See One, Do One – 1st September 2007

See One, Do One

BMA News, 1st September 2007.

Aidan M. O’Donnell.

Leanne was 18. She was tall, blonde and extremely beautiful. She was also unconscious. She lay on the trolley in the resuscitation room of the A+E department at about 3am. I was the admitting medical SHO.

There was very little history. She had been drinking in a nightclub with two of her friends. She had apparently had a row with her boyfriend earlier that evening. The friends found her unconscious in the alley beside the nightclub, with some empty packets of tablets beside her. Predictably, neither the friends nor the ambulance crew had retrieved the packets.

On examination, she had the sinus tachycardia and divergent gaze of the tricyclic antidepressant overdose, but there was nothing else to find. There was no sign of injury. A vigorous sternal rub produced no response. I sent off her bloods for paracetamol and salicylate levels.

I paged the ICU registrar. He listened, then came round. Impatiently, he crammed an oropharyngeal airway into her mouth. She gagged. He removed it. “She’s protecting her airway,” he announced. “She doesn’t need to come to ICU.” Then he left.

I phoned my consultant. He decided we should admit her to our medical HDU for close observation.

As I was writing in the notes, without warning, Leanne sat bolt upright, eyes wide. “Burns!” she shouted. “Where’s Burns?”

“I don’t know,” I answered. “You’re in the hospital. You’re very ill.”

“I need to get to Burns’s house!” she protested. “Burns will kill me if I don’t!”

She resisted all my efforts to keep her in the hospital. I still did not have her blood results. I paged the psychiatry registrar and told him the details.

“Clearly a crisis response,” he told me on the phone. “No suicidal intent. She can go.”

“No she can’t,” I replied. “She might have taken something lethal.”

“Nothing I can do,” he said. “She is not sectionable. Goodbye.”

I phoned my consultant again. “Get it all down on paper,” he advised. “Then let her sign herself out. If the blood levels come back high, we can ask the police to bring her back in.”

I burned with frustration. It seemed as if no-one wanted to help me deal with a patient I was extremely worried about. In my opinion, Leanne was not safe to be allowed to discharge herself. I felt as if I was wasting my time trying to help her. However, I documented everything very carefully, and let her go. I hoped Burns was pleased to see her. Later, her levels came back normal.

There was, however, a follow up. One of the A+E nurses bleeped me to say that, about 10 o’clock that morning, Leanne had called the A+E department, very worried. She had woken up and discovered ECG electrodes sticking to her chest, and had no memory of how they had come to be there.

Leanne’s lucky escape demonstrates how frustrating it can be to deal with patients whom the law insists are competent, even when that competence can be objectively challenged.

Aidan O’Donnell is a consultant anaesthetist from Livingston.

Copyright © Aidan O’Donnell 2007.
This article first appeared in BMA News on 1st September 2007.
Unauthorised reproduction prohibited.