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No time to laugh

It was the heart-sinker 4am call during an overnight psychiatry shift that signalled the end to my slumber. ‘There’s an overdoser for you downstairs. Cubicle two.’

Having established her identity, recent blood results, and sobriety, I plodded to the emergency department with a thick sheaf of assessment papers in hand, and entered cubicle two.

Andrea was hunched over in bed, looking extremely anxious, and young even for her 18 years. ‘Hello,’ I offered, ‘I’m the psychiatry doctor on-call today. I’d be very grateful if you could answer some questions about the events that have led you to be admitted to hospital this morning.’

And so Andrea outlined the circumstances surrounding her overdose: she was doing first-year exams at university and felt very stressed about achieving the necessary grades; her boyfriend had recently left her; she’d felt unable to cope with the pressures of life.

But she regretted the act, she assured me, and didn’t want to repeat it. I thanked her, and then explained that we needed full details of the medications she had taken, to ensure her physical health could be optimised.

‘Actually it was these,’ she muttered, somewhat sheepishly, and presented an empty tablet container from a bag by her side. I smothered an erupting guffaw, and turned the multivitamins bottle over in my hand. ‘I think any long-lasting health problems are unlikely,’ I replied, and wrapped up the consultation then promptly departed.

It was only later, back in the office and typing up my report, that I recognised the glaring omissions from our exchange. I hadn’t asked why Andrea had considered a few extra vitamins might be life-threatening, nor how she expected to cope with a life that some hours earlier had been unliveable.

And, what's more, I had laughed in the face of despair – an inexcusable act, however that face might have appeared. So it was my turn to accept the truth and sheepishly revisit the patient, this time to truly listen and not to judge.

Susanna Mills, ST1 in public health in Newcastle. At the time of the incident she was an F2 in psychiatry

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