Language Casualty...

Dear Sir/Madam,

I write to inform you of a disturbing situation pertaining to staff service, which you may or may not consider worthy of correcting.

The facts of the matter are straightforward.

Early Sunday afternoon, 19^th May, I was heading out for my daily walk outside my home, and was suddenly hit by a severe pain in my neck & head.

I described if for the attending medicos as a ‘sudden sledgehammer to the head, accompanied by a deep, throbbing pulsing pain in the back of my neck, so intense, it turned everything white- like a camera with the white balance too high’.

I stopped immediately, cut short my plans for a walk, and in such pain and disorientation, I got straight into the car and headed for accident and emergency.

I arrived & was admitted shortly after (the time I am uncertain of, due to the severe pain. I’m sure all the relevant details are noted.) For the record, let me simply say, this is a kind of pain unprecedented in my lifetime.

Upon admission, after some examination- it was decided to insert a catheter in order to take blood and administer pain killers.

One attempt at penetration of the needle failed. A second attempt- which seemed to pierce the muscle of my forearm- caused such excruciating pain, my head problems suddenly felt like a birthday present. As a matter of interest & for your viewing pleasure- I enclose a photograph of the FIRST & SECOND unsuccessful attempt.

It has caused a great deal of consternation and puzzlement amongst my friends in the medical profession in the United States. They think this is a sick joke.

It was not pleasant to be the brunt of that joke.

But it gets better. Here is a picture of attempts THREE & FOUR. It looks as if my attending nurse was Ray Charles. I have NO idea what the person was thinking looking for a vein in my inner bicep.

The final attempt lower down is where my veins have been found in the past. 

 

So it took FOUR attempts to get a satisfactory vein. I can only speculate why. I am told I have veins that would make a heroin addict jealous.

And now, I am a pincushion, and the reason for it eludes me. I can only hope that one day, giving injections and taking blood will be taught in nursing school. I would have thought that would be one of the first things they would teach, but obviously not. If only these people knew how traumatic it is to be punctured not once, not twice, not thrice but FOUR times on top of the agony of an excruciating headache…

& although the panic in needle park DID take my mind of the pain in my brain-

I could have done without it.

But this is not the purpose of my letter. I will assume for now that giving needles to patients is for the most part regarded as a hit and miss affair, and not taken especially seriously; more a game to pass the time - like darts- than a serious medical procedure.

The point of the story is that at this time, all this going on…I was in extreme pain.

(I was told by an attending Doctor subsequently that the pain was so intense…additional/concurrent pain was intensified by my already heightened pain sensitivity. However, at the time I had not the presence of mind to see things with such sobriety & moderation of sensibility.)

At one point, I screamed in total agony as the nurses drove the needle into my muscle even further (refer to the first photograph, attempt TWO, where the needle was inexplicably being driven into my forearm, but felt like they had successfully driven through to the bone marrow…), which was nothing more or less than sheer unadulterated AGONY.

& I don’t mind saying it. Keeping this kind of thing to oneself- suffering in silence- is anachronistic macho bullshit, and not very helpful. Perhaps you need to know how one of your patients suffered, that you might modify certain practices in the hospital.

Perhaps the squeaky wheel indeed gets the grease.

And it was here, in the depths of pain and suffering that I arrive at the point of my letter.

At this time- & in tears of agony- literally sobbing…I was soon sobered up by one of the ‘nurses’, who strode into the ward, glared at me like a member of a Gestapo Interrogation unit, and in an authoritative voice like the computer in 2001, said something like,

‘I know you’re in pain, but please watch your language; there are children present’.

I could not believe my ears.

This comment was so absurd…it cut through all the pain and agony and lodged itself in my consciousness like a tick burrowing in my brain.

‘Please watch your language; there are children present…’

The room cleared, the pain from the needle torture slowly subsided, and I had to time meditate on these words.

Even now, as I write this in my bed, recuperating from my experience, I can scarcely believe such a thing could happen, or that anyone could either be as ignorant, uncaring or deranged as to say such a thing to a person almost senseless with suffering.

To attack someone in such a way when they are at their weakest and most vulnerable about ‘rules of etiquette’ is not only ignorant, unprofessional and insensitive- but cowardly.

