I spent another afternoon “On Call” today as a Community First Responder. I am either jinxed or blessed as today, like the three times before, no-one called and I got no chance to try out my newly aquired skills. I spent a week in the ambulance centre last month updating my practical skills in emergemcy situations and had spent some months before that on-line and in the classroom getting my general knowledge brought to current standards. At the start of each ‘on call’ session I checked my kit to make sure it is all present and ready . The defibrillator, the oxygen cylinder, airways and masks, the tourniquets and bandages; it was all there pristine in its packs at the start of my session ready for use, and it was still there virginal and unused at the end of my on call. As I said, in some ways I feel jinxed as each time I have not had a chance to use the kit and test my skills. I did get to check that I know how to log-on to the emergency response system but have not has a chance to check I know what to do when I get the call to respond. However, I also feel blessed as my inactivity thankfully means nobody actually needs my help. Nobody has had to call the emergency services because of accident or illness and I have to think that this is good news for my neighbours.
It is an unusual feeling being “on call“. It reminds me of when I was in work. There is all the excitement of waiting for the alarm to ring. The hours of mental preparation of what to do when it does. Checking the alarm to check that it is still working and its silence is not a sign that it has broken and the rereading the text books to make sure that the information in my head is accurate and not a figment of my imagination. All these emotions are generally pleasant but there is also a background fear that accompanies them. The fear that one will be called to something beyound my abilities, or called to deal with something with which I have no experience. In sum, just the fear of finding that you fail somebody in a time of need. That when they needed help, and called you, were found wanting. I was surprised to find these memories coming back.
I recalled with pleasure the recollections of emergency sessions when I was a young medic. The rush of high intensity work and the pleasure of managing to deal with a crisis and pull someone back from the edge. Working against the clock, in a team that was functioning well, is one of the greatest pleasaures there is. Even on occasions when illness ot accident prevailed, as long as you and your team pushed everything to the limit and gave every chance to the patient, the sadness could be tempered by the knowledge that everything possible was done. I could understand why emergency medicine gave its practitioners such rewards. My skill set was not well matched to A&E (I have never been very dextrous) and I moved into psychological medicine but still enjoyed my emergency sessions even if these were less hands on.
But although I recalled “the buzz” I also recalled the “dread“. In my latter years working, and partially one of the reasons why I retired, I came to dread being on call. Over the decades the general drift of mental health services had lead to a general over-reach. Rather then being limited to mental illnees, mental health services had suggested that they could answer many personal and social problems. This increasingly lead to crises, which were largely social in nature, being presented to mental health services for resolution. Distress that arose from poverty, or spousal abuse, violence or drug abuse was presented to the emergency doctor for solution. While we did what we could, there was always the awareness that there was little we could do. There was also the recognition that others, a social worker or policeman, may have been able to help more and the bigger fear that sometimes we were making things worse. Pretending the problem was depression rather than the poverty or poor housing never seemed helpful. Suggesting that the battered wife had mental health issues didn’t empower her in her marital problems and possibly weakened her position. The recognition that you would face crises, you were not equipped to solve, lead to this growing feeling dread when on call came around.
I encountered a little bit of that feeling of dread again today. However, this in itself was valuable as it reminded me why I retired and made me happier with my lot.