An emergency not to be rushed
22 October, 2019
Dr Sebastian Rotheray pulls back the curtain on a busy – but stimulating – day in frontline child and adolescent psychiatry.
In A&E it’s heaving. Trolleys line the corridors, doctors chase, patients grimace. Being an A&E doctor was the one job that nearly turned my head away from child psychiatry – even though I love the adrenaline, the drama, the banter. But the scene awaiting me holds a storyline that I find so much more nuanced, fulfilling and protocol free.
A 17-year-old lad, withdrawn, huddled, confused. Parents exasperatedly trying yet again to reach out over a chasm of confusion to a challenge that seems beyond conceptualisation. He’s slipping into an alternate world, a herb-fuelled psychic escape from broken relations, slipped aspirations, perceived rejections. The need is urgent, but haste must give way to delicacy. I skip from mum to dad to patient, weaving patterns, seeking out the story of classic first episode psychosis.
This is the bit I enjoy the most
I see multiple patients. My day unfolds with a diagnostic challenge competing blow-by-blow with communication conundrums. Eliciting a vast array of highly specific information in a way that is therapeutic, measured and patient-led. The mystifying made manageable. My actions mirror the supervisors that trained me, excited to be here doing it for real, seeing all that training come to fruition.
Back to the 17-year-old and now his shoulders drop as his guards come down. We move from suspicion to stilted synchronicity, and a plan emerges. Biological, psychological, social; the pillars of containment and hope.We agree to follow up with him in the safety of his own home with the hope to build on this relational foundation, and this is the part that is truly satisfying.
There’s almost always time for lunch. Okay, I may live in Cornwall but a pasty usually does the trick.
The open road
Next, a home visit after a hospital discharge.
Last week she was acutely unwell, highly distressed and tormented in a world dominated by hallucinations and delusions. A short and effective hospital admission later I find her serenely perched in the riverside house she called home. Getting a precise picture of the underlying psychopathology is again essential, but once again can only be achieved with tentative curiosity.
The conversation evolves, emotions unravel, fears come to light: her hopes and reflections on recovery, her determination for the future and ultimately her inner world. The change from seven days ago is remarkable. Future beckons, the mental abscess drained. I leave with a sense of optimism.
My day is almost done.
One last stop
Sowenna – a magnificent new £12 million state-of-the-art inpatient hospital which will become Cornwall’s first for young people with mental health problems. I can’t wait to work here. I don a hard hat and wonder round the expanding structure. What a privilege to be somewhere when, despite austerity and the dreaded B word, child mental health is finally seeing proper investment.
5pm. Finished, and still time to go mountain biking with my brother. The joy and privilege of working in such a beautiful part of the world.
Tomorrows schedule remains interesting. A suicide safety project with some brilliant civil engineers in a local suicide hotspot... plus whatever else pops up. Bring it on.