I was in NO POSITION to defend myself.

I AM now.

In terms of absurdity- I can only compare it to losing an arm in a machete attack of ethnic cleansing in Rwanda, and then being asked not to bleed everywhere.

The absurdity will echo for eternity. It literally takes the cake.

As a victim of child abuse at the hands of my father and a certain local Catholic priest recently imprisoned for his crimes, I now know something about the trauma of victimization & its ongoing popularity.

It’s a question of POWER.

Such trauma inflicted by those wielding their power over another weaker human being has a way of lodging certain details in one’s consciousness; and this particular instance is a keeper. Talk about kicking a man while he is down.

I am UP now.

These days…it takes a great deal to distract me from my normal labour.

But given that most of my recent work has been documentary material cataloguing injustice in all its forms…this matter is not altogether too far from my normal field of endeavour.

I stress- I am not angry; it is impossible to get angry at such…Ignorance? (This is the only word I can think of to adequately describe it.) & I know ignorance is rife in the world.

But ignorance borne of such lack of empathy, intolerance, such inability to feel compassion for the agony of another living sentient being- in a facility supposedly devoted to the health and healing of ailing human beings, a theatre of compassion, tolerance and understanding…? It takes the breath away.

I write this letter also from a place of neither animosity nor vengeance, but from a genuine desire to inform, assist and educate.

Because this individual clearly had no conception of the various shades of pain and suffering; a field I regrettably know something about.

I write also NOT to get involved in some kind of war of words, because this communiqué comes also from a place of abiding satisfaction with the remainder of staff service throughout my stay. The balance was restored, if you will.

However, the only way I can fully and comprehensively achieve a holistic sense of healing, & put certain regrettable trauma to bed, is to get this other matter off my chest, as it were, in the hope that no other person need suffer due to ignorance. & I can ONLY assume that this is a case of ignorance, or insufficient knowledge of, or training in the area of pain and suffering, how these manifest themselves, and how they are best treated.

The woman in question- who saw fit to lecture me about my ‘language’, rather than understanding the particular quality and intensity of my extreme pain (which should have been obvious to someone of even marginal intelligence, if only for the volume of my shrieks) & dealing with the pain- was so very obviously missing…

something.

In a way…I hope it was ONLY compassion or empathy she was devoid of; it would be abhorrent to think she was deranged, or dim witted, working in a hospital.

And this letter is not to wave my finger at hospital administration, elicit some sort of revenge or apology, because again, the remainder of my treatment went quite smoothly. The hospital is one of the few institutions in the town (indeed the world at large) that actually works- and having travelled widely in the US as a film maker and writer- I can tell you, the standard of our health care is excellent, and on a pretty low budget.

At least I didn’t die, as happens in some parts of the world.

Working with such a low budget- I can only assume the hospital occasionally has to cut corners in order to employ staff of a poor standard.

& it is to these dregs of the hospital number- one of whom I met in my time of suffering- that drag the rest of the team down, & to whom I direct this letter.

I did not get this person’s name- such details escape one in the grips of severe pain & anguish. I can only assume she was NOT a nurse; indeed, she must have either been a volunteer or a file clerk, or someone on work experience given her ignorance.

Unless Portland A & E has never admitted someone in pain prior to my visit- & I have sincere doubts this is the case- then this person tutoring me on the kind of language I ought to be choosing in such absence of sound body and mind must have had NO experience of extreme pain whatsoever.

This is CRUCIAL if one is to even BEGIN to be possessed of any kind of empathy and compassion for working in such a sensitive environment.

Any nurse knows that agony can cause a condition known in the legal fraternity as ‘automatism.’

There is a dearth of material dealing with this concept; but I refer you to David Grace Q.C., whose comments are the most accessible, practical and workmanlike. I draw your attention in particular to the position at Common Law, which applies in my case, as I am defending my behaviour not to a court in reply to a charge for a specific defence, but in response to a clear and disturbing case of injustice and unfairness in our health service.

(The emphasis is mine.)

