“A border has been crossed”, or when the caregiver is confronted with his own injuries during a care situation. This is what Emmanuel Delporte, a nurse, says in his latest post published on his blog.
I’m looking for her, I can not find her, and I’m starting to worry. But where did she go? I push the locker room door and call him. Not getting an answer, I’m about to turn on my heels, when I hear a muffled sob. I enter the locker room, and I finally find it there, deep down, collapsed on the cold floor, head in hand. The locks of her hair are shaken to the rhythm of her sobs. She raises her head when she hears me approaching and reveals to me a face ravaged by tears. His makeup has run down his cheeks, leaving two black trails, fatal, that make his face an apocalyptic mask. I crouch in front of her, and I ask her, very gently, not to rush her, what happens to her, why this situation has upset her so much.
About twenty minutes ago, I had warned her that she was going to have to manage the patient’s entrance that we were waiting for. Anaïs is 22 years old, she is a third-year nursing student. She is motivated, rigorous, curious, invests in her internship in the best way. Very appreciated by the team, she found her place while remaining discreet. Nobody doubts that she will make an excellent professional. The resuscitator told us:
– Well, we’ll take an entry. A 19-year-old IMV (Voluntary drug poisoning: suicide attempt with medication). I do not know yet what he took. He is intubated / ventilated.
– OK, when does it happen?
– 10 or 15 minutes, the UAS is already on its way.
I have to take things in hand because Anaïs is paralyzed, draft, obviously does not know what to do. I have never seen her like this.
The nurse may be fragile and feel overwhelmed. In short, being human …
I turned to Anaïs and told her that she was going to take care of him, her orders. Obviously, she would not be alone, we are never alone, in intensive care, we are a team, we help each other. But it takes a referral, someone to whom the doctor gives the instructions, someone who directs the team, to avoid that it is the mess. I thought to please him by delegating this entry, showing him such a mark of confidence; it was a bit of a reward for the good internship she had been doing so far. I had been surprised to see her grow pale, lose countenance, and run away from my eyes. I was wondering what was wrong, and I did not have time to ask the question further. The double doors of the service were already opening (when a call says “10 to 15 minutes”, it is better to understand “1 to 2 minutes”). A stretcher, framed by two women and two men in white outfit marked with large blue letters: SAMU 75. The beep of machines, an imposing paraphernalia placed on a metal tray attached to the stretcher. Respirator, oxygen bottle, infusions. Eyes closed, a young man lying down was breathing with a plastic hose coming out of his mouth. Another plastic pipe came out of his left nostril. Another plastic pipe drained his urine. Two other plastic tubes, one in each arm, allowed him to inject drugs.
According to my empirical observation, some periods are more favorable than others to the acting out: the holidays, especially Christmas, the summer too, whatever the reasons; I am not a psychologist or a sociologist.
– Hello !
We say hello, we smiled, in the nice cacophony specific to SAMU entrances. I indicate the room where he will go. We will have to transfer the patient to his bed, connect it to our respirator, reinstall it properly, connect it to our surveillance devices, make administrative admission, in short, do our job. It will be reviewed by the internal and external, who will draft the medical observation and prescriptions.
There is an almost infinite variety of ways to fuck in the air. IMV is a widely used method. There are also hangings. Sometimes someone takes two months of anxiolytic treatment at once, drops a bottle of whiskey to slide, takes his car to throw himself into a canal, and miraculously gets out of it. More rarely, we see gun injuries. But in the end, we get a lot, suicide attempts. France is one of the countries in Western Europe where the suicide rate is the highest (10,500 deaths per year, three times more than road accidents, an assumption cost estimated at 5 billion euros annual report) and is also part of the leading European trio in benzodiazepine (anxiolytic) consumption. According to my empirical observation, some periods are more favorable than others to the acting out: the holidays, especially Christmas, the summer too, whatever the reasons; I am not a psychologist or a sociologist. Our work, in intensive care, consists in restoring the vital functions. Then, the patient will go to psychiatry where other caregivers will do their job, understand, explain, fix, prevent it from happening again, solve the problems of substance.
– He is 19 years old, it was his mother who found him and who called us. He was on the floor, unconscious, he vomited. Several boxes of empty treatments were recovered.
