What many people dont know is that if too much is taken, paracetamol destroys the liver. Even a moderate overdose as little as a dozen tablets can cause permanent damage. Higher doses can mean death, or at a minimum, the need for a new liver.
Fortunately for Catherine her liver had been saved. As soon as she had taken her overdose, shed called an ambulance. When shed been brought into the emergency room, the staff commenced an infusion of a drug which acts as an antidote to paracetamol.
Id been working in the psychiatric unit for over a year when I met Catherine, and I was still considered inexperienced. I was rarely given female patients instead, I was generally allocated younger males, sometimes aggressive. But today, as there was a shortage of young troubled male teenagers for me to look after, I was assigned Catherine.
Even though Catherine was technically an adult, she was still a school kid, and I knew it would be best to keep a close eye on her until she got used to the place.
I found Catherine walking down the corridor, clinging to the wall, unable to stop herself staring at everyone who passed. Why do they look like that? she whispered to me as a particularly interesting specimen walked by.
What do you mean? I replied.
You know what I mean, look at him, she said.
The case in question was Jacob, a 35-year-old schizophrenic whod been diagnosed at the age of 16. I knew Jacob well and I knew what Catherine was talking about, but I wanted to hear what she had to say not out of spite, but so that she could get the most of her experience in a psychiatric unit.
Well She paused, thinking carefully about what she should say. He just looks insane. And what is he smiling at? It gives me the creeps.
When Jacobs schizophrenia was in a good mood, the voices in his head were nice, sometimes even entertaining (although what you or I might find entertaining may not be exactly the same as what Jacob found entertaining), perhaps he was smiling at that. Of course, there was every possibility he was laughing at the cursing and other foul language directed at us, originating from the monster standing beside me.
Catherine and I made our way to the dining hall. I found her a table near the door, and left her alone while I rounded up the stragglers for dinner. I had just herded the last of the patients into the dining hall when I noticed Jeffrey sitting, staring at his food, mumbling under his breath.
Jeffrey was 20 years old, and like Jacob he suffered from schizophrenia. Id slowly got to know Jeffrey over the few weeks since he had been admitted, and it had taken all that time before he began to acknowledge me. Well, acknowledge me probably isnt quite right, it took him that much time to begin to trust me. Every day when I began work, I had to show him my staff ID card to prove that I was actually a nurse.
Everything okay? I asked. Jeffrey looked up from his plate, and mumbled an incoherent reply.
What was that?
Im not in the mood. Leave me alone.
I left Jeffrey in peace, but stayed in the doorway observing the diners, as well as glancing regularly in his direction.
Jeffrey had done what some people with schizophrenia commonly do. He had stopped taking his medications. Sometimes the reason for this is that the medications they take make a huge difference. They can completely stop the voices or visions, and allow patients to lead a completely normal life. What then happens is the patient might start to think they are cured. Maybe they forget to take their medications regularly, maybe theyre sick of the side effects of their prescription, or maybe they start drinking a bit of alcohol, or have a puff of a joint. In some cases all it takes is one smoke or one night out on the booze to hurl them back into an acutely schizophrenic state.
Jeffrey was studying architecture at university. Hed not had an admission to hospital in two years, mainly because he took his medications. He had then begun to occasionally forget his medications, before he stopped altogether.
Unfortunately, he didnt recognise that he was falling into a crisis. It was only after his mother got concerned that he wasnt answering his phone for several days that she paid him a visit and found him locked in his room, terrified of the world outside.
Paranoia is a common presentation. It can begin with something simple, like the voices start telling them that the medicine is really poisoned, but the delusions can come in an endless variety of ways. Maybe the television starts broadcasting straight into their heads. Whether it be a subtle, or sudden and violent, relapse, it is a very serious and frightening state to be in, both for the patient and the family or friends around them.
When I next glanced at Jeffrey, I noticed him staring intently at Mr Pike. Mr Pike was looking at the garden. He usually waited until everyone else had finished eating, then would sit and have his meal in peace and quiet. He was 45 years old, and had a history of bipolar disorder. He was due to be discharged soon.
Mr Pike hadnt noticed a thing. I kept watch, wondering what was going through Jeffreys head. For five minutes his gaze didnt leave Mr Pike. I maintained my vigil.