“The seminal statement and the foundation of the law of insanity is to be found in Tindal CJ’s answer to questions posed for the judges by the House of Lords in The Trial of Daniel M’Naghten:

[J]urors ought to be told in all cases that every man is to be presumed to be sane, and to possess a sufficient degree of reason to be responsible for his crimes, until the contrary be proved to their satisfaction; and that to establish a defence on the grounds of insanity, it must be clearly proved that, at the time of the committing of the act, the party accused was labouring under such a defect of reason, from disease of the mind, as not to know the nature and quality of the act he was doing; or, if he did know it, that he did not know that what he was doing was wrong.

The High Court, over many years, has refined the defence of insanity in the common law jurisdictions in Australia. In R v Porter, Dixon J defined the phrase “defect of reason” contained in Tindal CJ’s statement in M’Naghten’s case:

[H]is state of mind must have been one of disease, disorder or disturbance.

That does not mean that there must be some physical deterioration of the cells of the brain, some actual change in the material, physical constitution of the mind, as disease ordinarily means when you are dealing with other organs of the body where you can see and feel and appreciate structural changes in fibre, tissue and the like.

You are dealing with a very different thing--with the understanding. It does mean that the functions of the understanding are through some cause, whether understandable or not, thrown into derangement or disorder. …

If through the disordered condition of the mind he could not reason about the matter with a moderate degree of sense and composure it may be said that he could not know that what he was doing was wrong.

What is meant by "wrong"? What is meant by wrong is wrong having regard to the everyday standards of reasonable people.

Extra-judicially, His Honour subsequently stated:

I have taken it [disease of the mind] to include, as well as all forms of physical or material change or deterioration, every recognisable disorder or derangement of the understanding whether or not its nature, in our present state of knowledge, is capable of explanation or determination. “

This would apply to my case, without question.

Automatism as a direct result of, say, intense agony (a recognisable disorder or derangement) means that a person simply cannot help what they do…or SAY.

This is why I presented myself to casualty in the first place, rather than stand in a cue at McDonalds. In this kind of state, one literally does not know what will happen next. One presents to A & E in the hope of being CURED, AND in order to NOT be arrested for conducting oneself in an offensive of upsetting manner in public.

Sigh…this is very basic. I can scarcely believe I have to go over this.

In any case, I continue.

There are legal and historical precedents aplenty and documented cases of this kind of reaction- just in case any among you in general & this person in particular thinks I invented the phenomena to justify my poor form.

I did NOT.

If this woman IS a nurse, then I sincerely hope one day the topic of automatism is taught to nursing students as part of their curriculum.

Perhaps even in the same year as giving injections.

If she is NOT a nurse…she should not be anywhere near trauma or casualty.

Automatism is NOT uncommon- & there are people who have escaped jail terms for killing other human beings as a result of involuntary reaction to extreme pain/suffering/trauma.

A & E should be a safe place to flail in this temporary place of derangement of the senses.

Because believe you me, at such a time- in such intense pain- choices are limited. (I almost ‘soiled my undergarments’ in agony; not something I typically do.)

I am NOT the kind of person given to swearing in public; neither in front of women, children…indeed ANYONE.

It takes something pretty earth shattering to make me resort to foul language.

(I would love to argue about the obscenity or otherwise of the language/words I used…but frankly, I was possessed of such incredible pain…I have no idea what I said. If it was recorded…then I would be happy to argue as to which of my vocabulary is legally offensive, & which are simply not the words another would have chosen.)

In ordinary circumstances- I always choose my language and conduct very carefully; & it is only in EXTREME situations when someone loses their composure entirely.

Something like CHILDBIRTH.

I have seen a few births in my time, having spent over a decade as a Police Officer, and I can tell you- the most demur of creatures have been known to swear like ditch diggers & not even be aware of it.

Of all the births I have seen, very few women are chastised for their language.

I am unaware of it.

Indeed, a literature search conducted on the internet reveals no cases whatsoever of a person being charged with offensive behaviour as a result of using ‘language’ considered to be offensive whilst giving birth to a child.

If you locate any, I would love to see it.

It is- or at least it should be- understood by staff working in this field to be a normal part of the pain of the procedure; and to the best of my knowledge, accepted.

Understood.

Sadly, this consideration was not extended to me.

Nor, for that matter, was I able to detect any evidence on the internet of people in an A & E ward being similarly charged with offensive behaviour.

I would love to see that too.

