A Fox Lake Blog

The Psychologist

No-one who has been reading my meanderings will be at all surprised to learn that I know very little about psychology.  However, I had assumed that actually having a patient that could communicate in some way would make any course of trauma counseling more efficacious.  Imagine my surprise therefore when I was informed in the HD ward, whilst still intubated with my tracheostomy tubing and therefore unable to speak, that the hospital psychologist had been booked to come and give me a session ‘to help me over the trauma of being left alone for five and a half hours whilst I waited to be found after my fall’.  I received this news in (mute) astonishment since I didn’t consider myself traumatised at all by this part of the accident.  I mean, granted, it wasn’t the way I would have chosen to spend a Tuesday morning but as lying paralysed in a field goes, it could have been a lot worse.  The sun was shining, it was warm, I was close to home so I figured I would eventually be found and I was surprised to learn that it actually had been five and a half hours so clearly I had spent some of it unconscious, which is probably the most sensible way to have coped.  No, what had REALLY traumatised me was my induced coma in intensive care.  

It is difficult to relay just how confused you become and how quickly you entirely lose your grip on reality when being pumped full of incredibly powerful drugs that cause vivid hallucinations.  I am told that everyone patiently explained to me what was happening and what they were going to do to me before it was done.  I knew none of this.  What I knew is that I was trapped unable to move and not breathing. I couldn’t see anything but blackness interspersed with purple zigzag lines (occasionally yellow ones) but – and this is the key thing – I wasn’t unconscious.  I was still aware, still consciously processing, still thinking.  So conscious in fact that I remember the whole thing very clearly, even now.  To start with I was lying with enormous pressure on my face so, at some point I must have been put on my front.  I knew that I had broken my neck and that I had been paralysed.  I also knew that I was very seriously injured and that it was not at all certain that I was going to live.  I was relieved to be able to genuinely contemplate dying with the view that I had had an extremely good life and had no regrets.  Everyone I cared about knew I loved them, I’d been fortunate enough to travel widely, love my career and gather a bunch of fantastic people I am lucky enough to call friends.  But now, apparently trapped in the dark, motionless, unable to speak, with the pressure on my face, I thought I HAD died and been buried. 

My thought process went like this “Am I dead? If I’m not dead then why can’t I breathe or move or see or speak or hear anything? Why do I feel like I’m being pressed face first into the ground? And if I am dead then how long does this consciousness last? Will I be trapped like this forever? Or just until enough of my brain decays so I am no longer able to think?  I don’t think it’s supposed to be like this – there’s supposed to be either absolutely nothing or reincarnation or the pearly gates and tricky questions from a bloke with wings and a flaming sword – but what if this IS it? This horrific, trapped awareness with no relief and no escape?”  And then I felt this – understandably – huge wave of terror which lasted until they pulled me out of the coma from time to time – which was usually at least twelve hours but could have been days.  I have no idea.  No wonder people come out of ICU complete basket cases. 

Now, obviously, looking back, none of this thinking stands up to even a few seconds of logical thought but vast amounts of hallucinogenic drugs are not conducive to calm, logical thinking.  I expected to be lying in a hospital bed.  I did not expect to be consciously unconscious and I wonder now whether it would have been possible to keep me conscious but calm by hitting me with heavy doses of valium or other anti-anxiety meds rather than by trying to knock me out entirely.  I understand why intubated, ventilated patients are put in induced comas from a care point of view – it’s considered to be easier for them and for the medical staff.  Certainly I have two chipped teeth from gnashing furiously on my own tubing and staged several attempts to rip it all out – a common reaction from many patients in the same distressed situation where the brain has gone into fight and survival mode and it feels like the tubes are what is suffocating you.  However, after the accident but before the operation to piece me back together I WAS lucid enough when brought round to sign over power of attorney and to clearly remember them explaining – and putting me into – traction.  So, I put it out there that I would have much preferred to be lying in my ICU bed conscious but sedated.  MUCH preferred.  Instead I spent two weeks absolutely bloody terrified and confused and just wanting very much to actually die rather than endure this horrific, imagined half death.

All of this went through my head as I looked at the nurse.  Obviously I couldn’t say anything so I tried to convey with my eyebrows that I thought seeing a psychologist was an excellent idea because yes, I was a gibbering wreck but it wasn’t the accident per se that caused the trauma but rather intensive care but wouldn’t it be a better idea if we waited until I could, you know, actually talk back to the psychologist as that might immeasurably help the process?  I’m sorry to report that my eyebrows entirely failed to communicate any of the above so the nurse patted my hand and said “Good, that’s what we’ll do then.”