Sometimes unpleasant reflections are fired. I noticed that it happens especially when the teams are tired and the day has been difficult.
The nurse anesthetist hands me a big plastic bag stuffed with boxes: a sacred cocktail. Fortunately, he has disenchanted much of it. But there was enough left for him to go into a coma. The risks of coma are choking and pulmonary infection by the liquid in the stomach: inhalation. The SAMU team intubated him on the spot, in the small bathroom, under the eyes of his mother who was crying where was too shocked to really understand what was happening. This may not be the first time his son tries to kill himself. Sometimes we see the same patients five or six times. Call for help? Incompetence to fuck in the air? We put him in his bed, which is always a delicate maneuver. I have to take things in hand because Anaïs is paralyzed, draft, obviously does not know what to do. I have never seen her like this. Other colleagues are there to help us, all these gestures are done in the good mood and the conviviality, almost by automatism, the fruit of years of experience.
Sometimes unpleasant reflections are fired. I noticed that it happens especially when the teams are tired and the day has been difficult. We know that the TS (suicide attempts) do not have good press in intensive care.
– Hey here, another wasted bed.
– And if we have a real sick person to take, how are we going to do?
– Shit TS, at least if they did not miss, they would not waste our time.
– And then at the price of the day in shea, shit!
These are reflections that I have heard more than once. Violent words whose meaning eludes those who pronounce them. We do not have to decide who should be admitted to intensive care, or to judge why people do what they do. But the truth is not that caregivers lack empathy for these patients; simply by seeing people die stupidly or unjustly, because of flu, bacterial infection too late identified and treated, an unfortunate accident, an autoimmune disease, a they do not support the idea that some may voluntarily kill each other. I do not judge these patients or my colleagues, I do not have the right. I am not immune to hasty judgments myself. We all have our lives, our traumas, our experiences. We all carry too heavy baggage that prevents us from advancing, and blinkers that prevent us from seeing everything.
I suspect that his personal life has just collided with his work, and that something has exploded, that a border has been crossed.
Who has already entered an apartment plunged in the dim light, where floats a sweet smell of powder, and where one hears a liquid that drips on the ground, the same noise that would make a leaky faucet? By lighting the light, we find, sitting on the chair of the salon, a man, a shotgun between his knees, whose head was torn off above the lower jaw, whose brains are spread on the wall behind him. , on the picture frames of his wife and kids, on the drawings of his grandchildren. Who can support this vision? Who has already picked up the scattered pieces of what had been an arm or a leg, and who are spread out on tens of meters on the rails of the subway? Who can bear to see the pain, misfortune and pain, and to what extent? We should consider depression as a disease, just like pyelonephritis; no more no less. Potentially lethal. But the violence and despair contained in the act of giving oneself death can not leave any marble.
I watch Anaïs out of the corner of my eye, and I see her fade away as reflections and dubious jokes fly into the room, until she comes to throw away her gloves and leave hurriedly, without a word. It is an abandonment of post; the answer to something that was above his strength. I finish installing the patient, I make sure he is in a stable state, I pass the baton to a colleague and I go in search of the student. I find her in the locker room. I ask him what’s going on. I suspect that his personal life has just collided with his work, and that something has exploded, that a border has been crossed.
– What happened in this room? You knew someone, right?
She looks at me with her big eyes drowned in tears, and she seems so fragile, revealing to me in this single look widening faults, the ruins of something that will perhaps never be rebuilt. She looks at me as I look at the families of our patients. At this moment, Anaïs is no longer caring. She just went to the other side. She manages to calm her crisis of tears and articulates painfully, in a broken voice:
– My big brother … Nobody found it in time. He is dead.
I take her hand and I say nothing because there is nothing to say.
Anais has dropped out of nursing, and I do not know what she’s become.
Yes, caregivers are human, first and foremost. Humans, fragile, and sometimes overwhelmed by their own thoughts, their own words, their own wounds. Sometimes they can not heal because they have to heal themselves first. If this healing is possible.
According to the WHO report based on 2012 figures, 804,000 people commit suicide each year around the world, one person every 40 seconds. Suicide kills more people than wars and natural disasters. France is above the world average.
This post was published on July 10, 2015 by Emmanuel Delporte we thank for this exchange.