Again, I cannot comment on the vocab I used because I have no memory of it; nor would I, in that heightened state of agony.

So…upon what basis was I chastised in my weakened, vulnerable state?

What were the guidelines used to judge me?

& if an offence was committed- why was I NOT placed under arrest?

If this is simply a question of TASTE…then this woman has NO right to impose her preferences upon me. Or whomever I was possessed by.

I think in the case of a woman in childbirth- more pain killers are administered, in most cases- as opposed to a lecture in language use and decorum.

(I might also add that my pain was so severe- even MORPHENE had no effect. & they give this stuff to wounded soldiers! I have NEVER been in such pain that I even thought about asking for such a thing!)

In childbirth, besides hard drugs, those assisting the birth engage in patience, compassion, tolerance and understanding.

I have since spoken to a number of mothers, including my own, and the kind of pain I speak of in my case is comparable to the pain of childbirth.

So…because I was chastised-

& NOT women in the pain of childbirth…

can I then assume it was because I was a MAN, and not a WOMAN?

In which case- this would be a clear case of discrimination.

Why is a MAN not allowed to feel pain?

And experiencing same pain, comparable to the pain of childbirth, in an environment where pain & suffering would be typical- why then would I NOT be entitled to the same automatist reaction??

Or did the person- tutoring me in the ways of righteousness and etiquette whilst I was in such pain I would have considered a shotgun blast to the head a birthday present- simply take a profound and intolerable dislike to ME?

Because all the other staff in the hospital seemed sympathetic to my plight.

Not one of them judged me for any of my reactions to further pain.

Watch my language?

Really?

It is not unlike handing out speeding tickets at the Indy 500.

In such incredible agony…I had no idea I was even speaking a language!!

All I can remember is the sheer intense pain of the drilling in my arm, and any sound I heard sounded like something primal, channelled from a place far away from anything remotely resembling common courtesy and decency.

This was a reaction that goes BEYOND me…here…

‘Now’.

It was something woven into my DNA.

Some memory from a time long past, when the species from which we are descendant communicated in grunts, growls and screams.

I was NOT, at this time, conducting myself as if I was reciting Wordsworth. (I cannot even remember what I said.)

It was literally- for those interested in the shape and nature of intense pain- like the shrieks and yells were coming from another place. After the pain had subsided…I told the person in question, in an attempt to account for the phenomena. I literally explained to her (some professionals call it ‘feedback’) that;

‘I feel like I went to another place’.

She ignored me. Refused to even acknowledge me.

Such was the severity of my transgression against nature, my offence against God.

And her.

Perhaps it might be worth her spending some time in a maternity ward, so she can get some firsthand experience of what real suffering is like, if there is not a great deal of it in casualty.

As a cop…I spent a good many hours in A & E.

Accident and emergency in Melbourne is a place of pain and suffering, and reflex actions and screams would not be uncommon. I don’t remember ever charging anybody for it; I don’t think I EVER even contemplated issuing a caution.

But perhaps Portland Hospital is quite different.

Perhaps it is more like a finishing school.

Perhaps true agony is a rarity.

In Emergency…I thought pain and suffering were routine.

I am heartily sorry if any children were offended.

Perhaps Punch and Judy are playing in some other wing of the facility.

If these children were patients, then either they should be admitted to a children’s section…

Or the adults sequestered to a different department.

The last thing I expected in my time of suffering was a course in manners and etiquette.

Does someone with such delicate sensibilities and intolerance for the idiosyncrasies & extremities of human nature even belong in such a field??

At a time when I could have used some compassion….understanding…

I got the cold shoulder over a social faux pas.

I would understand if I had used such language at her children’s confirmation, or her Grandmother’s funeral.

But in A & E, where things occur that fly in the face of normal circumstance? Where the most ordinary, sedentary, gentle creatures can become transformed into DEMONS??

Hospital is indeed a lonely place; especially when your WORST crime is behaving in a natural, human way to sheer, unutterable, incomprehensible and totally unexpected AGONY.

Very lonely indeed.

My only companionship in that long painful evening and all through the night was my guilt and shame at things I was not even aware I had done.

And have no idea how I could have avoided them.

How does one prepare oneself for agony?

How does one learn to behave when transported to a place of total inability to exert any control over one’s actions?

