'Male – behaving strangely, threatening self harm'.
“Would you like the police to attend?”, asks Control.
For some reason I'm feeling brave this morning so I let them know that we can save the police some time and I'll take a look at the patient first.
It's a hostel, not one that we usually go to – as the owner leads us to the patient some other residents walk past us, they seem remarkably normal. I know that may seem judgemental but most of the hostels we go to are full of people with psychiatric problems and alcoholics. It's one of the perks of the job, we get to see all the nice places.
The landlord gives me the impression that he just wants our patient out of the hostel. For reasons best left unexplored it would seem that he prefers us tramping around his hostel than the police.
My patient opens the door to his room and looks at me. I look at him and realise that this person has serious mental health issues.
I'm sure that if you were to read this person's medical notes it would state 'flat affect', 'unable to maintain eye contact', 'meandering conversation', 'issues with self care' and 'threatening body language'.
For me, for any ambulance person, it's all laid out for me in that split second look.
He looks at me with confusion and with a grunt, invites me in.
He doesn't tell me much, he starts to talk then stops. He paces about like an animal in a too small cage. In and out of his room he paces, when he passes his door he rests his head on it for a moment.
From down the corridor two police officers arrive.
“I told Control we didn't need you”, I say to one of the (by coincidence the good looking female one).
“We were only down the road”, she says, “thought we'd come and check up on you, make sure you are all right”.
The patient sees them, he's obviously had run-ins with them in the past.
“Who called them?”, he says, “I've done nothing wrong”.
Hoping to build some sort of rapport with the patient I ask if the police could leave – while their presence can often have a calming effect, for some people it's a red flag to a bull.
With a friendly wave the police disappear back down the corridor.
Now, of course, the patient doesn't want to come to hospital – I let him know that while I'm not allowed to kidnap people, he'd be better off coming to the hospital for a check up.
He refuses a few more times. So we leave.
The landlord looks most upset, he wants me to take the patient away as he is 'disturbing other guests', but as I've told the patient, I can't kidnap people and that if he wants the person forcibly removed he'd be better off with the police.
I'm in the ambulance outside the hostel completing the paperwork when the landlord knocks on the window.
“He wants to go now”, he says.
I wonder what the landlord has said to the patient, but who am I to judge, so I open the back doors to the ambulance and the patient gets on board.
It's a very short trip to the hospital and I take the patient into the majors area to hand him over to the receiving nurse. The nurse is one of the good ones.
I explain all what has happened, and about the patient's mental state – not self-harming but 'not right' either.
Sadly (thanks to the healthcare commission, about which I will write later) there isn't any place for our patient to go than out in the waiting room.
We sit him out there and explain that a nurse will see him shortly, then go and book him in.
We watch our patient get up and walk out of the department to have a smoke. He walks back in with the lit cigarette and heads for the patient area.
I go to stop him – I explain politely that he can't smoke in the hospital, that it's not good to have naked flames near piped oxygen.
He bristles, squares up to me, stares me in the eyes.
I try again, polite but firm.
I signal one of the nurses, to let her know that this might get nasty. I can see the aggression in his eyes. I know that patients with schizophrenia aren't meant to be violent, but they still make up a sizeable proportion of people who have taken a swing at me.
Once more he squares up to me, daring me. his posture, his body language, his voice (the first time I've heard emotion in it) all have me wondering if I should be the one to make the first move.
But once that happens, there is no turning back – and I don't like fighting people.
I'm getting ready for him to take a swing at me when I hear a tiny voice behind me, “You can't smoke in here”.
It's the triage nurse, all four foot of her.
Our patient looks down at her, up at me.
He drops the cigarette and crushes it with his foot. Then walks back out to the waiting room.
I leave the department wondering if this little nurse could come with me when we get our next potentially violent call.