A few days later a very young girl approached my bed.  I say very young – she was possibly mid twenties but had a diffident and nervous demeanour that made her seem more childlike and certainly wasn’t the air of calm competence and seen-it-all-before experience you would like a counselor of any kind to exude. “Hi” she said, “I’m the psychologist.  I understand you are very traumatised by waiting so long to be found”.  This one was easy.  I shook my head vigorously. 

“Oh” she said “You’re not traumatised?”.  I considered.  Would it be better to nod first to indicate I WAS traumatised or would she think I was signalling agreement to not being traumatised? So then should I shake my head first and then nod it?  Or vice versa?  I nodded. 

“Does that mean you are traumatised by your accident or not?”

I nodded again.  Then shook my head.  Then gestured at my mouth full of tubing.

She frowned.  I suspect all the stats on ICU cognitive impairment were trickling through her brain.  “Do you not want to talk about it?” she asked. I gave her my hardest stare then waved my one trusty arm at my tubing again. Genuinely I don’t know whether she realised that I couldn’t talk or thought that I was just holding out on her.

“Maybe” she said “This would be better when you are ready to talk a bit. I’ll come back later.”  I tried my best to get my eyebrows to convey a world weary resignation at this piece of genius and on that note she departed and never came back.  This totalled the full extent of the psychological support I received after my accident since at my next hospital they didn’t even have a psychologist.  

Months after I’d been back at home a survey came through for ex patients from the second hospital asking whether we thought providing a psychologist would be a good idea.   I considered the feedback form.  Did I think that providing mental health support to people who have seen their lives ripped apart by the trauma of paralysis might be needed?  Those patients who, having survived awful trauma, had lost their independence and dignity, been almost gleefully told that they will “never walk again” and that “there isn’t and never will be a cure”? Those people who have seen their livelihoods disappear, lost their now inaccessible homes, many of whom have had relationships crumble under the strain?  People who, in addition to being trapped in a wheelchair, their sense of identity blown apart, are stalked by relentless nerve pain, facing a future full of uncertainty and knowing that getting older will only make things worse – not to mention the fact that they will have been told, as I was, that their life expectancy is now curtailed?  Those people.  Did I think that it might be a good idea to provide them with some psychological back up and help?  Yes, the powers that be really had found it necessary to canvas opinion on this question, which beggars belief.

If I sound angry it’s because I am.  And I’m also heartbroken that so many fellow SCI patients have had to fight their way through this horror without any mental health back up – often whilst having the very professionals who should be encouraging and protecting them, actively undermine their fragile hopes.  I have always been a relentlessly upbeat person but even I actively considered killing myself after I left hospital – not just because I was no longer able to do anything that I loved before the accident but because of the guilt I felt at dragging all my loved ones into this complete mess.  This injury doesn’t just blow apart the hopes and dreams of the injured; it rips up and tramples those of their partners and family too.  At first I was unconscionably annoyed that, given my paralysis, it was actually going to be rather difficult for me to successfully top myself.  I was fairly sure – note only ‘fairly’ – that those around me weren’t going to answer in the affirmative to requests such as ‘If I sit here, could you just accelerate at me?’ or “I can’t quite hold this knife, would you mind?’ so eventually I concluded that the only real solution would be to overdose on all my drugs at once.  Given I was on a cocktail of six at the time, with a three month supply provided of each, this was (does sums in head) a total of 558 tablets.  Whilst these would take a considerable amount of application to consume with only one working hand, the pharmaceutical collection also included peppermint pills so I would at least expire with minty, fresh breath.  It’s the little touches that count. 

In the end it was the impracticalities that stymied me.  I decided that, knowing my luck, I would probably fail to do anything more than make a bad situation worse by adding organ failure or brain damage to my collection of impairments so I just had to swallow the guilt, if not the pills and get on with it. 

FYI I ticked ‘YES’ on the questionnaire form and sent it back. 

3 replies on “The Psychologist”

There are plenty of fully trained therapists out there but the NHS doesn’t deem them worth employing. This is a very powerful argument. With your permission I will use it in my next (probably futile) interview! Perhaps you could write an article for Therapy Today? They’ll be others who have suffered intubation in ICU post Covid. Maybe you could have a problem page like Cathy and Claire. Another very funny and brave piece.Thanks Tara.x

Hi Liz – yes, please do mention in your next interview and good luck x

What I love about reading your post is that I hear YOU. Haven’t seen or worked with you for many a year but your voice and tonality is so very clear.

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