just rip the door open and crack on with things bubbles away inside, growing into a somewhat reasonable sounding idea. But you need to ground yourself, stop the cyclic thought pattern that things aren’t going the way you want them to. Your safety comes first and the last thing you want is to get cut up by someone because you didn’t have the patience to wait for more help.
It felt like an eternity standing there in the room waiting for the police to arrive, and they didn’t. At least not before there was some more movement in the wardrobe. With no prompting a flood of obscenities erupted from the otherside of the door accompanied by kicking at the inside of the door.
“Hey mate, are you ok in there?”, I ask in a final, honestly somewhat hollow, attempt at establishing a connection.
The yelling stops. I stand right back, allowing the maximum possible distance between the door and myself. In a matter of seconds, the door is pulled inwards and I briefly catch a view of a young face covered in dried blood stemming from multiple deep lacerations on both cheeks. As they make a dash past me, and out the bedroom door I note multiple other horizontal cuts to both forearms before they darted down the hallway in the direction of the entrance. I take a brief moment to glance past the wardrobe door that has been the source of my frustration for over an hour now and into the wardrobe itself. It’s difficult to exactly quantify how much blood was on the walls and floor, but it was likely in the area of less than half a litre. Not a lethal volume, but certainly cause for concern. On the carpeted floor remained a number of bloodied razor blades.
Exiting the room I see my partner returning from the open front door.
“Headed off down the street Dave, back toward the freeway”, he states.
“Why aren’t the police here yet?” asks one of the care staff, “Last time this happened they ran off and tried to jump off the freeway overpass.”
I could feel the situation spiralling out of control again. What am I meant to do? The police still aren’t here yet, we have a minor with considerable self harm wounds running off into the night, possibly with the intention of attempting to take their own life by jumping off a freeway overpass. I must’ve missed the lecture that taught how to deal with this situation when I was doing my training. So we tried to follow. Much like a dog chasing a car, we didn’t really have much of a plan once we caught up, but given the nature of how things had gone thus far, we didn’t want to risk the potential for a jump from height.
Down a number of streets, through an alleyway, across a small park, we drove the ambulance and eventually caught sight of our patient roughly a kilometre from the house. I looked at the mapping on the ambulance’s computer and realised our proximity to the freeway overpass. The road curved away from the direction they were running, so I made a decision to follow on foot. I followed through a lit car park and up a small shrubbed hill, keeping my distance in the event there were still razor blades in play. I tried over and over again to talk to them, encouraging them to stop running, that we were here to help, but my requests were left unanswered. They ascended the hill and broke through the shrubbery appearing on the main road that serviced the freeway overpass. In the dead of the night I could hear the diesel engine of the ambulance rounding the block onto the same road.
I could see the overpass now, and tailing metres behind I had no interest in seeing what would happen if we got there. I picked up my own pace but it was matched as we covered the distance toward the overpass. I glanced over my left shoulder and saw the all too recognisable headlights behind me of the ambulance driving up the opposite side of the road. Reaching the overpass, they jumped the chest high railing in a movement that reopened whatever clotting had occurred at the site of each laceration on both of their forearms. As they sidestepped along the railing, the ground fell away behind them and the asphalt of the freeway appeared fifteen meters below. Step by step, they inched further out, each movement left a bloodied handprint on the metallic railing. Finally, now face to face I was met with a flood of tears and a bloodied face of defeat.
“Just let me drop! I’m done, I don’t want to live anymore!”
I searched for something meaningful to say like they do in the movies, but I had nothing. My heart was beating so fast, my hands were trembling, I could feel the sweat accumulating under my shirt.
I am not in control of this situation.
As my partner pulled up in the ambulance I did the only thing I could, I extended my right arm forward reaching for their left tricep and gripped their left forearm as tightly as I could with my left hand. My partner ran over and did the same. At that moment they let go of the railing with their hands, suspended now only by their footing and our grip. In tandem we both pulled the teary minor over the railing and back into safety.
I certainly didn’t feel like a hero that saved a life after that. I felt like I had failed that patient by not having the skills to talk them out of the wardrobe. I felt like I should have made more phone calls to hurry the police up whilst they were still in the relative safety of the wardrobe. I felt like the patient had avoided a certain death by nothing more than chance because of how little I was in control. But as I thought more and more about the situation and the way that the events played out, I realised something. I have since that encounter never underestimated the capacity for any situation to spiral out of control. My guard remains almost permanently up now, especially with self harming minors locked in wardrobes.