The help that John does not want

John’s parents, Sue and Neville, thought he’d been doing well for a year or so. His schizophrenia had been under control.

He lives in a “granny flat” under their house; really more of a room with a bathroom and a sliding door to the back yard. They all prefer that he has a separate entrance. Nobody has to see the marijuana he smokes, and there is privacy when his case worker comes to visit.

But now, Sue and Neville are worried. Since an old friend of John’s died, they hardly ever see John outside. All they see is white smoke from his flat. And the television is on loud until very late. Plus, they suspect he has stopped taking his medications.

On Monday morning, Neville phones Kate, John’s caseworker. “I could see him this afternoon. Will he be in?”

“He’s always in. We’ll be here too.”

Kate knocks, slides open the door, and sees John in a T-shirt and tracksuit pants, joint in hand, staring at the television. He doesn’t turn or acknowledge her. Kate moves around him to be in his field of view. “Do you mind if I turn the TV off?” she asks.

“Just turn it down.”

They talk for a while. John seems OK, just a bit slow, with long pauses when he speaks. Then Kate mentions the medications.

“John, are you taking your pills?”

He stares at the silent television. “I don’t want to . . . poison . . . ”

“John, you’ve been good on them for a year. It’s really important.”

“Poison . . . I’m not hurting anybody and they should leave me alone . . . I just want to . . . watch TV. I’m allowed to be sad!”

Kate tries for a while longer, but in the end she leaves it. He’s not harming anybody, and apart from the joints, he’s not harming himself. She goes out from the sweet smoky smell to the fresh air. Sue and Neville meet her out the front and she explains that she can’t force John to receive appropriate health care. Neville looks at the ground and slowly nods. Kate says there will be a case conference on Thursday.

***

But on Wednesday it all goes bad. John has come into the house upstairs carrying a swivel chair above his head. He has a cigarette lighter held in his teeth. He is ranting, and Neville can’t understand what he is saying. He throws the swivel chair and it breaks a coffee table, so Sue and Neville retreat to the bedroom, lock the door and call an ambulance.

Sean, the paramedic, asks for police to be called when he is put on the job. When he arrives at the house the police are there in number and he parks the ambulance behind a police car and van.

Sean goes to the front door and finds it open. John is inside smoking, and refuses to come out. With police help, he is wrestled to the ground, handcuffed and taken outside to a police caged vehicle. After the cage door is closed there is banging from inside, and the van is rocking before it is driven away.

On arrival at the emergency department (ED), John is left in the vehicle while police and paramedics go in to explain the situation. There is a short delay while a space in a resuscitation room is made available and roles are allocated: two staff for each limb, one for the head and a separate doctor and nurse for medication and directions.

John is brought in kicking and ranting. At the code word, he is lifted onto the bed and held down. He fights for his life, certain he will be killed. But there are too many staff. He is injected with 5 mg droperidol through his tracksuit pants into his thigh. He hawks in preparation to spit. A nurse pulls John’s T-shirt over his face in time for a dark wet stain to appear where his mouth is. The T-shirt is swiftly exchanged for an oxygen mask. Now an intravenous cannula goes in and is strapped with brown sticking plaster. A dose of midazolam, and everybody begins to relax.

Later, John is to be transferred again — from the ED to a mental health unit at another site. Patients have to be conscious to be transferred, and after John is allowed to wake up he is restrained, and struggles endlessly.

Neville and Kate have both come in to the ED to try to calm him down, but are unsuccessful.

Neville says, “Kate, if you had just told him he had to, he would have gone with you on Monday. Now he’s tormented. From inside and outside.”