Dark Knights

Last week I spent 3 long days at training with other nurses from both ours and other prisons, we were learning about Pre-Hospital Emergency Care at St Johns Ambulance Headquarters, no doubt in order to make our emergency care more effective and efficacious for the patient/prisoner and of course to ensure prison nursing was up to community expectations - which as far as I'm concerned we already are, though of course training helps to ensure this continues.

Over the 3 days we were put through different scenarios - e.g. different medical and emergency presentations to assess, diagnose, treat and manage. We would be paired together - one being the patient/prisoner and the other the nurse. Many of these scenarios were had and assessed by our tutor, my poor head was full to over flowing by the end of the course.

So when on Friday (being back at prison, and at the end of the day) a young prisoner came into medical clutching the left side of his chest and complaining of tingling down his left arm naturally I looked around the room wondering where the tutor was hiding, not seeing her I then tried to find the camera and/or recording device as after 3 days of intensive training this seemed too simple and straight forward - this does not happen to me (I deal with the mentally unwell, personality disordered and at risk prisoners, so as a rule not the medical side of things) and for it to happen after 3 days of pre-hospital training when I was initially the only nurse in evidence seemed a little too contrived to me.

Not seeing the tutor or camera I did not discount the probability that this was still a test and so decided to play along and treat the presentation as real. I lay him down on one of our medical beds and took the history whilst Pam (a real nurse who turned up and was also in the class I had just completed) took the vital signs and we decided at this point an ambulance was required. We continued to take the history of presenting complaint, signs and symptoms, any allergies, medications he was on, pre-existing medical conditions, last food and fluid eaten, events leading up to the event, what was provoking the pain, quality of the pain, region or radiation of the pain, severity of pain, time of onset - etc, still believing that this was a test (Pam was of this thought too - I had an accomplice in the paranoid construct) though when the paramedics turned up and thought he needed to go to hospital I was less of the mind that this was part of an extended assessment; less of the mind though not entirely convinced as I know what extents the Government has gone to track and trace my movements since my teenage years, I must be a threat in some manner though I have not worked out what part I play in the script penned in 1984.

Next came the phone calls to Pam when she was in medical from hospital informing her that Dr's thought our patient/prisoner had indeed suffered a Transient Ischemic Attack (small resolvable stroke which can be a harbinger of further cerebral infarction) though the prisoner was refusing care and wanted to return to Prison - no discussion with him was able to have him remain in hospital and he returned to prison for us to look after him.

Due to the complexity of the presentation and the added complication of him refusing care again had my paranoia piqued though by that stage I had the hospital discharge letter in my hands and if this was indeed a test it was a bloody good one as most bases appeared to be covered. Even the discharge letter from the attending Dr indicated the seriousness of this presentation and the potential consequences of medical complication associated with refusal of care/medical intervention.

I thought the best way to ensure this prisoner was looked after was to place him in Special Needs Unit under 15 minute observations though as he knew this meant no TV in cell, no smoking and reduced freedom he became ++ agitated. Whilst I could have enforced my decision and course of action I considered that any potential therapeutic benefit would be heavily offset by the increase in his blood pressure alongside agitation which of course is something we never want in someone with a potential cerebral incident as another may be precipitated.

So I ended up placing him back in his cell with a cellmate he knows and who will also look out for any baseline changes and if needed press the alarm button in the cell.

Not ideal - though what in life these days is?

Funny (not really) how we have to go to the wall in order to be able to make decisions and plans in the absence of best therapeutic choice. In fact in life we, at times, have to make decisions in the absence of best option availability - this is the reality of risk assessment, in any field.

Those that make decisions in this environment are aware of the risk though also aware that should they abandon the need to make a call due to things not moving from a to b or 1 to 2 then there will be an even worse outcome.

In-decision I believe at times is worse than the wrong decision.

It's not about putting your balls on the line, it's how you handle them -its about leaning into the wind that discourages others and making a call that you are comfortable with, no matter what the outcome, because you have considered all sides - and it will be because of your decision that you own the outcome and move from that.

The Tiger knows how to attack and is fearsome, yet it is the Dragon that can both attack and defend in the same action, he knows both worlds and with fluid movement travels seamlessly through them both.

And so it is, knowing events and even being without power to change you still have variables to deal with and to manage - one just needs to know the players and the limits, we are not Gods, we should not live with the expectation exuded by those that look up at us with begging eyes.

So I left prison last Friday around 2300 hours wondering and hoping my previous charge would be OK, that he would not have a repeat medical emergency.

I spoke to one of the Undead who was shuffling in some sort of Michael Jackson homage on the road entrance to our prison on the way to my car, after giving him a run down of events he simply looked at me, his head still and focused whilst his body contorted in unnatural ways, and quipped

"You think too much, just let it be, nature always takes care of itself."

I countered with nurse role obligation and expectation from the Nursing Council but he was not moved and only retorted,

"Power is only gained by those who have been given it by others - have you learnt nothing from the Salem Trials?"

We sat and drank a mixture of Belladonna and Vodka, musing about the growing development of the new prison and wondering where we will sit once it is completed as the boulder we were reposed on will likely not remain. Again he reminded me that not all can see his kind as this requires a special sight, no doubt gently letting me know he would always be there for supervision in a way that supervision as a word was not created.

I like him and I like his advice, not that I understand all of it though it relaxed me as we sat on the railway tracks looking into the mist rolling around us, nearly 0000 hours and all life now made sense, well at least the small part I was privy too, but then again why should I look too far, I guess that was what he was telling me.

We sat and ruffled the thick neck fur of the Werebats who had found us philosophising and knew we were the right kind of Socratic thinkers to slide up next to, they must have felt the energy and wanted to be part of it, to be close if only for a while in order to say they had been there and felt it.

Indeed to be in the right place at the right time and to see the water hit the high mark, for it to remain there in order for those with sight to understand is an especial thing, before it dips again into the shared primordial soup,


Into the collective dull.



To be all that you can be depends on whether you understand and accept the sage inscription above the entrance to the Oracle -




Know thyself.




And don't discharge yourself against medical advice.







The Grey Madness