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This post is by Lucy Dimbylow, about her experiences of attending A&E (the emergency department) with injuries caused by self-harm, and the importance of treating all patients with care and compassion.
I’ve come to A&E with a large cut on my leg. It needs stitches. I apologise to the doctor for wasting her time, but it’s as if she hasn’t heard me. She hasn’t said a word to me whatsoever: not ‘hello,’ not ‘my name is,’ not ‘this is what I’m going to do.’ She didn’t even give me pain relief before starting to suture the wound.
It sounds unfathomable, doesn’t it? Indeed, this brusque, sneering attitude would be inexcusable if someone presented at hospital with a nasty accidental wound that needed suturing – caused, perhaps by tripping while out walking and getting caught on barbed wire.
But when I attended A&E in the midst of the Covid crisis with an injury caused by self-harm, this is exactly the treatment I received.
I’m 41, with a history of mental illness dating back to my teenage years, and what many would no doubt call a frequent flyer in terms of needing treatment for self-harm. And the example I’ve given above – which might sound shockingly disdainful, even borderline cruel – is far from the exception.
Over the years that I’ve presented at A&E or Minor Injuries in need of steri-strips or stitches, I’ve been treated in ways that seem to breach the Hippocratic Oath.
I’ve been denied pain relief. Treated by doctors and nurses who sigh that I’m ‘here again,’ and won’t look me in the eye. Given steri-strips for wounds that should have been stitched, resulting in severe scarring. Told off for making a mess by bleeding on the floor, and that I should have ‘grown out of’ self-harm by now.
The worst was when a nurse in Minor Injuries told me that she was surprised my husband hadn’t left me: words that are indelibly marked on my mind.
And as a mother of two, aged 15 and nine, every presentation with self-harm injuries earns me a referral to social services under suspicion of psychologically damaging my children (who I’m at pains to protect from the messy, frightening side of my mental illness).
In an NHS that is stretched to breaking point – even more so since the pandemic knocked the nation off its feet – there’s little sympathy for people who self-harm. Even the ICD description – ‘intentional self-harm’ – is judgemental. After all, the very word ‘intentional’ is the opposite of accidental, so what right do we have to be in Accident & Emergency?
What many medics seem to overlook is that while my injuries are caused by my own hand, the root cause lies in my mind. I suffer from severe and enduring mental illness, and it’s when my depression is at its worst that I’m driven to self-harm. So while the act may be intentional, the intense, unbearable distress that underpins it is anything but.
Self-harm can be addictive. Indeed, many people talk about it in terms of sobriety: ‘I’m 50 days clean!’ When the mental pain overwhelms me, I’m powerless to fight back. The safe alternatives that are often suggested – pinging an elastic band around my wrist, or squeezing ice cubes – seem utterly ridiculous at the point where I’m drowning, and self-harm is my life ring.
That’s why it’s so upsetting when medical professionals shower me with disdain for ‘choosing’ to injure myself, and in doing so, draining precious NHS resources that should be allocated to people who have ‘proper’ illnesses or injuries.
I’m far from alone. Twitter, in particular, is full of people who’ve been treated appallingly when seeking treatment for self-harm, and I hurt for every one of them who has been judged and condemned when they should have received support and empathy.
It doesn’t have to be like this. On some occasions, I’ve been treated with simple, quiet kindness. There was the foundation A&E doctor who gave me gas and air as well as local anaesthetic when he stitched me up (what sweet relief), the nurse at my GP practice who gently sympathised – ‘Oh, darling’ – and asked if I wanted to talk, and the Urgent Care nurse who shared her own experiences of self-harm and the encouragement that she had overcome it, and so could I.
Kindness is a wordless, compassionate hand on my shoulder, a gentle touch as the wounds are wiped clean, a bag of fresh dressings to take home so I don’t have to make do with plasters and Micropore tape.
It costs nothing to give – the time I spend in A&E is the same whether I’m treated with cruelty or compassion – but makes me feel a tiny bit less guilty for burdening the NHS; a tiny bit more seen, understood and cared for. Just knowing the name of the person who’s treating me makes me feel like a human rather than a lump of meat.
I wonder what you’re thinking as you read this. I wonder whether you think I am, indeed, a time-waster who deserves to be given short shrift, or whether you’re shocked that someone in mental and physical pain should be treated like as a troublesome fly buzzing around the A&E department, taking up unnecessary attention and getting in the way of the doctors and nurses doing their job.
As I write this, I’m six months ‘clean’ from self-harm. My mental state has been mostly stable over the past months, and I dearly hope that I’m never again gripped by the paralysing blackness that leads me to hurt myself.
My other dear hope is that should I find myself in that pit again, a strong, supportive hand reaches down to help lift me out, rather than slinging dirt over the edge and walking away. I hope that for others who’ve been hurt by the system, too.
Pain is real, whether it’s inside or out. And pain deserves kindness, whatever its origin.
Lucy Dimbylow is a freelance writer and editor, and social media manager at @The_School-Run. You can follow her on Twitter at @lucywriter.