Slowly, Jeffrey rose from his seat, and casually walked towards his subject. When he was an arms length away, he lashed out and his fist caught Mr Pike across the cheek. I yelled out down the corridor for help as I stepped into the fray.
Ill kill the little shit, yelled Mr Pike. I was standing between the two, with arms outstretched, holding them apart. Whyd you fucking do it? Jeffrey shouted back and lunged at Mr Pike. I managed to hold Jeffrey back. His gaze fell on me. Are you in it with him? Youre in this together.
It was at this point that I realised just how vulnerable I was. It dawned on me that I was standing between a furious Mr Pike and an obviously acutely psychotic Jeffrey.
Im sorry, Mr Pike, please dont hit him back. Hes just a kid really. Hes really unwell. Well sort it out, I rambled.
He hit me. Ill kill the little shit, Mr Pike said again.
I cant let you do it. Let me talk to Jeff for one minute.
Whyd you hit him, Jeff?
He spat on my food.
Jeff, no one spat on your food. I was watching the whole time, and I promise you, no one spat on your food.
Jeffrey paused in his efforts to reach Mr Pike and thought my words over.
Jeff, youve trusted me before today. Remember, I see you each morning, and I show you my ID. You know you can trust me, I pleaded. Just sit down, Jeff, please. He didnt budge.
It felt like forever, but was probably only 30 seconds before the rest of the staff came rushing in, to find me standing with arms outstretched, holding back the antagonists.
Youre all in on it, youre all together, Jeffrey said, before taking a swing at me. Before the blow could land, the ladies had Jeffrey immobilised.
Jeff was taken to seclusion and given a strong injection of medication to calm him down.
Throughout the whole affair, Catherine had sat open-mouthed, speechless and terrified. She stayed glued to me for the rest of the evening. What have I done? she kept on saying to herself, to me, to anyone that would listen. I dont belong here.
Psychiatric units like mine can be brutal at times, but they serve a purpose. For some patients, the psychiatric unit is a wake-up call. They realise just how lucky they are to be healthy and sane, with a future ahead of them.
Many of the patients here dont have a future. Sometimes, in their lucid moments, they realise this, and some lash out. But for the most part, the patients have no idea of how lost they are. Perhaps they just dont have time to think about it because their reality is already occupied with whats going on inside their head.
With counselling and the support of family and friends, Catherine made it back to school. Her overdose was deemed a cry for help, rather than a genuine attempt on her life. I do know she graduated and went to university. I never saw her again. I hope I never do.
As for young Jeffrey, it took three weeks to get him back on track. By the time he left, there was no way you would have ever guessed just how sick he had been. As long as he stays on his medications, he should hopefully be fine. He went back to university to finish his studies.
As for young Jeffrey, it took three weeks to get him back on track. By the time he left, there was no way you would have ever guessed just how sick he had been. As long as he stays on his medications, he should hopefully be fine. He went back to university to finish his studies.
I spent two years working in the psychiatric unit before I was ready for a change. I wasnt bored with psychiatric nursing how could I be? but there was another area of nursing that I had always wanted to work in: the emergency room.
I felt ready for the challenge. The emergency room deals with everything, and I felt that my experiences overseas, combined with my broad experiences in various fields of nursing, especially with my recent ones in the psychiatric unit, would make me the perfect fit for it.
V
Family man of steel
Rangi Nelson was a freezing worker. If you are unsure what that is, it involves killing sheep, cattle and pigs for a living. The hours are long, with the slaughter going on through the night during high season. It is the sort of work that breeds strong men, both physically and mentally.
Rangi had been working the evening shift and was on his way home. It was ten oclock at night, and he was tired. Thankfully, at that time, the back country roads are deserted. Rangi didnt have a car, or a motorbike, he had a 100cc moped not what you might expect a tough meat worker to be riding, but he was trying to gather together enough money to put a deposit on his own home. He was sick of his family having to live in state housing.
The first 13 or so kilometres from the freezing works to the city were pretty much a straight line. The only hazard was a single pair of railway tracks crossing the road. The railway line was rarely busy most people made only the most cursory of efforts to slow down. Aside from a sign with a picture of a train, there was no warning.