A & E should be the ONE place where this can be managed; such EXTREME circumstances of human existence.

Surely there is ONE place on the planet where it is safe to be POSSESSED (and it is a kind of possession) by the bad mannered evil demon PAIN.

Believe it or not…I am a good man.

My father would beat me from a very young age, and tell me I was a worthless dog. But I am NOT worthless.

Never.

I am a human being.

I deserve consideration. & respect.

When I present to casualty, suffering things no sane person would ask for…I deserve the SAME consideration given to a woman in agony.

To say it is OK for a woman to swear in agony- but not a man? This is NOT OK.

I am a thoughtful, respectful man.

A gentleman.

I would never knowingly offend ANYONE- let alone a woman in a caring profession.

Or a child. That is ALSO called ‘cowardice’.

It is the dominion of drunks, drug addicts and all the true dregs of society.

The selfish and the careless.

I did not deserve to spend my first night alone in my bed after the trauma of the day, feeling an abiding shame & guilt for things that were NOT my fault.

I was a child again.

Made to feel ashamed for what…I had no idea.

I was a child again…beaten for…being a child.

I was a child again…molested by a Catholic Priest and punished for…

What?

I write this letter- as an adult.

Standing up for the child…abused yet again.

When we present to Casualty…we, the genuine sufferers…

We present as children again.

We come to you in the way of a trusting child…

& hope that you will understand, and care, and be patient…

& tolerant.

I know a little fellow with Asperger’s.

Think of it this way; someone in pain…is like someone with Asperger’s.

They are a REAL handful.

Think of a person with Tourette’s syndrome.

Same kind of thing.

These people are NOT ill mannered bastards.

They have an affliction.

Pain and agony are afflictions, and we cannot always know how they will manifest.

But we should be prepared- in casualty, especially- for anything.

When I was a cop, my Law Sergeant said, ‘in this job, you never know what you’re going to get’. But we should be ready.

I do not seek to make anyone feel bad, nor do I seek to get even;

I am standing up for myself.

Life is hard enough without being humiliated and shamed by people who should be there to help when we are at our most vulnerable.

I defend myself…because I am WORTH it.

I realised just now…I write this letter in the hope that a certain person can understand the consequences of their lack of compassion.

I wonder if she is capable of understanding what it is like to be chastised for something that cannot be helped.

This woman reminded me once again of how I used to be beaten for bedwetting.

Also, an involuntary reaction.

I would no more deliberately use profane or offensive language in front of a woman or child any more than I would piss my own bed.

NEVER.

It is upon such assumptions…we build CIVILisations.

Life is about keeping ourselves nice. & knowing we have support and assistance during those times when things go awry.

How can someone suffering such pain ‘watch their language’??

& how can a so-called professional person possibly take advantage of their position of authority by chastising this person?

I stopped screaming and swearing.

Not because I chose to; but because they nurses stopped digging in the muscles and bone of my arm, left me in peace to suffer in silence, and then came back to find the CORRECT vein.

In seconds.

All that suffering was for nothing.

A NEW nurse- a more competent nurse, a fresh set of hands- found the vein.

Or perhaps only the squeaky wheel gets the grease.

Perhaps my cries of pain were enough to summon the services of someone who knew how to handle a needle, knew where and how to find a vein.

Because this finally happened.

And the initial absurdity I found in Cas. did NOT persist.

Comparative normalcy was restored for the reminder of my stay; which reassures me that the absurdity & ignorance I encountered in A & E were neither typical, nor systemic.

I don’t expect anything to come of this; people who speak up for themselves are generally thought of as at best slightly loopy, at worst insane.

One does well in this life to behave and keep quiet at all times when they see something wrong, and just keep on marching.

Not this little black duck.

Never.

Ours is a society that does not encourage protestation over injustice. I, however, will continue to do it- indeed I consider it my life’s work- until my very last breath.

As was once said to me, ‘John, you speak out when things are wrong; most people accept the bad things, and keep on going. Walk around them. You don’t.’

I don’t.

I simply cannot go gently into that good night.

I cannot bear the thought of someone else suffering unnecessarily as I had to.

It just doesn’t seem fair.

And I always thought Australia was the country of the fair go.

Old ideas die hard…